European Spine Journal

, Volume 15, Issue 7, pp 1108–1117 | Cite as

Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24

  • Karen Petra Weigert
  • Linda Marie Nygaard
  • Finn Bjarke Christensen
  • Ebbe Stender Hansen
  • Cody Bünger
Original Article


A retrospectively designed long-term follow-up study of adolescent idiopathic scoliosis (AIS) patients who had completed treatment, of at least 2 years, by means of brace, surgery, or both brace and surgery. This study is to assess the outcome after treatment for AIS by means of the Scoliosis Research Society Outcome Instrument 24 (SRS 24). One hundred and eighteen AIS patients (99 females and 19 males), treated at the Aarhus University Hospital from January 1, 1987 to December 31, 1997, were investigated with at least 2 years follow-up at the time of receiving a posted self-administered questionnaire. Forty-four patients were treated with Boston brace (B) only, 41 patients had surgery (S), and 33 patients were treated both with brace and surgery (BS). The Cobb angles of the three treatment groups did not differ significantly after completed treatment. The outcome in terms of the total SRS 24 score was not significantly different among the three groups. B patients had a significantly better general (not treatment related) self-image and higher general activity level than the total group of surgically treated patients, while surgically treated patients scored significantly better in post-treatment self-image and satisfaction. Comparing B with BS we found a significantly higher general activity level in B patients, while the BS group had significantly higher satisfaction. There were no significant differences between BS and S patients in any of the domain scores. All treatment groups scored “fair or better” in all domain scores of the SRS 24 questionnaire, except in post-treatment function, where all groups scored worse than “fair”. Improvement of appearance by means of surgical correction increases mean scores for post-treatment self-image and post-treatment satisfaction. Double-treatment by brace and surgery does not appear to jeopardize a good final outcome.


Scoliosis Quality of life Functional outcome Brace Surgery 



This study has been conducted at the Spine section, Department of Orthopedics, Aarhus University Hospital KH, Denmark. The study was supported by grants from the Danish Rheumatism Association grant no. 233-3425 and grants from the Arosia Spine Research Fund


