Conservative treatment in adolescent idiopathic scoliosis with curves over 45°: is the measurement in Cobb degrees the only parameter to be considered?

Abstract

Introduction The recent literature showed positive results in bracing patients with idiopathic scoliosis above 45degree that refused surgery. However, no one has investigated whether other parameters are able to affect the results. The aim of this study was to evaluate the effectiveness of the brace in idiopathic scoliosis with curves above 45degree and to assess whether the magnitude of the curve in Cobb degrees is the only parameter for the indication to surgical or conservative treatment. Methods This is a prospective study based on ongoing database including 1,238 patients with idiopathic scoliosis. The study including idiopathic scoliosis with 45degree or more, Risser 0-4, who had utterly deny any surgical intervention. Fulfil the inclusion criteria 160 patients. Of these, 104 patients has definite outcome, 28 abandoned treatment and 28 are currently under treatment. The minimum duration of follow-up was 24 months. X-rays was used to obtain Cobb degrees and torsion of the apical vertebra (Perdriolle's method). Three outcomes were distinguished in agreement with SRS criteria: curve correction, curve stabilization and curve progression. We have divided the sample in subgroup according to Risser (0-2; 3-4), to rotation (<20; >25) and to type of curve. The Kruskal- Wallis and Spearman Rank Correlation tests have been used as statistical tests. Results The results from our study showed that the 104 patients with a definite outcome Cobb mean value was 47 +/- 5.37 SD at beginning and 34.18 +/- 8.45 SD at follow-up. Perdriolle was 20.2 +/- 5.49 SD at beginning and 16.76 +/- 7.04 at follow-up. Curve correction was accomplished in 81 patients (77.8 %), whereas a curve stabilization was obtained in 15 patients (14.4 %), 9 patients (8.6 %) have a curve progression and 16 (15.4 %) where recommended for surgery. The subgroups with rotation <20 showed a correction/stabilization in 98.1 % and surgery referral in 1.8 % while in subgroups with rotation>25 a correction/stabilization was achieved in 69.4 % but surgery referral in 60.8 %. The subgroups with Risser 0-2 showed a correction/stabilization in 92.6 % and surgery referral in 10.3 % while in subgroups with Risser 3-4 a correction/stabilization was achieved in 91.6 % but surgery referral in 25 %. Discussion Results allow to say that an adequate brace treatment must be absolutely considered in the treatment of scoliotic curves above 45degree in patients who refuse surgery. Conclusions Brace treatment should be considered as the first choice to try avoiding fusion if the rotation is lower than 20degree and Risser is between 0-2.