SRS Criteria Research Articles

Results of bracing adolescent idiopathic scoliosis in the context of clinical practice and the Scoliosis Research Society’s criteria: 5-year observational study from a German orthopaedic university hospital

BackgroundBrace therapy’s influence on adolescent idiopathic scoliosis’s (AIS) natural course is inconclusive.MethodsBrace-treated AIS patients from 2016 to 2020 were examined regarding four endpoints at brace weaning: surgery need, curve progress ≥ 6° and > 45°, and curve improvement ≥ 6°. Prediction variables’ influence was computed for the all-patients group and three subgroups (Subgroup 1: fulfilling the Scoliosis Research Society’s [SRS] criteria, Subgroup 2: initial Cobb angle < 25°, Subgroup 3: initial Cobb angle > 40°). According to the data characteristics, parametric and non-parametric tests and binary logistic regression were performed.ResultsThe research included 69 patients. Overall, after brace weaning surgery was recommended for 20.3% of them, curve progression was ≥ 6° in 23.2%, the Cobb angle was beyond 45° in 11.6%, and the Cobb angle improved by ≥ 6° in 20.3%. Patients needing surgery had a significantly higher initial Cobb angle (38.8° ± 9.8° vs 27.8° ± 7.6°, p < 0.001), lower Risser stages (p = 0.010), and higher Nash and Moe degrees (p = 0.030). Patients with curve progress ≥ 6° were younger at first curve notification (12.4 ± 1.5 vs 13.7 ± 1.7 years, p = 0.011) and older at menarche (13.4 ± 1.1 vs 12.6 ± 1.2 years, p = 0.037). Furthermore, 21.6% of all Risser 3 and 4 patients had still curve progress ≥ 6°. In-brace correction was significantly higher in patients with curve improvement ≥ 6° vs < 6° (54.0% ± 31.2% vs 31.9% ± 30.7%; p = 0.019). Nine patients fulfilled the SRS criteria, 22 had initial Cobb angles < 25°, and 11 had > 40°. Real brace wear (RBW) in all groups had no significant effect on outcome. Two significant subgroup differences were found: Surgery recommendation and curve progression beyond 45° were significantly more frequent in the initial Cobb angle > 40° subgroup.ConclusionsBrace effectiveness can be assumed because curve improvement was achieved in nearly one-fifth with sufficient in-brace correction. However, no significant influence of RBW on the outcome endpoints was demonstrated. To clarify conflicting results, big data management, including untreated patients, must be employed to further research AIS’s multifactorial influenced aetiology and course. Meanwhile, it is worth starting bracing in AIS in practice also beyond the SRS’s criteria.

A Dangerous Curve: Impact of the COVID-19 Pandemic on Brace Treatment in Adolescent Idiopathic Scoliosis.

Study DesignObservational Cohort study.ObjectivesWe aim to document the abandon and irregular compliance rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression.MethodsWe reviewed a database of AIS patients recruited between March and September 2020. We included AIS patients under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with self-reported Good-Compliance (GC) to treatment and those who had a Bad-Compliance (BC). Data analysis included biometric and radiographic data at first visit and last follow-up and percentage of progression. Unpaired student-t tests and Chi2 were used for comparison.Results152 patients met inclusion criteria. 89 patients (age:12.1y.o.±1.4) reported good adherence to treatment, while 63 patients (age:12.7y.o.±1.8) were not compliant. Within the BC group, 18 patients reported irregular brace wear, while 45 had completely abandoned treatment (abandon rate of 29%). The GC cohort started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +.65°±7.5; mean progression rate was -4.6%. However, the BC cohort started with a mean MT curve of 27° and finished with 32°, with a mean increase of +5°±8 and a mean progression rate of -13%. The differences between the 2 cohorts were statistically significant (P = .0002). Six patients from the BC group progressed and were offered surgery.ConclusionThe abandon rate of brace treatment in AIS significantly increased during the first wave of COVID-19 pandemic. Patients who voluntarily discontinued treatment had significant increases in curve progression and surgical indication rates.Level of evidenceIII

Short-Term Outcomes of the Boston Brace 3D Program Based on SRS and SOSORT Criteria: A Retrospective Study.

