Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis

Abstract

Summary of background data

The curve pattern of idiopathic scoliosis is important for making decisions concerning bracing. However, whether the curve pattern changes during brace treatment have not been fully documented. The aim of this study was to investigate the changes of curve pattern during brace treatment in skeletally immature patients with adolescent idiopathic scoliosis (AIS).

Methods

From January 2002 to January 2011, AIS patients treated with a Boston or Milwaukee brace were recruited after meeting the following inclusion criteria: older than 10 years of age at initiation of bracing; having a Cobb angle of 25°–40°; with a Risser sign 0–2; being regularly followed until the weaning of brace or the necessity of surgical treatment; and without history of previous treatment. A total of 130 female and 11 male AIS patients were included. The mean age was 12.9 years at initiation of bracing, and the female patients were, on average, 2.7 months past menarche. The mean follow-up period was 2.6 years (range 1.0–5.5 years). The definitions of changes in curve patterns were divided into four categories as follows: (1) shift of the apex of the main curve; (2) change in the curve span of more than two vertebrae; (3) change in the main curve type with regard to the apex location; and (4) change of curve direction. The patients were divided into two groups. Group A was comprised of patients who had experienced one or more categories of curve pattern changes, and Group B was comprised of those who had not.

Results

Of these 39 patients, 14 had apex shifting, 2 underwent curve span changes, 22 experienced changes in the main curve type, and one female had both changes in the apex and curve span. At the initiation of bracing, patients in Group A demonstrated significantly lower menarchal status (P = 0.018) and lower Risser grade (P = 0.025) than those in Group B. The difference in the percentage of patients who underwent Boston bracing between the two groups was statistically significant (41.5 % for Group A vs. 24.0 % for Group B, P = 0.023).

Conclusion

Changes in curve pattern can occur during brace treatment. Patients with less skeletal maturity and those treated with a Boston brace are more susceptible to this phenomenon.

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References

  1. 1.

    Richards BS, Bernstein RM, D’Amato CR, Thompson GH (2005) Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on bracing and nonoperative management. Spine (Phila Pa 1976) 30:2068–2075

    Article  Google Scholar 

  2. 2.

    Lonstein JE, Winter RB (1994) The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients. J Bone Joint Surg Am 76:1207–1221

    PubMed  CAS  Google Scholar 

  3. 3.

    Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL (2007) A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity. Spine (Phila Pa 1976) 32:2198–2207

    Article  Google Scholar 

  4. 4.

    Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME (1986) The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients. Spine (Phila Pa 1976) 11:792–801

    Article  CAS  Google Scholar 

  5. 5.

    Howard A, Wright JG, Hedden D (1998) A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis. Spine (Phila Pa 1976) 23:2404–2411

    Article  CAS  Google Scholar 

  6. 6.

    Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV (2000) Effectiveness of the boston brace in treatment of large curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 25:2326–2332

    Article  CAS  Google Scholar 

  7. 7.

    Janicki JA, Poe-Kochert C, Armstrong DG, Thompson GH (2007) A comparison of the thoracolumbosacral orthoses and providence orthosis in the treatment of adolescent idiopathic scoliosis: results using the new SRS inclusion and assessment criteria for bracing studies. J Pediatr Orthop 27:369–374

    PubMed  Article  Google Scholar 

  8. 8.

    Goldberg CJ, Dowling FE, Hall JE, Emans JB (1993) A statistical comparison between natural history of idiopathic scoliosis and brace treatment in skeletally immature adolescent girls. Spine (Phila Pa 1976) 18:902–908

    Article  CAS  Google Scholar 

  9. 9.

    Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA (1996) Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg Am 78:557–567

    PubMed  CAS  Google Scholar 

  10. 10.

    Goldberg CJ, Moore DP, Fogarty EE, Dowling FE (2001) Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine (Phila Pa 1976) 26:42–47

    Article  CAS  Google Scholar 

  11. 11.

