In-brace alterations of pulmonary functions in adolescents wearing a brace for idiopathic scoliosis

Abstract

Background: Despite the common use of braces to prevent curve progression in idiopathic scoliosis, their functional effects on respiratory mechanics have not been widely studied. Objective: The objective was to determine the effects of bracing on pulmonary function in idiopathic scoliosis. Methods: A total of 27 adolescents with a mean age of 14.5 ± 1.5 years and idiopathic scoliosis were included in the study. Pulmonary function evaluation included vital capacity, forced expiratory volume, forced vital capacity, maximum ventilator volume, peak expiratory flow, and respiratory muscle strengths, measured with a spirometer, and patient-reported degree of dyspnea. The tests were performed once prior to bracing and at 1 month after bracing (while the patients wore the brace). Results: Compared with the unbraced condition, vital capacity, forced expiratory volume, forced vital capacity, maximum ventilator volume, and peak expiratory flow values decreased and dyspnea increased in the braced condition. Respiratory muscle strength was under the norm in both unbraced and braced conditions, while no significant difference was found for these parameters between the two conditions. Conclusion: The spinal brace for idiopathic scoliosis tended to reduce pulmonary functions and increase dyspnea symptoms (when wearing a brace) in this study. Special attention should be paid in-brace effects on pulmonary functions in idiopathic scoliosis. Clinical relevance Bracing seems to mimic restrictive pulmonary disease, although there is no actual disease when the brace is removed. This study suggests that bracing may result in a deterioration of pulmonary function when adolescents with idiopathic scoliosis are wearing a brace.

Immediate Effects of Sforzesco® Bracing on Respiratory Function in Adolescents with Idiopathic Scoliosis

“…Similar results in a comparable group of patients were obtained after the Milwaukee and Boston brace application [5]. Recently, a study investigating the acute effect of a cTLSO (custom-made rigid thoracolumbosacral orthosis) bracing treatment in moderate AIS found a significant reduction of pulmonary function parameters, including VC, FEV1, FVC, MVV, and PEF, along with an increased perception of dyspnea [8].…”

“…Given current evidence, bracing has been incorporated in the guidelines and recommended as a first line treatment for management of AIS in patients with a Cobb angle above 20 • , or more likely between 20 • and 40 • [11,21]. Despite long-term efficacy of bracing treatment, several authors highlighted the possible disadvantages, including a short-term decrease in pulmonary function and maximal exercise performance limitations, especially in girls [5][6][7][8].…”

“…Similar to chest wall strapping that reduces thoracic distensibility and restricts lung volumes in normal subjects [4], brace wearing impairs respiratory mechanics [5,6] and results in a reduction of pulmonary function [7,8] and increased dyspnea perception [8].…”

A 10-Week Program of Combined Hippotherapy and Scroth’s Exercises Improves Balance and Postural Asymmetries in Adolescence Idiopathic Scoliosis: A Randomized Controlled Study

“…Despite the bracing treatment’s long-term success, several authors have pointed out potential downsides, such as a temporary reduction in pulmonary functions and restrictions in the maximum capacity of exercises, particularly in girls [ 61 , 62 ]. However, bracing was advised for the treatment of AIS, especially for individuals having a Cobb angle greater than 20°, or most commonly between 20 and 40° [ 63 , 64 ].…”

Response to letter to editor regarding ‘In-brace alteration of pulmonary functions in adolescents wearing a brace for idiopathic scoliosis’ by Yagci et al. (2019)

“…My coauthors and I thank the author(s) for their inquiry and remarks regarding our recent study reporting in-brace alteration of pulmonary functions in adolescents with idiopathic scoliosis. 1 Your comments highlight several important points that need to be clarified.…”