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View Full Version : Brace Treatment Controls Progression in Adolescent Idiopathic Scoliosis - (The Proof)



Ballet Mom
12-01-2010, 02:13 PM
Here is a video of the lecture presented at the latest POSNA meeting by John A. Herring, MD of Texas Scottish Rite Hospital for Children.

It shows that bracing is effective if worn for enough hours each day and has some very interesting insights including:


Success Rates (progession <6 degrees):

>12 hours of wear per day - 82%

7-12 hours per day - 61%

<7 hours per day - 32%


Flexibility of the curve did not seem to alter the success rate or the frequency with which the brace was worn!


72 patients did not have surgery, average wear 8.1 hours per day!

28 patients had surgery, average wear of 4.3 hours per day.


Whether the patients were told to wear the brace 23 hours per day or 16 hours per day didn't matter, both groups ended up wearing the brace the same average total number of hours! There was no difference between the number of hours of brace wear of boys and girls.

Most important slide in my opinion:


Results vs. Natural History

Lonstein, Carlson results (Risser 0,1 Curves 20-29 degrees) :

68% progressed

Katz, Herring et al (this study) (Risser 0,1 Curves 25-45 degrees) curves larger and therefore more likely to progress:

Brace > 12 hours 18% progressed

Brace < 7 hours 69% progressed (back to the natural history)

Therefore, bracing alters the natural history!!


http://posna.gmetonline.com/PresentationSearch.aspx?fixedkey=~im4_j.xOb9x&subscriptionpackageid=44

Click on the link for Scientific Program Day 3, and then the sixth presentation at 9:04 a.m.


One item of concern for me:

Brace treatment was discontinued at Risser 4, 18 months post menarche in the girls, boys until growth ceased. This is very interesting because my daughter is already two years post menarche and is at Risser 4 and she will continue to wear her brace until her growth has ceased completely. She had 3/4 of an inch of growth in the last six months. I ran across a study recently that showed that Risser 5 isn't even an exact measure of completion of growth as growth has occurred in some patients even after reaching Risser 5.

Unfortunately, I am unable to come up with the right search terms to find that paper again. It seems to me girls should also stop bracing when growth has ceased also. It seems a shame to stop bracing too early in some cases, after all the effort, and have some unintended consequences of continued progression.

Ballet Mom
12-04-2010, 09:47 AM
I took note of the number of kids requiring bracing for scoliosis each year. It is apparently 30,000...each and every year!

Regarding the issue that comes up time and time again on this forum that lots of people continue to progress in adulthood even with small curves at physical maturity:

Anyone who is using the number of people on this forum who progressed during adulthood after being released from bracing with a smaller Cobb angle or who didn't brace but hit physical maturity with a smaller Cobb angle, is misleading people. The people who progressed on this forum represent an extremely minute portion of the total formerly braced population. This forum is not a random nor representative sample.

Listen to what your orthopedist tells you, not the "experts" on this forum, and do not get discouraged or despair.

Bigbluefrog
12-17-2010, 11:47 AM
We were told the same, to wear the brace up to 18 months after menses.

I wonder if they ever decide to wean the brace, just wear at night time, so after 18 months...less in brace hours but still wearing at night.

I have read a study of 80% success rate for those who wore the brace more than 16 hours a day.

Big day this Monday, we get X-rays and evaluate where she is now.

I hope the brace is working. We are blessed to have so many options available near by.

Ballet Mom
12-22-2010, 12:25 PM
We were told the same, to wear the brace up to 18 months after menses.


It's a real shame that cut-off is used. I took a stroll through a thread at Spinekids and there were many kids that had been taken out of their brace prematurely and had ended up progressing to surgery because of it. Really sad. My daughter's orthopedist told us that it had been proven that the progression continued after brace cessation because growth had not ceased.

There is a new study going on using the ultra-low dose x-ray systems to determine growth factors in scoliosis. Maybe this can help determine the best time to stop bracing.

Predicting growth and curve progression in the individual patient with adolescent idiopathic scoliosis: design of a prospective longitudinal cohort study

Iris Busscher,1 Frits Hein Wapstra,1 and Albert G Veldhuizen1
1University Medical Center Groningen, University of Groningen, Department of Orthopaedics, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881883/