Outcomes of Bracing in Juvenile Idiopathic Scoliosis Until Skeletal Maturity or Surgery. Issue 1 (1st January 2015)

• Record Type: Journal Article
• Authors: Khoshbin, Amir; Caspi, Liora; Law, Peggy W.; Donaldson, Sandra; Stephens, Derek; da Silva, Trevor; Bradley, Catharine S.; Wright, James G.
• Is Part Of: Spine. Volume 40:Issue 1(2015)
• Publication Date: 2015-01-01
• Subjects: juvenile idiopathic scoliosis -- bracing -- curve progression -- operative -- skeletal maturity; Spine -- Abnormalities -- Periodicals; Spine -- Diseases -- Periodicals; Spine -- Surgery -- Periodicals; 616.73005
• DOI: 10.1097/BRS.0000000000000669
• Languages: English
• ISSNs: 0362-2436

Abstract

Abstract : Study Design: Retrospective comparative study. Objective: To evaluate the outcome of bracing in patients with juvenile idiopathic scoliosis (JIS) at either skeletal maturity or time of scoliosis surgery. Summary of Background Data: JIS is generally thought to have poor outcomes with high rates of surgical fusion. Methods: All patients with JIS between the ages of 4 and 10 years treated with a brace at the Hospital for Sick Children (SickKids) between 1989 and 2011 were eligible. Data were collected from patient health records until either 2 years after skeletal maturity or date of surgery. Results: The average age at diagnosis of 88 patients with JIS was 8.4 ± 1.4 years, with a female to male ratio of approximately 8:1. Pretreatment, Risser score was zero for 80 patients (91%); 72 (92%) of the females were premenarche; and primary Cobb angles ranged from 20° to 71°. Of the 88 patients, 60 (68%) had used a thoracolumbosacral orthosis exclusively; 28 (32%) patients used "other braces" (Milwaukee, Charleston, or a combination of braces), with an average treatment duration of 3.6 ± 1.9 years. As per Scoliosis Research Society definitions, a "non–curve-progression" (⩽5° change) group consisted of 25 (28%) patients; and a "curve-progression" group consisted of 63 (72%) patients where the curve had progressed 6° or more. Of the 88 patients, 44 (50%) underwent surgery. The operative rate was higher for patients with curves 30° or more than those with curves 20° to 29° prior to brace treatment (37/58 [64%] vs . 7/30 [23%], respectively; P = 0.001); other braces compared with thoracolumbosacral orthosis (19/28 [68%] vs . 25/60 [42%], respectively; P = 0.02); Lenke I and III curves compared with Lenke VI curves (33/54 [61%] vs . 2/14 [14%], respectively; P = 0.007). Level of Evidence: 3 Abstract : Of a total of 88 patients, only 50% of patients with juvenile idiopathic scoliosis treated with bracing required surgery and 28% of curves did not progress. Full compliance with thoracolumbosacral orthosis brace treatment for with curves that are less than 30° and more "malleable, " may slow curve progression and decrease the need for scoliosis surgery.