Nighttime Bracing or Exercise in Moderate-Grade Adolescent Idiopathic Scoliosis

Abstract

ImportanceModerate-grade adolescent idiopathic scoliosis (AIS) may be treated with full-time bracing. For patients who reject full-time bracing, the effects of alternative, conservative interventions are unknown.ObjectiveTo determine whether self-mediated physical activity combined with either nighttime bracing (NB) or scoliosis-specific exercise (SSE) is superior to a control of physical activity alone (PA) in preventing Cobb angle progression in moderate-grade AIS.Design, Setting, and ParticipantsThe Conservative Treatment for Adolescent Idiopathic Scoliosis (CONTRAIS) randomized clinical trial was conducted from January 10, 2013, through October 23, 2018, in 6 public hospitals across Sweden. Male and female children and adolescents aged 9 to 17 years with an AIS primary curve Cobb angle of 25° to 40°, apex T7 or caudal, and skeletal immaturity based on estimated remaining growth of at least 1 year were included in the study. Dates of analysis were from October 25, 2021, to January 28, 2023.InterventionsInterventions included self-mediated physical activity in combination with either NB or SSE or PA (control). Patients with treatment failure were given the option to transition to a full-time brace until skeletal maturity.Main Outcomes and MeasuresThe primary outcome was curve progression of 6° or less (treatment success) or curve progression of more than 6° (treatment failure) seen on 2 consecutive posteroanterior standing radiographs compared with the inclusion radiograph before skeletal maturity. A secondary outcome of curve progression was the number of patients undergoing surgery up until 2 years after the primary outcome.ResultsThe CONTRAIS study included 135 patients (45 in each of the 3 groups) with a mean (SD) age of 12.7 (1.4) years; 111 (82%) were female. Treatment success was seen in 34 of 45 patients (76%) in the NB group and in 24 of 45 patients (53%) in the PA group (odds ratio [OR], 2.7; 95% CI, 1.1-6.6). The number needed to treat to prevent curve progression with NB was 4.5 (95% CI, 2.4-33.5). Treatment success occurred in 26 of 45 patients (58%) in the SSE group (OR for SE vs PA, 1.2; 95% CI, 0.5-2.8). Up to 2 years after the primary outcome time point, 9 patients in each of the 3 groups underwent surgery.Conclusions and RelevanceIn this randomized clinical trial, treatment with NB prevented curve progression of more than 6° to a significantly higher extent than did PA, while SSE did not; in addition, allowing transition to full-time bracing after treatment failure resulted in similar surgical frequencies independent of initial treatment. These results suggest that NB may be an effective alternative intervention in patients rejecting full-time bracing.Trial RegistrationClinicalTrials.gov Identifier: NCT01761305

The Efficacy of Night Bracing in the Treatment of Adolescent İdiopathic Scoliosis: A Systematic Review

“…After removing duplicate articles, a total of 89 articles were found between 1960 and February 2024. After abstract and full-text reviews, 20 studies (21 published articles) were included in our study (Figure 1) [13,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38]. The two included articles were from the same randomized controlled trial.…”

“…The two included articles were from the same randomized controlled trial. One included 6-month results from the same trial [33], and the other included the trial's full results [38]. The study characteristics are summarized in Table 1.…”

“…Most of the studies (14 studies) are retrospective studies with level IV evidence. Only one study from Sweden [33,38] is a randomized controlled study with level Ib evidence. In one study, the study design is not specified [12], and the others are uncontrolled prospective studies [13,20,23,25].…”

“…Overall, 1897 of these patients used a Providence or Charleston night brace. In a randomized controlled trial, 45 patients used a Boston brace at night [33,38]. In one study, a Boston brace was used in 168 patients, but it was reported that patients wore the brace for 12 to 13 h a day, but it is not clear at what time of day the brace was worn [30].…”

The New Modular Sforzesco Brace (Modular Italian Brace) Is as Effective as the Classical One: A Retrospective Controlled Study from a Prospective Cohort

“…Braces are recommended for moderate to severe idiopathic scoliosis during growth [1]. Good quality studies showed the efficacy of bracing to treat adolescents with idiopathic scoliosis (AIS) [4][5][6][7][8][9], and a Cochrane review summarized the current evidence [10]. Which brace has the best biomechanical action on the scoliotic spine is still unknown, but experts often link biomechanics to different brace designs [11].…”