Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

Study designRetrospective cross-sectional study.ObjectiveTo analyze the patient demographic referred for scoliosis to the Hospital for Sick Children to determine the proportion of patients suitable for brace treatment, as per the Scoliosis Research Society guidelines.Summary of background dataThere is level 1 evidence that bracing in adolescent idiopathic scoliosis (AIS) decreases the risk of curve progression and need for surgery, but optimal brace treatment requires early curve detection.MethodsWe performed a retrospective review of 618 consecutive patients who underwent initial assessment in our Spine Clinic between Jan. 1 and Dec. 31, 2014. We included children 10-18 years, with scoliosis greater than 10 degrees, excluding those diagnosed with non-idiopathic curves. Primary outcomes were Cobb angle, menarchal status, and Risser score. We analyzed the effect of specific referral variables (family history, the person who first noticed the curve, and geographic location of residence) on presenting curve magnitude.ResultsDuring the study period, 335 children met the inclusion criteria, with an average age of 14.11.8 years and a mean Cobb angle of 36.814.5 degrees. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (>40 degrees), and 55% were skeletally mature, therefore not brace candidates. The majority of curves (54%) were first detected by the patient or family member and averaged 7 degrees more than curves first detected by a physician. A family history of scoliosis made no difference to curve magnitude, nor did geographic location of residence.Conclusion The majority of AIS patients present too late for effective management with bracing.Level of evidence III.