Background: Treatment of adolescent idiopathic scoliosis (AIS) is one of the most challenging problems for spine surgeons. Although it has been previously demonstrated that curve pattern in AIS is different between males and females, there are, however, limited studies specially focused on the differences of AIS characteristics between the two genders. Objectives: In current study, we compared the demographics and curve patterns in male and female patients with AIS. Patients and Methods: A total of 68 girls and 17 boys with AIS were included in this cross-sectional study. The magnitude of curvature, thoracic kyphosis, flexibility and pattern of the deformity were measured on x-rays and compared between the two genders. Results: Although girls were significantly younger (15. 3 ± 2. 5 versus 16. 7 ± 2. 1 years; P = 0. 036), however, the Risser sign was the same. Most of the males were hypokyphotic (70. 6%), while most of the girls had normal thoracic kyphosis (69. 1%) (P = 0. 001). The main scoliotic curve (77. 2 ± 18. 2 versus 59. 6 ± 18. 6 degrees) and flexibility (25. 5% ± 18. 2% versus 41. 9% ± 18. 6%) were significantly greater and lower in males, respectively (P < 0. 05). The typical AIS pattern was present in 64. 7% of boys and 95. 6% of girls (P < 0. 001). Conclusions: The radiographic characteristics of AIS are substantially different between genders. In male patients, AIS is more severe and rigid compared to females. Also, hypokyphosis and atypical pattern of AIS are common findings in males compared to females.

Background: Bracing is the most common non-operative treatment for idiopathic adolescent scoliosis. Milwaukee brace is the best- known orthosis for his purpose. We wish to report our results with the use of this brace in idiopathic scoliosis.Methods: In a retrospective study, among 681 who had been treated for idiopathic scoliosis from 1994 to 2004 in two hospitals in Tehran, 335 cases had received non- operative treatment with Milwaukee brace. The radiographs of these patients were reviewed to evaluate the treatment outcome. These patients, who were 12.1 years old on average and had received no other prior treatment, had started with 23 hours per day bracing and continued in accordance with Scoliosis Research Society (SRS) protocol.Results: Milwaukee brace reduced the cobb ankle from an average of 32.8 to 30.6 degrees. The brace had no appreciable effect on curves of upper thoracic, double or triple curves. Initial thoracic kyphosis had no effect on final bracing outcome. Curve progression, while in brace, was more commonly seen in association with Risser signs “0” to “1”. The best prognostic evidence in terms of control of progression was initial reduction of over 30 percent in curve magnitude in the first post- bracing visit. A reduction in curve magnitude of less than 17 percent after the first visit was associated with poor final outcome.Conclusions: Milwaukee brace can effectively reduce and control idiopathic scoliotic curves. However good patient selection and close follow- up is mandatory.

Background: Recently, several authors have demonstrated the importance of sagittal spinopelvic alignment in patients with adolescent idiopathic scoliosis (AIS). Objectives: In the current study, we investigated the preoperative spinal and pelvic sagittal parameters in the abovementioned patients. Patients and Methods: There were 50 consecutive patients with AIS (16 males and 34 females) in the current prospective study. In addition to the measurement of main scoliotic curve on posteroanterior X-rays, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), and thoracic kyphosis (TK) were measured on lateral X-rays. Finally, the correlations between these parameters were investigated. We also compared the sagittal parameters between patients with main thoracic scoliosis (Lenke type I) and thoracolumbar/lumbar scoliosis (Lenke type V). Results: Main scoliotic curve (MSC) was correlated with TK and PT. LL was correlated positively with PI and SS. Negative correlation was found between SS and PI. The sagittal parameters were the same in patients with Lenke type I and Lenke type V scoliosis. In addition, MSC and LL were significantly greater in patients with thoracolumbar/lumbar scoliosis, while TK was significantly greater in patients with main thoracic scoliosis. In the main thoracic group, MSC and TK were positively and PI was negatively correlated with PT. LL and SS had a positive correlation. Conclusions: PI has a constant magnitude and is correlated with SS and LL. Postoperatively, pelvis can compensate for any change in LL. Therefore, the LL within fusion must be imposed in lordosis to the extent that the below fusion segments can compensate for intrafusion hypo/hyper lordosis to prevent the pelvis to compensate for hypo/hyper lordosis. This can result in a normal or near normal postoperative sagittal alignment. The authors recommend the surgeons to perform exact preoperative planning including the sagittal alignment of the pelvis in addition to spinal alignment.