Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

Abstract

Summary of background data The curve pattern of idiopathic scoliosis is important for making decisions concerning bracing. However, whether the curve pattern changes during brace treatment have not been fully documented. The aim of this study was to investigate the changes of curve pattern during brace treatment in skeletally immature patients with adolescent idiopathic scoliosis (AIS). MethodsFrom January 2002 to January 2011, AIS patients treated with a Boston or Milwaukee brace were recruited after meeting the following inclusion criteria: older than 10 years of age at initiation of bracing; having a Cobb angle of 25°-40°; with a Risser sign 0-2; being regularly followed until the weaning of brace or the necessity of surgical treatment; and without history of previous treatment. A total of 130 female and 11 male AIS patients were included. The mean age was 12.9 years at initiation of bracing, and the female patients were, on average, 2.7 months past menarche. The mean follow-up period was 2.6 years (range 1.0-5.5 years). The definitions of changes in curve patterns were divided into four categories as follows: (1) shift of the apex of the main curve; (2) change in the curve span of more than two vertebrae; (3) change in the main curve type with regard to the apex location; and (4) change of curve direction. The patients were divided into two groups. Group A was comprised of patients who had experienced one or more categories of curve pattern changes, and Group B was comprised of those who had not. Results Of these 39 patients, 14 had apex shifting, 2 underwent curve span changes, 22 experienced changes in the main curve type, and one female had both changes in the apex and curve span. At the initiation of bracing, patients in Group A demonstrated significantly lower menarchal status (P = 0.018) and lower Risser grade (P = 0.025) than those in Group B. The difference in the percentage of patients who underwent Boston bracing between the two groups was statistically significant (41.5 % for Group A vs. 24.0 % for Group B, P = 0.023). Conclusion Changes in curve pattern can occur during brace treatment. Patients with less skeletal maturity and those treated with a Boston brace are more susceptible to this phenomenon.

Does brace treatment impact upon the flexibility and the correctability of idiopathic scoliosis in adolescents?

“…It is best to explain to the parents the therapeutic options as well as our concerns about the limitation of our knowledge about the efficacy of the braces, and to provide with the most thorough information regarding treatment cost for both the brace and surgery if necessary. Despite all this, the results of our study do not show any negative influence on the recommendations of brace treatment for an eligible candidate with AIS, due to the sound evidence of effectiveness of brace treatment [10,14,17,19,34,35]. Also, notable in this study is how the impact of brace treatment on AIS patients differed slightly between diverse curve patterns, appearing less visible in a main thoracic curve.…”

“…Currently, the standard of care for AIS patients includes the following options: observation, for patients with a small curve or skeletal maturity; brace treatment, for those with a mild or moderate curve and skeletal immaturity; and surgical correction, for those with a severe curve [2]. Until now, brace treatment has served as a vital non-surgical procedure for immature AIS patients with a mild or moderate curve, because bracing can effectively halt curve progression and prevent surgical intervention in some cases [17,19,23,31,34,35]. To date, several types of brace devices have been developed, such as the Milwaukee [17], Boston [19], Charleston [25], Providence [32], Rosenberger [24], Wilmington [1] and Chêneau [34].…”

Very short-term effect of brace wearing on gait in adolescent idiopathic scoliosis girls

“…Most studies deal with the effect of the brace treatment regarding the evolution of frontal [35] and/or sagittal [26] spinal curve patterns and pelvic tilt [7], compliance [1] or changes in daily activities [21].…”

Evaluation of the influences of various force magnitudes and configurations on scoliotic curve correction using finite element analysis

“…The amount of correction which may be achieved by an orthosis depends upon the location of the curve, the type of curve (single or double) and the duration of orthotic use [13][14][15]. Correction is achieved through application of individually designed force configurations within the orthosis.…”