Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure

Isabel Alvarez,Lori Karol,Amy L Mcintosh,Kiley Poppino

doi:10.1186/s13018-021-02650-9

Abstract

BackgroundIn-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not.MethodsAll skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation.ResultsNinety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014).ConclusionsPatients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays.Trial registrationClinicalTrials.gov—NCT02412137, initial registration date April 2015Level of evidenceIII

Highlights

In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS)
It has been shown that a brace dose-response curve exists in AIS patients, in which increasing hours of daily brace wear correlates with increased rates of success
Patients with inconsistent in-brace correction documentation tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014). They were 3.1 times more likely to fail bracing than patients who were consistently followed with in-brace x-rays

Summary

Introduction

In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). It has been shown that a brace dose-response curve exists in AIS patients, in which increasing hours of daily brace wear correlates with increased rates of success. Studying a compliant population has become essential to understanding what factors associated with the brace itself are correlated with successful nonoperative management. In-brace correction is a value measuring the percent decrease in curve magnitude while the patient wears his or her brace compared to the curve magnitude without the brace. Braces that correct the scoliotic curve by at least 40–50% have been shown to stabilize or improve curves while braces that lead to less than 10% correction have been associated with an increased risk of brace failure [6, 10]

Methods

Results

Conclusion