Purpose: In pediatric orthopedics, Risser sign is used to assess skeletal maturity. Two grading system exist for the Risser sign, one US and one European. In adolescent idiopathic scoliosis (AIS) the curve acceleration phase begin at a digital skeletal age (DSA) score between 400 – 425. The objective was to asses the disagreement between both grading system and evaluate the best estimator of the curve acceleration phase. Method: One hundred twenty-one AIS patients had a PA and lateral X-rays of the spine and a left hand and wrist X-ray. Risser sign was measured according to both grading system and bone age was calculated according to Tanner-Whitehouse III method. Kappa statistics were done to evaluate concordance between US and Euro-pean grading system and 2 multiple linear regression models were performed to find which stage best predicts the beginning of the rapid acceleration phase. Results: Kappa statistic between the US and European system was 0.517 (moderate agreement). US Risser 1 was the best predictor of the curve acceleration phase. DSA scores predicted with Risser 1 were 425 and 445 for US and European system respectively. Conclusion: American and European Risser grading system use different criteria to define 6 stages of a same sign. This is reflected in our study with a moderate agreement between both grading systems. US Risser 1 is the stage that best predicts the beginning of the rapid acceleration phase and a close follow up should be made at the beginning of the iliac apophysis ossification

Aims. Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected. Methods. We conducted a retrospective analysis of clinical and radiological data of 20 patients aged between 9 and 17 years old, (with a 19 female: 1 male ratio) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7). Results. There were ten patients in each group with a total of 23 curves operated on. VBT-GM mean age was 12.5 years (9 to 14) with a mean Risser classification of 0.63 (0 to 2) and VBT-ASC was 14.9 years (13 to 17) with a mean Risser classification of 3.66 (3 to 5). Mean preoperative VBT-GM Cobb was 47.4° (40° to 58°) with a Fulcrum unbend of 17.4 (1° to 41°), compared to VBT-ASC 56.5° (40° to 79°) with 30.6 (2° to 69°)unbend. Postoperative VBT-GM was 20.3° and VBT-ASC Cobb angle was 11.2°. The early postoperative correction rate was 54.3% versus 81% whereas Fulcrum Bending Correction Index (FBCI) was 93.1% vs 146.6%. The last Cobb angle on radiograph at mean five years’ follow-up was 19.4° (VBT-GM) and 16.5° (VBT-ASC). Patients with open triradiate cartilage (TRC) had three over-corrections. Overall, 5% of patients required fusion. This one patient alone had a over-correction, a second-stage tether release, and final conversion to fusion. Conclusion. We show a high success rate (95%) in helping children avoid fusion at five years post-surgery. VBT is a safe technique for correction of scoliosis in the skeletally immature patient. This is the first report at five years that shows two methods of VBT can be employed depending on the skeletal maturity of the patient: GM and ASC. Cite this article: Bone Jt Open 2022;3(2):123–129

Aims. Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS). Methods. UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. Discussion. The primary outcome is ‘treatment failure’ (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or ‘treatment success’ (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry. Cite this article: Bone Jt Open 2023;4(11):873–880

