Adolescent idiopathic scoliosis: indications for bracing and conservative treatments

Abstract

Adolescent idiopathic scoliosis (AIS) represents the most frequent tridimensional spinal deformity. Progression of curves is linked mainly to the rapid growth around puberty. The natural history can lead to large spinal and thoracic deformities, which could impose surgical treatments. In that specific adolescent period, it is possible with very accurate treatments to alt curves progression. We describe the different types of braces used worldwide their indications, technical applications, results and failures, as well our own experience. The literature agrees that with proper indications that means, still growing patients, and documented progressive curves between 20° and 45°, a well-designed and adapted brace providing a correction of 50% can stop the curve's progression in most of the cases.

Keywords: Adolescent idiopathic scoliosis (AIS); brace; treatments.

Conflict of interest statement

Conflicts of Interest: The author has no conflicts of interest to declare.

2020 Annals of Translational Medicine. All rights reserved.

Figures

Figure 1

Patient 1. (A) X-ray at diagnosis, immature girl, at 10 years 4 months old. Right thoracic curve: 14°: open triradiate cartilage, Risser 0, no menstruation. As it is the first X-ray without documented progression surveillance by clinical examination and X-rays program is set-up; (B) X-ray at 13 years old, in the last 3 months sudden curve’s progression to 28°, Risser 0, menstruation 3 months ago. A clear indication for brace treatment.

Figure 2

Patient 2. (A) First visit, for a girl of 13 years old, Risser 0, no menstruation, the X-ray shows a thoraco-lumbar curve of 29°, immediate indication for bracing; (B) X-ray with the design of correction’s pads for the orthopedic technician; (C) computerized image of the trunk with the corrective pads placement. The data are sent to a milling machine, which trims a polyurethane mold. A polypropylene heated foil is applied on the mold, and then cut at the patient’s size, the pads are fixed inside the brace; (D) brace fitted on the patient; (E) X-ray done immediately after the first brace fitting in order to check the correction. The index of brace’s treatment success is the correction index (Cobb pre-brace, Cobb in-brace/Cobb pre-brace*100); the correction must be at least 50%. For this patient the thoraco-lumbar curve decreases from 29° to 0°. The metallic dots are the landmarks for the corrective pads, this allows easy correction of the pad if needed. Rotational correction is also obtained; (F) X-ray at 15 years old, at the end of brace treatment, Risser 4, one year after first menstruation, the growth as stopped. Without brace for a month, the thoraco-lumbar curve is 17° (improvement of 12°), there is a compensatory thoracic curve of 14°; (G) at 2 year’s follow-up after brace discontinuation, the patient is 17 years old, the thoraco-lumbar curve is 21°and the thoracic one is 16°. Full bone maturity. Brace treatment has stopped the progression and the correction is 8° on the long term.