Conservative treatment of main thoracic adolescent idiopathic scoliosis: Full-time or nighttime bracing?

Abstract

Purpose: To compare treatment efficacy between the Boston full-time brace and the Providence part-time brace in main thoracic adolescent idiopathic scoliosis (AIS). Methods: Patients were treated with either the Boston brace ( n = 37) or the Providence brace ( n = 40). Inclusion criteria were Risser grade ≤2, major curve between 25° and 40° with the apex of the curve between T7 and T11 vertebrae. Two-year follow-up was available in all patients unless brace treatment had reached endpoint. The primary outcome measure was main curve progression to ≥45°. Results: Median age was 12.6 years and median treatment length at follow-up was 25 months (interquartile range (IQR): 18–32)) with no difference between the groups ( p ≥ 0.116). Initial median main Cobb angle was 29° (IQR: 27–33) and 36° (IQR: 33–38) in the Boston and Providence groups, respectively ( p < 0.001). At follow-up, 13 patients (35%) had progressed to ≥45° in the Boston group versus 16 patients (40%) in the Providence group ( p = 0.838). Twenty-three patients (62%) had progressed by more than 5° in the Boston group versus 22 patients (55%) in the Providence group ( p = 0.685). The secondary thoracolumbar/lumbar curve progressed by more than 5° in 14 (38%) and 18 (45%) in the Boston and Providence groups, respectively ( p = 0.548). Conclusions: Despite a larger initial curve size in the Providence group, progression of more than 5° or to surgical indication area was similar in the Boston group. Our results indicate that nighttime bracing is a viable alternative to full-time bracing also in main thoracic AIS.

The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis

“…Three studies, Yrjönen et al ( n = 72), Janicki et al ( n = 83), and Ohrt-Nissen et al ( n = 77), prospectively compared the Providence brace and the full-time TLSO [ 4 , 48 , 49 ]. Success rate was defined as curve progression ≤5° or residual curve < 45° [ 49 ]. Providence brace was successful in 31%, when the full-time TLSO was in 15% [ 4 , 48 ].…”

“…Comparison of the effectiveness between the different brace concepts revealed that rigid braces have better outcomes than soft braces and that night-time braces have comparable effectiveness compared to full-time braces. Rigid part-time bracing data were too limited to be included in the meta-analysis [ 4 , 42 , 48 , 49 , 50 , 51 ]. Most of the studies used as curve type thoracic, thoraco-lumbar, and lumbar curves with no subgroups organization.…”

Controversies with nonoperative management for adolescent idiopathic scoliosis: Study from the APSS Scoliosis Focus Group

“…There are many brace options but the results appear similar. 31 Various aspects of brace treatment such as indications to start and discontinuing, methods to assess skeletal maturity, and ideal frequency of follow-up and imaging methods are not standardized. One recent best practice guidelines study 4 based in North America suggested that there is relative consensus for indication of bracing to prevent or limit curve progression, when to prescribe bracing, and the acceptable compliance.…”

The Influence of Lumbar Modifiers on Functional and Radiological Outcomes in the Brace Treatment of Lenke Type 1 Adolescent Idiopathic Scoliosis

“…In the present study, Lenke type 1 curves, which were relatively rigid, were evaluated and brace treatment was found to be successful. However, the duration of bracing is still controversial in the literature [23,24]. Katz et al reported that full-time bracing gives better results than nighttime bracing [25].…”