Application of different measures of skeletal maturity in initiating weaning from a brace for scoliosis: two case reports

Abstract

IntroductionVarious measures of skeletal maturity are used to initiate weaning from a brace in patients suffering from idiopathic scoliosis, resulting in different outcomes. We present two cases with double major curves, treated with the Rigo System Cheneau brace, and weaned using different criteria.Case presentationCase 1 was a South African, Caucasian girl who was initially treated with a brace at 14.75 years and who began weaning at 16.25 years on the basis of the Greulich and Pyle Index. She was out of her brace in 6 months, at least 11 months before reaching skeletal maturity as shown by the Risser Sign. Case 2 was a South African, Caucasian girl, initially treated with a brace at 14.25 years and who began the weaning process at 17.67 years on the basis of skeletal maturity according to the Risser Sign and static height for a period of 6 months. She was out of the brace 12 months later. In Case 1, the thoracic Cobb angle progressed during weaning and scoliometer readings deteriorated. The iliac apophysis fused 11 months after the wrist. In Case 2, the therapeutic gains made during the period of bracing were maintained during weaning, that is the improvement in the lumbar Cobb angle was maintained until the brace was removed, and scoliometer readings improved. The iliac apophysis fused 8.5 months after the wrist.ConclusionsIn patients with idiopathic scoliosis, it would seem to be more appropriate to base the timing of weaning on the Risser Sign and static height measurements rather than on traditional methods such as the Greulich and Pyle Index.

The effect of compliance to a Rigo System Cheneau brace and a specific exercise programme on idiopathic scoliosis curvature: a comparative study: SOSORT 2014 award winner

“…The fact that peak bone mineralization and peak muscle strength occurs at 25, and peak ligamentous stability occurs in the early 20’s [ 92 ], was considered when deciding on weaning. Bracing is sometimes considered ineffective, when actually the subjects have just been weaned out too early or too quickly [ 93 ]. The optimal weaning process is not known and has not been standardised [ 8 , 12 ] and therefore was not included in this study.…”

An insight of how multiple skeletal maturity indices can be used for growth assessment: relationship between the simplified olecranon, simplified digital, and distal radius and ulna classifications

“…Assessment of skeletal maturity is essential in pediatric orthopedics when making decisions for timely initiation and completion of treatments; this is especially so for growth-modulated interventions of the lower limbs and spine [1,2]. Examples include decision-making for limb lengthening surgery [3], pediatric anterior cruciate ligament reconstruction [4], and the timing of brace initiation and weaning for idiopathic scoliosis [5][6][7]. Growth potential is therefore a key parameter for predicting disease progression and for treatment planning [3,[8][9][10][11].…”