    Dolan LA, Weinstein SL (2007) Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine (Phila Pa 1976) 32:S91–S100

    Article  Google Scholar 

  12. 12.

    van Rhijn LW, Plasmans CM, Veraart BE (2002) Changes in curve pattern after brace treatment for idiopathic scoliosis. Acta Orthop Scand 73:277–281

    PubMed  Article  Google Scholar 

  13. 13.

    van Rhijn LW, Jansen EJ, Plasmans CM, Veraart BE (2001) Changing curve pattern in infantile idiopathic scoliosis: family report with a follow-up of 15 years. Spine (Phila Pa 1976) 26:E373–E376

    Article  Google Scholar 

  14. 14.

    Coonrad RW, Murrell GA, Motley G, Lytle E, Hey LA (1998) A logical coronal pattern classification of 2,000 consecutive idiopathic scoliosis cases based on the scoliosis research society-defined apical vertebra. Spine (Phila Pa 1976) 23:1380–1391

    Article  CAS  Google Scholar 

  15. 15.

    Qiu Y, Sun X, Cheng JC, Zhu F, Li W, Zhu Z, Wang B, Yu Y (2008) Bone mineral accrual in osteopenic and non-osteopenic girls with idiopathic scoliosis during bracing treatment. Spine (Phila Pa 1976) 33:1682–1689

    Article  Google Scholar 

  16. 16.

    Wu L, Qiu Y, Wang B, Zhu ZZ, Ma WW (2010) The left thoracic curve pattern: a strong predictor for neural axis abnormalities in patients with “idiopathic” scoliosis. Spine (Phila Pa 1976) 35:182–185

    Article  Google Scholar 

  17. 17.

    Richards BS, Sucato DJ, Johnston CE, Diab M, Sarwark JF, Lenke LG, Parent S (2010) Right thoracic curves in presumed adolescent idiopathic scoliosis: which clinical and radiographic findings correlate with a preoperative abnormal magnetic resonance image? Spine (Phila Pa 1976) 35:1855–1860

    Article  Google Scholar 

  18. 18.

    Shurtleff H, Warner M, Poliakov A, Bournival B, Shaw DW, Ishak G, Yang T, Karandikar M, Saneto RP, Browd SR, Ojemann JG (2010) Functional magnetic resonance imaging for presurgical evaluation of very young pediatric patients with epilepsy. J Neurosurg Pediatr 5:500–506

    PubMed  Article  Google Scholar 

  19. 19.

    Lonstein JE (2003) Milwaukee brace treatment of scoliosis. Scoliosis Research Society Bracing Manual. (http://www.srs.org/professionals/education_materials/SRS_bracing_manual/index.htm)

  20. 20.

    Yrjonen T, Ylikoski M, Schlenzka D, Poussa M (2007) Results of brace treatment of adolescent idiopathic scoliosis in boys compared with girls: a retrospective study of 102 patients treated with the Boston brace. Eur Spine J 16:393–397

    PubMed  Article  Google Scholar 

  21. 21.

    Cobb JR (1958) Scoliosis; quo vadis. J Bone Joint Surg Am 40-A:507–510

    Google Scholar 

  22. 22.

    Risser JC (1958) The Iliac apophysis; an invaluable sign in the management of scoliosis. Clin Orthop 11:111–119

    PubMed  CAS  Google Scholar 

  23. 23.

    Wang WW, Xia CW, Zhu F, Zhu ZZ, Wang B, Wang SF, Yeung BH, Lee SK, Cheng JC, Qiu Y (2009) Correlation of Risser sign, radiographs of hand and wrist with the histological grade of iliac crest apophysis in girls with adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 34:1849–1854

    Article  Google Scholar 

  24. 24.

    Gauchard GC, Lascombes P, Kuhnast M, Perrin PP (2001) Influence of different types of progressive idiopathic scoliosis on static and dynamic postural control. Spine (Phila Pa 1976) 26:1052–1058

    Article  CAS  Google Scholar 

  25. 25.