Background: Adolescent idiopathic scoliosis (AIS) is characterized by a lateral curvature of the spine with a Cobb angle greater than 10 degrees, accompanied by rotation of the vertebral body. Bracing has been shown to be effective in halting the progression of at-risk curves, and, in some cases, even improving the Cobb angle by 6° or more. The Boston Brace 3D is part of the Boston Orthotics and Prosthetics standardized scoliosis program. The orthosis is custom-fabricated from scans, computer-aided design (CAD), and computer-aided manufactured (CAM) thoracolumbosacral orthosis used in the non-operative management of AIS. Aim: To evaluate the outcomes of a scoliosis program utilizing the Boston Brace 3D orthosis for patients with AIS, based on SRS and SOSORT criteria. Design: Retrospective study. Methods: An electronic medical records search was conducted to identify first-time brace wearers fitted between 1 January 2018, and 30 June 2019, at Boston Orthotics and Prosthetics Boston area clinics that met the SRS/SOSORT research guidelines. The initial out-of-brace, in-brace, and last follow-up X-rays (taken at least 12 months after fitting) were compared. Results: 84% of patients presenting with a single curve and 69% of patients with a double curve saw their curves improve (reduced 6° or more) or remain unchanged (±5°). Thirty-one patients started with a single curve between 25° and 30°, and thirty-two presented at 30° or below. Fifty-nine patients started with a double curve between 25° and 30°, and 59 patients presented at 30° or below. In general, the patients who wore their brace for more hours per day saw improved results. Conclusion: The Boston Brace 3D program is effective in controlling (and in some cases improving) curve progression in the non-operative management of adolescent idiopathic scoliosis. The approach is a repeatable system, as shown in this cohort of thirteen clinicians across six area clinics following the Boston Brace 3D clinical guidelines.

Biomechanical Effects of Thoracolumbosacral Orthosis Design Features on 3D Correction in Adolescent Idiopathic Scoliosis: A Comprehensive Multicenter Study.

Multicenter numerical study. To biomechanically analyze and compare various passive correction features of braces, designed by several centers with diverse practices, for three-dimensional (3D) correction of adolescent idiopathic scoliosis. A wide variety of brace designs exist, but their biomechanical effectiveness is not clearly understood. Many studies have reported brace treatment correction potential with various degrees of control, making the objective comparison of correction mechanisms difficult. A Finite Element Model simulating the immediate in-brace corrective effects has been developed and allows to comprehensively assess the biomechanics of different brace designs. Expert clinical teams (one orthotist and one orthopedist) from six centers in five countries participated in the study. For six scoliosis cases with different curve types respecting SRS criteria, the teams designed two braces according to their treatment protocol. Finite Element Model simulations were performed to compute immediate in-brace 3D correction and skin-to-brace pressures. All braces were randomized and labeled according to 21 design features derived from Society on Scoliosis Orthopaedic and Rehabilitation Treatment proposed descriptors, including positioning of pressure points, orientation of push vectors, and sagittal design. Simulated in brace 3D corrections were compared for each design feature class using ANOVAs and linear regressions (significance P ≤ 0.05). Seventy-two braces were tested, with significant variety in the design approaches. Pressure points at the apical vertebra level corrected the main thoracic curve better than more caudal locations. Braces with ventral support flattened the lumbar lordosis. Lateral and ventral skin-to-brace pressures were correlated with changes in thoracolumbar/lumbar Cobb and lumbar lordosis (r =- 0.53, r = - 0.54). Upper straps positioned above T10 corrected the main thoracic Cobb better than those placed lower. The corrective features of various scoliosis braces were objectively compared in a systematic approach with minimal biases and variability in test parameters, providing a better biomechanical understanding of individual passive mechanisms' contribution to 3D correction.

