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Early night-time-bracing – an alternative in AIS management

Introduction

As a result of physical and psychological stress we often find very weak compliance for traditional Scoliosis Full-Time-Bracing (FTB) in comparison to Night-Time-Bracing (NTB) [1]. The investigation tries to find out whether or not Early Night-Time-Bracing (ENTB, 16-25 COBB) can effectively stop AIS progression and prevent Full-Time-Bracing.

Material and methods

Out of 671 AIS brace-patients we selected the ENTB-patients. Out of them we excluded patients with further diseases, patients who moved, patients with very high reaching thorathic curves and patients with follow-up’s of less than 3 years. That left us with a small group of 20 patients with initial COBB angles 16-25° , all treated in one institution with a Dresdner NTB, without further treatment, with an average age of 11.6 years at brace discontinuation and an average follow-up of 5 years (3.1 - 7.8). Treatment was considered successful if there was improvement or at least 5° progression of primary curve and no progression (neither primary nor secondary curve) above absolute value of 25° COBB.

Results

We obtained primary correction of 87.8%. After an average of 5.2 years (3.1 - 7.8) we found “true correction” (upright, standing position without wearing the brace) of 24.4% for primary curve and 12.2% for secondary curve. All in all we obtained a success rate of 85% (improvement or constancy).

We could suspend treatment in 4 cases before Risser 4 because of single-digit COBB-angles after an average of 1.9 years (1.1 – 3.4). We had to complete the treatment to Full-Time for 3 patients (15%) because after longer periods of NTB their COBB-angles got worse and crossed the 25° COBB-mark. They nonetheless had comfortable Part-Time-Bracing times of an average of 4.6 years (2.3 – 6.6). Their progression could be stopped by FTB. No one passed the 30° COBB-mark and no surgery was needed.

Discussion

93.8% of our patients feel their QOL has been affected by a brace [1]. 91.4% of full-time treated patients identified daytime as the most frustrating time [1]. Accordingly, ENTB of moderate curvatures (16-25° ) seems to be the bracing method with the lowest physical and psychological impact, combined with a low risk of overtreatment (daytime life without any restrictions, possibility to suspend the night-treatment if scoliosis decreases significantly). ENTB shows an excellent success rate (85%). It even has an obvious option for the 15% failures (change to FTB) and is still beneficial for these patients, because it also enlarges their period of living without a brace during the daytime. AIS patients with initial COBB-angles > 25° have not been included in the investigation.

Conclusion

ENTB of moderate curvatures is a sufficient method to stop AIS progression and to avoid FTB. It should become an integral part of AIS therapy in between only physiotherapy and Full-Time-Bracing.

References

  1. Andreas Selle, Jens Seifert, Carl Gustav Carus: Compliance comparison of different bracing concepts. Scoliosis. 2010, 5 (Suppl 1): O59-

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Selle, A., Seifert, J. & Carus, C.G. Early night-time-bracing – an alternative in AIS management. Scoliosis 5 (Suppl 1), O57 (2010). https://doi.org/10.1186/1748-7161-5-S1-O57

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  • DOI: https://doi.org/10.1186/1748-7161-5-S1-O57

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