Abstract
Study Design
Retrospective comparative therapeutic clinical study evaluating the results of bracing for juvenile idiopathic scoliosis (JIS).
Objectives
To evaluate if bracing has a role in treatment of JIS and, if so, to report its success rate and factors associated with successful bracing.
Summary of Background Data
Patients with JIS have higher mortality and morbidity in comparison to those with adolescent idiopathic scoliosis (AIS) or general population. Untreated JIS may cause severe cardiorespiratory compromise.
Methods
All children treated at our institute and followed up until either skeletal maturity or surgeries between 1956 and 1999 with JIS were included. Those who had an incomplete set of radiographs or those treated by mere observation were excluded.
Results
One hundred twenty-five patients, comprising of 93 who were braced as juveniles and 32 who were braced in adolescence, met the inclusion criteria. Fifty-six of them were successfully treated by bracing (32 juveniles and 24 adolescents) and 69 patients needed surgery despite bracing. When final curves greater than 45° were regarded as failure of bracing, the success rate was 41%. The braces used were Milwaukee brace (MB) and thoraco-lumbo-sacral orthosis (TLSO) and no statistically significant difference was found between the two. None of the patients had surgery of any kind during the juvenile phase (ie, at age <10 years).
Discussion
The overall success rate with bracing was 41%. A third of them (ie, 18/56) could be safely weaned prior to skeletal maturity without risking curve progression. The odds of needing a surgery when braced as a juvenile was 2-in-3 (34% success), which fell to almost 1-in-4 for an adolescent (75% success) and was statistically significant (p = .001). Curves with Cobb angle ≤29° when braced progressed to a degree warranting surgery at a lower rate as compared to those ≥30°, this difference was not statistically significant (p = .22).
Conclusion
Bracing obviated the need for surgery during juvenile years in all patients and was a successful delaying strategy.
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References
James JIP. Idiopathic scoliosis: the prognosis, diagnosis, and operative indications related to curve patterns and the age at onset. J Bone Joint Surg Br 1954;36B:35–49.
James JIP. The etiology of scoliosis. J Bone Joint Surg Br 1970;52B: 410–9.
Pehrsson K, Larson S, Odon A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine 1992;17:1091–6.
Karol LA, Johnston C, Mladenov K, et al. Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis. J Bone Joint Surg Am 2008;90:1272–81.
Aulisa AG, Guzzanti V, Marzetti E, et al. Correlation between compliance and brace treatment in juvenile and adolescent idiopathic scoliosis: SOSORT 2014 award winner. Scoliosis 2014;9:6.
Trivedi JM, Thomson JD. Results of Charleston bracing in skeletally immature patients with idiopathic scoliosis. J Pediatr Orthop 2001;21:277–80.
Fernandez-Feliberti R, Flynn J, Ramirez M, et al. Effectiveness of TLSO bracing in the conservative treatment of idiopathic scoliosis. J Pediatr Orthop 1995;15:176–81.
Blount WP, Moe JH. The Milwaukee Brace. Baltimore, MD: Williams and Wilkins; 1973.
Richards BS, Bernstein RM, D’Amato CR, et al. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Non-operative Management. Spine 2005;30: 2068–75.
Tolo VT, Gillespie R. The characteristics of juvenile idiopathic scoliosis and results of its treatment. J Bone Joint Surg Br 1978;60B: 181–8.
Figueiredo UM, James JIP. Juvenile idiopathic scoliosis. J Bone Joint Surg Br 1881;63B:61–6.
Kahanovitz N, Levine DB, Lardone J. The part-time Milwaukee Brace treatement of juvenile idiopathic scoliosis. Long-term follow-up. Clin Orthop Relat Res 1982;167:145–51.
Mannherz RE, Betz R, Clancy M, et al. Juvenile idiopathic scoliosis followed to skeletal maturity. Spine 1988;13:1087–90.
Robinson CM, McMaster MJ. Juvenile idiopathic scoliosis. Curve patterns and prognosis in one hundred and nine patients. J Bone Joint Surg Am 1996;78A: 1140–8.
Masso PD, Meeropol E, Lennon E. Juvenile-onset scoliosis followed up to adulthood: orthopaedic and functional outcomes. J Pediatr Orthop 2002;78A:279–84.
Jarvis J, Garbedian S, Swamy G. Juvenile idiopathic scoliosis: the effectiveness of part-time bracing. Spine 2008;33:1074–8.
Coillard C, Circo AB, Rivard CH. SpineCor treatment for Juvenile Idiopathic Scoliosis: SOSORT award 2010 winner. Scoliosis 2010;5:25.
Khoshbin A, Caspi L, Law P, et al. Outcomes of bracing in juvenile idiopathic scoliosis until skeletal maturity or surgery. Spine 2015;40: 50–5.
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Author disclosures: NSH (none); JEL (other from Zimmer Biomet, outside the submitted work).
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Harshavardhana, N.S., Lonstein, J.E. Results of Bracing for Juvenile Idiopathic Scoliosis. Spine Deform 6, 201–206 (2018). https://doi.org/10.1016/j.jspd.2017.10.009
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DOI: https://doi.org/10.1016/j.jspd.2017.10.009