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. 2024 Dec;33(12):4740-4749.
doi: 10.1007/s00586-024-08496-z. Epub 2024 Sep 21.

Postoperative adding-on phenomenon in Lenke 1A/B and 2A/B adolescent idiopathic scoliosis: risk factors and predictive index

Hongqi Zhang  1   2 , Tao Li  1   2 , Gengming Zhang  1   2 , Ang Deng  1   2 , Yuxiang Wang  1   2 , Yunjia Wang  1   2 , Lige Xiao  1   2 , Guanteng Yang  1   2 , Chaofeng Guo  3   4
Affiliations

Postoperative adding-on phenomenon in Lenke 1A/B and 2A/B adolescent idiopathic scoliosis: risk factors and predictive index

Hongqi Zhang et al. Eur Spine J. 2024 Dec.

Abstract

Purpose: The aim of this study was to identify associated risk factors of distal adding-on phenomenon in Lenke 1A/B and 2A/B adolescent idiopathic scoliosis (AIS) patients and establish the corresponding prediction model.

Methods: The clinical data of 119 Lenke 1A/B and 2A/B AIS patients were retrospectively analyzed. Preoperative, first erect (FE) radiographic parameters and radiographic parameters at the last follow-up were measured. Patients were divided into the adding-on group and the no adding-on group according to whether the adding-on phenomenon was observed at the last follow-up. Univariate analysis and multivariate logistic regression analysis were used to establish the corresponding prediction model.

Results: Adding-on affected 39 (32.8%) patients at the last follow-up. Risser sign and 19 radiographic parameters showed significant differences between the two groups by univariate analysis. Stepwise logistic regression analysis found that the Risser sign and so on five predictor variable, and the nomogram was drawn. The calibration curve showed that the model fitted well. The area under the receiver operating characteristic (ROC) curve is 0.949. And the decision curve analysis curve model within the threshold range for interventions to improve clinical outcomes. There was no significant difference in SRS-22 scores between the two groups.

Conclusions: This study established a prediction model with adding-on in Lenke 1A/B and 2A/B AIS patients. The nomogram contains five predictive variables, which can effectively predict the probability of adding-on phenomenon during follow-up, and may have greater clinical value for the treatment and prevention of adding-on phenomenon.

Keywords: Adding-on; Adolescent idiopathic scoliosis; Lenke 1A/B and 2A/B; Lowest instrumented vertebra; Risk factors.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Xiangya Hospital, Central South University. Written informed consent was acquired from each of the patients to authorize treatment, imaging, and photographic documentation. The whole research process complied with the Declaration of Helsinki. Consent for publication: The patients provided informed consent for the publication of their pictures as well as their anonymous and pooled data. Competing interests: All authors declare that there are no conflicts of interest.

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