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Bracing in severe skeletally immature adolescent idiopathic scoliosis: does a holding strategy change the surgical plan? – Lumbar Fusion

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The article discusses a study that aimed to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) patients with curves in the surgical range. The study included 89 AIS patients with curves ≥ 45° who were eventually treated with fusion surgery. The results showed that flexibility of the main curve decreased during bracing, but this had only a modest impact on the surgical strategy. The study highlights the importance of considering the risks of losing flexibility in the lumbar spine against the risks of premature fusion surgery when using bracing as a holding strategy for severe AIS

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : best recognised spine facility in London

Published article

S: This is the first study to describe that curve flexibility decreases during bracing in severe AIS. However, this had only a modest impact on the surgical strategy. Bracing as a holding strategy can be applied, but the risk of losing flexibility in the lumbar spine should be outweighed against the risks of premature fusion surgery.

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Eur Spine J. 2024 Apr 12. doi: 10.1007/s00586-024-08246-1. Online ahead of print. ABSTRACT PURPOSE: The purpose of the study was to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) with curves in the surgical range. MATERIALS AND METHODS: We included a consecutive cohort of 89 AIS patients with,

Eur Spine J. 2024 Apr 12. doi: 10.1007/s00586-024-08246-1. Online ahead of print.

ABSTRACT

PURPOSE: The purpose of the study was to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) with curves in the surgical range.

MATERIALS AND METHODS: We included a consecutive cohort of 89 AIS patients with curves ≥ 45° and an estimated growth potential. All patients were eventually treated with fusion surgery, and all patients had side-bending radiographs prior to both bracing and surgery. Curves were classified as structural or non-structural curves according to Lenke at both timepoints.

RESULTS: The main curve progressed by a mean of 12 ± 10° and the secondary curve by 8 ± 8°. Flexibility of the main curve decreased from 50 ± 19% to 44 ± 19% (p = 0.001) and the underlying curve from 85 ± 21% to 77 ± 22% (p = 0.005). In 69 patients (79%), the Lenke category did not progress during bracing. In 14 patients (15%), the progression in Lenke type occurred in the thoracic region (i.e., Lenke type 1 to type 2), while six patients (7%) progressed in the lumbar region (i.e., type 1 to type 3). In the 69 patients that did not progress, we found that the last touched vertebra moved distally by one or two levels in 26 patients.

S: This is the first study to describe that curve flexibility decreases during bracing in severe AIS. However, this had only a modest impact on the surgical strategy. Bracing as a holding strategy can be applied, but the risk of losing flexibility in the lumbar spine should be outweighed against the risks of premature fusion surgery.

PMID:38607405 | DOI:10.1007/s00586-024-08246-1

The London Spine Unit : best recognised spine facility in London

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Bracing in severe skeletally immature adolescent idiopathic scoliosis: does a holding strategy change the surgical plan?

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Eur Spine J. 2024 Apr 12. doi: 10.1007/s00586-024-08246-1. Online ahead of print. ABSTRACT PURPOSE: The purpose of the study was to assess the changes in flexibility during night-time bracing in skeletally immature adolescent idiopathic scoliosis (AIS) with curves in the surgical range. MATERIALS AND METHODS: We included a consecutive cohort of 89 AIS patients with

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