Adolescent idiopathic scoliosis detection and referral trends: impact treatment options

Abstract

Study design: Retrospective cross-sectional study.

Objective: To 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. There 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.

Methods: We 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°, 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.

Results: During the study period, 335 children met the inclusion criteria, with an average age of 14.1 ± 1.8 years and a mean Cobb angle of 36.8 ± 14.5°. Brace treatment was indicated in 17% of patients; 18% had curves beyond optimal curve range for bracing (> 40°), 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° 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.

Keywords: Adolescent idiopathic scoliosis; Appropriateness of care; Brace treatment; Pediatric; Referral pattern.

Fig. 1

Local Health Integration Networks in Ontario

Fig. 2

Classification of suspected adolescent idiopathic scoliosis cases according to defined criteria of appropriateness of referral

Fig. 3

Distribution of adolescent idiopathic scoliosis patients presenting to spine clinic for initial assessment

Fig. 4

Relationship between Cobb angle and level of skeletal maturity of adolescent idiopathic scoliosis patients presenting to spine clinic on initial assessment