The Outcome of Providence Nighttime Bracing in Adolescent Idiopathic Scoliosis

Abstract

Introduction Six years ago, the primary conservative treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing to nighttime bracing. The purpose of this study is to evaluate the effectiveness of nighttime bracing in AIS. Patients and Methods Patients diagnosed with AIS and skeletal immature. With an apex of the primary curve from TH7 and below and with a Cobb angel between 20 and 45 degrees. The patients were asked to wear the brace at least 7 8 hours per night. No other previous treatments were accepted and a follow-up at least 6 months out of brace. The brace treatment was continued until 2 years post menarche or for male at the expected adult height. Cross-measured X-rays were used to compare the primary Cobb angel, the in-brace correction and the outcome Cobb angel. A decreased outcome Cobb angle as well as the overcorrection of the curve measured in brace was recorded as zero. The brace treatment was considered failed if progression more than 5 degrees occurred and if surgery were performed. Results A total of 55 patients, 8 males and 47 females, with the mean age at 14 years (range, 11–16.5 years) and the mean primary Cobb at 31 degrees (range, 20–41 degrees) were included in this study. The mean time of treatment was 18 months (range, 5–59 months). After ended treatment, the mean Cobb angle was 28 degrees (range, 7–50 degrees), and we observed in average no progression of the curves. The end results were 11 failures (range, 6–15 degrees); equal 20% and of these 11 patients, 3 patients had surgery performed (5%). Conclusion The results show a good curve control and an acceptable 20% failure rate, which is equal to other studies. The progression of the curves is controlled acceptable, even with the larger curves included in this study. The providence brace is an excellent alternative to standard conservative treatment. Larger studies are needed to establish the relationship between embrace correction and curve progression.