Maria Adelaide brace in the management of Scheuermann\u2019s Kyphosis

PurposeThis prospective observational study aims to assess the MA brace effectiveness in hyperkyphosis correction, focusing also on patients’ compliance of bracing and its psychological impact.MethodsPatients referring to our spine outpatient department with Scheuermann’s kyphosis (SK) from January 2011 to January 2017 were prospectively recruited. Patients were divided into two groups, according to their global thoracic kyphosis (TK): Group-A TKT0 < 60°, Group-B TKT0 ≥ 60°.The MA brace was prescribed according to SRS criteria. Full spine X-rays were analyzed at conventional times: at the beginning of treatment (T0), at 6-months follow-up (T1, in-brace X-rays), at the end of treatment (T2) and at 2-year minimum follow-up from bracing removal (T3). At T0, T2 and T3 all the patients were assessed using the Italian Version of the SRS-22 Patient Questionnaire (I-SRS22). Variability between and within-groups was assessed; a p value < 0.05 was considered significant.Results192 adolescents (87 girls and 105 boys, mean age 13.1) were recruited. The mean global TK at recruitment was 61.9° ± 11.3°, the mean follow-up time was 57.4 months. A good patients’ reported compliance was observed: 84.9% of patients used the brace as scheduled. A mean in-brace correction (in-brace TK%) of 37.4% was observed and a mean final correction (TK%T3) of 31.6%. At final follow-up (T3), curve reduction (ΔTK ≤ − 5°) was observed in 60.4% of patients and curve stabilization (− 5° < ΔTK < 5) in 29.7% of patients. At baseline, worse SRS22-mental health (p = 0.023) and self-image mean scores (p = 0.001) were observed in Group-B, compared with Group-A. At the end of treatment (T2), an improvement of all items was observed, wit significantly better improvement of self-image domain in Group-B.ConclusionThe MA brace has shown to be effective in the management of SK; good patients’ reported compliance and a positive effect on the patients’ mental status were recorded.

Could the Clinical Effectiveness Be Improved Under the Integration of Orthotic Intervention and Scoliosis-Specific Exercise in Managing Adolescent Idiopathic Scoliosis?: A Randomized Controlled Trial Study.

The aim of the study was to compare the effectiveness of the integration of orthotic intervention and scoliosis-specific exercise with orthotic intervention only via assessing the spinal deformity, back muscle endurance, and pulmonary function of the patients with adolescent idiopathic scoliosis. It is a prospective randomized controlled study. Patients who fulfilled the SRS criteria for orthotic intervention were randomly assigned to the orthosis combined with exercise group (combined orthotic and exercise intervention) or the orthotic intervention group (orthotic intervention only). All the subjects were prescribed with a rigid thoracolumbosacral orthosis and scoliosis-specific exercise program was provided to the subjects in the orthosis combined with exercise group. Cobb angle, back muscle endurance, and pulmonary function of subjects were measured at baseline, 1-mo, and 6-mo follow-up visits. After 6 mos of intervention, the subjects in the orthosis combined with exercise group showed better Cobb angle correction than those in the orthotic intervention group. The back muscle endurance and pulmonary function decreased in the subjects of the orthotic intervention group, whereas some improvement happened in the subjects of the orthosis combined with exercise group. Between-group statistical significance was detected at the 6-mo follow-up among back muscle endurance time and parameters of pulmonary function. In this study, orthotic intervention combined with scoliosis-specific exercise offered better Cobb angle correction and improvement of the respiratory parameters and back muscle endurance of the patients with adolescent idiopathic scoliosis as compared with orthotic intervention only.

Immediate in-brace correction with the new Lyon brace (ARTbrace): Results of 141 consecutive patients in accordance with SRS criteria for bracing studies

All recent studies confirm that the outcome of a conservative orthopaedic treatment depends on the compliance and the effectiveness of bracing measured by immediate in-brace curve correction. There is a correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. In a retrospective analysis of the immediate in-brace correction obtained from a consecutive series of patients treated by the major SOSORT teams, the conclusion was that an effective brace should be able to achieve 50% correction of the curve magnitude, immediately after application. The aim of this study is to provide a point of comparison between different braces and study the factors determining the reduction. This is a prospective controlled cohort observational study based on ongoing database including 544 patients with AIS treated with ARTbrace from May 2013 to November 2015. Only primary curves were selected, lumbar curves Lenke 5 are excluded as treated with the short GTB brace. The SRS criteria group consisted of 141 patients with 177 curves. Brace checking is performed 3–4 days after brace delivery with ultra-low dose EOS system. All 141 patients was reviewed at the control: no drop out. The mean age was 12.92 years (SD = 1.39, range: 10–15). One hundred and twenty-five patients are female (88.7%). The average initial Cobb angle was 29.62° (SD = 4.6, range: 25–40°). The average in-brace correction (percent) was 72.5% (SD = 21.9, range: 29–140%). At the thoracic level ( n = 98). The average initial Cobb angle was 30.33° (SD = 4.6, range: 25–40°). The average in-brace Cobb angle was 10.04° (SD = 7.1, range: −12 to 29°). The average in-brace correction (percent) was 67.6% (SD = 21.2, range: 29–140%), significant ( P = 0.000). At the thoracolumbar and lumbar for double major level ( n = 75). The average initial Cobb angle was 28.61° (SD = 4.1, range: 20–40°). The average in-brace Cobb angle was 6.36° (SD = 6.5, range: −9 to 25°). The average in-brace correction (percent) was 78.8% (SD = 21.3, range: 40–136%), significant ( P = 0.000). For the BrAIST study, average in-brace correction was 33% ( n = 152, range: −48 to 100%). The in-brace correction obtained by the asymmetrical high rigid polycarbonate detorsion brace corrects at least two times more than conventional polyethylene braces.