Primary care physicians rely on radiology reports to confirm a scoliosis diagnosis and inform the need for spine specialist referral. In turn, spine specialists use these reports for triage decisions and planning of care. To be a valid predictor of disease and management, radiographic evaluation should include frontal and lateral views of the spine and a complete view of the pelvis, leading to accurate Cobb angle measurements and Risser staging. The study objectives were to determine 1) the adequacy of index images to inform treatment decisions at initial consultation by generating a score and 2) the utility of index radiology reports for appropriate triage decisions, by comparing reports to corresponding images. We conducted a retrospective chart and radiographic review including all idiopathic scoliosis patients seen for initial consultation, aged three to 18 years, between January 1-April 30, 2021. A score was generated based on the adequacy of index images to provide accurate Cobb angle measurements and determine skeletal maturity (view of full spine, coronal=two, lateral=one, pelvis=one, ribcage=one). Index images were considered inadequate if repeat imaging was necessary. Comparisons were made between index radiology report, associated imaging, and new imaging if obtained at initial consultation. Major discrepancies were defined by inter-reader difference >15°, discordant Risser staging, or inaccuracies that led to inappropriate triage decisions. Location of index imaging, hospital versus community-based private clinic, was evaluated as a risk factor for inadequate or discrepant imaging. There were 94 patients reviewed with 79% (n=74) requiring repeat imaging at initial consultation, of which 74% (n=55) were due to insufficient quality and/or visualization of the sagittal profile, pelvis or ribcage. Of index images available for review at initial consult (n=80), 41.2% scored five out of five and 32.5% scored two or below. New imaging showed that 50.0% of those patients had not been triaged appropriately, compared to 18.2% of patients with a full score. Comparing index radiology reports to initial visit evaluation with <60 days between imaging (n=49), discrepancies in Cobb angle were found in 24.5% (95% CI 14.6, 38.1) of patients, with 18.4% (95% CI 10.0, 31.4) categorized as major discrepancies. Risser stage was reported in only 14% of index radiology reports. In 13.8% (n=13) of the total cohort, surgical or brace treatment was recommended when not predicted based on index radiology report. Repeat radiograph (p=0.001, OR=8.38) and discrepancies (p=0.02, OR=7.96) were increased when index imaging was obtained at community-based private clinic compared to at a hospital. Re-evaluation of available index imaging demonstrated that 24.6% (95% CI 15.2, 37.1) of Cobb angles were mis-reported by six to 21 degrees. Most pre-referral paediatric spine radiographs are inadequate for idiopathic scoliosis evaluation. Standardization of spine imaging and reporting should improve measurement accuracy, facilitate triage and decrease unnecessary radiation exposure

Aims. Spinal fusion remains the gold standard in the treatment of idiopathic scoliosis. However, anterior vertebral body tethering (AVBT) is gaining widespread interest, despite the limited data on its efficacy. The aim of our study was to determine the clinical efficacy of AVBT in skeletally immature patients with idiopathic scoliosis. Methods. All consecutive skeletally immature patients with idiopathic scoliosis treated with AVBT enrolled in a longitudinal, multicentre, prospective database between 2013 and 2016 were analyzed. All patients were treated by one of two surgeons working at two independent centres. Data were collected prospectively in a multicentre database and supplemented retrospectively where necessary. Patients with a minimum follow-up of two years were included in the analysis. Clinical success was set a priori as a major coronal Cobb angle of < 35° at the most recent follow-up. Results. A total of 57 patients were included in the study. Their mean age was 12.7 years (SD 1.5; 8.2 to 16.7), with 95% being female. The mean preoperative Sanders score and Risser grade was 3.3 (SD 1.2), and 0.05 (0 to 3), respectively. The majority were thoracic tethers (96.5%) and the mean follow-up was 40.4 months (SD 9.3). The mean preoperative major curve of 51° (SD 10.9°; 31° to 81°) was significantly improved to a mean of 24.6° (SD 11.8°; 0° to 57°) at the first postoperative visit (45.6% (SD 17.6%; 7% to 107%); p < 0.001)) with further significant correction to a mean of 16.3° (SD 12.8°; -12 to 55; p < 0.001) at one year and a significant correction to a mean of 23° (SD 15.4°; -18° to 57°) at the final follow-up (42.9% (-16% to 147%); p < 0.001). Clinical success was achieved in 44 patients (77%). Most patients reached skeletal maturity, with a mean Risser score of 4.3 (SD 1.02), at final follow-up. The complication rate was 28.1% with a 15.8% rate of unplanned revision procedures. Conclusion. AVBT is associated with satisfactory correction of deformity and an acceptable complication rate when used in skeletally immature patients with idiopathic scoliosis. Improved patient selection and better implant technology may improve the 15.8% rate of revision surgery in these patients. Further scrutiny of the true effectiveness and long-term risks of this technique remains critical. Cite this article: Bone Joint J 2020;102-B(12):1703–1708

