Scientists say that the use of bracing in adolescents suffering from idiopathic scoliosis may reduce the risk of the condition progressing to the point that surgery is needed.
Scoliosis is a condition in which the spine abnormally curves to the right or left. When it occurrs in a child or teen, the condition is referred to as adolescent idiopathic scoliosis (AIS).
It is unknown what causes the disorder, but severe cases of the condition, if untreated, may cause pain and disability, particularly if a child is still growing.
According to the National Scoliosis Foundation, scoliosis affects approximately 6 million people of all age groups in the US. There is no cure for the disorder, but bracing is the usual treatment for children and adolescents with a spine curvature of between 25-40 degrees.
However, the researchers say that while this is the preferred treatment for AIS, evidence regarding its impact has been inconclusive.
For the study, published in The New England Journal of Medicine, researchers from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) wanted to compare the risk of curve progression in adolescents with AIS who wore a brace, and those who did not.
The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health.
The research team analyzed 242 patients aged 10-15-years, from 25 institutions in the US and Canada between 2007 and 2011. Patients were recruited who were at high risk for continued worsening of their curved spines, based on their age, skeletal immaturity and the severity of their curvature.
The study originally began as a randomized study, the researchers say, but they later added a “preference cohort,” meaning that the patients and their families were able to choose their own treatments.
Of the 242 patients included, 116 were randomly assigned to either bracing or observation – where they received no specific treatment. The other 126 chose between bracing and observation.
Patients in the bracing group were required to wear them 18 hours a day. The researchers defined the treatment as unsuccessful when a patient’s curve progressed to 50 degrees or more.
This is a point at which surgery is usually recommended. If a child reached “skeletal maturity” with a spinal curve less than 50 degrees, the treatment was classed as successful.
The researchers say that in January 2013, the trial was stopped early due to the signifiant success the braces had on reducing the risk of curve progression and the need for surgery.
Of patients who wore braces, 72% were defined as having successful treatment. Furthermore, it was found that the more hours the patients wore the braces, the better the success rate. Wearing a brace for more than an average of 13 hours a day was linked to a 90-93% success rate.
Stuart Weinstein, of the University of Iowa and lead study author, says:
“This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS – to brace or not to brace. Now we can say with confidence that bracing prevents the need for surgery.”
The researchers also report that 48% of patients in the observation group showed successful outcomes, as well as 41% of patients in the bracing group who wore the braces infrequently.
The study authors note that, as others have suggested, current bracing indications may be too broad, resulting in unnecessary treatment for many patients.
They add:
“It is important to identify patients at high risk for clinically significant curve progression who are also most likely to benefit from bracing.”
Last year, Medical News Today reported a study that showed how magnetically controlled growing rods may be successful in treating scoliosis in children.