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"Bracing Works", an update on bracing from the Scoliosis Research Society Annual Meeting

For more than seventeen years, bracing has been one of the most important issues of the National Scoliosis Foundation. Thus, we were elated with the results of recent findings of Dr. Alf L. Nachemson, an orthopedic surgeon and scoliosis specialist, who practices at Sahlgren Hospital, Gothenberg Sweden.

At the 1993 Annual Meeting of the Scoliosis Research Society, held in Dublin, Ireland, Dr. Nachemson presented his summary report on the "Effectiveness of Brace Treatment in Modern Adolescent Idiopathic Scoliosis." What follows are excerpts taken from that summary, and from Dr. Nachemson's remarks at the 1993 New England Spine Conference. Upon publication of the full study, a more comprehensive report will be provided in a future issue of the Spinal Connection.

Q: Why was this study undertaken?
A: This study was sponsored by the Scoliosis Research Society. Lack of scientific evidence has lead many scoliosis specialists to disbelieve the effect of bracing and has resulted in recommendations against school screening in the U.S., Great Britain, Canada, and Sweden.

Q: Who was included in the study?
A: We studied girls 10 to 15 years old with idiopathic adolescent thoracic and thoracolumbar scoliosis between 25 and 35 degrees. Between April, 1985 and March, 1989, 294 patients were enrolled in a prospective controlled study at a number of centers. Five centers preferred observation, and contributed 131 patients; 3 centers preferred brace treatment and contributed 115 patients; and 1 center preferred electrical stimulation and contributed 49 patients. By the end of 1993 all of the girls will have reached 16 years of age.

Q: How were results measured?
A: A progression greater than 6 degrees on two different x-rays was considered a failure. Patients lost to follow-up occurred in 6% of the observed cases, 20 % of the braced and 11% of the electrically stimulated patients, for a total of 15%. Even in a worst case analysis whereby all patients lost to follow up were considered failures there was firm conclusion of the results.

Q: What about the electrically stimulated and observed patients?
A: After five years, 70% of those using electrical stimulation or being observed had progressed 6 degrees or more. We found there is no difference whatsoever between electrical stimulation and observation. Electrical stimulation is now discarded as a method of treatment.

Q: What was the conclusion of the study with respect to bracing?
A: There was a very significant difference in braced patients. Bracing failed in only about 20% of the girls; it stopped progression in 80%. This prospective study demonstrates that brace treatment has a significant effect on the progression of adolescent idiopathic scoliosis 16 years of age.

In response to Dr. Nachemson's report, Dr. John Lonstein, from the Minnesota Spine Center, made the following comments at the SRS meeting:

"These are the long-awaited results of the SRS sponsored multicenter prospective controlled study of the comparison of non-operative treatment -i.e. bracing or electrical stimulation, versus natural history -i.e. observation."

"The take home message is easy: Firstly, electrical stimulation is no different from observation -it does not work. This in effect gave a larger natural history group which included the observation and electrical stimulation patients."

"Secondly, there is a statistical positive effect of bracing in preventing curve progression, comparing the braced to the natural history patients. In short, BRACING WORKS, even taking the "worst case" analysis, calling every patient lost to follow up a failure."

"On the basis of these results and the retrospective studies of Basset and the Minnesota Spine Center, it is incumbent on the Canadians, British and U.S. Preventive Services Task Force to re-evaluate their negative positions on scoliosis screening for adolescents as there is now irrefutable proof that bracing is effective in preventing curve progression in adolescent idiopathic scoliosis."


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