Adolescent Idiopathic Scoliosis: Immaturity Predicts Progression, but Is More Brace Wear Time Beneficial? Commentary on an article by Lori A. Karol, MD, et al.: "The Effect of the Risser Stage on Bracing Outcome in Adolescent Idiopathic Scoliosis".

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The study by Karol et al. evaluated the relationship between the Risser stage and bracing outcome for adolescent idiopathic scoliosis (AIS). Previous studies, including the important Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST), have generally described combined results for patients at Risser stages 0, 1, and 21. However, Karol et al. evaluated each stage of maturity independently. Brace wear time was also measured objectively with a thermal monitor in each brace. One hundred and sixty-eight patients were followed from the time of brace delivery until cessation of bracing or surgical intervention. This provided a large cohort of patients at Risser stage 0 for subgroup analysis. One limitation of the study, as noted by the authors, is that some of the subgroups became small, but several useful observations were identified by this study. The rate of progression to a curve magnitude requiring surgery was 44.2% for patients at Risser stage 0, 6.9% for patients at Risser stage 1, and 0% for patients at Risser stage 2. This confirms the importance of growth velocity in scoliosis progression. These findings also call into question all studies that have combined patients at Risser stages 0, 1, and …