• Matias Pereira-Duarte, Antoine Dionne, Julie Joncas, Stefan Parent, Hubert Labelle, Soraya Barchi, and Jean-Marc Mac-Thiong.
• Université de Montréal, Montréal, Canada.
• Eur Spine J. 2024 Oct 1; 33 (10): 379237973792-3797.

PurposeTo identify the clinical phenotypes associated with the rate of progression while waiting for surgery and propose a classification scheme for identifying subgroups of patients to prioritize for surgery when long surgical delays are expected.MethodsWe reviewed the clinical and radiographic data of a prospective cohort of patients scheduled for IS surgery from 2004 to 2020 with a minimum 1-year wait prior to surgery. Candidate predictors consisted of age, sex, Risser sign, menarchal status, angle of trunk rotation, scoliotic curve type, and main Cobb angle at baseline when scheduled for surgery. Univariate and Regression Tree analysis were performed to identify predictors associated with the annual curve progression rate in the main Cobb angle between baseline and surgery.ResultsThere were 214 patients (178 females) aged 15 ± 2 years, with a Risser sign 3.4 ± 1.6 and a main Cobb angle 55°±10° at baseline. The average wait prior to surgery was 1.3 ± 0.4 years. Only the Risser sign, menarchal status and sex were significantly associated with the annual progression rate. We have identified 3 clinically and significantly different groups of patients presenting slow (3 ± 4°/yr if Risser sign 3 to 5), moderate (8 ± 4°/yr if female with Risser sign 0 to 2 and post-menarchal), and fast (15 ± 10°/yr if Risser sign 0 to 2 and premenarchal or male) progression rates.ConclusionWe present an evidence-based surgical prioritization algorithm for pediatric idiopathic scoliosis that can easily be implemented in clinical practice when long surgical delays are expected.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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