Is Brace Treatment Appropriate for Adolescent Idiopathic Scoliosis Patients Refusing Surgery with COBB Angle Between 40 and 50 Degrees.

STUDY DESIGN: A retrospective study to determine whether brace treatment is appropriate for adolescent idiopathic scoliosis(AIS) patients with Cobb angle between 40 and 50 degrees who utterly refuse surgery.

OBJECTIVE: To investigate whether it is possible to halt the curve progression of AIS patients with Cobb angle between 40 and 50 degrees through bracing, and to identify factors that could influence the effectiveness of brace treatment in such patients.

SUMMARY OF BACKGROUND DATA: Despite of the great achievements in treating patients with mild curve, bracing has been considered to be inappropriate for those with curves more than 40 degrees. However, in clinical practice surgeons could encounter a series of patients who utterly refused surgery and insisted on wearing brace despite having a curve larger than 40 degrees.

METHODS: A cohort of 54 patients with Cobb angle between 40 and 50 degrees were reviewed in the current study. All the patients refused surgery at their first visit and insisted on receiving brace treatment. Each patient was followed up at an interval of 3-6 month. Variants such as initial Risser sign, initial age, gender, curve pattern and initial curve magnitude were compared between patients with and without curve progression. A logistic regression analysis was performed to determine the independent predictors of the curve progression.

RESULTS: On the whole, the curve progressed in 35 patients, remained stable in 12 patients and improved in the else 7 patients. All the patients with curve progression finally received surgical intervention. The mean grade of initial Risser sign in patients with curve progression was significantly lower than that in patients with stable or improved curve (0.3±0.8 vs. 1.2±1.4, P=0.02). In terms of gender, age, curve pattern and curve magnitude, there were no significant differences between the two categories. The results of the logistic regression analysis showed that initial Risser sign of grade 0 or 1 had significant associations with the curve progression of patients with curves larger than 40 degrees (OR=7.51, 95% CI=1.27-24.43, P=0.02).

CONCLUSIONS: The effectiveness of brace treatment significantly decreases when applied to patients with curve magnitude between 40 and 50 degrees. Although a majority of these patients will inevitably undergo a surgical intervention, and thus wearing a brace may not be the best alternative to surgical intervention, there are patients who will stabilize with the brace until skeletal maturity thus warranting this option for those patients refusing surgical intervention with curves between 40-50 degrees.