Effectiveness of Bracing in Male Patients With Idiopathic Scoliosis

Abstract

Bracing of male patients with idiopathic scoliosis is ineffective. Curves measuring > or =30 degrees are very likely to progress to surgery, especially in immature patients.

Brace Management in Adolescent Idiopathic Scoliosis

“…Brace compliance was potentially responsible for the disparity of success between males and females treated with bracing [22,59] and may explain the similar results of noncompliant patients with the natural history. Numerous studies have demonstrated compliant brace wear leads to successful results, yet much of the data, as acknowledged by the authors, is subjective based on incomplete assessments of compliance such as office notes, questionnaires, or phone or office interviews [22,30,34,58]. Thus, this has led some to doubt the efficacy of bracing and the need for objective compliance measures [51].…”

“…Poor compliance with wear schedules is a major recurring theme in the braced patient, particularly males. Karol [22] found only 38% of males were compliant with brace wear, and 74% progressed 6°with nearly half reaching a surgical threshold of 50°. Immature Risser status related to both progression and surgery with greater than 80% progressing a minimum 6°and half reaching surgery.…”

“…It is these characteristics that cause bracing in the overweight patient to be ineffective and lead to increased curve progression compared with patients who are not overweight [31,35]. Brace compliance was potentially responsible for the disparity of success between males and females treated with bracing [22,59] and may explain the similar results of noncompliant patients with the natural history. Numerous studies have demonstrated compliant brace wear leads to successful results, yet much of the data, as acknowledged by the authors, is subjective based on incomplete assessments of compliance such as office notes, questionnaires, or phone or office interviews [22,30,34,58].…”

Idiopathic scoliosis: Etiological concepts and hypotheses

“…Higher rates of atypical curves and failure of bracing treatment have been reported in male patients [25,62]. A genomic screening study of chromosome 17 in a subgroup of families in which affected males had undergone surgery showed that a specific genetic locus (d17s975 and d17s2196) was significantly associated with the familial IS phenotype [13].…”

Professional Opinion Concerning the Effectiveness of Bracing Relative to Observation in Adolescent Idiopathic Scoliosis

“…Several uncontrolled retrospective case series of braced patients have been published; those reporting surgical rates demonstrate widely varying outcomes ranging from 7% to 43%. [10][11][12][13][14][15][16][17][18][19][20][21][22] Two studies have simultaneously compared untreated and braced curves. 2,3 Fernandez-Feliberti et al 2 reported a 26% surgery rate in the braced cases compared with 38% in the observed cases.…”