Nighttime Bracing Research Articles

Initial experience with the providence nighttime bracing in adolescent idiopathic scoliosis

Aim To evaluate the effectiveness of nighttime bracing in AIS. Methods: Inclusion criteria were patients diagnosed with AIS and skeletal immature. With an apex of the primary curve from TH7 and below and with a Cobb angel between 2045 degrees. The patients were asked to wear the brace at least 7-8 hours pr. night. No other previous treatments were accepted and a follow up at least 6 months out of brace. The brace treatment was continued until two 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 > 5 degrees occurred and if surgery were performed.

Effectiveness of Providence nighttime bracing in patients with adolescent idiopathic scoliosis.

Interest has increased in adolescent idiopathic scoliosis braces that are worn only part time. One such brace, the Providence brace, is being used with increasing frequency despite limited literature evaluating its ability to alter the natural course of disease. The authors retrospectively identified 34 patients meeting modified Scoliosis Research Society (SRS) inclusion criteria who were treated with the Providence brace. In accordance with SRS criteria, patients were followed for progression more than 5°, progression to more than 45°, and recommendation for or performance of surgical fusion. Seventeen (50%) patients progressed more than 5°, and 9 (26%) progressed to more than 45° and had fusion surgery recommended or performed. Noncompliance was associated with progression to more than 45° (P=.045) and having fusion surgery recommended or performed (P=.045). Males had a higher rate of progression more than 5° than did females (100% vs 41%; P=.015). This is only the second study of the Providence brace to be guided by SRS criteria. The somewhat higher rates of progression more than 5° reported in these 2 studies compared with those reported in earlier studies likely result from this distinction. This study suggests a rate of progression that is similar to or lower than rates reported in natural history studies, possibly supporting the efficacy of the Providence brace. Additional studies using SRS criteria, including high-quality randomized, controlled trials, will be important to further understanding the relative effectiveness of this and other bracing protocols.

Detorsion night-time bracing for the treatment of early onset idiopathic scoliosis

BackgroundManagement for early onset scoliosis has recently changed, with the development of new surgical procedures. However, multiple surgeries are often required and high complication rates are still reported. Conservative management remains an alternative, serial casting achieving excellent results in young children. Better compliance and improvement over natural history have been reported with night-time bracing in adolescent idiopathic scoliosis (AIS), but this treatment has never been reported in early onset idiopathic scoliosis (EIOS). MethodsAll patients treated for progressive EOIS by detorsion night-time bracing (DNB), and meeting the Scoliosis Research Society (SRS) criteria for brace studies were reviewed. Recommendations were given to wear the DNB 8h/night and no restriction was given regarding sports activities. Radiological parameters were compared between referral and latest follow-up. Based on the SRS criteria defined for AIS, a similar classification was used as follows to analyze the course of the curves: success group: patients with a progression of 5° or less; unsuccess group (progression or failure): patients with a progression>5°, patients with curves exceeding 45° at maturity, or who have had recommendation for/undergone surgery, or patients who changed orthopaedic treatment, or who were lost to follow-up. ResultsThirty-three patients were included (21 girls and 12 boys), with a median Cobb angle of 31° (Q1–Q3: 22–40). Age at brace initiation averaged 50months (Q1–Q3: 25–60). Median follow-up was 102–months (Q1–Q3: 63–125). Fifteen patients (45.5%) had reached skeletal maturity at last follow-up. The success rate was 67% (22 patients), with a median Cobb angle reduction of 15° (P<0.001). Four patients stopped DNB due to an important regression. Eleven patients were in the unsuccessful group (33%). Only one had surgery. All patients remained balanced in the frontal plane and normokyphotic. Initial curve magnitude and age at brace initiation appeared to be important prognostic factors. ConclusionsDNB is an effective conservative treatment, which can be considered a delaying tactic in the management of EOIS. This brace offers potential psychosocial and compliance benefits, and allows unconstrained spinal and chest wall growth, resulting in normokyphosis at maturity. Level of evidenceTherapeutic study (retrospective consecutive case series): Level IV.

CORR Insights®: Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review

This CORR Insights® is a commentary on the article “Results of Clubfoot Management Using the Ponseti Method: Do the Details Matter? A Systematic Review” by Zhao and colleagues available at: DOI: 10.1007/s11999-014-3463-7. The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®. This CORR Insights® comment refers to the article available at doi:10.1007/s11999-014-3463-7.

