Review Question - QID 218686

Bracing for patients with adolescent idiopathic scoliosis (AIS) is indicated for patients with curve magnitudes between 25°-45° who remain skeletally immature (Risser 0, 1, or 2), making answer choice 5 correct.

Adolescent idiopathic scoliosis (AIS) typically affects adolescent females and most commonly features right thoracic curves. When determining treatment, one must consider the magnitude of the curve and the amount of remaining skeletal growth. Generally speaking, curves less than 25° can be treated with observation, regardless of skeletal maturity. Skeletally immature patients (Risser 0, 1, or 2) with curve magnitudes of 25-45° are treated with brace therapy in an attempt to halt or slow the progression of the curve. In order to achieve success with brace therapy (often defined as <5° curve progression), patients are recommended to wear the brace at least 16 hours per day (with actual wear time of 12 hours showing decreased progression). Skeletally mature patients (Risser 4 or 5) with 25-45° curves are treated with observation, as the risk of curve progression is minimal. In all patients, curves >45-50° are treated with surgical stabilization, as curves in excess of 50° are associated with a high risk of continued worsening throughout adulthood.

Katz et al. performed a prospective study to evaluate the success (<6° of curve progression) of brace therapy in patients with AIS. The authors used temperature sensors to track the time patients wore their braces. Results demonstrated a correlation between lack of curve progression and total hours in the brace with no curve progression in 82% of patients who wore the brace more than 12 hours per day. The authors concluded that bracing is an effective treatment to stop curve progression when worn for over 12 hours per day.

Weinstein et al. performed the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) study to evaluate the effects of bracing in adolescents with AIS. This multi-centered study featured two groups of skeletally immature patients treated with either bracing or observation alone and 72% of patients who wore the brace for over 18 hours per day saw success (defined as no curve progression) in treatment, compared to 48% with observation alone. The authors concluded that bracing can significantly decrease curve progression in skeletally immature patients with AIS.

Illustration A is a table of general guidelines for the treatment of patients with adolescent idiopathic scoliosis.

Incorrect Answers:
Answer choice 1: This patient has a moderate curve but is nearing skeletal maturity (Risser 4 or 5). Due to the decreased risk of curve progression, observation is the treatment of choice.
Answer choice 2: Patients with a curve over 45°-50° are indicated for posterior spinal fusion.
Answer choice 3: Curves <25° can be treated with observation alone.
Answer choice 4: Patients with a curve over 45°-50° are indicated for surgical intervention. Some authors recommend combined anterior and posterior instrumentation for very young patients.