Abstract. Aims. Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis allowing correction of scoliosis through growth modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemiepiphysiodesis concept. The other modality is anterior scoliosis correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected. Methods. A retrospective analysis of 20 patients (M:F=19:1 – 9–17 years) between January 2014 to December 2016 with a mean five-year follow-up (4 to 7). Results. There were ten patients in each group with a total of 23 curves operated upon. VBT-GM mean age −12.5 years (9 to 14), mean Risser of 0.63 (0 to 2) and VBT-ASC was 14.9 years (13 to 17) and mean Risser of 3.66 (3 to 5). Mean preoperative VBT-GM Cobb was 47.4° (40°–58°) compared to VBT-ASC 56.5° (40°–79°). Postoperative VBT-GM Cobb was 20.3° and VBT-ASC was 11.2°. The early postoperative correction rate was 54.3% versus 81% whereas Fulcrum Bending Correction Index (FBCI) was 93.1% vs 146.6%. Latest Cobb angle at mean five years' follow-up was 19.4° (VBT-GM) and 16.5° (VBT-ASC). Overall, 5% of patients required fusion. Conclusion. We show a high success rate (95%) in helping children avoid fusion at five years post-surgery. VBT is a safe technique for scoliosis correction in the skeletally immature patient. This is the first report at five years showing two possible options of VBT depending on the skeletal maturity of the patient: GM and ASC

Aims. The aim of this study was to assess the ability of morphological spinal parameters to predict the outcome of bracing in patients with adolescent idiopathic scoliosis (AIS) and to establish a novel supine correction index (SCI) for guiding bracing treatment. Methods. Patients with AIS to be treated by bracing were prospectively recruited between December 2016 and 2018, and were followed until brace removal. In all, 207 patients with a mean age at recruitment of 12.8 years (SD 1.2) were enrolled. Cobb angles, supine flexibility, and the rate of in-brace correction were measured and used to predict curve progression at the end of follow-up. The SCI was defined as the ratio between correction rate and flexibility. Receiver operating characteristic (ROC) curve analysis was carried out to assess the optimal thresholds for flexibility, correction rate, and SCI in predicting a higher risk of progression, defined by a change in Cobb angle of ≥ 5° or the need for surgery. Results. The baseline Cobb angles were similar (p = 0.374) in patients whose curves progressed (32.7° (SD 10.7)) and in those whose curves remained stable (31.4° (SD 6.1)). High supine flexibility (odds ratio (OR) 0.947 (95% CI 0.910 to 0.984); p = 0.006) and correction rate (OR 0.926 (95% CI 0.890 to 0.964); p < 0.001) predicted a lower incidence of progression after adjusting for Cobb angle, Risser sign, curve type, menarche status, distal radius and ulna grading, and brace compliance. ROC curve analysis identified a cut-off of 18.1% for flexibility (sensitivity 0.682, specificity 0.704) and a cut-off of 28.8% for correction rate (sensitivity 0.773, specificity 0.691) in predicting a lower risk of curve progression. A SCI of greater than 1.21 predicted a lower risk of progression (OR 0.4 (95% CI 0.251 to 0.955); sensitivity 0.583, specificity 0.591; p = 0.036). Conclusion. A higher supine flexibility (18.1%) and correction rate (28.8%), and a SCI of greater than 1.21 predicted a lower risk of progression. These novel parameters can be used as a guide to optimize the outcome of bracing. Cite this article: Bone Joint J 2022;104-B(4):495–503

Introduction. Vertebral body tethering (VBT) is a non-fusion technique to correct scoliosis. It allows correction of scoliosis through Growth Modulation (GM) by tethering the convex side to allow concave unrestricted growth similar to the hemi-epiphysiodesis concept. The other modality is Anterior Scoliosis Correction (ASC) where the tether is able to perform most of the correction immediately where limited growth is expected. Methods. Retrospective analysis of clinical and radiographic data of 20 patients between 2014 to 2016 with a mean 5 year follow (range 4–6). Results. There were 10 patients in each group with a total of 23 curves operated on. VBT-GM mean age was 12.5y with mean Risser 0.63 and VBT-ASC was14.9y with a Risser of 3.66. Mean preop VBT-GM Cobb was 46° with a Fulcrum unbend of 13.6° compared to VBT-ASC 56.9° with 32.2° unbend. Postop VBT-GM was 21° and VBT-ASC Cobb was 10.8°. The early postop Correction Rate was 54.3% vs 81% whereas FBCI was 77.1% vs 186.6%. The last XR at mean 5y was 22.2° (VBT-GM) and 16.9° (VBT-ASC) 95% avoided fusion. Open TRC group had 3 over corrections. 1 patient alone had overcorrection, unplanned second stage and conversion to fusion. Discussion and Conclusion. We show a high success rate (95%) in helping children avoid fusion. Vertebral body tethering is a safe technique for correction of scoliosis in the skeletally immature patient. This is the first report at 5 years that shows two modalities of VBT can be employed depending on the skeletal maturity of the patient: Growth Modulation and Anterior Scoliosis Correction

