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Retrospective comparative study.To evaluate the outcome of bracing in patients with juvenile idiopathic scoliosis (JIS) at either skeletal maturity or time of scoliosis surgery.JIS is generally thought to have poor outcomes with high rates of surgical fusion.All patients with JIS between the ages of 4 and 10 years treated with a brace at the Hospital for Sick Children (SickKids) between 1989 and 2011 were eligible. Data were collected from patient health records until either 2 years after skeletal maturity or date of surgery.The average age at diagnosis of 88 patients with JIS was 8.4 ± 1.4 years, with a female to male ratio of approximately 8:1. Pretreatment, Risser score was zero for 80 patients (91%); 72 (92%) of the females were premenarche; and primary Cobb angles ranged from 20° to 71°. Of the 88 patients, 60 (68%) had used a thoracolumbosacral orthosis exclusively; 28 (32%) patients used "other braces" (Milwaukee, Charleston, or a combination of braces), with an average treatment duration of 3.6 ± 1.9 years.As per Scoliosis Research Society definitions, a "non-curve-progression" (≤5° change) group consisted of 25 (28%) patients; and a "curve-progression" group consisted of 63 (72%) patients where the curve had progressed 6° or more.Of the 88 patients, 44 (50%) underwent surgery. The operative rate was higher for patients with curves 30° or more than those with curves 20° to 29° prior to brace treatment (37/58 [64%] vs. 7/30 [23%], respectively; P = 0.001); other braces compared with thoracolumbosacral orthosis (19/28 [68%] vs. 25/60 [42%], respectively; P = 0.02); Lenke I and III curves compared with Lenke VI curves (33/54 [61%] vs. 2/14 [14%], respectively; P = 0.007).

Original publication

DOI

10.1097/brs.0000000000000669

Type

Journal article

Journal

Spine

Publication Date

01/2015

Volume

40

Pages

50 - 55

Addresses

*Faculty of Orthopaedic Surgery, University of Toronto †Child Health Evaluative Sciences ‡Developmental and Stem Cell Biology Program §Centre for Orthotics and Medical Devices; ¶Department of Rehabilitation Services; and ∥Department of Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada.

Keywords

Humans, Scoliosis, Disease Progression, Treatment Outcome, Spinal Fusion, Severity of Illness Index, Retrospective Studies, Braces, Bone Development, Adolescent, Child, Child, Preschool, Female, Male