Nighttime Bracing Versus Observation for Early Adolescent Idiopathic Scoliosis

Abstract

Background:Spinal bracing is widely utilized in patients with moderate severity adolescent idiopathic scoliosis with the goal of preventing curve progression and therefore preventing the need for surgical correction. Bracing is typically initiated in patients with a primary curve angle between 25 and 40 degrees, who are Risser sign 0 to 2 and <1-year postmenarchal. The purpose of this study is to determine whether nighttime bracing using a Charleston bending brace is effective in preventing progression of smaller curves (15 to 25 degrees) in skeletally immature, premenarchal female patients relative to current standard of care (observation for curves <25 degrees).Methods:Premenarchal, Risser 0 female patients presenting to 2 pediatric orthopaedic specialty practices for evaluation of idiopathic scoliosis with Cobb angle measurements between 15 and 25 degrees were selected. They were randomized by location to receive nighttime bending brace treatment or observation. Patients in the observation group were converted to fulltime TLSO wear if they progressed to >25 degrees primary curve Cobb angle. Curve progression was monitored with minimum 2-year follow-up.Results:Sixteen patients in the observation group and 21 patients in the bracing group completed 2-year follow-up. All patients in the observation group progressed to fulltime bracing threshold. In the nighttime bracing group, 29% of the patients did not progress to 25 degrees primary curve magnitude. Rate of progression to surgical magnitude was similar in the 2 groups.Conclusions:Risser 0 patients presenting with mild idiopathic scoliosis are at high risk for progression to >25 degrees primary curve magnitude. Treatment with the Charleston nighttime bending brace may reduce progression to full-time bracing threshold. No difference in progression to surgical intervention was shown between nighttime bracing and observation for small curves.Level of Evidence:Level II—therapeutic study (prospective comparative study).

Rib-vertebral angle measurements predict brace treatment outcome in Risser grade 0 and premenarchal girls with adolescent idiopathic scoliosis

“…The main reason, we believe, could lie in the relative lower maturity status (premenarchal and Risser 0) of our cohort, which has been identified as one of the key risk factors in predicting curve progression [22,26]. Despite all this, in line with the study by Wiemann et al [13], the results of the current study provide sound evidence supporting that continuous brace treatment could effectively prevent curve progression in more than half of early AIS patients with premenarchal and Risser 0 status.…”

“…Lonstein and Winter [1] reported [24,25] reported the natural history of curve progression that nearly 70 % of IS patients with Risser 0 progressed greater than 5°for curves between 20°and 30°. Wiemann et al [13] evaluated the effectiveness of nighttime brace treatment for Risser 0 and premenarchal AIS patients, and reported that 29 % of them were maintained without curve progression. In our study, the incidence of progression of early AIS (premenarchal and Risser 0) was 38 % (18/48), similar to Lonstein and Winter [1], yet higher than that reported by Nachemson and Peterson [2].…”

“…In a study on early AIS patients presenting with a curve between 15 and 25 degrees, Wiemann et al [13] detected high risk of curve progression in non-treated cases, and proved the benefit of nighttime brace. Clinically, early AIS patients with a moderate curve are not uncommon, and would require early treatment with braces due to the high risk of progression.…”

“…Among the candidates of brace treatment, early AIS patients, characterized as the unique population with premenarche and Risser 0 [13], have been documented to progress most rapidly during the pubertal growth spurt. In a study on early AIS patients presenting with a curve between 15 and 25 degrees, Wiemann et al [13] detected high risk of curve progression in non-treated cases, and proved the benefit of nighttime brace.…”

Scoliosis surgery, predictors and outcomes in a tertiary care hospital, Riyadh, KSA

“…A study in patients with adolescent idiopathic scoliosis (AIS) showed that patients with bracing have less progressive scoliosis when compared to observation group [8] . Another study by Wiemann et al showed the same results [9] . These results have demonstrated the importance of intervention for further prevention of scoliosis progression.…”