We assessed the Japanese specific bone age standard with Tanner-Whitehouse 2 (TW2) method for the evaluation of skeletal maturity in adolescent scoliosis. TW2 bone age was investigated by the left hand-wrist X-rays of 120 girls with adolescent scoliosis. Their chronological age ranged from 10.2 to 19.0 years. Because Risser’s sign is uncertain between Risser IV and V, for comparison of TW2 bone age with Risser’s sign, we classified apophyses that with an apparent narrowing of cartilage and that with a partial fusion as the later of Risser IV. In addition, clinical courses of the skeletal matured cases (adult bones) in 6 months before investigation were reviewed retrospectively. Even or less than 5 degrees change of Cobb’s angle was evaluated as unchanged. Furthermore, bone age distribution of immature cases was also reviewed for comparision of the unchanged group with the progressive group. None was evaluated as adult bone in the stage from Risser 0 to III. The rate of adult bone which was shown in Risser IV was 43.5%, but 88.9% was in the later of IV. 95.8% of Risser V was already adult bone. Moreover, 93.1% of adult bone was unchanged in their clinical courses. Remaining 4 cases (6.9%) was progressive, but had not progressed in the following 6 months. Bone ages of the progressive immature group distributed in the range from 11.7 to 13.9 years. Those of the unchanged immature group distributed mainly over 13.1 years. Although it is necessary to follow the immature longitudinally, adult bone appeared almost in the later of Risser IV, and appeared earlier than Risser V. And Cobb’s angle may become unchanged before adult bone. At least adult bone would be an indicator between Risser IV and V

To analyze the dynamics of the thoracic spine during deep breathing in AIS patients and in healthy matched controls. Case-control cross-sectional study. 20 AIS patients (18 girls, Cobb angle, 54.7±7.9°; Risser 1.35±1.2) and 15 healthy volunteers (11 girls) matched in age (12.5 versus 15.8 yr. mean age) were included. In AIS curves, the apex was located in T8 (14) and T9 (6). Conventional sagittal radiographs of the whole spine were performed at maximal inspiration and expiration. The ROM of each spinal thoracic functional segment (T1-T7, T7-T10, T10-T12), the global T1–T12 ROM were measured. Respiratory function was assess by forced vital capacity (FVC), expiratory volume (FEV1), FEV1/FVC, inspiratory vital capacity (IVC) and peak expiratory flow (PEF). In healthy subjects, the mean T1–T12 ROM during forced breathing was 16.7±3.8. AIS patients showed a T1-T12 ROM of 1.1±1.5 (p<0.05) indicating a sagittal stiffness of thoracic spine. A wide T7–T10 ROM (15.3±3.0) was found in healthy controls (91.6% of the T1–T12 ROM). AIS patients showed only 0.4±1.4 ROM at T7-T10 (36.4% of the T1–T12 ROM) (p<0.001). There was a significant correlation between T7-T10 ROM and IVC. Lenke 1A AIS patients show a restriction of the thoracic spine motion with an almost complete abolition of T7-T10 ROM, a crucial segment participating in the deep breathing. T7-T10 stiffness could explain the ventilatory limitations found in AIS patients