CONTRAIS: CONservative TReatment for Adolescent Idiopathic Scoliosis: a randomised controlled trial protocol

BackgroundIdiopathic scoliosis is a three-dimensional structural deformity of the spine that occurs in children and adolescents. Recent reviews on bracing and exercise treatment have provided some evidence for effect of these interventions. The purpose of this study is to improve the evidence base regarding the effectiveness of conservative treatments for preventing curve progression in idiopathic scoliosis.Methods/designPatients: Previously untreated girls and boys with idiopathic scoliosis, 9 to 17 years of age with at least one year of remaining growth and a curve Cobb angle of 25–40 degrees will be included. A total of 135 participants will be randomly allocated in groups of 45 patients each to receive one of the three interventions.Interventions: All three groups will receive a physical activity prescription according to the World Health Organisation recommendations. One group will additionally wear a hyper-corrective night-time brace. One group will additionally perform postural scoliosis-specific exercises.Outcome: Participation in the study will last until the curve has progressed, or until cessation of skeletal growth. Outcome variables will be measured every 6 months. The primary outcome variable, failure of treatment, is defined as progression of the Cobb angle more than 6 degrees, compared to the primary x-ray, seen on two consecutive spinal standing x-rays taken with 6 months interval. Secondary outcome measures include the SRS-22r and EQ5D-Y quality of life questionnaires, the International Physical Activity Questionnaire (IPAQ) short form, and Cobb angle at end of the study.DiscussionThis trial will evaluate which of the tested conservative treatment approaches that is the most effective for patients with adolescent idiopathic scoliosis.Trial registrationNCT01761305

Effectiveness of the Charleston Night-time Bending Brace in the Treatment of Adolescent Idiopathic Scoliosis

Part-time or night-time bracing has been introduced to address the poor compliance and psychological burden of full-time bracing. The results of various bracing methods vary, however, due to a lack of consistent inclusion criteria and definitions of brace effectiveness. We have evaluated the effectiveness of the Charleston night-time bending brace in the treatment of adolescent idiopathic scoliosis based on the new standardized criteria proposed by the Scoliosis Research Society. To be included in this study, patients met the following criteria proposed by the Scoliosis Research Society: diagnosis of adolescent idiopathic scoliosis, age 10 years and older when the orthosis was prescribed, Risser 0-2, a primary curve magnitude of 25 to 40 degrees, and no prior treatment. A total of 95 patients (87 girls, 8 boys) were included. At skeletal maturity, 80 patients (84.2%) had 5 degrees or less curve progression and 15 (15.8%) had 6 degrees or more progression. Seven patients (7.8%) were recommended to undergo or underwent surgery before skeletal maturity. Eleven patients (12.6%) progressed beyond 45 degrees. According to these 3 criteria, the Charleston night-time brace was successful in 74 patients (77.9%). Depending on curve type, we observed success rates of 78.3% (47/60) for double, 71.4% (15/21) for thoracic, 83.3% (5/6) for thoracolumbar, and 87.5% (7/8) for lumbar curves. Success rates of 80.0% (36/45) and 76.0% (38/50) were observed in patients with curve magnitudes at bracing of 25 to 30 degrees and 31 to 40 degrees, respectively. Patients with high apex curves had a 67.6% (23/34) success rate, and those with low apex curves had 83.0% (39/47) success rate. Brace success rates among patients with initial Risser signs of 0, 1, and 2 were 68.8% (22/32), 80.6% (25/31), and 84.4% (27/32), respectively. Compared with the results of previous natural history and conventional brace study, the Charleston night-time bending brace is effective for the treatment of adolescent idiopathic scoliosis. Level VI.

Brace Treatment Resulting in Overcorrection of Adolescent Idiopathic Scoliosis

Brace treatment for idiopathic scoliosis in skeletally immature children is the only effective nonoperative modality for the control of curve progression. The Charleston bending brace is a custom-molded spinal orthosis that holds the patient in a completely corrected or overcorrected position while worn at night. A 9-year-old girl presented with 10° right upper thoracic and 7° left lower thoracic curves and was Risser sign 0. Nighttime treatment with a Charleston bending brace was initiated when the left lower thoracic curve progressed to 19°. After 27 months of nighttime brace wear, the lower thoracic curve was 21° to the right. Further investigation, including magnetic resonance imaging of the spine, failed to diagnose an identifiable explanation for this atypical occurrence. Conservative treatment may improve radiographic and cosmetic appearance. Overcorrection of the curve, although not likely, is possible when part-time or nighttime bracing is implemented as a means of conservative management.

