Brace Management in Adolescent Idiopathic Scoliosis

Abstract

Skeletally immature patients with adolescent idiopathic scoliosis are at risk for curve progression. Although numerous nonoperative methods have been attempted, including physical therapy, exercise, massage, manipulation, and electrical stimulation, only bracing is effective in preventing curve progression and the subsequent need for surgery. Brace treatment is initiated as either full-time (TLSO, Boston) or nighttime (Charleston, Providence) wear, although patient compliance with either mode of bracing has been a documented problem. We review the natural history of adolescent idiopathic scoliosis, identify the risks for curve progression, describe the types of braces available for treatment, and review the indications for and efficacy of brace treatment.

Rib-vertebral angle measurements predict brace treatment outcome in Risser grade 0 and premenarchal girls with adolescent idiopathic scoliosis

“…In our study, the incidence of progression of early AIS (premenarchal and Risser 0) was 38 % (18/48), similar to Lonstein and Winter [1], yet higher than that reported by Nachemson and Peterson [2]. The main reason, we believe, could lie in the relative lower maturity status (premenarchal and Risser 0) of our cohort, which has been identified as one of the key risk factors in predicting curve progression [22,26]. Despite all this, in line with the study by Wiemann et al [13], the results of the current study provide sound evidence supporting that continuous brace treatment could effectively prevent curve progression in more than half of early AIS patients with premenarchal and Risser 0 status.…”

“…According to the outcomes of bracing at latest followup, all patients were divided into two groups: Group A, with a non-progressed curve; and Group B, with a progressed curve, namely worsening greater than 6°of the primary curve as compared to bracing initiation or being indicated for correction surgery [21,22].…”

Adolescent Idiopathic Scoliosis

“…The SRS currently recommends initiation of brace treatment in skeletally immature patients who present with curves greater than 30 degrees on initial presentation or who progress greater than 10 degrees to a magnitude greater than 25 degrees. 13 Braces are prescribed to be worn 18 to 23 hours a day, although evidence demonstrates the effectiveness of part-time (at least 12 hours per day) brace wear to address patient compliance issues. 14 Brace wear is continued until skeletal growth is complete, as determined by unchanged height measured consecutively 6 months apart, Risser stage 4 (females) or 5 (males), or until 2 years after menarche in females.…”

Early onset scoliosis: What the primary care provider needs to know and implications for practice

“…Decreased popularity of the Milwaukee brace may be because of the psychological impact caused by its built in visible neck ring and its 23‐h wearing protocol (Maruyama et al, 2008). The Charleston nighttime bending brace holds the patient in an overcorrected position and is worn part‐time at night only, which may reduce psychological stress and increase patient adherence (Jarvis et al, 2008; Maruyama et al, 2008; Schiller, Thakur, & Eberson, 2010). Quality of life and psychological well‐being are fundamental aspects of treatment and should be considered when choosing the most appropriate treatment option (Maruyama et al, 2008).…”