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Thread: Predicting Brace-Resistant Adolescent Idiopathic Scoliosis

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    Predicting Brace-Resistant Adolescent Idiopathic Scoliosis

    Predicting Brace-Resistant Adolescent Idiopathic Scoliosis

    James W. Ogilvie, MD (Axial Biotech, Inc.); Lesa M. Nelson, BS; Rakesh Chettier, MS; Therese Smith-Berry; Kenneth Ward, MD

    Introduction: Brace treatment for adolescent idiopathic scoliosis (AIS) is commonly prescribed for skeletally immature patients with curves in the 25-40 range. One-third of patients Risser 0, 1 with curves 20-29 will not progress if left untreated and approximately 20% will fail brace treatment and have surgery. We tested prognostic genetic markers in brace-resistant AIS
    patients who were brace compliant.

    Methods: 57 Caucasian female patients with AIS who wore a brace for at least one year, but progressed to surgery had genotypeanalysis with a panel of 30 genetic markers. Brace compliance was determined through medical record review and by patient interview.

    Results: Ninety five percent of the brace failure patients (54/57) had a calculated probability of progression over 0.35 based upon their genetic profile alone. Only 9% of 500 mild AIS patients who did not progress beyond 25 by skeletal maturity had a genetic risk profile of >0.35. Fully100% of study patients who wore a brace without efficacy were classified as having a high risk of progression when the predictive algorithm considers age and Cobb angle at first clinical presentation as well as the genetic markers.

    Conclusion: Using a 30 marker genetic panel, we may be able to predict which patients are likely to be brace-resistant. Additional cohorts of brace-resistant and brace-responsive AIS patients are being tested, and these data will be available for presentation at the annual meeting.

    Significance: A gene-based prognostic test may allow evidence-based decisions on the appropriateness of brace treatment in AIS.

    ---------------

    This study was part of the SRS 2008 conference. Here's the link and other interesting abstracts if anyone is interested:

    http://www.srs.org/professionals/mee..._abstracts.pdf

    Perhaps this test is what Concerned Dad and Pooka are looking for. If 100% of study patients who's bracing failed showed a high risk of progression with their predictive algorithm, it may very well be able to keep kids who are using a brace needlessly from doing so. I have to wonder, however, if these results would change using different braces like the Cheneau brace....and I'd love to know what my daughter's score is because I have to believe it would be pretty darned high! I might have a little more faith in the test if I knew my daughter's Scoliscore! But interesting nevertheless.

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    Fully 100% of study patients who wore a brace without efficacy were classified as having a high risk of progression when the predictive algorithm considers age and Cobb angle at first clinical presentation as well as the genetic markers.
    I guess upon further consideration of that remark, I have to wonder how many other braced patients that were successful with the bracing had a high risk of progression from their algorithm....and by eliminating them from bracing using their algorithm would cause them not to be a success story. That would be a big problem...that's where my daughter probably falls into this equation.

  3. #3
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    Quote Originally Posted by Ballet Mom View Post
    I have to wonder how many other braced patients that were successful with the bracing had a high risk of progression from their algorithm....and by eliminating them from bracing using their algorithm would cause them not to be a success story. That would be a big problem...
    Damn good question!

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    Quote Originally Posted by Ballet Mom View Post
    One-third of patients Risser 0, 1 with curves 20-29 will not progress if left untreated and approximately 20% will fail brace treatment and have surgery.
    They are saying they know that about 47% of this group is braced successfully. That is, would have progressed to surgery territory absent the bracing.

    I'd like to know how they know that. That sounds way too high based on the few studies that have attempted to find this number. That number is more like 20-30% at most as far as I can tell and has large error bars.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  5. #5
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    Blood test / bracing

    The Braist study as well as the genetic test are probably obsolete at this point. It reminds me of the old show biz saying, "here today, gone later today."

    A curve cannot progress without OPN and a simple blood test will tell someone if a brace is doing it's job. If OPN goes down the brace is working, if OPN doesn't go down the brace is a waste of time.

    METHOD OF DETERMINING RISK OF SCOLIOSIS

    [0014] In accordance with another aspect of the present invention, there is provided a method for assessing the efficacy of a brace on a subject having a scoliosis comprising measuring osteopontin (OPN) expression in a sample from the subject prior to and at least once after bracing the subject, wherein an increase in the OPN expression after as compared to prior to bracing the subject is indicative that the brace is ineffective.

    [0015] In a specific embodiment, the determining the OPN expression after the bracing is performed at least one month after the bracing. In another specific embodiment, the determining the OPN expression after bracing the subject is performed at least 2 months after the bracing. In another specific embodiment, the determining the OPN expression after bracing the subject is performed at least three months after the bracing. In another specific embodiment, the determining the OPN expression after bracing the subject is performed at least six months after the bracing.

    [00165] A distribution of AIS patients across the predefined cut-off zones was also performed prior to being treated with bracing and after bracing. Eight patients were tested a certain number of months after bracing, namely for each of patients #1 to 8: 7, 7, 8, 22, 22, 22 and 26 months after bracing, respectively. Figure 16 shows that prior to being treated with bracing (Panel A), 63% of these patients were in the red and yellow zones. A significant shift towards the green zone (<700ng/mL) was observed, which is consistent with the trend observed in surgically treated patients, as presented in Figures 13 -15.
    Last edited by Dingo; 10-01-2009 at 06:04 PM.

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