Brace Treatment For Adolescent Idiopathic Scoliosis Research Articles

Discontinuation of brace treatment in adolescent idiopathic scoliosis (AIS): a scoping review.

Brace treatment for adolescent idiopathic scoliosis (AIS) is usually prescribed for 20-40° curves in patients with growth potential. The aim is to reduce the risk of curve progression during growth and to avoid the curve reaching a surgical threshold. Having as small a curve as possible at skeletal maturity will reduce the risk of curve progression during adult life. While evidence exists for brace treatment in AIS, there is disagreement on how and when to discontinue bracing. The purpose of this review was to investigate what criteria have been reported for initiating brace cessation and published weaning protocols and to look at estimates of the number of patients that may progress > 5 degrees after the end of growth. This scoping review summarizes existing knowledge on the best time to stop bracing in AIS patients, how to "wean," and what happens to spinal curves after bracing. Searches were carried out through MEDLINE, EMBASE, and PsycINFO in April 2022. A total of 1936 articles were reduced to 43 by 3 reviewers. Full papers were obtained, and data were extracted. Weaning was most commonly determined by Risser 4 (girls) and 5 (boys). Other requirements included 2years post-menarche and no growth in standing/sitting height for 6months. Skeletal maturity assessed from hand and wrist radiographs, e.g., Sanders' stage; distal radius and ulnar physes, could determine the optimal weaning time to minimize curve progression. Complete discontinuation was the most common option at skeletal maturity; variations on weaning protocols involved gradual reduction of bracing over 6-12months.Curve progression after weaning is common. The 12 studies reporting early curve progression after brace weaning found a mean Cobb angle progression of 3.8° (n = 1655). From the seven studies reporting early curve progression by > 5 degrees, there were 236/700 (34%) patients. There is limited information on risk factors to predict early curve progression after finishing brace treatment with larger curves, especially those over 40 degrees possibly having more chance of progression. Curve progression after bracing cessation is a negative outcome for patients who have tolerated bracing for several years, especially if surgery is required. The literature shows that when to start brace cessation and weaning protocols vary. Approximately 34% of patients progressed by more than 5 degrees at 2-4years after brace cessation or weaning. Larger curves seem more likely to progress. More research is needed to evaluate the risk factors for curve progression after brace treatment, defining the best time to stop bracing based on the lowest risk of curve progression and whether there is any benefit to weaning.

Methodology and application of three-dimensional technology for brace design and production for treatment in patients with adolescent idiopathic scoliosis: a scoping review protocol

IntroductionConservative treatment for adolescent idiopathic scoliosis (AIS) using bracing has proven to be effective at reducing curve progression. However, variation in brace design and lack of brace specificity hamper clinical...

The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis.

Brace treatment is the most common noninvasive treatment in adolescent idiopathic scoliosis (AIS); however it is currently not fully known whether there is a difference in effectiveness between brace types/concepts. All studies on brace treatment for AIS were searched for in PubMed and EMBASE up to January 2021. Articles that did not report on maturity of the study population were excluded. Critical appraisal was performed using the Methodological Index for Non-Randomized Studies tool (MINORS). Brace concepts were distinguished in prescribed wearing time and rigidity of the brace: full-time, part-time, and night-time, rigid braces and soft braces. In the meta-analysis, success was defined as ≤5° curve progression during follow-up. Of the 33 selected studies, 11 papers showed high risk of bias. The rigid full-time brace had on average a success rate of 73.2% (95% CI 61–86%), night-time of 78.7% (72–85%), soft braces of 62.4% (55–70%), observation only of 50% (44–56%). There was insufficient evidence on part-time wear for the meta-analysis. The majority of brace studies have significant risk of bias. No significant difference in outcome between the night-time or full-time concepts could be identified. Soft braces have a lower success rate compared to rigid braces. Bracing for scoliosis in Risser 0–2 and 0–3 stage of maturation appeared most effective.

