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Scoliosis Spinal Curve Braces Prevent Progression and Surgery

  • Publish Date : 2016/01/11 - (Rev. 2019/05/13)
  • Author : American Academy of Orthopaedic Surgeons*
  • Contact : aaos.org

Synopsis: Monitoring adolescent scoliosis patients on brace use prevents curve progression and surgery. Bracing is often recommended for adolescents diagnosed with idiopathic adolescent scoliosis. Children who did not need surgery wore their brace 2.1 hours more per day on average.


Main Document

Adolescent idiopathic scoliosis is defined as an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated "S" or "C" shape; the bones of the spine are also slightly twisted or rotated.

Scoliosis is typically classified as either congenital (caused by vertebral anomalies present at birth), idiopathic (cause unknown, sub-classified as infantile, juvenile, adolescent, or adult, according to when onset occurred), or secondary to a primary condition.

Bracing often is recommended for adolescents diagnosed with idiopathic adolescent scoliosis, and a spinal curve between 25 and 45 degrees. When worn consistently and as directed, braces have been found to effectively halt or slow further progression of a spinal curve, often preventing surgery.

Note the spinal curve to the right in the medium back and to the left in the lower back. Source: Blausen.com staff (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons.
Note the spinal curve to the right in the medium back and to the left in the lower back. Source: Blausen.com staff (2014). Medical gallery of Blausen Medical 2014. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. [CC BY 3.0 (https://creativecommons.org/licenses/by/3.0)], from Wikimedia Commons.

In a new study appearing in the Journal of Bone and Joint Surgery, adolescent scoliosis patients each received a brace with embedded sensors to monitor use.

Patients were then divided into two groups:

  • In the first group, 93 patients were told about the existence and purpose of the monitors, and data and time spent wearing the brace were discussed at follow-up visits.
  • The 78 patients in the second group were not told about the purpose of the monitors, nor did they receive data on brace compliance.

"Patients who were aware that their device measured brace use, wore their brace, on average, an additional three hours each day," said orthopaedic surgeon and lead study author Lori Karol, MD.

The study also found that patients who wore their brace were less likely to require surgery, by 11 percent, due to less spinal progression.

The average curve magnitude at the start of bracing was comparable at the start of the study:

  • 33.2 degrees in the counseled group
  • 33.9 in the non-counseled group

Among the Specific Findings

  • Daily brace wear during the initial 180-day time period averaged 15 hours in the counseled group and 12.5 hours in the non-counseled group.
  • Counseled patients who completed bracing averaged 13.8 hours per day of orthotic wear during the entire course of bracing, compared with 10.8 hours per day for patients who did not receive compliance reports.
  • The spinal curve did not progress more than 6 degrees between the start of bracing and brace termination in 59 percent of patients in the counseled group, and 36 percent of patients in the non-counseled group.
  • Children who did not need surgery wore their brace 2.1 hours more per day on average.

"Shared information between the teen, parents, orthotist (who oversees the creation and fit of the custom brace), and physician resulted in improved brace compliance," said Dr. Karol.

"These findings emphasize the role that open doctor-patient communication plays in encouraging treatment effectiveness in the adolescent age group."

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