Abstract
Study designRetrospective cross-sectional study.ObjectiveTo analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines.Summary of background dataThere is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection.MethodsWe performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10–18 years, with scoliosis greater than 10°, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude.ResultsDuring the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7° more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence.ConclusionThe majority of AIS patients present too late for effective management with bracing.Level of evidenceIII.
Highlights
Adolescent Idiopathic Scoliosis (AIS) is the most common form of scoliosis
A total of 335 patients were eligible for inclusion in the study (Fig. 2) with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8° ± 14.5°
Brace treatment is a conservative management modality that aims to decrease the burden of operative treatment for AIS patients
Summary
Adolescent Idiopathic Scoliosis (AIS) is the most common form of scoliosis. It occurs in otherwise healthy children around puberty, during the period of rapid skeletal growth [1,2,3,4]. The Scoliosis Research Society (SRS) [13] has developed guidelines based on the magnitude of curvature, described by the Cobb angle [14, 15], and skeletal growth potential, using the Risser Scale [15, 16]. The SRS treatment recommendations for AIS fall into three main categories: observation, bracing, and. The SRS guidelines consider curves between 40 and 50° borderline, or a “gray zone” for surgical consideration many centers, including ours, use greater than 50° as the threshold for surgery [11, 17]
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