Brace Treatment in Adolescent Idiopathic Scoliosis

Introduction Adolescent idiopathic scoliosis (AIS), the most common pediatric spine problem, is a structural lateral and rotatory curvature of the spine arising in otherwise normal children during puberty [1,2]. It occurs before skeletal maturity. Although there is still no cause for AIS, the natural history of AIS has been established in the literature very well [1-16]. Lonstein and Carlson [2] found that in skeletally immature patients with curves of 20 to 29 degrees, there is a 68% risk of curve progression. They also found that these patients with a curve of <20° are three times more likely to show curve progression than others. Nachemson and Peterson [17], in a prospective study of 286 girls with curves of 25° to 35°, found the incidence of progression to be 66%. Bunnell [1] reported progression of at least 5 degrees in 68% of patients, 10 degrees in 34% of patients, and 20 degrees in 18% of patients in his series. Rogala et al, [18] also reported significant curve progression in their patients. Long-term follow-ups indicate that patients with scoliosis may have a higher prevalence of back pain, and of significant deformity if the curve becomes extremely large [9,10,16]. Severe thoracic curvatures slightly increase risk for pulmonary dysfunction and corpulmonale [9,10,15]. Large curvatures and large degrees of rotation can cause significant cosmetic deformity and psychologic distress to the patients. The aim of nonoperative treatment is mainly an attempt to prevent progression of the curve. Bracing and surgery have been used for large and or