Effects of Bracing in Adolescents with Idiopathic Scoliosis

Uno, Hajime; Wei, Lee‐Jen; Hughes, Michael D.

doi:10.1056/nejmc1314229

Cited by 18 publications

(23 citation statements)

References 16 publications

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“…Recently, bracing has been rigorously tested scientifically, and it seems to minimize the risk of progression for AIS in respect of the threshold for surgery [ 67 ]. However, it is still being questioned in spite of this meticulous scientific effort [ 68 ]. Moreover, bracing is physically and emotionally strenuous for the AF with a correspondingly low compliance [ 69 - 71 ].…”

Section: Treatmentmentioning

confidence: 99%

Mechanism of right thoracic adolescent idiopathic scoliosis at risk for progression; a unifying pathway of development by normal growth and imbalance

Wong¹

2015

Scoliosis

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Adolescent idiopathic scoliosis is regarded as a multifactorial disease and none of the many suggested causal etiologies have yet prevailed. I will suggest that adolescent idiopathic scoliosis has one common denominator, namely that initial curve development is mediated through one common normal physiological pathway of thoracic rotational instability. This is a consequence of gender specific natural growth of the passive structural components of thoracic spinal tissues for the adolescent female. This causes an unbalanced mechanical situation, which progresses if the paravertebral muscles cannot maintain spinal alignment. The alteration in the coronal plane with the lateral curve deformity is an uncoupling effect due to a culmination of a secondary, temporary sagittal plane thoracic flattening and of a primary, temporary transverse plane rotational instability for the adolescent female. Treatment of adolescent idiopathic scoliosis should address this physiological pathway and the overall treatment strategy is early intervention with strengthening of thoracic rotational stability for small curve adolescent idiopathic scoliosis.

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Section: Treatmentmentioning

confidence: 99%

Mechanism of right thoracic adolescent idiopathic scoliosis at risk for progression; a unifying pathway of development by normal growth and imbalance

Wong¹

2015

Scoliosis

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“…Bracing is typically prescribed either based on guidelines set by the Scoliosis Research Society [ 9 ] or by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) [ 10 ], in which the Cobb angle is greater than 20° with considerable growth remaining or show at least 5 o of Cobb angle increase between consecutive clinic visits. Recent scientific evidence has shown that brace treatment is effective [ 11 – 14 ], and a pilot study from a single centre has shown a predicted success rates of 95%, when brace wear quantity combined with the brace wear quality is over 43% of the prescribed dosage [ 15 ]. A combined value of brace wear quantity and quality can be achieved in many different ways by trading off wear time and wear tightness; a subject can wear the brace 43% of prescribed time (9.9 h/day) and 100% of time at the prescribed tightness level.…”

Section: Introductionmentioning

confidence: 99%

Results of ultrasound-assisted brace casting for adolescent idiopathic scoliosis

et al. 2017

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BackgroundFour factors have been reported to affect brace treatment outcome: (1) growth or curve based risk, (2) the in-brace correction, (3) the brace wear quantity, and (4) the brace wear quality. The quality of brace design affects the in-brace correction and comfort which indirectly affects the brace wear quantity and quality. This paper reported the immediate benefits and results on using ultrasound (US) to aid orthotists to design braces for the treatment of scoliosis.MethodsThirty-four AIS subjects participated in this study with 17 (2 males, 15 females) in the control group and 17 (2 males, 15 females) in the intervention (US) group. All participants were prescribed full time TLSO, constructed by either of the 2 orthotists in fabrication of spinal braces. For the control group, the Providence brace design system was adopted to design full time braces. For the intervention group, the custom standing Providence brace design system, plus a medical ultrasound system, a custom pressure measurement system and an in-house software were used to assist brace casting.ResultsIn the control group, 8 of 17 (47%) subjects needed a total of 11 brace adjustments after initial fabrication requiring a total of 28 in-brace radiographs. Three subjects (18%) required a second adjustment. For the US group, only 1 subject (6%) required adjustment. The total number of in-brace radiographs was 18. The p value of the chi-square for requiring brace adjustment was 0.006 which was a statistically significant difference between the two groups. In the intervention group, the immediate in-brace correction as measured from radiographs was 48 ± 17%, and in the control group the first and second in-brace correction was 33 ± 19% and 40 ± 20%, respectively. The unpaired 2 sided Student’s t test of the in-brace correction was significantly different between the US and the first follow-up of the control group (p = 0.02), but was not significant after the second brace adjustment (p = 0.22).ConclusionsThe use of the 3D ultrasound system provided a radiation-free method to determine the optimum pressure level and location to assist brace design, resulting in decreased radiation exposure during follow-up brace evaluation, increased the in-brace correction, reduced the patients’ visits to both brace adjustment and scoliosis clinics. However, the final outcomes could not be reported yet as some of patients are still under brace treatment.Trial registration NCT02996643, retrospectively registered in 16 December 2016

