Perspective

DNA-based scoliosis scores did not differ in patients with, without curve progression


Investigators sought to evaluate the ability of ScoliScore to estimate the risk of curve progression of 40° or more in patients with AIS.


NEW ORLEANS — A scoliosis rating score that uses DNA to estimate the risk of curve progression of 40° or more in patients with adolescent idiopathic scoliosis did not differ between patients with and without curve progression, researchers found in a recent study.


“For our results, we found no significant differences in ScoliScores between those patients that progressed and those that did not,” Benjamin D. Roye, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting.


Roye and colleagues used the ScoliScore AIS Prognostic Test (Transgenomic; Omaha, Neb.) to study the genetic risk of 40° or more of curve progression in children with adolescent idiopathic scoliosis (AIS).


The saliva-based DNA test involves analyzing a panel of 53 markers, Roye said. 


This was the first study to look at the ability of ScoliScore to stratify the risk of curve progression in patients with AIS, he noted.


Practical predictive test


“It has been found this test may have potential to decrease visits, X-rays and bracing of children with very low scores and low risk. On the other side of that, we might be able to identify candidates for early intervention in those with high scores,” Roye said. 


The investigators retrospectively studied 85 patients at two centers — Children’s Hospital in New York and DuPont Hospital for Children in Delaware — who had the ScoliScore test administered. Patients included in the study needed to be Caucasian, have AIS, be between 9 years and 13 years old and have an initial Cobb angle of 10° to 25°. They were then divided into a progression group who had subsequent Cobb angles greater than 40° or fusion and a non-progression group who reached skeletal maturity without any curve progression. 


The average ScoliScore was 111 ± 58 (2-193), where low scores were 0 to 50, intermediate scores were 50 to 179 and high scores were 180-200, according to the results. Twenty-three patients (27%) had a curve progression of greater than 40° degrees or fusion. The ScoliScore risk distribution in the study population was low (18.8%), intermediate (65.9%) and high (15.3%). 


Scores do not show a difference


Patients with curve progression scored 108 ± 51 and those without curve progress scored 107 ± 63.


The investigators found the scores and curve progression rates were not impacted by brace wear. 


“One hundred seven was the average ScoliScore for patients that progressed to 40 degrees or more and 102 for those that did not. This was highly insignificant,” Roye said. “Additionally we then went on and stratified these patients according to ScoliScore criteria.”


When patients were classified as low, intermediate or high risk based on the ScoliScore, the scores were different for patients who had curve progression and who did not have curve progress, however this difference was not statistically significant, Roye said. 


The trend line in this study was inconsistent with initial results with the score that were published, which investagators noted in the study abstract may be due to a different test population in the two studies, inaccuracies in classifying the patients by race or the inability to fully followup some patients. 


“In conclusion, we found that the risk of progression based on ScoliScore differed very significantly between our study population and the initial validation group that ScoliScore published,” Roye said. – by Robert Linnehan 


Reference:

Roye BD. Paper #151. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

For more information:

Benjamin D. Roye, MD, can be reached at MSCHONY, 3959 Broadway, Suite 800 North, New York, NY 10032; email: bdr5@columbia.edu.

Disclosure: Roye is a paid consultant to Stryker and receives research/institutional support from Scoliosis Research Society, Pediatric Orthopaedic Society of North America, OMeGA, Orthopaedic Research and Education Foundation and CWSDSG


NEW ORLEANS — A scoliosis rating score that uses DNA to estimate the risk of curve progression of 40° or more in patients with adolescent idiopathic scoliosis did not differ between patients with and without curve progression, researchers found in a recent study.


“For our results, we found no significant differences in ScoliScores between those patients that progressed and those that did not,” Benjamin D. Roye, MD, said at the American Academy of Orthopaedic Surgeons Annual Meeting.


Roye and colleagues used the ScoliScore AIS Prognostic Test (Transgenomic; Omaha, Neb.) to study the genetic risk of 40° or more of curve progression in children with adolescent idiopathic scoliosis (AIS).


The saliva-based DNA test involves analyzing a panel of 53 markers, Roye said. 


This was the first study to look at the ability of ScoliScore to stratify the risk of curve progression in patients with AIS, he noted.


Practical predictive test


“It has been found this test may have potential to decrease visits, X-rays and bracing of children with very low scores and low risk. On the other side of that, we might be able to identify candidates for early intervention in those with high scores,” Roye said. 


The investigators retrospectively studied 85 patients at two centers — Children’s Hospital in New York and DuPont Hospital for Children in Delaware — who had the ScoliScore test administered. Patients included in the study needed to be Caucasian, have AIS, be between 9 years and 13 years old and have an initial Cobb angle of 10° to 25°. They were then divided into a progression group who had subsequent Cobb angles greater than 40° or fusion and a non-progression group who reached skeletal maturity without any curve progression. 


The average ScoliScore was 111 ± 58 (2-193), where low scores were 0 to 50, intermediate scores were 50 to 179 and high scores were 180-200, according to the results. Twenty-three patients (27%) had a curve progression of greater than 40° degrees or fusion. The ScoliScore risk distribution in the study population was low (18.8%), intermediate (65.9%) and high (15.3%). 


Scores do not show a difference


Patients with curve progression scored 108 ± 51 and those without curve progress scored 107 ± 63.


The investigators found the scores and curve progression rates were not impacted by brace wear. 


“One hundred seven was the average ScoliScore for patients that progressed to 40 degrees or more and 102 for those that did not. This was highly insignificant,” Roye said. “Additionally we then went on and stratified these patients according to ScoliScore criteria.”


When patients were classified as low, intermediate or high risk based on the ScoliScore, the scores were different for patients who had curve progression and who did not have curve progress, however this difference was not statistically significant, Roye said. 


The trend line in this study was inconsistent with initial results with the score that were published, which investagators noted in the study abstract may be due to a different test population in the two studies, inaccuracies in classifying the patients by race or the inability to fully followup some patients. 


“In conclusion, we found that the risk of progression based on ScoliScore differed very significantly between our study population and the initial validation group that ScoliScore published,” Roye said. – by Robert Linnehan 


Reference:

Roye BD. Paper #151. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 11-15, 2014; New Orleans.

For more information:

Benjamin D. Roye, MD, can be reached at MSCHONY, 3959 Broadway, Suite 800 North, New York, NY 10032; email: bdr5@columbia.edu.

Disclosure: Roye is a paid consultant to Stryker and receives research/institutional support from Scoliosis Research Society, Pediatric Orthopaedic Society of North America, OMeGA, Orthopaedic Research and Education Foundation and CWSDSG


    Perspective

    The eventual utility of a DNA prognostic test for adolescent idiopathic scoliosis explains why ScoliScore has been adopted so quickly in clinical practice despite lack of independent validation of its accuracy. Roye and colleagues report their experience with 85 patients, and found no difference in ScolioScores between patients with and without curve progression. Scoliosis is a complex genetic trait, meaning there are multiple genetic and environmental factors contributing to its risk. Unfortunately, ScoliScore only takes into account common genetic variants with no consideration of how rare variants may also influence risk. In fact, only with the advent of next-generation sequencing of entire genomes has it been possible to evaluate these rare variants. So, stay tuned, as accurate tests of scoliosis progression will be achieved, but only when all risk factors are considered.

    • Matthew B. Dobbs, MD
    • Washington University School of Medicine St. Louis, Mo.

    Disclosures: Dobbs has no relevant financial disclosures.