Volume 8 Supplement 2

10th International Conference on Conservative Management of Spinal Deformities - SOSORT 2013 Annual Meeting

Oral presentation
Open Access

Two year post-menarche rule for bracing: myth or reality?

  • Stefano Negrini1Email author,
  • Sabrina Donzelli1,
  • Monia Lusini1,
  • Salvatore Minnella1 and
  • Fabio Zaina1
Scoliosis20138(Suppl 2):O14

https://doi.org/10.1186/1748-7161-8-S2-O14

©  Negrini et al.; licensee BioMed Central Ltd. 2013

Published: 18 September 2013

Background

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.

Purpose

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?

Methods

We consecutively developed four studies from our clinical prospective database, including 5,142 Females with Idiopathic Scoliosis Patients below the age of 20 years.

Table 1

Study

Design

Inclusion criteria

Population

Outcome

1

Cross-sectional

All FISP with an x-ray at 2YPM

1102 patients

Age 13.0±1.8

29.4±12.4° Cobb

European Risser staging

2

Prospective

All FISP followed-up from Menarche to end of growth (Risser 5 or twice Risser 4 in 12 months)

263 patients

Age 13.1±1.1

35.2±11.1° Cobb

Height growth

3

Prospective

All FISP with at least two x-rays after 2YPM

902 patients with 2110 x-rays

Age 15.0±1.1

31.8±12.4° Cobb

Progression

4

Prospective

All FISP braced after Menarche followed-up to the end of growth

230 patients

Age 13.6±1.7

34.1±10.3° Cobb

Results of bracing

Classical parametric statistics have been used.

Results

At 2YPM:

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.

Authors’ Affiliations

(1)
University of Brescia - IRCCS Don Gnocchi

References

  1. Richards BS, Bernstein RM, D'Amato CR, Thompson GH: Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005, 30 (18): 2068-2075. 10.1097/01.brs.0000178819.90239.d0. discussion 2076-2067View ArticlePubMedGoogle Scholar
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  3. Negrini S, Aulisa AG, Aulisa L, Circo AB, de Mauroy JC, Durmala J, Grivas TB, Knott P, Kotwicki T, Maruyama T: 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis. 2012, 7 (1): 3-10.1186/1748-7161-7-3.PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Negrini et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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