Weaning results of a consecutive series of 125 adolescent idiopathic scoliosis treated by the new Lyon Brace (ART brace)

ART is the acronym for Asymmetry, Rigid, Torsion. The realization of this brace is based on new concepts (circled helicoid, global detorsion, Soft Contact, Mayonnaise tube effect, axilla baby lift, wrench & bolt…). The excellent in-brace correction has been proved on a consecutive series of 141 AIS selected according to the SRS criteria in a prospective database. Results at six months and a year were compared with those of the former Lyon brace and confirm that these good results remain constant. It is now possible to study the Cobb angle results of the first 125 AIS reaching the end of treatment. Are the first results at 1 year confirmed? This is a prospective controlled cohort observational study based on ongoing database including 544 patients with AIS treated with ART brace from May 2013 to November 2015. Only primary curves were selected and lumbar scoliosis (Lenke 5) are excluded as treated with the short GTB brace. The weaning protocol is identical to that of the former Lyon brace and compliant with the SOSORT guidelines. The dropout rate calculated for the first 125 patients is 14%. The mean age is 14.44 years (SD = 1.32, range: 10–17). One hundred and six patients are female (85%). The average Initial Cobb angle is 26.84° (SD = 7.15, range: 18–48°). The average In-brace Cobb angle is 6.19° (SD = 8.27, range: [−18] −34°). The average In-brace correction (percent) is 79.4% (SD = 26.6, range: 28–150%). The average Weaning Cobb angle is 15.89° (SD = 9.40, range: [−4] −44°). The average Weaning correction (percent) is 53.0% (SD = 25.6, range: 4–150%). In our experience, the weaning results are very close to those 2 years after weaning and can be considered as significant. Patients are a little older (14.4 vs 13.4) and with lower initial angulation than in the general statistics (26.84 vs 29.61). The in-brace reduction is greater (79.4% vs 69.4%) which explains the outstanding weaning correction rate (50% vs 25% for the old Lyon brace)

SU-F-T-604: Dosimetric Evaluation of Intracranial Stereotactic Radiotherapy Plans On a LINAC

Purpose: To evaluate the dosimetry of cranial stereotactic radiotherapy (SRT) plans of varying techniques on linac that meets appropriate TG-142 tolerances using 1 cm leaf width multileaf collimator (MLC). Methods: Seventeen spherical targets were generated in the center of a head phantom with diameters ranging 8 mm to 40 mm. SRT plans used 100° non-coplanar arcs and 5 couch angles with 35° spacing. The field size was target plus 1 mm margin. Four plans were created for each target: symmetrical jaws blocking for 5 arcs with 0° collimator (J1C), symmetrical jaws blocking with 5 clockwise arcs with 0° collimator and 5 counter-clockwise arcs with 45° collimator (J2C), MLC blocking for 5 dynamic conformal arcs with 0° collimator (M1C), and MLC blocking for 5 clockwise dynamic conformal arcs with 0° collimators and 5 counter-clockwise dynamic conformal arcs with 45° collimator (M2C).Conformity was evaluated using a ratio of Rx to target volume (PITV). Heterogeneity was determined using a ratio of maximum dose to Rx dose. Falloff was scored using CGIg: difference of effective radii of spheres equal to half and full Rx volumes. Results: All plans met RTOG SRS criteria for conformity and heterogeneity. The mean PITV was 1.52±0.07, 1.49±0.08, 1.39±0.05, and 1.37±0.04 for J1C, J2C, M1C, and M2C plans respectively. The mean CGIg was 75.35±15.79, 74.19±16.66, 77.14±15.12, and 76.28±15.78 for J1C, J2C, M1C, and M2C plans respectively. The mean MDPD was 1.25±0.00 for all techniques. Conclusion: Clinically acceptable SRT plans for spherical targets were created on a linac with 1 cm MLC. Adding two collimator angles and MLC to arcs each improved conformity. The MLC improved the dose falloff while two collimator angles degraded it. This technique can expand the availability of SRT to patients especially to those who cannot travel to a facility with a dedicated stereotactic radiosurgery machine.

