Matching Curve Progression With Skeletal Growth In Adolescent Idiopathic Scoliosis: Insight Into The Best Period For Brace Treatment

Abstract

Introduction: Determining the peak growth velocity of an adolescent idiopathic scoliosis (AIS) patient is important for timely treatment in preventing curve progression. However, successful bracing is only achieved in at best 75% of patients. This highlights a significant limitation in understanding growth and curve progression patterns. Hence, this study aimed to determine the relationship between growth and curve progression in AIS patients. Methods: This was a prospective study of AIS patients presented at Risser 0-3 and followed up to maturity. Body height, arm span, curve magnitude, Risser and distal radius and ulna grades were studied. Only data from initial presentation to commencement of intervention were recorded to eliminate confounders from bracing or surgery. Comparisons between the curve progression and growth rates with correlation analyses were performed. Results: A total of 318 AIS patients with mean age of 12.3 ± 1.5 years and follow-up of 4.3 ± 2.3 years were studied. Peak curve progression rate occurred 9.2 months after the peak growth spurt. Reductions in growth and curve progression rates reached a plateau at R9/U7. Mean time elapsed between peak curve progression and no progression risk was 16 to 17 months. Discussion and Conclusion: This large-scale study illustrates that maximal curve progression occurs after the peak growth spurt and extends nearly 1.5 years beyond that, suggesting that the curve should be monitored closely even after peak growth. By observing the trend of growth and curve progression rate, one may ‘predict’ which patients are most indicated for interventions like bracing.