Efficacy of bracing treatment in lenke type 5, risser stage 4-5 adolescent idiopathic scoliosis patients and its effects on pelvic parameters

Objective: Scoliosis is the most common deformity of the spine. It is idiopathic in most cases, and this is the most common form of scoliosis. Idiopathic cases are most commonly observed in the adolescent age group (10-18 years). As long as skeletal maturity continues, the curve has the potential to grow. Risser 4 is the end of spinal growth, and Risser 5 is skeletal maturity. Sagittal plane and spinopelvic parameters, a popular subject of investigation in recent years, vary in the adolescent age group. Their relationship with the disease and their effect on the course of the disease in the AIS patient population is not clearly understood. Therefore, we aimed to investigate the efficacy of bracing treatment and its effect on pelvic parameters in Lenke type 5 adolescent idiopathic scoliosis cases, which occurs in the late phases of skeletal growth in the adolescent age group. Patients and Methods: Lenke type 5 adolescent idiopathic scoliosis patients admitted to the Orthopedics and Traumatology outpatient clinic of Ondokuz Mayıs University Faculty of Medicine Hospital between 2020 and 2023 were screened. Of 184 patients who applied due to this screening, 63 with sufficient follow-up time and met the inclusion criteria were included in the study. Coronal, sagittal, and pelvic parameters were measured and recorded on the scoliosis radiographs taken at admission and follow-up. Differences between the measurements were calculated and noted. Patients who used bracing were classified as Group 1, and patients who were followed up only with follow-up were classified as Group 2. Results: Of the 63 patients, 44 were female (70%), and 19 were male (30%). The mean age of the patients was 14 years (minimum 11, maximum 17). The mean follow-up period was six months (minimum five and maximum 26), and 34 patients were in Risser stage 4 (55%), and 29 patients were in Risser stage 5 (45%) during the first measurements. There was a statistically significant reduction in thoracic and thoracolumbar curvature in Group 1 (p<0.05). It was also found that shoulder balance shifted to the left side in Group 1. With these measurements, the change in pelvic parameters was analyzed, and a decrease in sacral slope with a median value of -7.0 degrees (minimum -10.0, maximum -2.0) was observed in Group 1, while a change with a median value of +1 degree (minimum -7.0, maximum +4.0) was observed in Group 2. As a result of this change in sacral slope, pelvic tilt changed with a median value of +1.0 degrees in Group 1 (minimum -5.0, maximum 8.0) and 0 degrees in Group 2 (minimum -6.0, maximum 5.0). Pelvic incidence varied with median values of -6.0 degrees (minimum -14.0, maximum +5.0) in Group 1 and 1.0 degrees (minimum -6.0, maximum 10.0) in Group 2. Reductions in sacral slope and pelvic incidence in patients in Group 1 were statistically significant (p<0.05). Conclusion: Although Risser 4 is considered an indicator of the end of spinal growth and Risser 5 as an indicator of the end of skeletal growth, it has been observed that the use of bracing in appropriate cases in Lenke type 5 AIS patients in this period reduces the main curve and affects pelvic parameters while reducing this curve.