Early night-time-bracing – an alternative in AIS management

As a result of physical and psychological stress we often find very weak compliance for traditional Scoliosis Full-Time-Bracing (FTB) in comparison to Night-Time-Bracing (NTB) [1]. The investigation tries to find out whether or not Early Night-Time-Bracing (ENTB, 16-25 COBB) can effectively stop AIS progression and prevent Full-Time-Bracing.

Hat die Nachtorthese in der Skoliosetherapie noch eine Berechtigung?

The aim of our investigation was to evaluate the effectiveness of isolated night-time treatment in idiopathic scoliosis. Twenty-two children (average age 11.9 years; range 5-12 years) underwent treatment with the "Dresdner night-time brace." We indicated brace treatment in all children with a Cobb angle of 20-25 degrees and also in those with an angle of 15-19 degrees in cases of progression. Over a follow-up period of 25 months, clinical and radiological observations were made. A primary correction of 82.2% was obtained. The mean Cobb angle in an upright position without orthosis before treatment was 20.2 degrees. At the end of treatment, this angle reached 15.8 degrees. Operations were able to be avoided completely. In only three cases with radiographic progression (development of angles >25 degrees), part-time bracing had to be stopped and changed to full-time bracing. We observed an overall success rate of 86.4% (patients with improved Cobb angles or halted progression). We were able to show a positive effect of part-time bracing in selected patients with mild scoliosis and a higher risk of progression. The negative medical and psychosocial consequences of 23-h brace treatment can therefore be avoided in certain patients.

Changing a "progressive" factor into a "corrective" factor: the effect of intervertebral disc modulation in treatment of idiopathic scoliosis

Background The rationale for management of scoliosis during skeletal growth assumes a biomechanical mode of deformity progression, based on the Hueter-Volkmann principle, whereby extra axial compression decelerates growth and reduced axial compression accelerates it. Wedging of the intervertebral disc (IVD) is known to contribute to the progression of idiopathic scoliotic (IS) curves. This report illustrates the effect of IVD modulation and its subsequent benefits in IS treatment. The proposed model is examined on conservative treatment (fulland night-time braces and exercises) and fusionless IS surgery with staples.

Early night-time-bracing – an alternative in scoliosis management

Methods We present the results of 22 early treated scoliosis patients, treated all with a Dresdner night-time brace at one institution. The average age was 11.9 years and the average follow up was 24.9 months after brace discontinuation. Treatment was considered successful if there was improvement in the curve or up to a maximum progression of 5° and if there was no progression above an absolute value of 25° COBB.

Night-time braces for treatment of Adolescent Idiopathic Scoliosis

Purpose. This review article aims at providing an update on the basic science and clinical information underlying the use of nocturnal braces for adolescent idiopathic scoliosis.Method. The National Institutes of Health online medical database (Medline) was used to retrieve all articles pertinent to clinical research on night-time bracing; data were also collected from manufacturing companies. Additional information was obtained from literature on pathomechanics of scoliosis.Results. The cardinal feature of night-time braces lays in their ability to hypercorrect the scoliotic curvature, thereby eliminating the asymmetric water accumulation that occurs in the apical and adjacent intervertebral discs. Previously wedge-shaped discs resume a nearly cylindrical configuration, thus restoring a close-to-normal force application to the endplates through the Hueter-Volkmann principle and preventing curve progression. The two night-time braces mostly used hypercorrect the spine through different mechanisms.Conclusions. On the basis of clinical results available, night-time braces constitute an attractive option for single-major lumbar/thoracolumbar curves not exceeding 35° in magnitude. Multi-center, randomized studies using strict criteria set forth by the Scoliosis Research Society (SRS) and the Society on Spinal Orthopaedic and Rehabilitation Treatment (SOSORT) are needed to better define the role of nocturnal bracing in the conservative treatment of adolescent idiopathic scoliosis.

A Randomized Trial to Assess the Efficacy of Nighttime Bracing for Rotator Cuff Tendinopathy

