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Adolescent Scoliosis: Is Bracing Effective?

October 9, 2013

Adolescent Scoliosis: Is Bracing Effective?

  1. Martin T. Stein, MD

The amount of time spent wearing a brace was positively associated with treatment success.

  1. Martin T. Stein, MD

Idiopathic adolescent scoliosis develops in 3% of youth younger than 16 years, but only 0.3%–0.5% of cases progress to spine curves that require treatment. Curve progression <40 degrees typically stabilizes without long-term effects, and progression >50 degrees increases risk for progressive deformity, disc and joint degeneration, and neurological complications. Rigid thoracic-lumbar bracing is the most common nonoperative treatment to prevent progression >40 degrees, but studies of the effects of bracing are inconsistent.

In a multicenter study of 242 patients (age range, 10–15 years) with idiopathic adolescent scoliosis (Cobb angle for largest curve, 20–40 degrees), 116 agreed to be randomized to bracing or observation. The remaining 126 patients chose between bracing (71%) and observation. Treatment success rates (skeletal maturity without progression >50 degrees) were 72% in 146 patients treated with bracing and 48% in the 96 patients who were observed (odds ratio, 1.93). Daily duration of wearing a brace (determined by a temperature logger embedded in the brace) was positively related to treatment success: Success rates were >90% in patients who wore the brace for a mean of at least 12.9 hours daily and 41% in those who wore the brace for a mean of 0–6 hours daily.

Comment

Bracing led to spine curve progression <50 degrees significantly more often than no bracing. However, the results are limited because many eligible patients chose not to be randomized. Remarkably, 48% of patients in the observation group achieved treatment success status. Editorialists note that patients with idiopathic adolescent scoliosis are a heterogeneous group and suggest that future research focus on identifying those most likely to do well without treatment and those who might benefit most from bracing.

  • Disclosures for Martin T. Stein, MD at time of publication Consultant / advisory board BioBehavioral Diagnostics; OptumRx Speaker’s bureau Indiana University; Michigan State University; University of Wisconsin Grant / research support Eli-Lilly Editorial boards Journal of Developmental and Behavioral Pediatrics

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Reader Comments (1)

DANA ONIFER Physician, Family Medicine/General Practice, U.S. military

Considering that I am only looking at this abstract, shouldn't a prospective trial, such as this have results reported in risk reduction calculations, vs. odds ratio, which is typically used in case-controlled and retrospective studies?

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