SOSORT Award Winner 2015: a multicentre study comparing the SPoRT and ART braces effectiveness according to the SOSORT-SRS recommendations.

BackgroundData comparing different braces for adolescent idiopathic scoliosis (AIS) are scant. The SRS criteria represent some guidelines for comparing results from different studies, but controlled studies are much more reliable. Recently, super-rigid braces have been introduced in clinical practice with the aim of replacing Risser and EDF casts. The aim of the present study is to compare the short-term radiographic results of two super-rigid braces, the ART and the SPORT (Sforzesco) brace.MethodsA group of consecutive patients with Cobb >40°, Risser 0–4, age >10 treated with the ART brace for 6 months were matched with a group of similar patients taken from a prospective database of patients treated with the Sforzesco brace. Patients were matched according to Cobb severity, pattern and localization of the curve.All patients had a full-time brace prescription (23–24 hours per day) and an indication to perform scoliosis-specific exercises and were assessed radiographically both immediately in the brace and after 6 months of treatment out of brace. Curves were analyzed according to the pattern and localization taking into consideration both the in-brace correction and the 6-month out-of-brace results.Statistical analysis: t-test, ANOVA, linear regression, alpha set at 0.05.ResultsTwenty-six patients were included in the ART brace group, and 26 in the Sforzesco brace group. At baseline, no differences were noted for gender (3 males for each group), age (14.1 ± 0.3 for ART vs 13.9 ± 0.3 for Sforzesco), ATR (11.8 ± 3.2 vs 11.5 ± 4.2 for thoracic curves and 7.8 ± 4.0 vs 7.1 ± 6.1 for lumbar/thoracolumbar), Cobb angle (44.8 ± 2 vs 45.5 ± 2 for thoracic; 43.8 ± 2 vs 46.0 ± 2 for lumbar/thoracolumbar) or Risser sign (median 2 for both groups).The in-brace correction was slightly better for the ART brace, but didn’t reach statistical significance (24.3 ± 8.5 vs 28.0 ± 6.8 for thoracic; 23.7 ± 10.4 vs 29.9 ± 4.2 for lumbar/thoracolumbar). At 6 months, results were similar both for thoracic (34.4 ± 10.4 vs34.8 ± 6.8) and for lumbar/thoracolumbar (32.8 ± 10.8 vs 36.6 ± 5.2). Also, with regard to the pattern, results were similar for double major and for thoracic, while there were not enough data for single lumbar to make a comparison.No differences for ATR were found (7.8 ± 3.2 vs 8.6 ± 2.9 for thoracic; 4.3 ± 3.4 vs 4.3 ± 3.7 for lumbar/thoracolumbar).ConclusionThese two super-rigid braces showed similar short-term results, despite the better in-brace correction for lumbar curves shown by the ART brace. According to our data, the asymmetric design showed results similar to the symmetric one. After these preliminary data, further studies are needed to check end growth results and the impact of compliance, rigidity of curve, exercise and assessing quality of life.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-015-0049-4) contains supplementary material, which is available to authorized users.

SU‐E‐T‐320: Dosimetric Evaluation of Intracranial Stereotactic Radiotherapy Plans Using Jaws‐Only Collimation On a LINAC

