{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:10:27Z","timestamp":1789179027211,"version":"build-2803163510"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,2,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Adolescent idiopathic scoliosis (AIS) curves of 50\u00b0 to 75\u00b0 are inclined to progress and are thus indicated for surgery. Nevertheless, the natural history of curves of 40\u00b0 to 50\u00b0 following skeletal maturity remains uncertain and presents a clinical dilemma. The aim of this study was to determine the prevalence, rate, and prognostic indicators of curve progression within this patient group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This was a retrospective study of 73 skeletally mature patients with AIS. Following yearly or more frequent follow-up, patients were stratified as having no progression (&lt;5\u00b0 increase) or progression (\u22655\u00b0 increase). Those with progression were further differentiated as having standard progression (&lt;2\u00b0 increase\/year) or fast progression (\u22652\u00b0 increase\/year). Radiographic parameters (coronal balance, sagittal balance, truncal shift, apical translation, T1 tilt, apical vertebral wedging) and height were determined on skeletal maturity. Parameters that were significantly associated with progression were subject to receiver operating characteristic (ROC) curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The average period of post-maturity follow-up was 11.8 years. The prevalence of progression was 61.6%. Among those with progression, the curve increased by a mean of 1.47\u00b0 \u00b1 1.22\u00b0 per year, and among those with fast progression, by 3.0\u00b0 \u00b1 1.2\u00b0 per year. Thoracic apical vertebral wedging (concave\/convex vertebral height \u00d7 100) was more apparent in those with progression than in those without progression (84.1 \u00b1 7.5 versus 88.6 \u00b1 3.1; p = 0.003). Increased coronal imbalance (C7 plumb line to central sacral vertebral line) differentiated those with fast progression from others (16.0 \u00b1 11.0 versus 8.7 \u00b1 7.7 mm; p = 0.007). An ROC curve of height-corrected coronal balance demonstrated an area under the curve (AUC) of 0.722, sensitivity of 75.0%, and specificity of 72.5% in identifying fast progression. An ROC curve of height-corrected coronal balance together with apical vertebral wedging to identify those with progression demonstrated an AUC of 0.746, with specificity of 93.7% and sensitivity of 64.5%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>While the majority of curves progressed, the average rate of progression was slow, and thus, yearly observation was a reasonable management approach. Upon validation in larger cohorts, apical wedging and coronal imbalance may identity patients suited for closer monitoring and early spinal fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.22.00939","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T14:01:56Z","timestamp":1674482516000},"page":"277-285","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":18,"title":["Post-Maturity Progression in Adolescent Idiopathic Scoliosis Curves of 40\u00b0 to 50\u00b0"],"prefix":"10.2106","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2826-6364","authenticated-orcid":false,"given":"Sze-Hon","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9226-1122","authenticated-orcid":false,"given":"Cheuk-Man","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7052-0875","authenticated-orcid":false,"given":"Jason Pui-Yin","family":"Cheung","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3480-371X","authenticated-orcid":false,"given":"Graham Ka-Hon","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,23]]},"reference":[{"issue":"9623","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/S0140-6736(08)60658-3","article-title":"Adolescent idiopathic scoliosis","volume":"371","author":"Weinstein","year":"2008","journal-title":"The Lancet."},{"issue":"18","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"2068","DOI":"10.1097\/01.brs.0000178819.90239.d0","article-title":"Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management","volume":"30","author":"Richards","year":"2005","journal-title":"Spine (Phila Pa 1976)."},{"issue":"5","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1001\/jama.289.5.559","article-title":"Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study","volume":"289","author":"Weinstein","year":"2003","journal-title":"JAMA."},{"issue":"4","key":"bib4-20250430","first-page":"CD010663","article-title":"Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis","author":"Bettany-Saltikov","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"issue":"6","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.jspd.2019.04.004","article-title":"The Adolescent Idiopathic Scoliosis International Disease Severity Study: Do Operative Curve Magnitude and Complications Vary by Country?","volume":"7","author":"Toombs","year":"2019","journal-title":"Spine Deformity."},{"issue":"1","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/1754-9493-2-25","article-title":"Adolescent idiopathic scoliosis - to operate or not? A debate article","volume":"2","author":"Weiss","year":"2008","journal-title":"Patient Saf Surg."},{"issue":"1","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11832-012-0457-4","article-title":"Epidemiology of adolescent idiopathic scoliosis","volume":"7","author":"Konieczny","year":"2013","journal-title":"Journal of Children's Orthopaedics."},{"issue":"4","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1302\/0301-620X.104B4.BJJ-2021-1677.R1","article-title":"Curve type, flexibility, correction, and rotation are predictors of curve progression in patients with adolescent idiopathic scoliosis undergoing conservative treatment : a systematic review","volume":"104-B","author":"Wong","year":"2022","journal-title":"The Bone & Joint Journal."},{"issue":"5","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1097\/00007632-199503010-00006","article-title":"New prognostic factors to predict the final outcome of brace treatment in adolescent idiopathic scoliosis","volume":"20","author":"Upadhyay","year":"1995","journal-title":"Spine (Phila Pa 1976)."},{"issue":"2","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1007\/s11999.0000000000000027","article-title":"Curve Progression in Adolescent Idiopathic Scoliosis Does Not Match Skeletal Growth","volume":"476","author":"Cheung","year":"2018","journal-title":"Clin Orthop Relat Res."