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.

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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.