Time series spinal radiographs as prognostic factors for scoliosis and progression of spinal deformities

The effectiveness of clinical measures to predict scoliotic progression is unclear. The objective of this study was to identify potential prognostic factors affecting scoliosis progression. Consecutive measurements (181) from 35 non-instrumented adolescent idiopathic scoliosis patients with at least two follow-up assessments were studied. Potential prognostic factors of gender, curve pattern, age, curve magnitude, apex location and lateral deviation and spinal growth were analyzed. Stable and progressed groups were compared (threshold: Cobb angle ≥5° or 10°) with sequential clinical data collected in 6-month intervals. Double curves progressed simultaneously or alternatively on curve regions. Age was not significantly different prior to and at maximal Cobb angle. Maximal Cobb angles were significantly correlated to initial Cobb angles (r = 0.81–0.98). Progressed males had larger initial Cobb angles than progressed females. Apex locations were higher in progressed than stable groups, and at least a half vertebra level higher in females than males. Maximal apex lateral deviations correlated significantly with the initial ones (r = 0.73–0.97) and moderately with maximal Cobb angles (r = 0.33–0.85). In the progressed groups, males had larger apex lateral deviations than females. Spinal growth did not relate to curve progression (r = −0.64 to +0.59) and was not significantly different between groups and genders. Scoliosis may dynamically progress between major and minor curves. Gender, curve magnitude, apex location and lateral deviation have stronger effects on scoliosis progression than age or spinal growth. Females with high apex locations may be expected to progress.