},{"issue":"12","key":"bib11-20250430","first-page":"2709","article-title":"Osteopenia: a new prognostic factor of curve progression in adolescent idiopathic scoliosis","volume":"87","author":"Hung","year":"2005","journal-title":"The Journal of Bone & Joint Surgery."},{"key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"100236","DOI":"10.1016\/j.eclinm.2019.12.006","article-title":"A validated composite model to predict risk of curve progression in adolescent idiopathic scoliosis","volume":"18","author":"Zhang","year":"2020","journal-title":"EClinicalMedicine."},{"issue":"9","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1097\/CORR.0000000000000781","article-title":"When Should We Wean Bracing for Adolescent Idiopathic Scoliosis?","volume":"477","author":"Cheung","year":"2019","journal-title":"Clin Orthop Relat Res."},{"issue":"7","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1007\/BF00223081","article-title":"Variation in Cobb angle measurements in scoliosis","volume":"23","author":"Pruijs","year":"1994","journal-title":"Skeletal Radiol."},{"issue":"9","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1097\/01.brs.0000160840.51621.6b","article-title":"Intra-observer reproducibility and interobserver reliability of the radiographic parameters in the Spinal Deformity Study Group\u2019s AIS Radiographic Measurement Manual","volume":"30","author":"Dang","year":"2005","journal-title":"Spine 1976"},{"issue":"2","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1097\/CORR.0000000000000989","article-title":"Does Curve Regression Occur During Underarm Bracing in Patients with Adolescent Idiopathic Scoliosis?","volume":"478","author":"Cheung","year":"2020","journal-title":"Clin Orthop Relat Res."},{"issue":"5","key":"bib17-20250430","first-page":"702","article-title":"Idiopathic scoliosis: long-term follow-up and prognosis in untreated patients","volume":"63","author":"Weinstein","year":"1981","journal-title":"The Journal of Bone & Joint Surgery."},{"issue":"Supplement 1","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"S44","DOI":"10.1097\/BPO.0000000000001350","article-title":"The Natural History of Adolescent Idiopathic Scoliosis","volume":"39","author":"Weinstein","year":"2019","journal-title":"Journal of Pediatric Orthopaedics."},{"issue":"3","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"437","DOI":"10.14245\/ns.2040654.327","article-title":"The Effect of Brace Treatment on Large Curves of 40\u00b0 to 55\u00b0 in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study","volume":"18","author":"Razeghinezhad","year":"2021","journal-title":"Neurospine."},{"issue":"2","key":"bib20-20250430","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/BSD.0b013e3182a1de29","article-title":"Is Brace Treatment Appropriate for Adolescent Idiopathic Scoliosis Patients Refusing Surgery With Cobb Angle Between 40 and 50 Degrees","volume":"30","author":"Zhu","year":"2017","journal-title":"Clinical Spine Surgery: A Spine Publication."},{"issue":"4","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/00002517-200108000-00006","article-title":"Disc and vertebral wedging in patients with progressive scoliosis","volume":"14","author":"Stokes","year":"2001","journal-title":"Journal of Spinal Disorders."},{"issue":"20","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"E455","DOI":"10.1097\/01.brs.0000142430.65463.3a","article-title":"Vertebral wedging characteristic changes in scoliotic spines","volume":"29","author":"Parent","year":"2004","journal-title":"Spine 1976"},{"issue":"4","key":"bib23-20250430","first-page":"447","article-title":"Curve progression in idiopathic scoliosis","volume":"65","author":"Weinstein","year":"1983","journal-title":"The Journal of Bone & Joint Surgery."},{"issue":"6","key":"bib24-20250430","first-page":"815","article-title":"Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society","volume":"77","author":"Nachemson","year":"1995","journal-title":"The Journal of Bone & Joint Surgery."},{"issue":"1","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s00586-018-5826-3","article-title":"Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline","volume":"28","author":"Obeid","year":"2019","journal-title":"Eur Spine J."},{"key":"bib26-20250430","doi-asserted-by":"crossref","DOI":"10.1115\/1.4043650","article-title":"Spinal Balance\/Alignment - Clinical Relevance and Biomechanics","author":"Shah","year":"2019","journal-title":"J Biomech Eng."},{"issue":"1","key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1748-7161-3-11","article-title":"Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis - A cross sectional study in 150 patients","volume":"3","author":"Modi","year":"2008","journal-title":"Scoliosis."},{"issue":"19","key":"bib28-20250430","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1097\/00007632-199610010-00004","article-title":"Effects of muscle dysfunction on lumbar spine mechanics. A finite element study based on a two motion segments model","volume":"21","author":"Kong","year":"1996","journal-title":"Spine 1976"},{"issue":"4","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1016\/j.jspd.2018.11.007","article-title":"Analysis of Center of Mass and Gravity-Induced Vertebral Axial Torque on the Scoliotic Spine by Barycentremetry","volume":"7","author":"Thenard","year":"2019","journal-title":"Spine Deformity."},{"issue":"9","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/BRS.0000000000003316","article-title":"A Predictive Model of Progression for Adolescent Idiopathic Scoliosis Based on 3D Spine Parameters at First Visit","volume":"45","author":"Nault","year":"2020","journal-title":"Spine 1976"},{"issue":"4","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1007\/s43390-020-00088-3","article-title":"Intermediate-term annualized curve progression of adolescent idiopathic scoliosis curves measuring 40\u00b0 or greater","volume":"8","author":"Ward","year":"2020","journal-title":"Spine Deform."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:44:48Z","timestamp":1787751888000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.22.00939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,23]]},"references-count":31,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.22.00939","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,23]]}}}