Two year post-menarche rule for bracing: myth or reality?
© Negrini et al.; licensee BioMed Central Ltd. 2013
Published: 18 September 2013
The SRS criteria for bracing studies proposes the limit of two years post-menarche (2YPM). This is also frequently used for bracing in the clinical everyday world.
To verify whether the 2YPM rule for bracing is appropriate in clinics, we aimed to answer the following four questions:
Is bone growth (according to Risser) almost completed?
Is stature growth ended?
Has scoliosis definitively finished progressing?
Are bracing results significantly reduced?
All FISP with an x-ray at 2YPM
European Risser staging
All FISP followed-up from Menarche to end of growth (Risser 5 or twice Risser 4 in 12 months)
All FISP with at least two x-rays after 2YPM
902 patients with 2110 x-rays
All FISP braced after Menarche followed-up to the end of growth
Results of bracing
Risser stage is below 3 in 15.7%, and is still 0 in 2.4%.
Growth is not ended and is still decreasing (2.5 cm/y): 5% of patients have 4 cm of residual growth, 12% 3 cm and 25% 2 cm. End of growth is reached around 48 months post-menarche.
Scoliosis has not yet finished progressing, particularly in the third year, but also in the subsequent six months.
There is no change in the positive results of bracing before and after 2YPM, either for clinical-radiographic results and for percentage of patients improved/worsened.
Conclusions and discussion
These results suggest the need to carefully check the usefulness of the 2YPM rule for clinical studies. While reaching clinical therapeutic decisions in front of single patients, 2YPM is not a reliable parameter, at least not in Italy.
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