In healthy subjects, respiratory maximal volumes are highly dependent on the sagittal range of motion of the T7-T10 segment. In AIS, the abolition of T7-T10 dynamics related to the stiffness induced by the apex region in Lenke IA curves could harm ventilation during maximal breathing. The aim of this study was to analyze the dynamics of the thoracic spine during deep breathing in AIS patients and in healthy matched controls. This is a cross-sectional, case-control study. 20 AIS patients (18 girls, Cobb angle, 54.7±7.9°; Risser 1.35±1.2) and 15 healthy volunteers (11 girls) matched in age (12.5 versus 15.8 yr. mean age) were included. In AIS curves, the apex was located at T8 (14) and T9 (6). Conventional sagittal radiographs of the whole spine were performed at maximal inspiration and exhalation. The ROM of each spinal thoracic functional segment (T1-T7, T7-T10, T10-T12) and the global T1-T12 ROM were measured. In healthy subjects, the mean T1-T12 ROM during forced breathing was 16.7±3.8. AIS patients showed a T1-T12 ROM of 1.1±1.5 (p<0.05), indicating a sagittal stiffness of the thoracic spine. A wide T7-T10 ROM (15.3±3.0) was found in healthy controls (91.6% of the T1–T12 ROM). AIS patients showed only 0.4±1.4 ROM at T7-T10 (36.4% of the T1-T12 ROM) (p<0.001). There was a significant positive correlation between the magnitude of T7-T10 kyphosis in maximal exhalation and both FVC (% of predicted FVC) and FEV1. In conclusion, Lenke 1A AIS patients show a restriction of the thoracic spine motion with an almost complete abolition of T7-T10 ROM, a crucial segment for deep breathing. T7-T10 stiffness could explain the ventilatory limitations found in AIS patients

Anterior vertebral body tethering (AVBT) is a growth modulating procedure used to manage idiopathic scoliosis by applying a flexible tether to the convex surface of the spine in skeletally immature patients. The purpose of this study is to determine the preliminary clinical outcomes for an adolescent patient cohort. 18 patients with scoliosis were selected using a narrow selection criteria to undergo AVBT. Of this cohort, 11 had reached a minimum follow up of 2 years, 4 had reached 18 months, and 3 had reached 6 months. These patients all demonstrated a primary thoracic deformity that was too severe for bracing, were skeletally immature, and were analysed in this preliminary study of coronal plane deformity correction. Using open-source image analysis software (ImageJ, NIH) PA radiographs taken pre-operatively and at regular follow-up visits post-operatively were used to measure the coronal plane deformity of the major and compensatory curves. Pre-operatively, the mean age was 12.0 years (S.D. 10.7 – 13.3), mean Sanders score 2.6 (S.D. 1.8-3.4), all Risser 0 and pre-menarchal, with mean main thoracic Cobb angle of 52° (S.D. 44.2-59.8°). Post-operatively the mean angle decreased to 26.4° (S.D. 18.4-32°) at 1 week, 30.4° (S.D. 21.3-39.6°) at 2 months, 25.7° (S.D. 18.7-32.8°) at 6 months, 27.9° (S.D. 16.2-39.6°) at 12 months, and 36.8° (S.D. 22.6– 51.0°) at 18 months and 38.2° (S.D. 27.6-48.7°) at 2 years. The change in curve at 2 years post-operative was statistically significant (P=0.004). There were 4 tether breakages identified that did not require return to theatre as yet, one patient underwent a posterior spinal instrumented fusion due to curve progression. AVBT is a promising new growth modulation technique for skeletally immature patients with progressive idiopathic scoliosis. This study has demonstrated a reduction in scoliosis severity

There is a significant positive association between hours of brace wear and rate of success in the treatment of Adolescent Idiopathic Scoliosis (AIS). The abandon rate reported in the literature averages 18%. In a recent randomized trial conducted at our center; the abandon rate was 4%. We aim to document the abandon rate towards brace treatment during the COVID-19 pandemic and its impact on AIS progression. We reviewed a database of AIS patients recruited between March and September 2020. Inclusion criteria were patients with AIS under brace treatment according to SRS criteria. The patients were divided in 2 cohorts: those with a self-reported good adherence to treatment and those who voluntarily abandoned treatment during follow-up. Patients with irregular adherence were excluded. Data analysis included age, gender, Risser stage, type of brace, Cobb angles at first visit and last follow-up (mean 11 months) and % of progression. Unpaired student tests were used for comparison. 154 patients met inclusion criteria. 20 patients were excluded due to irregular adherence. 89 patients (age: 12.1 y.o. ±1.4) reported good adherence to treatment, while 45 patients (age: 12.6 y.o. ±1.5) abandoned treatment, an abandon rate of 29%. The cohort of compliant patients started treatment with a mean main thoracic (MT) curve of 26° and finished with 27°. The mean difference between measurements was +0.65°±7.5; mean progression rate was −4.6%. However, patients who abandoned treatment started with a mean MT curve of 28° and finished with 33°, with a mean increase of +5°±8 and a mean progression rate of −11%. The differences between the 2 cohorts were statistically significant (p=0.002). Five (5) patients from the abandon group were offered for surgery because of curve progression. The 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

