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Kedar Padhye, MBBS, DNB (Ortho), Clinical Fellow (Pediatric Spine Surgery)Division of Paediatric Surgery, Section of Orthopaedic Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta.
Reza Ojaghi, MD, Orthopaedic Surgery Resident, Department of Orthopedics, University of Ottawa, Ottawa, Ontario.
Fábio Ferri-de-Barros, MD, MSc, FSBOT, FSBOP (Hon.), FRCSC, FCS(ECSA), Department of Orthopedics, Alberta Children's Hospital, Calgary, Alberta.
Abstract
Adolescent Idiopathic Scoliosis (AIS) is defined as curvature of spine in the coronal plane with a Cobb angle of more than 10°. AIS affects 1-3% of children younger than 16 years of age. Less than 20% of those children will progress to severe deformity requiring interventions. Screening with clinical examination and selective radiographic assessment seems to be a cost-effective approach to filter specialist referrals but current literature is controversial. Evidence supports brace management of AIS for skeletally immature patients with primary scoliosis measuring 25°–40. The risk reduction for progression to the surgical range (deformity greater than 50 degrees) is 56%. Timely diagnosis and evidence-based brace management of AIS seem likely to reduce the surgical burden. The implementation of screening guidelines at the primary care level is a critical step.
Key Words: scoliosis; idiopathic; Brace treatment; conservative treatment; screening.
Adolescent Idiopathic Scoliosis (AIS) is defined as a curvature of the spine in the coronal plane with a Cobb angle measurement of more than 10 degrees. AIS affects 1-3% of children younger than 16 years of age. Less than 20% of those children will develop severe deformity requiring interventions such as bracing or surgery.1,2 Conventionally deformities larger than 50° are managed with operative intervention.1,2
The purpose of this manuscript is to review controversial themes related to screening and brace management of AIS, providing an approach based on our interpretation of the current evidence and its relevance to the Canadian health care setting.