    Sadeghi H, Allard P, Barbier F, Gatto L, Chavet P, Rivard CH, Hinse S, Simoneau M (2008) Bracing has no effect on standing balance in females with adolescent idiopathic scoliosis. Med Sci Monit 14:CR293–CR298

    PubMed  Google Scholar 

  26. 26.

    Karol LA (2001) Effectiveness of bracing in male patients with idiopathic scoliosis. Spine (Phila Pa 1976) 26:2001–2005

    Article  CAS  Google Scholar 

  27. 27.

    Dickson RA, Weinstein SL (1999) Bracing (and screening)—yes or no? J Bone Joint Surg Br 81:193–198

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Heary RF, Bono CM, Kumar S (2008) Bracing for scoliosis. Neurosurgery 63:125–130

    PubMed  Article  Google Scholar 

  29. 29.

    Galante J, Schultz A, Dewald RL, Ray RD (1970) Forces acting in the Milwaukee brace on patients undergoing treatment for idiopathic scoliosis. J Bone Joint Surg Am 52:498–506

    PubMed  CAS  Google Scholar 

  30. 30.

    Mulcahy T, Galante J, DeWald R, Schultz A, Hunter JC (1973) A follow-up study of forces acting on the Milwaukee brace on patients undergoing treatment for idiopathic scoliosis. Clin Orthop Relat Res 93:53–68

    PubMed  Article  Google Scholar 

  31. 31.

    Wynarsky GT, Schultz AB (1991) Optimization of skeletal configuration: studies of scoliosis correction biomechanics. J Biomech 24:721–732

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Jansen RC, van Rhijn LW, Duinkerke E, van Ooij A (2007) Predictability of the spontaneous lumbar curve correction after selective thoracic fusion in idiopathic scoliosis. Eur Spine J 16:1335–1342

    PubMed  Article  Google Scholar 

  33. 33.

    Modi HN, Suh SW, Yang JH, Hong JY, Venkatesh K, Muzaffar N (2010) Spontaneous regression of curve in immature idiopathic scoliosis—does spinal column play a role to balance? An observation with literature review. J Orthop Surg Res 5:80

    PubMed  Article  Google Scholar 

  34. 34.

    van Rhijn LW, Veraart BE, Plasmans CM (2003) Application of a lumbar brace for thoracic and double thoracic lumbar scoliosis: a comparative study. J Pediatr Orthop B 12:178–182

    PubMed  Article  Google Scholar 

  35. 35.

    Wong MS, Mak AF, Luk KD, Evans JH, Brown B (2000) Effectiveness and biomechanics of spinal orthoses in the treatment of adolescent idiopathic scoliosis (AIS). Prosthet Orthot Int 24:148–162

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Papaioannou T, Stokes I, Kenwright J (1982) Scoliosis associated with limb-length inequality. J Bone Joint Surg Am 64:59–62

    PubMed  CAS  Google Scholar 

  37. 37.

    Nie WZ, Ye M, Liu ZD, Wang CT (2009) The patient-specific brace design and biomechanical analysis of adolescent idiopathic scoliosis. J Biomech Eng 131:041007

    PubMed  Article  Google Scholar 

  38. 38.

    Negrini S, Zaina F, Atanasio S (2008) BRACE MAP, a proposal for a new classification of braces. Stud Health Technol Inform 140:299–302

    PubMed  CAS  Google Scholar 

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Acknowledgments

This study was supported by Medical Science and technology development Foundation, Nanjing Department of Health (Grant No. ZKX11016) and the Fundamental Research Funds for the Central Universities (Grant No. 021414350009). No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Correspondence to Yong Qiu.

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X. Zheng and X. Sun contributed equally to this work.

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Zheng, X., Sun, X., Qian, B. et al. Evolution of the curve patterns during brace treatment for adolescent idiopathic scoliosis. Eur Spine J 21, 1157–1164 (2012). https://doi.org/10.1007/s00586-012-2258-3

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Keywords

  • Adolescent idiopathic scoliosis
  • Brace treatment
  • Curve pattern