A Large Adolescent Idiopathic Scoliosis Curve in a Skeletally Immature Patient: Is Early Surgery the Correct Approach?

Abstract

The goal of this study was to determine whether the available studies provide enough evidence that, in a borderline case of adolescent idiopathic scoliosis with a large (35 to 50 degrees) curve in a skeletally immature patient (Risser 0 to 2) with significant growth potential left, a conservative line of management in the form of bracing can be considered, rather than to rush into a potentially unnecessary major spinal surgery. We reviewed the literature spanning the last 20 years for the results of bracing in this specific group of patients. From the 9 studies selected, a group-specific data extraction was carried out. Three hundred and five patients with a 36 to 50 degrees scoliosis curve and Risser stages 0 to 2 were treated by bracing and the treatment was termed successful in 160 patients. Thus, more than half (52.5%) of the patients were successfully managed with a brace and were spared surgery. The current trend for management of these curves is early surgical intervention, the rationale being the ineffectiveness of bracing in preventing the progression of such a large curve and the difficulty in obtaining satisfactory correction by postponing surgery to a later date. On the basis of our results, we propose a conservative line of management for these curves, in contrast with current views, rather than to rush into a major spine surgery, expecting a favorable outcome with a well-supervised bracing program. If the curve progresses, surgery can always be considered later, keeping in mind the excellent correction obtained with the pedicle screw systems even for large curves of 70 to 100 degrees.

Selective Fusion in Lenke 1 B/C: Before or After Menarche?

“…Growth velocity and skeletal age, with different measurement methods, are objective markers of pubertal maturation; however, menarche, although one of the late signs of skeletal maturity, is an event clearly identifiable by the patient and generally discussed during the medical interview, is still one of the most commonly used parameters in daily clinical practice. 3 , 4 , 6 , 7 Considering this paradigm, in our series this aspect of skeletal maturation was evaluated in relation to the progress of the lumbar curve in patients with AIS who underwent selective thoracic fusion.…”

“…Menarche is the culmination of a series of physiological and anatomical processes of puberty, occurring after hypothalamic-pituitary-gonadal axis reactivation and gonadotropin-releasing hormone secretion. 2 - 4 …”

“…Skeletal maturity is a relevant aspect to consider in the management of patients with AIS for prognostic and therapeutic purposes. 4 , 5 …”

Mapping the SRS-22r questionnaire onto the EQ-5D-5L utility score in patients with adolescent idiopathic scoliosis

“…Among those with curves between 35° to 55°, there is controversy upon which whether observation, bracing or surgery is better indicated in the context of cost-utility or HRQoL. [11, 12] Differentiating treatment options such as surgical approaches, implant strategy and instrumentation systems with regards to cost-utility is also necessary. As such, little is known to elucidate the health economic values of AIS treatment modalities.…”

Bracing for Scoliosis

“…In 2006, Telang et al (28) investigated whether the available data provided enough evidence that bracing was indicated in borderline cases of AIS with a large (35-50 degrees) curve in a skeletally immature patient (Risser Grades 0-2) with significant growth potential remaining. They reviewed the literature from the last 20 years for the results of bracing in this specific group of patients.…”