Braces for Idiopathic Scoliosis in Adolescents

Abstract

To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, psychological and cosmetic issues. Summary of Background Data Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. While adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. Methods Search methods We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015. We also checked reference lists and hand searched grey literature. Selection criteria RCTs and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. Data collection and analysis We used standard methodological procedures expected by The Cochrane Collaboration. Results We included seven studies. Five were planned as RCTs, two as prospective CCT`s. One RCT failed completely, another was continued as an observational study. There was very low quality evidence from one small RCT that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation. Conclusions Two studies showed that bracing did not change QoL during treatment, and QoL, back pain psychological and cosmetic issues in the long term (16 years.) All papers showed that bracing prevented curve progression. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children.

Predicting success or failure of brace treatment for adolescents with idiopathic scoliosis

“…A brace can reduce the risk of progression if it achieves good correction of the deformity [34] and the patient complies with prescribed wear time [13]. Literature on brace treatment's effectiveness has been reviewed [12,27,30,31] and found to be "troublingly inconsistent" [12], but this is probably because these two key ingredients (in-brace correction and patient compliance) have been neglected in many studies.…”

Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review

“…The appropriate choice of treatment depends on the type of curve and the severity of the deformity. [19] Orthoses are commonly prescribed for skeletally immature AIS with CA greater than 25 . [1,2,20] The primary objective of this treatment is to reduce the risk of curve progression and secondary health implications associated with spinal deformity and ultimately avoid the need for surgery.…”

Nighttime Bracing Versus Observation for Early Adolescent Idiopathic Scoliosis

“…Despite the presence of these criteria for the last 15 years, there remains a significant debate with regard to the efficacy of bracing and a paucity of high-quality studies to show efficacy 3. Furthermore, many different brace designs exist with conflicting evidence on their relative efficacy 1,4–9…”