Brace weaning is a critical transition for children and adolescents with scoliosis, requiring careful management to prevent regression. Weaning age is influenced by skeletal maturity. There are two useful skeletal scores used to determine skeletal maturity. The Risser sign is a classification system that assesses the ossification of the iliac crest apophysis on an x-ray. The Sanders score method is based on a single x-ray of the left hand, fingers, and wrist. Recent studies highlight that scoliosis can still progress at Risser stage 4 or 5, where it was once assumed growth had stabilised.
One study found that adolescents at Sanders stage 7A exhibited greater spinal and total body height gains than those at 7B, suggesting that earlier weaning may not be advisable.
The first study investigates growth differences in spine and total body height between Sanders stages 7A and 7B in patients with adolescent idiopathic scoliosis (AIS). It found that Sanders 7A patients experienced significantly greater spine and body height growth compared to those in 7B. Additionally, more patients at Sanders 7A showed substantial curve progression, suggesting that delaying brace discontinuation until reaching stage 7B may be advantageous, especially for those with larger curves.
For more details, you can read the full article here: https://link.springer.com/article/10.1007/s43390-024-00829-8.
Another study revealed a correlation between continued growth and curve progression in patients at stage 7A, emphasising the need for ongoing monitoring.
This study, titled ‘Puberty changes the natural history of idiopathic scoliosis: three prediction models for future radiographic curve severity from 1563 consecutive patients’ explores how idiopathic scoliosis (IS) evolves during different puberty stages. By analysing data from 1,563 patients, the authors developed predictive models that more accurately assess future curve severity when accounting for three peri-pubertal growth periods (before, during and after puberty).
Their findings can enhance shared decision-making between patients and clinicians by identifying risks and informing treatment planning.
For more details, you can read the full paper here: https://link.springer.com/article/10.1007/s00586-024-08487-0.
This diagram shows comparisons between both Sanders and Risser scores:
We do not want out patients to regress by removing their brace too soon in their growth trajectory. We carefully manage the reduction of brace hours as growth stabilises so in the latter teenage years, we can safely reduce hours in brace when its matters most to the brace user.
At this stage, remaining fit and active is key to the outcome. We aim to help young people maintain their progress as they navigate this important phase of growth.
If you have concerns about your child’s brace weaning process, please reach out for support.