12th International Conference on Conservative Management of Spinal Deformities – SOSORT 2015 Annual Meeting

Abstract

Introduction Most recent evidence has proved the efficacy of brace in the treatment of spinal deformities for young adolescents. Scoliosis Research Society (SRS) and Society on Scoliosis Orthopedic Treatment (SOSORT) have produced guidelines to indicate when brace treatment must be applied. The purpose of this study was to evaluate the rate of overtreatment for AIS and Kyphosis in Greece, according to SOSORT and SRS guidelines. To date, this is the first study to investigate overtreatment percentage in a group of patients with spinal deformities. Material and 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 treated patients, 167 young adolescents (128 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 SRS and SOSORT indications for brace treatment, and referred to individuals that should have never started wearing a brace or to those that brace weaning was very prolonged. Overtreatment was assessed by a Schroth certified Physiotherapist, by estimating Cobb angle, Risser sign, age of me-narche in girls, and vertebral wedging in Scheuermann's kyphosis, alongside with a subsequent analysis of risk prognostic factors (family history, angle trunk rotation, thoracic hypokyphosis, and curve type). The braces were prescribed by 34 medical doctors (MD) 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. The percentage of overtreat-ment was similar for AIS (51/118 patients, 43,2 %) and kyphosis (20/49 patients, 40,8 %). A further analysis showed that in the AIS subgroup, 20 subjects (16,9 %) had Cobb angle < 20o, 7 subjects (5,9 %) had Cobb angle 20o-25o but good prognosis, 12 subjects (10,2 %) started bracing after Risser 4 or 5, and 12 subjects (10,2 %) had not reached brace weaning even a long time after skeletal maturity. It is noticeable that 8 subjects (6,8 %) were at Risser 5 with Cobb angle < 20o and were pre-scribed a brace. In the Kyphosis subgroup, 11 subjects (22,5 %) showed no signs of Scheuermann's disease and no clinical rigidity, 3 subjects (6,1 %) started bracing after Risser 4 or 5, and 6 subjects (12,2 %) should have reached brace weaning much earlier. 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. This is probably attributed to lack of knowledge in the field of conservative treatment of spinal deformities. It also seems that the majority of MDs ignore the role of the Physiotherapeutic Scoliosis Specific Exercises (PSSE) in the treatment of scoliosis. Over-treating a child with a brace can cause social, financial and psychological problems to them. The present study pinpoints the need for an evidence-based approach to conservative treatment of idiopathic scoli-osis and kyphosis, according to SOSORT and SRS guidelines, in order to avoid overtreatment and to enhance clinical outcomes.