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- Open Access
End-growth results in juvenile idiopathic scoliosis treated with conservative approach
© Fusco et al; licensee BioMed Central Ltd. 2010
Published: 10 September 2010
According to SRS (Scoliosis research Society) Juvenile idiopathic scoliosis (JIS) is defined as a scoliosis that is first diagnosed between the age of 4 and 10 years. The natural history is characterized by an early deformity that leads to a major but extremely variable progression risk throughout growth. Objectives of the study is verifying the efficacy of a complete conservative treatment of juvenile idiopathic scoliosis.
Materials and methods
Observational retrospective study. Population: we included all JIS patients for which we have consecutive radiographies from Risser test 0 and to 3 since our database start in 2003. We had 30 patients, 27 females and 3 males; mean age at start 7.8 ±1.5, mean treatment lasting 5, 8 years. For 23 of 30 patient studied we have also radiography at Risser 5 and we evaluated radiographic evolution from Risser 3 to Risser 5. Finally we split patient in 3 groups according to curve degrees at first diagnosis: 9 patients presented a curve under 20 Cobb, 11 patients between 20 and 30° Cobb and 7 over 30° Cobb. Methods: according to individual needs patient were treated with physical exercises alone or with brace and physical exercises. Outcome criteria: radiographic (Cobb degrees) and clinical (ATR, hump, TRACE,).
Mean thoracic Cobb degrees values changed with treatment from 24.4 ± 10.0 to 25.8 ± 11.2, thoracolumbar from 1.7±7.4 to 1.0±4.1 and lumbar from 17.9±10.4 to 18±11.7. We have not statistically significant differences in the Cobb degrees and also in the evaluation of the hump. 6.6% of patients started with a curve over 45 Cobb degrees and improved during the treatment. While 33.3% worsened at end of treatment more than 5 Cobb degrees. In the subset of patients under 20° Cobb and between 20 to 30° Cobb we observed a consistent but not significant change while in the group of patient that started treatment over 30° we observed a non significant improvement. In 23 cases that reached end of growth (for which we have radiography at Risser 5) we observed a maintenance of results reached at Risser 3.7 of 23 (30.4%) patient arrived at end of treatment with a curve over 35° and 2 of 23.
JIS may have a variable behaviour but generally it shows a progressive worsening during the year. Treatment can face this natural worsening trend .We observed a good corrective power of brace in the first years of treatment until Risser test 1 with a decrease of correction in the following years and a maintenance of achieved correction.
Conservative treatment start in childhood may favourable changes natural history of scoliosis. Prospective studies are needed to better investigate this particular kind of scoliosis.
This article is published under license to BioMed Central Ltd.