A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data

Abstract

Background: There is a paucity of literature regarding the conservative management of adult scoliosis. The authors review and summarize the literature from 1967 to 2018 on the clinical outcomes of spinal brace/orthosis use in this subgroup of the population. Methods: CINAHL, Embase, CENTRAL, PubMed and PEDro were searched from database inception to the 30th of October, 2018. A combination of medical subject heading terms and keywords pertaining to three core concepts (adult, scoliosis, and braces/orthoses) were used in the search. Studies were included if A) clinical outcomes were collected from B) participants ≥18 years C) receiving spinal brace/orthosis treatment for D) primary degenerative (de novo) scoliosis or progressive idiopathic scoliosis. A step-wise screening process was employed which involved a title and abstract screen for relevancy followed by a full text eligibility appraisal by two authors. Data were extracted, and a risk of bias assessment was performed on the included cohort studies using the Newcastle-Ottawa Scale. Given the overall level and quality of the available evidence, conclusions were drawn based on a qualitative summary of the evidence. Results: Ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/ rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Commonly reported outcomes were pain (7 studies), function (3 studies) and Cobb angles (3 studies), with followup times ranging from 2 days to 17 years. Brace wear prescriptions ranged from 2 to 23 h per day, and there was mixed brace-compliance reported. Most studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing. Participants from one study noted discomfort associated with bracing. Each of the six cohort studies demonstrated a high risk of bias.

Spine Bracing: When to Utilize—A Narrative Review

“…A 2016 prospective study with a sample size of 158 patients demonstrated this with 80% of their brace wearers showing unchanged or improved Cobb angles after adhering to bracing for around 8.5 years [ 80 ]. However, these results do not represent a statistically significant trend across similar studies [ 79 ]. There are plenty of adult scoliosis cases where patients continue to deteriorate despite the use of bracing [ 79 ].…”

“…However, these results do not represent a statistically significant trend across similar studies [ 79 ]. There are plenty of adult scoliosis cases where patients continue to deteriorate despite the use of bracing [ 79 ]. Higher-quality studies and specifically randomized control trials (RCTs) are needed to determine bracing’s true utility in treating adult scoliosis, as there are not yet enough reliable findings to suggest their use beyond improving pain levels and function.…”

“…Even so, bracing is still used as a nonoperative treatment in adults with scoliosis. While a recent 2020 systematic literature review of 61 studies on adult scoliosis did not find sufficient evidence to suggest that bracing can reliably correct spinal curvature, it did observe that bracing temporarily reduces pain levels and improves function [ 79 ]. The brace achieves this improvement as it transfers trunk weight from the ribs to the iliac crests [ 80 ].…”

Spinal Deformities and Advancement in Corrective Orthoses

“…objective is to describe the existing technologies in order to develop corrective orthoses and their applicability. The current statistical studies [5,9,10] have determined that there is no adequate evidence to reach one concurrent decision about what type of brace is the best among all other types. The adequacy of the scoliosis treatment using braces remains controversial, due to inadequacy in the selection criteria of patients and the definition of brace efficacy.…”

“…Several literature studies [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ] have been conducted to evaluate the effectiveness of corrective orthoses. These studies mainly considered the selection of the effective brace type and predictive factors (compliance, curve magnitude, growth stage, body mass index, and exercise potential) that contribute to promising outcomes.…”