European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026
Determining the minimal clinically important difference of angle of trunk rotation for monitoring conservatively treated adolescent idiopathic scoliosis.
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Kuru Çolak Tuğba, Akçay Genal Burçin, Çolak İlker
Аннотация
PURPOSE: The angle of trunk rotation (ATR) is widely used in the clinical follow-up of adolescent idiopathic scoliosis (AIS); however, the minimal clinically important difference (MCID) has not been clearly defined. This study aimed to determine treatment-specific MCID values for ATR in conservatively treated AIS patients.
METHODS: This retrospective cohort study included 316 AIS patients treated with brace plus exercise or exercise alone. Radiographic outcomes at 6 months were classified as improvement (ΔCobb ≤ - 5°), stabilization (- 5° < ΔCobb < + 5°), or worsening (ΔCobb ≥ + 5°). Receiver operating characteristic (ROC) analyses were performed to determine optimal ΔATR cut-off values for clinically meaningful improvement and worsening in the overall cohort and separately by treatment group.
RESULTS: In the overall cohort, ΔATR showed good discriminative ability for improvement (AUC = 0.778) and worsening (AUC = 0.777). The optimal cut-offs were ΔATR ≤ - 1.5° for improvement and ΔATR ≥ + 0.5° for worsening. In subgroup analyses, the improvement threshold was ΔATR ≤ - 1.5° in the exercise-only group and ≤ - 4.5° in the brace-plus-exercise group. For radiographic worsening, the optimal thresholds were ΔATR ≥ + 0.5° in the exercise-only group and ≥ - 2.5° in the brace-plus-exercise group.
CONCLUSIONS: Treatment-specific ΔATR thresholds provide clinically meaningful benchmarks for monitoring both improvement and worsening, supporting the use of ATR as a practical radiation-free follow-up parameter in AIS management.
METHODS: This retrospective cohort study included 316 AIS patients treated with brace plus exercise or exercise alone. Radiographic outcomes at 6 months were classified as improvement (ΔCobb ≤ - 5°), stabilization (- 5° < ΔCobb < + 5°), or worsening (ΔCobb ≥ + 5°). Receiver operating characteristic (ROC) analyses were performed to determine optimal ΔATR cut-off values for clinically meaningful improvement and worsening in the overall cohort and separately by treatment group.
RESULTS: In the overall cohort, ΔATR showed good discriminative ability for improvement (AUC = 0.778) and worsening (AUC = 0.777). The optimal cut-offs were ΔATR ≤ - 1.5° for improvement and ΔATR ≥ + 0.5° for worsening. In subgroup analyses, the improvement threshold was ΔATR ≤ - 1.5° in the exercise-only group and ≤ - 4.5° in the brace-plus-exercise group. For radiographic worsening, the optimal thresholds were ΔATR ≥ + 0.5° in the exercise-only group and ≥ - 2.5° in the brace-plus-exercise group.
CONCLUSIONS: Treatment-specific ΔATR thresholds provide clinically meaningful benchmarks for monitoring both improvement and worsening, supporting the use of ATR as a practical radiation-free follow-up parameter in AIS management.