Efficacy of bracing in worst cases (over 45°): end-growth results of a retrospective case series
© Negrini et al; licensee BioMed Central Ltd. 2009
Published: 14 December 2009
The objective of this study was to verify the efficacy of bracing for adolescent idiopathic scoliosis (AIS) in the worst cases (over 45°) refusing surgery.
45°-50° curves are considered surgical, but not all patients want to face surgery, and a treatment should be warranted to help them avoid fusion. The efficacy of bracing in this degree of curve is generally considered poor, but our experience seems to point to a different conclusion which needs verification.
In this retrospective study, the population included all AIS patients with at least one 45° degree curve at first evaluation that reached the end of treatment since our database started in 2003. We had 14 females and 2 males. 6 had a previous, failed brace treatment. At the start of their treatment, the mean age was 14.1 ± 1.7 years, and the mean Cobb angle measurement was 49.4° ± 4.3° (range 45°-58°). Patients received full time treatment (23 or 24 hours per day) for one year with a Risser cast (11) or a Sforzesco brace (5) respecting SOSORT criteria, in addition to specific exercises. Outcome criteria included the following: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated; 2 years follow-up); clinical (ATR, hump, Aesthetic Index, plumbline distances); radiographic (Cobb degrees); and ISICO (optimum; minimum). ANOVA and chi-test were used in data analysis.
The reported compliance in the 4.5 ± 1.6 treatment years was 90.5 ± 15.5%. At the end, 5 patients (31%) were still measuring over a 45° Cobb angle (range 32°-50°). No one was fused, and this remained true at the 2 years follow-up for the 50% that reached it. Improvements were found in 69% and 56% of worst and average curves, and in 56% and 80% of Thoracic and Lumbar curves respectively. We found highly statistically significant reductions of maximal (-8.6°), average (-4.8°), thoracic (-6.0°) and lumbar (-10.2°) curves. Statistically significant improvements were found for Aesthetic Index and Thoracic ATR, with a decrease of plumbline distances. According to ISICO criteria, 75% of patients had minimum and 63% optimal results.
Curves over 45° represent a challenge for physicians and patients that can be faced with high efficacy braces, good methodology (SOSORT criteria), dedication, and compliance (high motivation that can come from a decision or hope to avoid surgery). In these optimal situations, according to this retrospective study, surgery can be avoided in some cases.
This article is published under license to BioMed Central Ltd.