We have read with great interest the article published by Bunge EM and colleagues [1] about short-term effects regarding health-related quality of life (HRQoL) in patients affected by adolescent idiopathic scoliosis (AIS) after a brace or surgical treatment.Recently, we performed a similar study about long-term effects on HRQoL in surgically or conservatively treated patients affected by scoliosis between 45°-60°Cobb and we believe we can provide a further contribution to this important topic.We have reviewed 840 clinical histories of patients treated for scoliosis (between 45°-60°Cobb) from 1975 to 1985 at the Fondazione Don C. Gnocchi (Rome). Of the initial population (840 patients), 98 showed a scoliosis with 45°-60°Cobb, 13 out of these 98 refused to participate in this study, 64 were untraceable, and the remaining 21 patients agreed to participate in this study giving their informed consent. Ten patients were surgically treated (SURG) and 11 received a conservative treatment (CONS). In terms of gender, 20 of the patients were women and 1 was man; and the mean age at follow-up was 36.7 ± 4.7 years (range 20-31 years).The conservative treatment consisted of the use of: plaster cast in one patient; plaster cast and Lyonnais in three patients; plaster cast, Lyonnais and Milwaukee brace in five; plaster cast and Milwaukee in one; Lyonnais in two patients; Milwaukee brace in one; and all treatments presented in eight patients. All the patients were instructed to wear their braces for about 20 h per day. In addition, all CONS patients underwent a rehabilitation program based on a postural re-education method. Wearing over was initiated when the patient's curve had not progressed on two successive visits and the patient was judged skeletally mature. The brace period was mean 5.2 years (range ±3.4).With regard to SURG cases, after surgery, all patients wore a plaster brace and performed a rehabilitation program based on a postural re-educational method.Note that, the surgical treatment was always indicated in patients with a documented progression (Cobb angle between 45°and 60°) and expected remaining skeletal growth. Our 11 CONS patients had refused the surgical treatment and they chose the conservative management.At follow-up each patient underwent a multidimensional protocol including an anamnestic evaluation (school abandonment, current employment, sport practices, occurrence of pregnancy, menarche and abortions, cervicalgy and headache) physical examination (rib-hump measuring, sagittal and coronal alignment), radiological evaluation (using the Cobb technique), disability evaluation (Barthel Index and Deambulation Index), HRQoL and back pain evaluation (the Short Form-36 Health Survey [SF-36], NASS scale, Backill Scale and Visual Analogue Scale).As expected, comparing the two groups, we have observed: (1) an higher brace period in CONS group (P = 0.005); (2) a more severe pre-therapy scoliosis degree in SURG group (mean value 59.2°in SURG group versus 50.4°in CONS group, P = 0.005) and (3) a more severe
