Skeletally Immature Patients With Adolescent Idiopathic Scoliosis Curves 15°–24° Are at High Risk for Progression

Abstract

Study DesignRetrospective review. ObjectivesTo evaluate the incidence of adolescent idiopathic scoliosis (AIS) curve progression and brace prescription in skeletally immature patients (Risser 0 to Risser 1) with curves 15°–24°. Summary of Background DataMany skeletally immature patients with mild AIS ask about the likelihood of curve progression. No studies have answered these questions. MethodsThe charts and radiographs of 302 consecutive patients with curves 15°–24° at initial visit, Risser 0 to Risser 1, were reviewed until skeletal maturity (≥Risser 4) or surgery. Curves averaged 19.1° ± 2.9° at initial visit. The Risser grade was 0 in 247 patients (82%) and 1 in 55 patients (18%). Patients who were Risser 0 were compared with those who were Risser 1, curves 15°–19° were compared with curves 20°–24°. ResultsThe majority of patients demonstrated curve progression ≥5° (65%). Patients who were Risser 0 did not progress significantly more than patients who were Risser 1 (10° vs. 8°) (p = .22). Patients with curves 20°–24° did not progress significantly more than patients with curves 15°–19° (10° vs. 9°) (p = .65). ConclusionsCurve progression for small curves (15°–19°) is similar to curves between 20° and 24°. Close observation or perhaps early intervention for these patients is necessary. These data may suggest a paradigm shift to earlier brace initiation and call for early treatment in small curves. Level of EvidenceLevel II.