This study examines the demographic characteristics of patients referred for scoliosis to the Hospital for Sick Children (Ontario, Canada) and determines the proportion eligible for brace treatment according to Scoliosis Research Society guidelines based on the magnitude of curvature, described by the Cobb angle, and skeletal growth potential, using the Risser Scale.

The Scoliosis Research Society (SRS) provides treatment recommendations for adolescent idiopathic scoliosis (AIS), dividing them into observation, bracing, and surgery.

The SRS guidelines suggest a «gray zone» for surgical consideration for curves between 40 and 50°, but many centers, including ours, consider surgery for curves greater than 50°.

The Spine Clinic at the Hospital for Sick Children was at the time of the study a pediatric tertiary care center affiliated with a University, and had a staff comprising 1.2 orthopedic pediatric spine surgeons, an orthopedic spine fellow, 2 nurse practitioners, and a physical therapy practitioner.

This clinic receives the largest proportion of spine-related referrals in Ontario, which is divided into 14 Local Health Integration Networks (LHINs). LHINs are government-funded organizations coordinating services for specific geographic regions that covers a population of 13.6 million people. 

The institution receives over 800 referrals annually for spinal pathology, with approximately 40% diagnosed with adolescent idiopathic scoliosis (AIS). 

Children categorized as skeletally immature are triaged and seen within 6 weeks of referral, while low-risk referrals are seen within 3 months.


Realtionship between Cobb angle and skeletal maturiy of AIS patients presenting to the Spine clinic on initial assessment

Background data revealed that bracing in adolescent idiopathic scoliosis (AIS) reduces the risk of curve progression and surgery, emphasizing the importance of early detection.

A retrospective review of 618 consecutive patients assessed in the Spine Clinic from January to December 2014 was conducted.

Inclusion criteria comprised children aged 10–18 years with scoliosis > 10°, excluding non-idiopathic curves.

Primary outcomes included Cobb angle, menarchal status, and Risser score. 

Referral variables (family history, initial observer of the curve, and geographic location) were analyzed for their impact on curve magnitude. 

Results showed that 335 children met the criteria, averaging 14.1 ± 1.8 years with a mean Cobb angle of 36.8 ± 14.5°.

  • Brace treatment was indicated for 17% of patients.


  • 18% of the children had curves > 40° unsuitable for bracing


  • 55% of the children were already skeletally mature when they arrived at the Spine clinic.

Most curves (54%) were first detected by patients or family members, with these curves averaging 7° greater than those initially detected by physicians.

Family history and geographic location did not affect curve magnitude. 

The authors concluded that majority of AIS patients present too late for effective brace management, highlighting the need for improved early detection strategies. 


Anthony, A., Zeller, R., Evans, C. et al. Adolescent idiopathic scoliosis detection and referral trends: impact treatment options. Spine Deform 9, 75–84 (2021).


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