Even with brace wear, patients with Risser stage 0 AIS were at risk for surgery

Results from this study demonstrated that despite brace wear, patients with Risser stage 0 adolescent idiopathic scoliosis were at risk of needing surgery.

Karol LA, et al. J Bone Joint Surg Am. 2016;doi:10.2106/JBJS.15.01313

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Lori A. Karol, MD, and colleagues prospectively identified 168 patients who were prescribed brace wear for adolescent idiopathic scoliosis. At the time they prescribed the brace, investigators determined patient age, sex, menarcheal status, curve magnitude, Risser sign and whether the triradiate cartilage was open or fused. Thermal monitors were used to measure patient compliance.

Lori A. Karol

Results showed 44.2% of patients at Risser stage 0; 6.9% at Risser stage 1; and 0% at Risser stage 2 had surgery or progression of their curves to a magnitude of greater than or equal to 50°. Investigators noted brace wear in patients at Risser stage 0 averaged 11.3 hours, while patients at Risser stage 1 and Risser stage 2 wore braces for 13.4 hours and 14.2 hours per day, respectively. There was no difference in the initial curve magnitude amongst the groups; however, more patients with Risser stage 0 progressed to surgery compared with patients who had either Risser stage 1 or stage 2 despite brace use.

According to researchers, 41.9% of patients at Risser stage 0 wore a brace greater than or equal to 12.9 hours per day and needed surgery. They found 10 patients in the Risser 0 group who had closed triradiate cartilage and who wore a brace for at least 18 hours per day did not need surgery. However, seven patients with Risser stage 0 with open triradiate cartilage and comparable brace wear needed surgery. Investigators found seven of the nine patients at Risser stage 0 who had open triradiate cartilage and wore their braces for a minimum of 12.9 hours daily and had curves smaller than 30° did not need surgery.

“Risser stage 0 patients should be prescribed a minimum of 18 hours of brace wear. Bracing should be initiated for curves of less than 30° in patients at Risser stage 0, especially those with open triradiate cartilage,” Karol and colleagues wrote. ‒ by Monica Jaramillo and Gina Brockenbrough, MA

Disclosure: Karol reports she is a board or committee member of Pediatric Orthopaedic Society of North America and receives publishing royalties, financial or material support from Saunders/Mosby-Elsevier.



Source : Healio, 19th Oct 2016