Infantile Idiopathic Scoliosis: Outcomes of Brace Treatment until Skeletal Maturity or Spinal Fusion.

Abstract

Serial casting under general anesthesia, which is considered as a gold standard of treatment for patients with infantile idiopathic scoliosis (IIS), can lead to significant negative neurodevelopmental effects. Therefore, the appropriateness of this type of treatment is controversial. Brace treatment is one alternative method of treatment for IIS patients. However, long-term studies have not yet verified its effectiveness. Thus, the present study aimed to evaluate the effectiveness of brace treatment in patients with IIS until skeletal maturity or spinal fusion. The medical records of all IIS patients with the referral age of 0-3 years who received brace treatment from June 1986 to November 2013 were reviewed. Those patients with pre-brace Cobb angle > 20° were included and followed up to skeletal maturity or the time of spinal fusion. The Cobb angle was recorded at the time of diagnosis before the initiation of bracing, weaning time, brace discontinuation, and final follow-up. In addition, the maximum in-brace curve correction was measured. Out of 87 patients with IIS, a total of 29 cases (19 males and 10 females) with the average curve magnitude of 35.62° at the time of diagnosis were included in the study. The average best in-brace correction was 57.32% for successfully treated patients and 36.97% for progression/surgery patients. Based on the results, brace treatment failed for a total of 20 patients (69%), with a scoliosis curvature progress ≥ 45°. Of these patients, 12 cases (60%) reached spinal fusion. Finally, four patients (13%) in the surgery-treated group underwent surgery before the age of 10. The results revealed that bracing was successful for more than two-thirds of patients with IIS curves, preventing surgery before the age of 10.