Purpose:To evaluate the dosimetry of cranial stereotactic radiotherapy (SRT) plans using jaws‐only collimation on linac that meets appropriate TG‐142 tolerances.Methods:Seventeen spherical targets were generated in the center of a head phantom with diameters ranging from 8 mm to 40 mm. Plans balanced treatment time with dose gradient and conformity using 13 static fields and 3 couch angles: 9 non‐opposed and coplanar fields and 4 non‐coplanar fields. The symmetrical jaws field size was target diameter plus 2 mm. The prescription (Rx) was 7 Gy per fraction to the 80% isodose line. Two plans were created for each target: one kept the collimator at 0° (C0), one adjusted the collimator angle 40° for each field to create a 360° sweep over the 9 coplanar fields (CR).Conformity of the Rx to the target was evaluated using a ratio of Rx to target volume (PITV). Heterogeneity was determined using a ratio of maximum dose to Rx dose. Falloff was scored using CGIg: the difference of effective radii of spheres equal to half and full Rx volumes.Results:All plans met RTOG SRS criteria for conformity and heterogeneity. The use of collimator rotation improved conformity by 3.2% on average, the mean PITV was 1.7±0.1 for C0 plans and 1.6±0.1 for CR. Mean heterogeneity was 1.25±0.0 for both C0 and CR. The mean CGIg was 75.9±16.4 for C0 plans and 74.4±17.0 for CR; with a mean dose falloff degradation of 2.5% by CR.Conclusion:Clinically acceptable SRT plans for spherical targets were created using jaws‐only collimation with static fields. The addition of sweeping collimator rotation improves conformity at the expense of gradient. This technique can expand the availability of SRT to patients especially to those who cannot travel to a facility with a dedicated stereotactic radiosurgery machine.

The efficacy of SpineCor brace for adolescent idiopathic scoliosis in Singapore according to the SRS criteria

The efficacy of SpineCor brace for adolescent idiopathic scoliosis in Singapore according to the SRS criteria

Initial Cobb angle reduction velocity following bracing as a new predictor for curve progression in adolescent idiopathic scoliosis.

The initial correction rate (ICR) has been widely used as a predictor for curve progression in adolescent idiopathic scoliosis (AIS) undergoing bracing treatment. We proposed a new parameter, the initial Cobb angle reduction velocity (ARV), for prediction of curve progression. The purpose of this study was to identify whether the initial ARV was a more effective predictor than ICR for curve progression in AIS patients undergoing brace treatment, and to evaluate the ideal cut-off point of initial ARV for prediction of curve progression. This was a retrospective cohort study on AIS girls receiving standardized bracing treatment regularly followed up every 3-6months. Standardized SRS criteria for bracing study were utilized in the case selection. The demographic data, maturity status and Cobb angle of each visit were recorded. The initial ARV and ICR were identified. Patients were divided into progressive (≥6°) and non-progressive (<6°) groups based on their final bracing outcome. Differences between two groups were identified and logistic regression analysis was applied to compare the predictive values of initial ARV and ICR for curve progression during bracing treatment. Seventy-six patients were included in the non-progressive group and 19 in the progressive group. Significant differences between non-progressive and progressive groups were found in terms of initial ARV (12.8±21.4°/year vs -5.4±15.2°/year, P=0.001) and ICR (12.1±20.7% vs -5.8±18.0%, P=0.001). The logistic regression analysis revealed that age at initial visit (OR 1.742, P=0.043) and initial ARV (OR 1.057, P=0.002) had higher predictive values than ICR (P=0.601) for curve progression in braced AIS girls. The ideal cut-off point of initial ARV was 10°/year (OR 8.959, P=0.005) for the prediction of curve progression. The initial Cobb angle reduction velocity serves as a better predictor for curve progression than initial correction rate in braced AIS patients with follow-up interval of 3-6months. At the second visit following bracing prescription, those AIS patients with reduction velocity in Cobb angle lower than 10°/year have significantly higher risk of curve progression.

Conservative treatment in adolescent idiopathic scoliosis with curves over 45°: is the measurement in Cobb degrees the only parameter to be considered?

Methods The study including idiopathic scoliosis with 45° or more, Risser 0-4, who had utterly deny any surgical intervention. Fulfill the inclusion criteria 160 patients. Of these, 104 patients has definite outcome, 28 abandoned treatment and 28 are currently under treatment. The minimum duration of follow-up was 24 months. Xrays was used to to obtain Cobb degrees and torsion of the apical vertebra (Perdriolle’s method). Three outcomes were distinguished in agreement with SRS criteria: curve correction, curve stabilization and curve progression. We have divided the sample in subgroup according to Risser (0-2; 3-4), to rotation ( 25) and to type of Curve. The Kruskal Wallis and Spearman Rank Correlation tests have been used as statistical tests.

In favour of the definition "adolescents with idiopathic scoliosis": juvenile and adolescent idiopathic scoliosis braced after ten years of age, do not show different end results. SOSORT award winner 2014.

