Can I Stop Bracing Now? Utilizing Hand X-rays as Standalone Criterion for Discontinuation of Bracing in Adolescent Idiopathic Scoliosis

Abstract

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Chronic Illness, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Purpose The purpose of this study is to determine if Sanders maturation stage 7 can be utilized as a stand-alone criteria for discontinuation of a thoracolumbosacral orthosis (TLSO) in adolescent idiopathic scoliosis (AIS). Background TLSO, or “bracing,” is a common treatment modality offered to skeletally immature patients with AIS. Maturation markers such as Risser sign on pelvis x-ray, growth velocity, time from first menses and curve stability are common factors utilized to determine end of brace treatment. However, these methods can be fraught with variability. The Sanders classification is a simplified, reliable bone age classification system that correlates strongly with the behavior of idiopathic scoliosis. Methods Inclusion criteria consisted of brace treatment in AIS measuring between 25 and 40 degrees, main cobb curve remaining Results Seventy-five patients (71 female [94.7%]; mean age 12.72 years) met the criteria. Main Cobb angle at brace application was 28.60°±4.38°. Forty-two patients had at least a one-year minimum follow up post treatment. One year after discontinuing the brace, eight patients (19%) increased 5 or more degrees (5°, 6°, 7°, 8°) above their largest curve measurement during treatment. Mean progression one-year post brace discontinuation was 2.28°±1.23°. Final mean Cobb angle measured 32.07° for the group. Two patients in the group had a Cobb measurement above 40° at one year after treatment. No significant difference in Cobb angle was found between pre brace measurements and end of brace treatment, nor between the end of brace treatment and at final follow up. No patient in the group progressed to surgical intervention. Discussion Eight patients (19%) increased more than 4° one year after the end of brace treatment, but no patient progressed to a curve that necessitated surgical intervention. Sanders maturation stage 7 may be useful as a stand-alone criterion for termination of brace treatment in AIS.