Is There a Role for Conservative Treatment for Large Curvatures in Patients With Adolescent Idiopathic Scoliosis?: Commentary on “The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study”

摘要

Adolescent idiopathic scoliosis (AIS) is a condition that has been treated by spine surgeons around the world for many years. With a good understanding of the natural history and modern day successes in anaesthesia, neuromonitoring, and instrumentation, most surgeons would recommend surgeries for curves of over 45° to 50°. However, a gap exists for those curves that are over 40° that have not quite reached the indications for surgery and also for those who are not willing to accept surgical treatment. The article by Razeghinezhad et al.1 on “The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study” is a timely reminder that other options are available. This is quite a sizable study with 60 subjects, all of which were skeletally immature as indicated by a Risser sign of 0 to 2, and all were uniformly treated using one type of brace. They showed in this study that some patients may still benefit from bracing and that the indicators of response to brace treatment include older chronologic age at brace initiation, a longer duration of brace wear, smaller Cobb angle at presentation, and higher in-brace correction (indicating more flexible curves). They were able to show that 43% of their subjects either did not progress or even had some improvement. Their results are in line with other studies of a similar nature.