Primary correction results in the prediction of the basic scoliotic curves and postoperative progression in patients with youth idiopathic scoliosis of the thoracic localization surgical treatment

BACKGROUND: Predicting the results of the surgical treatment of idiopathic scoliosis is important, as the role of communication between the doctor and the patient increases in discussing possible outcomes of treatment and developing a plan for surgical intervention.

AIM: To create a multivariate model for predicting the surgical results of juvenile idiopathic scoliosis based on the identification of predictors that affect the quantity of the main scoliotic curve primary correction and postoperative progression.

MATERIALS AND METHODS: The surgical results of 922 patients with juvenile idiopathic thoracic scoliosis who underwent surgery from 1999 to 2019 were analyzed. The mean age was 14.6 ± 1.2 years (men, 16.8%; women, 83.1%). The patients were divided into four groups according to the types of surgical interventions: group I included 247 patients (26.8%) who received correction using laminar fixation and anterior stage; group II, 450 patients (48.8%) who underwent correction using hybrid fixation; group III, 80 (8.7%) patients who had correction using hybrid fixation and anterior stage; and group IV, 145 (15.7%) patients who underwent correction with total transpedicular fixation. Clinical and radiological data were analyzed in the preoperative, postoperative, and late postoperative periods. Predictors of undercorrection and postoperative progression (loss of achieved correction) were identified by constructing univariate and multivariate logistic regression models.

RESULTS: The greatest correction of the thoracic scoliotic curve (74.3%) was noted in group IV. In patients with spinal deformity of >80° and mobility of <25%, the smallest correction (44.8%) was noted in group III. Postoperative progression of >10° was observed in groups I and II. Multiplicative predictors of insufficient correction of the main scoliotic curve of <50% and postoperative progression of >10° were identified. The sensitivity and specificity to predict undercorrection were 75.2% and 82.6% and for postoperative progression were 68.6% and 66.8%, respectively (p < 0.05).

CONCLUSIONS: The identification of multiplicative predictors of insufficient correction and postoperative progression makes it possible to predict the risk of insufficient correction with an accuracy of 75% and the risk of postoperative progression with an accuracy of 68.6%. If transpedicular fixation to correct the main scoliotic curve is impossible, additional anterior intervention may be performed to prevent postoperative progression.