title: A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity.
abstract: METHODS
  The Swedish patients included in the previous SRS brace study were invited to take part in a long-term follow-up.
  
  
  OBJECTIVE
  To investigate the rate of scoliosis surgery and progression of curves from baseline as well as after maturity.
  
  
  BACKGROUND
  Brace treatment was shown to be superior to electrical muscle stimulation, as well as observation alone, in the original SRS brace study. Few other studies have shown that brace treatment is effective in the treatment of scoliosis.
  
  
  METHODS
  Of 106 patients, 41 in Malmö (all Boston brace treatment) and 65 in Göteborg (observation alone as the intention to treat), 87% attended the follow-up, including radiography and chart review. All radiographs were (re)measured for curve size (Cobb method) by an unbiased examiner. Searching in the mandatory national database for performed surgery identified patients who had undergone surgery after maturity.
  
  
  RESULTS
  The mean follow-up time was 16 years and the mean age at follow-up was 32 years The 2 treatment groups had equal curve size at inclusion. The curve size of patients who were treated with a brace from the start was reduced by 6 degrees during treatment, but the curve size returned to the same level during the follow-up period. No patients who were primarily braced went on to undergo surgery. In patients with observation alone as the intention to treat, 20% were braced during adolescence due to progression and another 10% underwent surgery. Seventy percent were only observed and increased by 6 degrees from inclusion until now. No patients underwent surgery after maturity. Progression was related to premenarchal status.
  
  
  CONCLUSIONS
  The curves of patients with adolescent idiopathic scoliosis with a moderate or smaller size at maturity did not deteriorate beyond their original curve size at the 16-year follow-up. No patients treated primarily with a brace went on to undergo surgery, whereas 6 patients (10%) in the observation group required surgery during adolescence compared with none after maturity. Curve progression was related to immaturity.
authors.affiliation: Department of Orthopedics, Sahlgrenska University Hospital, Göteborg, Sweden. danielsson.aina@telia.com
authors.forename: Aina J
authors.initials: AJ
authors.lastname: Danielsson
authors.forename: Ralph
authors.initials: R
authors.lastname: Hasserius
authors.forename: Acke
authors.initials: A
authors.lastname: Ohlin
authors.forename: Alf L
authors.initials: AL
authors.lastname: Nachemson
mesh_terms: D000293:Adolescent; D000328:Adult; D001915:Braces; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D019637:Orthopedic Procedures; D011446:Prospective Studies; D011627:Puberty; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012720:Severity of Illness Index; D013548:Sweden; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome