Retrospective analysis of idiopathic scoliosis medical records coming from one out-patient clinic for compatibility with Scoliosis Research Society criteria for brace treatment studies

Background First author attempted to analyse medical records of patients with idiopathic scoliosis for compliance with the Scoliosis Research Society brace studies criteria. A retrospective analysis of medical records of 2705 girls treated from 1989 to 2002 was carried out. Methods Age, Cobb, Risser and menarchal status were analyzed for compliance with the Scoliosis Research Society brace studies criteria: a) age ≥10 years, b) Risser 0–2, c) 25–40° Cobb angle, d) no earlier treatment, e) patients before first menses or not more than one year from first menses. Results It has been found that 183 girls out of 2705 were ≥10 years old and in the range 25–40° Cobb angle. One hundred two out of 2705 patients revealed eligible for brace effectiveness study according to SRS 2005 criteria. 120 out of 2705 patients revealed eligible for brace brace effectiveness study according to SRS-SOSORT 2014 criteria. Conclusion The excluded patients revealed too old or with too significant Cobb angles. This indicates the changing criteria for scoliosis brace treatment over the time. Direct comparison of current results of brace treatment with historical series of cases turns out to be very difficult.


Background
The initial idea of the work was to evaluate results of Idiopathic Scoliosis (IS) brace treatment performer at one outpatient clinic in the years 1989-2002. First author attempted to analyse medical records of patients with idiopathic scoliosis for compliance with the Scoliosis Research Society 2005 brace studies criteria. In 2015, the SRS-SOSORT Consensus modified those criteria by excluding the 1-year post-menarche limit as the inclusion criterion [1]. The research on the effectiveness of the brace treatment in IS according to different criteria were carried out. In 1995 Nachemson, Peterson [2] as experts of Scoliosis Research Society presented the results of brace treatment for 286 girls followed through the prospective assessment. The inclusion criteria were: a) female sex, b) diagnosed idiopathic scoliosis, c) bone age between 10-15 years, d) single curvature with apex between 8th thoracic vertebra and 1st lumbar vertebra, e) 25-35°Cobb angle [2]. Also in 1995, Olafsson et al published a retrospective assessment of the effectiveness of Boston brace treatment in 64 patients, 61 girls (95.3 %) and three boys (4.7 %). The inclusion criteria were: at least one year to growth completion considering the bone maturity and curvature progression, b) 25-45°Cobb angle, c) progression ≥5°c onfirmed with X-ray performed in the period of 6 months before brace application, d) no previous treatment, e) minimum two years of observation from the moment of stopping of brace application and at least 18 years of age, f) both sexes, g) diagnosed idiopathic scoliosis [3].  [7] published on retrospectively assessed the effectiveness of OMC brace treatment in 31 patients, 29 girls (93.5 %) and two boys (6.5 %) treated in the years 1999-2010. The inclusion criteria were modified SRS criteria: a) diagnosed idiopathic scoliosis, b) age ≥10 years, c) Risser 0-2, d) patients before first menses or no more than one year from first menses, e) 20-40°Cobb angle, with at least two years observation after reaching the bone maturity. The authors modified the SRS criteria by Cobb angle parameter from the value 25-40°to 20-40°invoking the conformity of Weinstein and the associates [7,8].

The aim of the study
To find out how many patients treated in one outpatient clinic in the years 1989-2002 for IS with a corrective brace fulfilled the SRS criteria.

Study design
Retrospective.

Methods
A retrospective review of the medical records of girls with IS treated in outpatient clinic of Wiktor Dega University Orthopaedic Hospital in Poznan, Poland in years 1989-2002 was carried out. The outpatient clinic's scope was intended for all types of scoliosis. The patients age, Cobb angle, Risser bone maturity and menses status were recorded from medical charts and available X-ray documentation. The medical reports were analysed in compliance with 2005 SRS criteria of the brace treatment results assessment (inclusion criteria): a) age ≥10 years, b) Risser 0-2, c) 25-40°Cobb angle, d) no earlier treatment, e) patients before first menses or not more than one year from first menses. Exclusion criteria: a) <10 years, b) Risser >2, c) <25°or >40°Cobb angle, d) patients treated earlier, e) patients with first menses >1 year, f ) non-idiopathic form of disease [9].

Results and discussion
The total number of analysed medical records amounted to 2705. The study included only girls. It has been found that 183 girls out of 2705 (6.8 % of the total treated with a brace) were ≥10 years old and in the range 25-40°Cobb angle. However, considering the status of maturation, the number of girls complying with complete SRS criteria amounted to 102 out of 183 (3.8 % of total of the treated): 42 girls with single thoracic curvature, 60 girls with double thoracic and lumbar curvature. The reasons of excluding 81 girls from analysis were: a) first menses >1 year = 18 patients, b) Risser >2 = 24 patients, c) first menses >1 year and Risser >2 = 39 patients. In the final group of 102 girls the mean age at first visit was 12.6 ± 1.7 years, the mean age at the moment of beginning of brace treatment was 12.9 ± 1.7 years.
If the study followed SRS-SOSORT 2015 criteria [1], the study would include 120 girls. Excluded patients show Table 1.