BackgroundThe most important factor discriminating juvenile (JIS) from adolescent idiopathic scoliosis (AIS) is the risk of deformity progression. Brace treatment can change natural history, even when risk of progression is high. The aim of this study was to compare the end of growth results of JIS subjects, treated after 10 years of age, with final results of AIS.MethodsDesign: prospective observational controlled cohort study nested in a prospective database. Setting: outpatient tertiary referral clinic specialized in conservative treatment of spinal deformities. Inclusion criteria: idiopathic scoliosis; European Risser 0–2; 25 degrees to 45 degrees Cobb; start treatment age: 10 years or more, never treated before. Exclusion criteria: secondary scoliosis, neurological etiology, prior treatment for scoliosis (brace or surgery). Groups: 27 patients met the inclusion criteria for the AJIS, (Juvenile Idiopathic Scoliosis treated in adolescence), demonstrated by an x-ray before 10 year of age, and treatment start after 10 years of age. AIS group included 45 adolescents with a diagnostic x-ray made after the threshold of age 10 years. Results at the end of growth were analysed; the threshold of 5 Cobb degree to define worsened, improved and stabilized curves was considered. Statistics: Mean and SD were used for descriptive statistics of clinical and radiographic changes. Relative Risk of failure (RR), Chi-square and T-test of all data was calculated to find differences among the two groups. 95% Confidence Interval (CI) , and of radiographic changes have been calculated.ResultsWe did not find any Cobb angle significant differences among groups at baseline and at the end of treatment. The only difference was in the number of patients progressed above 45 degrees, found in the JIS group. The RR of progression of AJIS was, 1.35 (IC95% 0.57-3.17) versus AIS, and it wasn't statistically significant in the AJIS group, in respect to AIS group (p = 0.5338).ConclusionThere are no significant differences in the final results of AIS and JIS, treated with total respect of the SRS and SOSORT criteria, in adolescence. Brace efficacy can neutralize the risk of progression.

Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner.

BackgroundOver the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. Yet, little information is available on the impact of compliance on the outcome of conservative treatment in scoliotic subjects. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS).MethodsAmong 1.424 patients treated for idiopathic scoliosis, 645 were eligible for inclusion criteria. Three outcomes were distinguished in agreement with the SRS criteria: curve correction, curve stabilization and curve progression. Brace wearing was assessed by one orthopaedic surgeon (LA) and scored on a standardized form. Compliance to treatment was categorized as complete (brace worn as prescribed), incomplete A (brace removed for 1 month), incomplete B (brace removed for 2 months), incomplete C (brace removed during school hours), and incomplete D (brace worn overnight only). Chi square test, T test or ANOVA and ANOVA for repeated measures tests were used as statistical tests.ResultsThe results from our study showed that at follow-up the compliance was: Complete 61.1%; Incomplete A 5.2%; Incomplete B 10.7%; Incomplete C 14.2%; Incomplete D 8.8%. Curve correction was accomplished in 301/319 of Complete, 19/27 Incomplete A, 25/56 Incomplete B, 52/74 Incomplete C, 27/46 Incomplete D. Cobb mean value was 29.8 ± 7.5 SD at beginning and 17.1 ± 10.9 SD at follow-up. Both Cobb and Perdriolle degree amelioration was significantly higher in patients with complete compliance over all other groups, both in juvenile, both in adolescent scoliosis. In the intention-to-treat analysis, the rate of surgical treatment was 2.1% among patients with definite outcome and 12.1% among those with drop-out. Treatment compliance showed significant interactions with time.ConclusionCurve progression and referral to surgery are lower in patients with high brace compliance. Bracing discontinuation up to 1 month does not impact on the treatment outcome. Conversely, wearing the brace only overnight is associated with a high rate of curve progression.

Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies - SOSORT award 2013 winner.

