Review Question - QID 3380

Of the clinical scenarios presented, brace treatment is only indicated in the pre-menarchal girl with adolescent scoliosis and a Cobb angle curve of 30 degrees.

Brace treatment may be beneficial for a patient with substantial growth potential (Risser 0-2, Sanders 1-3) and a moderate curve (20-45 degrees). Bracing is effective at limiting curve progression in this population, but it does not diminish a curve. Furthermore, bracing curves > 45 degrees has not been shown to limit curve progression and this population maintains a higher risk of ongoing progression into adulthood.

Weinstein et al. evaluated both a randomized and preference-based cohort of bracing versus observation. The trial was stopped early due to efficacy of bracing. The rate of treatment success was 72% after bracing and 48% after observation. Treatment success was strongly correlated to time of brace wear.

Sponseller et al. examined the literature form the past 25 years to summarize the current practice of bracing in the treatment of adolescent idiopathic scoliosis. They found the highest level of existing evidence from a prospective center-randomized study, which showed that thoracolumbosacral bracing was most effective for single curves of 25 to 35 degrees in female patients with a starting Risser score of 0 to 2.

Incorrect Answers:
Answer 1: Patients with a 25 degree curve are only indicated for bracing if they are Risser 0-2
Answer 2: A boy with a curve of 50 degrees should be treated with surgery regardless of skeletal maturity
Answer 4: A skeletally immature boy with 6 degrees of progression leading to a current curve of 12 degrees should be treated with observation alone
Answer 5: Bracing would not be effective in a girl who is Risser 4, Sanders 7, with a 30 degree curve, because she is nearly skeletally mature and her risk of progression to greater-than 40 degrees is very low.