Study Design: Prospective cohort study. Objective: To determine the rate of curve progression and factors related to curve progression in untreated adolescent idiopathic scoliosis in a prospective cohort study within a national school screening program. Methods: Over 140,000 school children are screened annually in Singapore for common health conditions, including scoliosis. In 1996–97, a randomized sample in four age groups consisting of 72,699 children was enrolled in a scoliosis prevalence study, 263 were found to have spinal curvatures of 10 degrees or more. After exclusions, 250 children were followed up over a five year period up to 2001–02. Basic demographic data, age at menarche or break of voice, scoliometer reading, curve type, Cobb angle, curve rotation, and Risser grade were recorded. Curve progression was correlated to individual factors such as age, sex, puberty, curve type and magnitude as well as combinations of factors. Results: Overall, 28% of the 250 curves progressed. Age at diagnosis, sex, pre-menarche status, and curve magnitude were statistically correlated to curve progression. Taking curve magnitude and age together, 53% of 11–12 year-olds with curves 20 degrees or more progressed compared to 10% of 13–14 year-olds with curves less than 20 degrees. 56% of children with curves 20 degrees or more and Risser grades 0–2 progressed, compared to 17% with curves less than 20 degrees and Risser grades 3–5. Combining curve magnitude, age, sex, and puberty together, a pre-pubertal female under 13 years old with a curve of 25 degrees or more has a 70% chance of curve progression. In comparison, a post-pubertal female older than 13 years of age and a curve of less than 25 degrees has only a 10% chance of progression. Curve progression in adolescent idiopathic scoliosis has been reported to vary from 5.2% to 56%, with the lower rates being found in school screening studies. Nachemson et al (1982) reported that 10–12 year old girls with untreated scoliosis of 20–29 degrees had a 60% risk of curve progression. Lonstein and Carlson (1984) reported progression in 23.2% of untreated children and that curve magnitude, skeletal immaturity, and curve pattern were associated with progression. Conclusions: Our findings are similar, with pre-pubertal females under the age of 13 years old and with large curves at diagnosis having the greatest risk of progression

Aim: To review the effect of school screening on the referral pattern and management at a provincial scoliosis clinic. Methods: Records of all females aged 10 to 17 years with scoliosis seen in Mackay (North Queensland) were reviewed. The age, date of presentation, magnitude of the curve, Risser sign, menarche and previous treatments were noted. Patients wearing scoliosis braces were reviewed to determine compliance. School Health, Mackay, provided data on number of females who were in grade seven at school and these were screened. The number having a possible deformity, and the number of confirmed cases per year were recorded. Results: Notification rates for potential scoliosis cases ranged from 29.5% in 1993 to1.8% in 1998. The annual prevalence of confirmed scoliosis ranged from 3.3% in 1992 to 1% in 1997. Twenty-four of 57 cases seen in the clinic were initially detected by school screening. Those in the group detected by screening were significantly younger than other referrals, but no significant differences were noted in curve size, Risser sign or the menarche. The proportion treated with a brace was significantly greater in the screened group (p=.03), but the proportion coming to surgery was not significantly different (p=.07) between groups. Conclusions: Although school screening for scoliosis resulted in referral at an earlier age, it did not translate to detection of smaller curves at an earlier stage of development, nor to a trend to brace treatment. The efficacy of bracing depended on compliance