BackgroundThe Juvenile idiopathic scoliosis by age of onset, severity and evolutivity is source of great doubts concerning the purpose and use of conservative treatment. The different clinical experiences leave unsolved the question that arises in applying a conservative treatment when the patients are effectively forward a long growing period, in scoliosis characterized by inevitable evolutivity. The purpose of the present prospective study was to determine the effectiveness of conservative treatment in Juvenile idiopathic scoliosis.MethodsFrom 1238 patients treated for idiopathic scoliosis between 1995 and 2012 fulfill the inclusion criteria 163 patients treated with PASB, Lyon brace and Milwaukee. Of these, 113 patients had a definite outcome, 27 have abandoned treatment e 23 are still in treatment. The minimum follow-up was 24 months. Radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning (t1), 6 months after the beginning (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-years minimum follow-up (t5). Three outcomes were distinguished in agreement with SRS criteria: correction, stabilization and progression.ResultsThe results from our study showed that of the 113 patients with a definite outcome CM mean value was 29.6 ± 7.5 SD at t1 and 16.9 ± 11.1 SD at t5. TA was 13.5 ± 5.4 SD at t1 and 8.5 ± 5.6 at t5. The variations between CM t5-t1 and TA t5-t1 were statistically significantly different. Curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Of 26 patients who abandoned the treatment, at the time of abandonment (12.5 age) have achieved curve correction in 19 cases (70.0%), stabilization in 5 cases (19%) and progression in 3 cases (11%). Of these patients, reviewed at the end of growing, four have been operated on.ConclusionsOur study confirmed that conservative treatment with brace is highly effective in treating juvenile idiopathic scoliosis, in particular most patients reaching a complete curve correction and only 4.9% of patients need surgery.

A prospective study in adolescent idiopathic scoliosis affected by thoracolumbar and lumbar curves in treatment with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria

Methods We have carried out a prospective study of 197 adolescents (mean age 11.8 ± 0.5 years) treated from 1993 to 2012 with thoracolumbar and lumbar curve and a pretreatment Risser scores ranging from 0 to 2. To evaluate the effectiveness of treatment and standardize the results, SRS criteria were used. All patients were prescribed a full-time PASB. The minimum duration of follow-up was 24 months. Anteroposterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at five time points: beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), and 2-year minimum follow-up from t4 (t5). Three outcomes were distinguished: curve correction, curve stabilization and curve progression. Statistical analyses were performed with GraphPad Prism 6.

Prospective study according to the SRS and SOSORT criteria on the effectiveness of a complete conservative treatment (bracing and exercises) for adolescent idiopathic scoliosis: efficacy and intent-to-treat analysis

Methods Study Design: Prospective data extraction from a clinical database started in 2003. Population: According to SRS inclusion criteria (AIS, age 10 years or older; Risser test 0-2; Cobb degrees 25-40°; no prior treatment; less than one year post-menarche). 73 patients (60 females 82.2% and 13 males 17.8%) have been included, age 12 years 10 months ± 17 months, with 39 single, 32 double, and 2 triple curves. Methods: Braces have been personalized (Sibilla 61.6%, Lyon 16.4%, Sforzesco 13.7%, SpineCor 6.8%). At the start of treatment, 30 patients used the brace 22-23 hours per day (h/d), 22 for 20-21 h/d, and 21 for 16-18 h/d; weaning was gradual after Risser 3; all patients performed exercises; SOSORT management criteria were respected. Outcome: SRS (unchanged; worsened 6° or more; over 45° at the end of treatment; surgically treated) and rate of improvement (6° or more); radiographic and clinical data. Analyses: overall results at the last evaluation of all patients. Intent-to-treat: failures included all dropouts (treatment stopped before Risser 3, or without medical indication). Efficacy: end-of-treatment patients.

Brace efficacy: meta-analysis of studies conducted according to the SRS criteria for brace studies

Results 5 studies have been included (4 retrospective, one prospective), with a total of 416 patients, Cobb Angle range 25-40°, Risser 0-2, more than 10 years old, and less than 1 year post menarche at baseline. Pooling data, we had 40% of patients worsened >36° Cobb, including 27% with curves over 45°; 30% of patients were fused. Making subgroup analysis, we compared rigid braces managed according to SOSORT Criteria (SOSORT-C), with rigid braces managed without: 2% worsened (OR: 95.21; CI 93.7596.66), without any patients exceeding 45°, or fused, versus 67% worsened (44%>45°Cobb), and 55% fused. Comparing rigid braces altogether with SpineCor, we had similar efficacy, 38% vs 42% worsened (24% vs 31% >45°), 30% vs 29% fused. We had better results for papers respecting SOSORT-C, intermediate for SpineCor, and the worst for the other rigid braces papers with significant OR.