Results of brace treatment of adolescent idiopathic scoliosis in boys compared with girls: a retrospective study of 102 patients treated with the Boston brace

Abstract

The aim of the study was to compare the results of brace treatment of adolescent idiopathic scoliosis (AIS) in male patients with matched female patients and to assess the effectiveness of bracing of boys in AIS and to discuss the results with published data. Between 1987 and 1995, 51 consecutive male patients with AIS were treated with the Boston brace. The patients were advised to wear the brace 23 h/day. The medical records of all patients were reviewed. Cobb angles and Risser signs were measured before bracing, in brace, at brace discontinuation and at final follow-up. Everyone of 51 male patients was compared with a female patient who was treated by the same method and matched by Risser sign, curve pattern, curve magnitude and duration of treatment and follow-up time. Compliance with brace was noted at every visit. Fourteen boys had worn the brace only during nighttime or occasionally and were considered non-compliant. Only compliant patients with treatment period > 1 year and follow-up > 1 year after treatment were accepted for the analyses of effectiveness of brace treatment and its prognostic factors. Thirty-three boys met these inclusion criteria. Bracing was considered to have a failure if > 5 degrees progression occurred or if surgery was performed. At the final follow-up study progression > 5 degrees was found in 16/51 (31.4%) of male patients. Corresponding figures of female patients were 11/51 (21.6%), respectively. In compliant boys progression > 5 degrees occurred in 6/33 boys compared with 9/33 girls. The association between risk of progression and correction% in brace was statistically significant. The overall results of brace treatment of idiopathic scoliosis in male patients were inferior compared with matched females. One reason for inferior overall results in boys was poor compliance with brace wear. However, brace treatment in AIS may be recommended with the same principles in both genders.

Brace Management in Adolescent Idiopathic Scoliosis

“…Similarly, 55% of curves measuring greater than 30°at brace prescription progressed to surgery or greater than 50°. Yrjonen et al [59] supported these results finding 35% of braced males were noncompliant. However, although compliant males progressed greater than 5°10% more frequently than the females (21%), they concluded brace treatment for idiopathic scoliosis was beneficial for both genders.…”

“…It is these characteristics that cause bracing in the overweight patient to be ineffective and lead to increased curve progression compared with patients who are not overweight [31,35]. Brace compliance was potentially responsible for the disparity of success between males and females treated with bracing [22,59] and may explain the similar results of noncompliant patients with the natural history. Numerous studies have demonstrated compliant brace wear leads to successful results, yet much of the data, as acknowledged by the authors, is subjective based on incomplete assessments of compliance such as office notes, questionnaires, or phone or office interviews [22,30,34,58].…”

Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

“…The duration for which the brace was to be worn was adjusted during each follow-up based on the Risser sign, the menarchal status in females, and whether the Cobb angle was stable compared with earlier data. If the curve remained stable (i.e., the change in the Cobb angle of the main curve was less than 5°) [15,20], the daily wearing time of the brace would not change for the first 6 months; rather, it would be shortened to 18 h per day for the next 6 months. The patients' scoliosis was considered to be worse if the Cobb angle increased by more than 6° [15,20].…”

“…If the curve remained stable (i.e., the change in the Cobb angle of the main curve was less than 5°) [15,20], the daily wearing time of the brace would not change for the first 6 months; rather, it would be shortened to 18 h per day for the next 6 months. The patients' scoliosis was considered to be worse if the Cobb angle increased by more than 6° [15,20]. If this occurred, then daily bracing time was maintained at 22 h per day.…”

“…If this occurred, then daily bracing time was maintained at 22 h per day. The scoliosis was thought to have improved if the Cobb angle decreased by more than 6° [15,20] or if the Risser grade was greater than 3 and/or if the females were more than 1 year after menarche in females; for these patients, daily bracing time was shortened by 2-4 h per day at each follow-up.…”