Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2015; 6(7): 537-558
Published online Aug 18, 2015. doi: 10.5312/wjo.v6.i7.537
Predictors of spine deformity progression in adolescent idiopathic scoliosis: A systematic review with meta-analysis
Andriy Noshchenko, Lilian Hoffecker, Emily M Lindley, Evalina L Burger, Christopher MJ Cain, Vikas V Patel, Andrew P Bradford
Andriy Noshchenko, Emily M Lindley, Evalina L Burger, Christopher MJ Cain, Vikas V Patel, Department of Orthopaedics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Lilian Hoffecker, Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Andrew P Bradford, Department of Orthopaedics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, United States
Author contributions: Noshchenko A contributed to development of the study conception, design, and goals for electronic literature search, participation in analysis of the electronically revealed citations, and in selection of publications for systematic review, participation in the selected studies quality assessment, data extraction, meta-analysis of the extracted data, participation in the results interpretation and level of evidence assessment, writing of the manuscript draft; Hoffecker L contributed to development of the electronic literature search strategy, providing of the comprehensive electronic literature search and preliminary analysis of the results, in particular, removal of the duplicates, participation in the manuscript drafting; Lindley EM contributed to critical revision of the manuscript draft, creation of the final version of the manuscript; Burger EL contributed to analysis of the electronically revealed citations, selection of publications for systematic review, evaluation of the publications’ quality, control of the data extraction, interpretation of the analysis results, level of evidence and clinical applicability assessment, writing of the manuscript, approval of the final version to be published; Cain CMJ and Patel VV contributed to critical revision of the manuscript; Bradford AP contributed to participation in the study design development, analysis of the literature search results, contribution into the manuscript draft and final version writing.
Conflict-of-interest statement: The manuscript presents results of original study that was performed as authors’ own initiative. The authors did not obtain any outside financial support from commercial or other organization to fulfil this research. Authors stated absence of any conflict of interest concerning current study. The obtained results can be used for grounding of research proposals in future.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andriy Noshchenko, PhD, Department of Orthopaedics, University of Colorado Anschutz Medical Campus, 13001 E. 17th Place, Mail Stop F432, Aurora, CO 80045, United States. andriy.noshchenko@ucdenver.edu
Telephone: +1-303-7247591 Fax: +1-303-7240919
Received: February 7, 2015
Peer-review started: February 8, 2015
First decision: April 10, 2015
Revised: May 27, 2015
Accepted: June 9, 2015
Article in press: June 11, 2015
Published online: August 18, 2015
Processing time: 194 Days and 3.3 Hours
Abstract

AIM: To evaluate published data on the predictors of progressive adolescent idiopathic scoliosis (AIS) in order to evaluate their efficacy and level of evidence.

METHODS: Selection criteria: (1) study design: randomized controlled clinical trials, prospective cohort studies and case series, retrospective comparative and none comparative studies; (2) participants: adolescents with AIS aged from 10 to 20 years; and (3) treatment: observation, bracing, and other. Search method: Ovid MEDLINE, Embase, the Cochrane Library, PubMed and patent data bases. All years through August 2014 were included. Data were collected that showed an association between the studied characteristics and the progression of AIS or the severity of the spine deformity. Odds ratio (OR), sensitivity, specificity, positive and negative predictive values were also collected. A meta-analysis was performed to evaluate the pooled OR and predictive values, if more than 1 study presented a result. The GRADE approach was applied to evaluate the level of evidence.

RESULTS: The review included 25 studies. All studies showed statistically significant or borderline association between severity or progression of AIS with the following characteristics: (1) An increase of the Cobb angle or axial rotation during brace treatment; (2) decrease of the rib-vertebral angle at the apical level of the convex side during brace treatment; (3) initial Cobb angle severity (> 25o); (4) osteopenia; (5) patient age < 13 years at diagnosis; (6) premenarche status; (7) skeletal immaturity; (8) thoracic deformity; (9) brain stem vestibular dysfunction; and (10) multiple indices combining radiographic, demographic, and physiologic characteristics. Single nucleotide polymorphisms of the following genes: (1) calmodulin 1; (2) estrogen receptor 1; (3) tryptophan hydroxylase 1; (3) insulin-like growth factor 1; (5) neurotrophin 3; (6) interleukin-17 receptor C; (7) melatonin receptor 1B, and (8) ScoliScore test. Other predictors included: (1) impairment of melatonin signaling in osteoblasts and peripheral blood mononuclear cells (PBMC); (2) G-protein signaling dysfunction in PBMC; and (3) the level of platelet calmodulin. However, predictive values of all these findings were limited, and the levels of evidence were low. The pooled result of brace treatment outcomes demonstrated that around 27% of patents with AIS experienced exacerbation of the spine deformity during or after brace treatment, and 15% required surgical correction. However, the level of evidence is also low due to the limitations of the included studies.

CONCLUSION: This review did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.

Keywords: Orthopedics; Scoliosis; Adolescent idiopathic scoliosis; Spine deformity; Predictors

Core tip: The systematic review with meta-analysis was performed for combining the published data on the predictors of progressive adolescent idiopathic scoliosis (AIS). Comprehensive literature search revealed 1391 citations, 25 of which were selected. All studies showed statistically significant or borderline association between severity or progression of AIS with the different characteristics such as: clinical, radiographic, physiologic, biochemical, genetic, and combinatorial. However, predictive values of all these findings were limited, and the levels of evidence were low. Current study did not reveal any methods for the prediction of progression in AIS that could be recommended for clinical use as diagnostic criteria.