Can I Stop Bracing Now? Utilizing Hand X-rays as Standalone Criterion for Discontinuation of Bracing in Adolescent Idiopathic Scoliosis

Category/Date Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Pediatric Research: Chronic Illness, Presented at NAPNAP's 40th National Conference on Pediatric Health Care, March 8, 2019, New Orleans, LA. Purpose The purpose of this study is to determine if Sanders maturation stage 7 can be utilized as a stand-alone criteria for discontinuation of a thoracolumbosacral orthosis (TLSO) in adolescent idiopathic scoliosis (AIS). Background TLSO, or “bracing,” is a common treatment modality offered to skeletally immature patients with AIS. Maturation markers such as Risser sign on pelvis x-ray, growth velocity, time from first menses and curve stability are common factors utilized to determine end of brace treatment. However, these methods can be fraught with variability. The Sanders classification is a simplified, reliable bone age classification system that correlates strongly with the behavior of idiopathic scoliosis. Methods Inclusion criteria consisted of brace treatment in AIS measuring between 25 and 40 degrees, main cobb curve remaining Results Seventy-five patients (71 female [94.7%]; mean age 12.72 years) met the criteria. Main Cobb angle at brace application was 28.60°±4.38°. Forty-two patients had at least a one-year minimum follow up post treatment. One year after discontinuing the brace, eight patients (19%) increased 5 or more degrees (5°, 6°, 7°, 8°) above their largest curve measurement during treatment. Mean progression one-year post brace discontinuation was 2.28°±1.23°. Final mean Cobb angle measured 32.07° for the group. Two patients in the group had a Cobb measurement above 40° at one year after treatment. No significant difference in Cobb angle was found between pre brace measurements and end of brace treatment, nor between the end of brace treatment and at final follow up. No patient in the group progressed to surgical intervention. Discussion Eight patients (19%) increased more than 4° one year after the end of brace treatment, but no patient progressed to a curve that necessitated surgical intervention. Sanders maturation stage 7 may be useful as a stand-alone criterion for termination of brace treatment in AIS.

Outcomes of brace treatment for Adolescent Idiopathic Scoliosis - factors affecting the results of the treatment

Background Controversies still exist regarding the effectiveness of brace treatment for adolescent idiopathic scoliosis (AIS). Purpose The goal of this study was to analyze the outcomes of brace treatment for AIS and to clarify the factors affecting the results of the treatment. Methods According to the Scoliosis Research Society (SRS) AIS brace studies standardization criteria, the following conditions were used to determine which patients to include in this study: aged 10 years or older, Risser 0-II, primary curve magnitude 25°-40° and no prior treatment when the brace was subscribed. At skeletal maturity, the percentage of patients whose curve progressed more than 6°, whose curve exceeded 45° or who underwent surgery was investigated. These results were compared with natural history or other brace studies. Factors affecting the results were analyzed. Results

Bracing in adolescent idiopathic scoliosis.

The article reviews the present knowledge about brace treatment for adolescent idiopathic scoliosis (AIS). Indications, technique, problems, and results, are presented based on the literature. It is stressed by the authors that more scientific evidence is needed to reach a final conclusion whether brace treatment in AIS is effective or not.

The effect of time on qualitative compliance in brace treatment for AIS

Brace treatment is the most commonly used non-surgical treatment method for adolescent idiopathic scoliosis (AIS). This study is to determine the force changes exerted by a brace over time during both day and night-time wear and to explore correlations between force changes to bracing outcomes. Twenty subjects (three male, 17 female) diagnosed with idiopathic scoliosis who had worn their braces for six months participated into this study. However, due to non-continuous brace wear and exclusion of subjects with large curves (Cobb angle >40 degrees), only nine subjects were included into the day-time analysis and 11 subjects were included into night-time analysis. All subjects used a load monitor system from four days up to 14 days with Boston braces. Cobb angle measurements were taken at initiation of brace treatment as well as after weaning upon completion of the treatment. After the monitoring period, the data was extracted and analyzed. Forces were compared between hours 1, 2, and 5 for the day and night groups, and the correlation of force changes to bracing outcomes were analyzed. In daytime wear, a significant decrease in force over time was found. Most of the decrease occurred within hours 1 and 2 of brace wear. There was no significant decrease during night wear. There were no significant correlations between force decline and outcome.

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

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.