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“…Bracing is frequently prescribed as a non-surgical treatment option to patients with idiopathic scoliosis and a spinal curvature greater than 20° Cobb. Notably, bracing is the only conservative approach with proven effectiveness in such condition [3-8]. Several factors may have influence the efficacy of brace treatment, including age, gender, bone maturity, prescribed hours of bracing, and curve pattern and magnitude.…”

Section: Introductionmentioning

confidence: 99%

Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner

et al. 2014

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BackgroundOver the last years, evidence has accumulated in support of bracing as an effective treatment option in patients with idiopathic scoliosis. Yet, little information is available on the impact of compliance on the outcome of conservative treatment in scoliotic subjects. The aim of the present study was to prospectively evaluate the association between compliance to brace treatment and the progression of scoliotic curve in patients with idiopathic adolescent (AIS) or juvenile scoliosis (JIS).MethodsAmong 1.424 patients treated for idiopathic scoliosis, 645 were eligible for inclusion criteria. Three outcomes were distinguished in agreement with the SRS criteria: curve correction, curve stabilization and curve progression. Brace wearing was assessed by one orthopaedic surgeon (LA) and scored on a standardized form. Compliance to treatment was categorized as complete (brace worn as prescribed), incomplete A (brace removed for 1 month), incomplete B (brace removed for 2 months), incomplete C (brace removed during school hours), and incomplete D (brace worn overnight only). Chi square test, T test or ANOVA and ANOVA for repeated measures tests were used as statistical tests.ResultsThe results from our study showed that at follow-up the compliance was: Complete 61.1%; Incomplete A 5.2%; Incomplete B 10.7%; Incomplete C 14.2%; Incomplete D 8.8%. Curve correction was accomplished in 301/319 of Complete, 19/27 Incomplete A, 25/56 Incomplete B, 52/74 Incomplete C, 27/46 Incomplete D. Cobb mean value was 29.8 ± 7.5 SD at beginning and 17.1 ± 10.9 SD at follow-up. Both Cobb and Perdriolle degree amelioration was significantly higher in patients with complete compliance over all other groups, both in juvenile, both in adolescent scoliosis. In the intention-to-treat analysis, the rate of surgical treatment was 2.1% among patients with definite outcome and 12.1% among those with drop-out. Treatment compliance showed significant interactions with time.ConclusionCurve progression and referral to surgery are lower in patients with high brace compliance. Bracing discontinuation up to 1 month does not impact on the treatment outcome. Conversely, wearing the brace only overnight is associated with a high rate of curve progression.

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Effects of Bracing in Adolescents with Idiopathic Scoliosis

Cited by 18 publications

References 16 publications

Mechanism of right thoracic adolescent idiopathic scoliosis at risk for progression; a unifying pathway of development by normal growth and imbalance

Mechanism of right thoracic adolescent idiopathic scoliosis at risk for progression; a unifying pathway of development by normal growth and imbalance

Results of ultrasound-assisted brace casting for adolescent idiopathic scoliosis

Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner

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