Bracing for Adolescent Idiopathic Scoliosis (AIS) and Scheuermann Kyphosis: the issue of overtreatment in Greece

Nikos S Karavidas, Nikos S Karavidas

Abstract

Background: Most recent publications have provided evidence for brace treatment in spinal deformities. The purpose of this study was to evaluate the rate of overtreatment for AIS and Kyphosis in Greece, according to the Society on Scoliosis Orthopedic Rehabilitation Treatment (SOSORT) and the Scoliosis Research Society (SRS) guidelines for brace treatment. To date, this is the first study to investigate overtreatment percentage in a group of patients with spinal deformities.

Methods: Cross-sectional study design and data analysis were performed in a group of patients that received treatment in a private clinic, in 2014. Of 289 patients treated with a brace, 167 young adolescents (126 females - 41 males, mean age 15, 7 years) were eligible for inclusion criteria (age 9-18 years, brace wearing). Overtreatment was defined as the unnecessary use of brace according to the international indications for brace treatment. Overtreatment was assessed by a BSPTS - Schroth certified physiotherapist. The brace prescription was made by 34 medical doctors from different geographical areas of Greece.

Results: The data analysis revealed that 71 out of 167 subjects (42,5 %) had received some kind of overtreatment. A further analysis showed that in the AIS subgroup, 20 subjects (16,9 %) had Cobb angles < 20°, 7 subjects (5,9 %) had Cobb angles 20 - 25° but good prognosis, 12 subjects (10,2 %) started bracing after Risser 4, and 12 subjects (10,2 %) had delayed brace weaning. It is noticeable that 8 subjects (6,8 %) were at Risser 5 with Cobb angle < 20° and were prescribed a brace. In the Kyphosis subgroup, 11 subjects (22,5 %) showed no signs of Scheuermann's disease, 3 subjects (6,1 %) started bracing after Risser 4 or 5, and 6 subjects (12,2 %) had delayed brace weaning.

Conclusions: An extremely high rate of overtreatment (42, 5 %) was identified in a random group of adolescents treated with a brace for AIS and Kyphosis. Overtreating a child with a brace can cause social, financial and psychological problems. The present study pinpoints the need for an evidence-based approach to conservative treatment of idiopathic scoliosis and kyphosis. Overtreatment can be avoided when the indications are strictly based on the guidelines published internationally.

Figures

Fig. 1
Fig. 1
Overtreatment case 1. Case 1: 16 years old, first brace at 15 years, 1 ½ year post-menarche, Risser 4, Th (R)11°, Lu (L) 18°, ATR Th(R) 3°, Lu (L) 4°. Brace prescription for 20 h
Fig. 2
Fig. 2
Overtreatment case 2. 15 years old, Lu (L) 18°, ATR 5°, Risser 5, 4 ½ years post-menarche, Brace prescription for 15-16 h, After 2 PSSE sessions she complained for pain only when she wore her brace
Fig. 3
Fig. 3
Overtreatment case 3. 17 years old, First brace 12 years, initially (2009) Th-Lu (R) 16°, Risser 0. 03/14: Th-Lu (R) 8°, ATR 4°, Risser 5, continue wearing the brace for 15-16 h, no brace weaning, 4 years post-menarche
Fig. 4
Fig. 4
Overtreatment case 4. 15 years old, 1 ½ years post-menarche, Risser 4, Th (L) 13°, Lu (R) 15°, ATR Th 2°, Lu 4°. Brace prescription for 18 h (12/14)
Fig. 5
Fig. 5
Lonstein formula and risk for progression
Fig. 6
Fig. 6
Total results for overtreatment
Fig. 7
Fig. 7
Results for AIS
Fig. 8
Fig. 8
Results for kyphosis

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Source: PubMed

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