title: Curve progression in idiopathic scoliosis: follow-up study to skeletal maturity.
abstract: METHODS
  This is a follow-up study to skeletal maturity on a cohort of students screened for a 1-year prospective epidemiological prevalence study for scoliosis.
  
  
  OBJECTIVE
  This study aims to identify the prognostic factors for curve progression to a magnitude of 30 degrees at skeletal maturity in skeletally immature patients with adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  The natural history of idiopathic scoliosis is not well understood. Previous reports have focused on the characteristics of curve progression where progression has been predefined at specific angles of 5 degrees to 6 degrees. However, the absolute curve magnitude at skeletal maturity is more predictive of long-term curve behavior rather than curve progression of a defined magnitude over shorter periods of skeletal growth. It is generally agreed that curves less than 30 degrees are highly unlikely to progress after skeletal maturity. Hence, defining the factors that influence curve progression to an absolute magnitude of more than 30 degrees at skeletal maturity would more significantly aid clinical practice.
  
  
  METHODS
  One hundred eighty-six patients who fulfilled the study criteria were selected from an initial 279 patients with idiopathic scoliosis detected by school screening, and who were followed-up till skeletal maturity. The initial age, gender, pubertal status, and initial curve magnitude were used as risk factors to predict the probability of curve progression to more than 30 degrees at skeletal maturity.
  
  
  RESULTS
  Curve magnitude at first presentation was the most important predictive factor for curve progression to a magnitude of more than 30 degrees at skeletal maturity. An initial Cobb angle of 25 degrees had the best receiver-operating characteristic of 0.80 with a positive predictive value of 68.4% and a negative predictive value of 91.9% for curve progression to 30 degrees or more at skeletal maturity.
  
  
  CONCLUSIONS
  Initial Cobb angle magnitude is the most important predictor of long-term curve progression and behavior past skeletal maturity. We suggest an initial Cobb angle of 25 degrees as an important threshold magnitude for long-term curve progression. Initial age, gender, and pubertal status were less important prognostic factors in our study.
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, National University of Singapore, 5 Lower Kent Ridge Road, Singapore. jinmi@pacific.net.sg
authors.forename: Ken-Jin
authors.initials: KJ
authors.lastname: Tan
authors.forename: Maung Maung
authors.initials: MM
authors.lastname: Moe
authors.forename: Rose
authors.initials: R
authors.lastname: Vaithinathan
authors.forename: Hee-Kit
authors.initials: HK
authors.lastname: Wong