End-growth results of a personalised conservative approach in 1938 high risk adolescents with idiopathic scoliosis: Prospective observational multicentre study

Abstract

End of growth RCTs showed the efficacy of bracing and physiotherapic scoliosis specific exercises (PSSE). Current guidelines propose PCA according to the step-by-step theory: invasivity increases with treatment intensity, from observation to PSSE to soft, rigid and very rigid bracing. This requires to set individualised outcomes and propose the less invasive treatment according to the outcome. Inclusion criteria: AIS, 11–45°, Risser 0–2, age 10–16, first consultation, no previous bracing. End of observation: Risser 3, medical prescription. Groups were defined according to the main end outcome (SRS-SOSORT Consensus): low degree (LD) (< 31° at start) remain < 30°; high degree (HD) (> 30° at start) remain < 50°. Treatment: PCA including observation, PSSE (SEAS school), soft (SpineCor), hard (Sibilla) and very rigid (Sforzesco) braces. Classical statistics and propensity scores have been applied. We excluded 207 (10.7%) drop-outs and 274 (14.1%) still in therapy. Treatment intensity increased with Cobb degrees, as well as rate of improvement (from 13.6% to 56.1% – P < 0.05). Rate of progression was higher in the less intensively treated very low degree curves (11–20°) ( P < 0.05), while did not change significantly in those above 20° (between 12.9 and 15.9%). Rate of patients < 30° were 69.3% at start and 78.3% at the end ( P < 0.05); patients > 50° at the end were 1.6%. Defining different outcomes according to PCA allows to perform less aggressive treatments for LD, and concentrating the efforts in HD. Failure rates can be low in both groups. Progression is not the best outcome for all patients and type of treatments.