Shoulder pain is a common presentation in the primary care setting. Standardized assessment and treatment protocols for the most part are not validated. PURPOSE: The purpose of this study was to assess the efficacy of a nighttime brace in the treatment of rotator cuff tendinopathy in a primary care setting. METHODS: Following IRB consent, 23 patients diagnosed with rotator cuff tendinopathy were randomized to nighttime treatment with a brace to limit active abduction to 5 degrees (n=11) or no brace (n=12). Inclusion criteria included shoulder pain of at least 1 month duration, 25–65 yrs of age, nighttime shoulder pain, no recent shoulder/neck trauma. All subjects were recruited from a primary care setting. Exclusion criteria included no history of upper extremity DVT, hypercoagulable state, or steroid injection of the shoulder during the one month study. Patients were instructed on a home PT program or formal PT and use of medication was monitored. The primary outcome variable was the Simple Shoulder Test (SST), a shoulder function scale consisting of 12 items that ask people about their ability to tolerate or perform 12 activities of daily living (ADL)1. Subjects were interviewed 7 and 28 days post initial evaluation to determine change in SST score. Data were analyzed with by an ANOVA with repeated measures. RESULTS: All 23 subjects completed the study. Self-reported medication use was similar between the two groups. Self report of compliance with PT was the same between the two groups. All subjects in the brace group showed an improvement in their SST score. Sixty-four percent reported at least a 25% improvement in their SST score. Six of the twelve patients in the no brace group reported no improvement in their symptoms or SST score. The improvement was greater for the brace group than the no brace group at 28 days (p<0.05). Conclusions: This study suggests that nighttime use of a brace to limit shoulder abduction is useful in patients with a clinical diagnosis of rotator cuff tendinopathy. Future studies should address longer term outcomes and if the current findings can be extended across various patient populations and clinical settings.

Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: a comparative study of 36 female patients

The aim of the study was to assess the results of treatment of adolescent idiopathic scoliosis (AIS) with the Providence nighttime brace at 1.8 years after discontinuation of bracing. A total of 36 consecutive female patients with an average Cobb angle of 28.4 degrees and an apex below T 10 were studied prospectively. For comparisons, 36 matched patients treated with the Boston full-time brace were studied retrospectively. With the Providence night brace an average of 92% for brace correction of the primary curve was achieved and during follow-up progression of the curve >5 degrees occurred in 27% of the patients. In the control group of the Boston full-time brace patients, brace correction was 50% and the progression of the major curve occurred in 22% of the patients. We conclude that the Providence night brace may be recommended for the treatment of AIS with curves less than 35 degrees in lumbar and thoracolumbar cases.

Nighttime Bracing for Adolescent Idiopathic Scoliosis with the Charleston Bending Brace: Long-Term Follow-up

We report long-term experience with the Charleston Bending Brace for treatment of adolescent idiopathic scoliosis. This brace holds the patient in maximal side-bending correction and is worn at nighttime only. Patients included in this prospective multicenter study met all of the following criteria: skeletal immaturity (Risser 0, 1, or 2), curvature >25 degrees before bracing, no prior treatment, and >1-year follow-up since completion of bracing (skeletal maturity or progression to surgery). All curves were monitored and reported. There were 149 structural curves in 98 patients. Sixty-five (66%) patients showed improvement or <5 degrees change in curvature. Seventeen (17%) patients progressed to the point of requiring surgery for their scoliosis. Based on these long-term results and improvement of the natural history of adolescent idiopathic scoliosis, continued use of the Charleston Bending Brace is justified.

脳性麻ひ股関節亜脱臼に対する筋解離術の冶療経験

Release surgery of soft tissues including the iliopsoas, adductor muscle of the hip, hamstring and Achilles' tendon has been performed for subluxation in patients with cerebral palsy. This retrospective study evaluated 47 hips in 31 patients with cerebral palsy. Results were analyzed a mean of four years after procedures with assessment of their locomotion, migration percentage, sharp angle and center edge angle. Locomotion improved in 24 (71%) of the 31 cases. Postoperatively 19 patients night-time bracing, had a significantly improved migration percentage, and center edge angle. This treatment is useful for treating hip subluxation in spastic cerebral palsy patients.

Nighttime Bracing for Adolescent Idiopathic Scoliosis with the Charleston Bending Brace

The authors report their preliminary experience with the Charleston bending brace for the treatment of adolescent idiopathic scoliosis. This brace holds the patient in the position of maximum side bend correction and is worn only at night. Patients in this prospective multicentered study met all the following criteria: skeletal immaturity (Risser 0, 1+, or 2+), curvature greater than 25 degrees before bracing, no prior treatment, and greater than 1-year follow-up since initiation of treatment. There were 191 structural curves in the 139 patients. One hundred fifteen patients (83%) showed improvement or less than 5 degree change in curvature. Twenty-four patients (17%) demonstrated an increase in curvature greater than 5 degrees. Based on these preliminary results, continued use of bending brace treatment at nighttime only is justified for adolescent idiopathic scoliosis. Patients with double curves should be observed closely for increase in compensatory curves.