  1. 1.
    Roach JW (1999) Adolescent idiopathic scoliosis. Orthop Clin North Am 30:353–365, vii–viiiGoogle Scholar
  2. 2.
    Montgomery F, Willner S (1997) The natural history of idiopathic scoliosis. Incidence of treatment in 15 cohorts of children born between 1963 and 1977. Spine 22:772–774CrossRefPubMedGoogle Scholar
  3. 3.
    Kehl DK, Morrissy RT (1988) Brace treatment in adolescent idiopathic scoliosis. An update on concepts and technique. Clin.Orthop Relat Res 229:34–43PubMedGoogle Scholar
  4. 4.
    Montgomery F, Willner S (1989) Prognosis of brace-treated scoliosis. Comparison of the Boston and Milwaukee methods in 244 girls. Acta Orthop Scand 60:383–385PubMedCrossRefGoogle Scholar
  5. 5.
    Bridwell KH (1994) Surgical treatment of adolescent idiopathic scoliosis: the basics and the controversies. Spine 19:1095–1100PubMedGoogle Scholar
  6. 6.
    Hopf C (2000) Criteria for treatment of idiopathic scoliosis between 40 degrees and 50 degrees. Surgical vs. conservative therapy. Orthopade 29:500–506CrossRefPubMedGoogle Scholar
  7. 7.
    Nachemson AL, Peterson LE (1995) Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 77:815–822PubMedGoogle Scholar
  8. 8.
    Andersen MO, Andersen GR, Thomsen K, Christensen SB (2002) Early weaning might reduce the psychological strain of Boston bracing: a study of 136 patients with adolescent idiopathic scoliosis at 3.5 years after termination of brace treatment. J Pediatr Orthop B 11:96–99CrossRefPubMedGoogle Scholar
  9. 9.
    Clayson D, Levine DB (1976) Adolescent scoliosis patients. Personality patterns and effects of corrective surgery. Clin Orthop Relat Res 116:99–102PubMedGoogle Scholar
  10. 10.
    Clayson D, Luz-Alterman S, Cataletto MM, Levine DB (1987) Long-term psychological sequelae of surgically versus nonsurgically treated scoliosis. Spine 12:983–986PubMedCrossRefGoogle Scholar
  11. 11.
    Clayson D, Mahon B, Levine DB (1981) Preoperative personality characteristics as predictors of postoperative physical and psychological patterns in scoliosis. Spine 6:9–12PubMedCrossRefGoogle Scholar
  12. 12.
    Climent JM, Reig A, Sanchez J, Roda C (1995) Construction and validation of a specific quality of life instrument for adolescents with spine deformities. Spine 20:2006–2011PubMedCrossRefGoogle Scholar
  13. 13.
    Climent JM, Sanchez J (1999) Impact of the type of brace on the quality of life of adolescents with spine deformities. Spine 24:1903–1908CrossRefPubMedGoogle Scholar
  14. 14.
    Danielsson AJ, Wiklund I, Pehrsson K, Nachemson AL (2001) Health-related quality of life in patients with adolescent idiopathic scoliosis: a matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J 10:278–288CrossRefPubMedGoogle Scholar
  15. 15.
    Fallstrom K, Cochran T, Nachemson A (1986) Long-term effects on personality development in patients with adolescent idiopathic scoliosis. Influence of type of treatment. Spine 11:756–758PubMedCrossRefGoogle Scholar
  16. 16.
    Koch KD, Buchanan R, Birch JG, Morton AA, Gatchel RJ, Browne RH (2001) Adolescents undergoing surgery for idiopathic scoliosis: how physical and psychological characteristics relate to patient satisfaction with the cosmetic result. Spine 26:2119–2124CrossRefPubMedGoogle Scholar
  17. 17.
    Olafsson Y, Saraste H, Ahlgren RM (1999) Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis. Eur Spine J 8:402–405CrossRefPubMedGoogle Scholar
  18. 18.
    Wickers FC, Bunch WH, Barnett PM (1977) Psychological factors in failure to wear the Milwaukee brace for treatment of idiopathic scoliosis. Clin Orthop Relat Res 126:62–66PubMedGoogle Scholar
  19. 19.
    Haher TR, Gorup JM, Shin TM, Homel P, Merola AA, Grogan DP, Pugh L, Lowe TG, Murray M (1999) Results of the Scoliosis Research Society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. A multicenter study of 244 patients. Spine 24:1435–1440CrossRefPubMedGoogle Scholar
  20. 20.
    Haher TR, Merola A, Zipnick RI, Gorup J, Mannor D, Orchowski J (1995) Meta-analysis of surgical outcome in adolescent idiopathic scoliosis. A 35-year English literature review of 11,000 patients. Spine 20:1575–1584PubMedCrossRefGoogle Scholar
  21. 21.
    Merola AA, Haher TR, Brkaric M, Panagopoulos G, Mathur S, Kohani O, Lowe TG, Lenke LG, Wenger DR, Newton PO, Clements DH III, Betz RR (2002) A multicenter study of the outcomes of the surgical treatment of adolescent idiopathic scoliosis using the Scoliosis Research Society (SRS) outcome instrument. Spine 27:2046–2051CrossRefPubMedGoogle Scholar
  22. 22.
    Wilson PL, Newton PO, Wenger DR, Haher T, Merola A, Lenke L, Lowe T, Clements D, Betz R (2002) A multicenter study analyzing the relationship of a standardized radiographic scoring system of adolescent idiopathic scoliosis and the Scoliosis Research Society outcomes instrument. Spine 27:2036–2040CrossRefPubMedGoogle Scholar
  23. 23.
    White SF, Asher MA, Lai SM, Burton DC (1999) Patients’ perceptions of overall function, pain, and appearance after primary posterior instrumentation and fusion for idiopathic scoliosis. Spine 24:1693–1699CrossRefPubMedGoogle Scholar
  24. 24.
    Apter A, Morein G, Munitz H, Tyano S, Maoz B, Wijsenbeek H (1978) The psychosocial sequelae of the Milwaukee brace in adolescent girls. Clin Orthop Relat Res 131:156–159PubMedGoogle Scholar
  25. 25.
    Goldberg MS, Mayo NE, Poitras B, Scott S, Hanley J (1994) The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study. Part I: description of the study. Spine 19:1551–1561PubMedCrossRefGoogle Scholar
  26. 26.
    Noonan KJ, Dolan LA, Jacobson WC, Weinstein SL (1997) Long-term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop 17:712–717CrossRefPubMedGoogle Scholar
  27. 27.
    Asher M, Min LS, Burton D, Manna B (2003) Scoliosis research society-22 patient questionnaire: responsiveness to change associated with surgical treatment. Spine 28:70–73CrossRefPubMedGoogle Scholar
  28. 28.
    Asher MA, Min LS, Burton DC (2000) Further development and validation of the Scoliosis Research Society (SRS) outcomes instrument. Spine 25:2381–2386CrossRefPubMedGoogle Scholar
  29. 29.
    Asher M, Min LS, Burton D, Manna B (2003) The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine 28:63–69CrossRefPubMedGoogle Scholar
  30. 30.
    Asher M, Min LS, Burton D, Manna B (2003) Discrimination validity of the scoliosis research society-22 patient questionnaire: relationship to idiopathic scoliosis curve pattern and curve size. Spine 28:74–78CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Karen Petra Weigert
    • 1
  • Linda Marie Nygaard
    • 1
  • Finn Bjarke Christensen
    • 1
  • Ebbe Stender Hansen
    • 1
  • Cody Bünger
    • 1
  1. 1.Orthopedics Research LaboratoryAarhus University HospitalAarhus CDenmark

Personalised recommendations