In order to determine the effectiveness of part-time bracing in juvenile idiopathic scoliosis (JIS) a retrospective review of thirty-four patients treated with a Charleston bending brace for JIS was undertaken. The patients were analyzed in three groups including:. success;. progression;. progression requiring surgery. Of twenty-three patients meeting the inclusion criteria, nine achieved success, seven progressed, and seven required surgery. Success correlated with best in brace correction radiograph but not with initial curve magnitude. Part-time bracing is as successful as full-time bracing in JIS and better than the natural history. In order to determine the effectiveness of part-time bracing in JIS, a retrospective review of thirty-four patients treated with a Charleston bending brace for JIS was undertaken. Twenty-three patients met the inclusion criteria which included: curves greater than twenty degrees at initiation of bracing, Risser zero, bracewear more than twelve months, completion of the bracing program and Risser greater than or equal to four at final follow-up. Patients were analyzed in three groups, including. success (progression less than five degrees or less);. progression more than five degrees (but not requiring surgery) and. progression requiring surgery. There were seven boys and sixteen girls with thirty-seven curves analyzed. Age at referral averaged 8.3 years. Average curve at time of bracing was thiry degrees. Length of bracing averaged 4.2 years with follow-up averaging 6.2 years. Nine patients met the criteria for success with seven patients progressing and seven patients requiring surgery. Of all curves, nineteen (51%) were successfully managed in the brace. Magnitude of curvature at initiation of bracing was not related to ultimate success, whereas success did correlate with higher best in brace correction radiographs. Part-time bracing offers potential psychosocial and compliance benefits considering the length of treatment necessary in patients with juvenile idiopathic scoliosis. Although previous bracing studies have included some JIS patients, no authors have dealt specifically with the part-time bracing for JIS. Part-time bracing is as successful as full-time bracing in JIS and better than the natural history

Introduction: A comparison of the success of the thoracolumbosacral orthosis (TLSO) and the Providence orthosis in the treatment of adolescent idiopathic scoliosis (AIS) using the new Scoliosis Research Society’s (SRS) Committee on Bracing and Nonoperative Management inclusion and assessment criteria for bracing studies. Methods: A retrospective study of brace patients with AIS between 1992 and 2004. We have used a custom TLSO (22 hour/day) and the Providence orthosis (8–10 hour/night) to control progressive curves. A total of 83 patients met the new inclusion criteria: 10 years of age and older at initiation of bracing; initial curve of 25 to 40 degrees; Risser sign 0–2; females, premenarchal or less than one year post menarchal; and no prior treatment. There were 48 patients in the TLSO group and 35 in the Providence group. The new SRS assessment criteria of effectiveness included the percentage of patients who had 5 degrees or less and 6 degrees or more of curve progression at maturity; the percentage of patients whose curve progressed beyond 45 degrees; the percentage of patients who had surgery recommended or undertaken; and a minimum of two years of follow-up beyond maturity in those patients who were felt to have been successfully treated. All patients are analyzed irregardless of compliance (“intent to treat”). Results: There were no significant differences in age at brace initiation, initial primary curve magnitude, gender, or initial Risser sign between the two groups. In the TLSO group, only 7 patients (15%) did not progress (5 degrees or less), while 41 patients progressed 6 degrees or more (85%), including 30 patients that exceeded 45 degrees. Thirty-eight patients (79%) ultimately required surgery. In the Providence group, 11 patients (31%) did not progress, while 24 patients (69%) progressed 6 degrees or more, including 15 patients that exceeded 45 degrees. Twenty-one patients (60%) required surgery. However, when the initial curve at initiation of bracing was 25 to 35 degrees, the results improved. Five of 34 patients (15%) in the TLSO group and 10 of 24 patients (42%) in the Providence group did not progress, while 29 patients (85%) and 14 patients (58%) progressed 6 degrees or more and 26 patients (76%) and 11 patients (46%) required surgery, respectively. Conclusions: Using the new SRS criteria, the Providence orthosis was more effective for avoiding surgery and preventing curve progression than the TLSO when the primary initial curves were 35 degrees or less. However, the overall success in both groups was inferior to previous studies. Our results raises the question of the effectiveness of orthotic management in AIS and supports the need for a multicenter, randomized study utilizing the new SRS inclusion and assessment criteria

Aims

The aim of this study was to review the current evidence surrounding curve type and morphology on curve progression risk in adolescent idiopathic scoliosis (AIS).

Aims

To determine whether side-bending films in scoliosis are assessed for adequacy in clinical practice; and to introduce a novel method for doing so.

Aims

To systematically evaluate whether bracing can effectively achieve curve regression in patients with adolescent idiopathic scoliosis (AIS), and to identify any predictors of curve regression after bracing.