Does apical vertebra location influence the final outcome of bracing for idiopathic scoliosis?
Angelo G Aulisa, Martina Marsiolo, Marco Giordano and 3 others
Bracing corrected the curve in 411 of 491 girls with adolescent scoliosis.
The apex location mattered: lumbar curves (L1, L2) corrected significantly more than upper thoracic curves (T7, T8, T9), so the apex level should factor into prognosis.
Key findings
1The mean Cobb correction from baseline to 2-year follow-up was -13.36° (P<0.0001), and the mean Perdriolle correction was -4.58° (P<0.0001). 411 of 491 patients (84%) achieved curve correction, and 70 (14%) achieved stabilization.
2Lumbar apex curves (L1, L2) showed significantly greater Cobb correction than upper thoracic apex curves (T7, T8, T9). Mean differences: L1 vs T9 = 4.345°, L1 vs T8 = 4.067°, L1 vs T7 = 9.997°, L2 vs T7 = 8.845°, T12 vs T7 = 9.48°.
3A significant correlation was found between apical vertebra level and mean Cobb correction (P<0.0001, R=0.64). The association was strongest in the lumbar segment (r=0.78) and weakest in the thoracic segment (r=0.34).
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What it does not show
The statistical model used a one-way ANOVA on mean corrections and did not adjust for age, menarche, Risser score, or brace type, so the observed differences between apex levels may reflect confounding rather than a true effect of apex location. The T7 group contained only 9 patients, making the significant differences involving T7 (L1 vs T7, L2 vs T7, T12 vs T7) based on a very small subgroup. All participants were female, so the findings cannot be generalised to male patients. This was an observational cohort, not a randomised trial, so causal attribution to bracing or to apex level is not possible.
Declared interests
The authors declared no conflict of interest with any financial organization. The work was supported by the Italian Ministry of Health through Current Research funds.
The easy way to misread this
Do not read the T7 comparisons as a firm prognostic rule. Only 9 patients had a T7 apex, and the statistical model did not adjust for age, menarche, Risser score, or brace type, so the observed differences may reflect confounding rather than a true effect of apex level.
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