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Efficacy of bracing in skeletally immature patients with moderate–severe idiopathic scoliosis curves between 40° and 60°

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Abstract

Study design

Retrospective case-series.

Objectives

To evaluate the outcomes of bracing in skeletally immature patients with moderate–severe idiopathic scoliosis (IS) curves ≥ 40°.

Background

In contrast to prior beliefs, the recent studies have reported successful outcomes with brace treatment may occur in some patients with moderate–severe scoliosis ≥ 40°. Despite other encouraging case-series, non-operative treatment is rarely attempted and the efficacy of bracing large curves remains uncertain.

Methods

100 skeletally immature children (mean 11.8 ± 2.36 years; range 6.1–16.5) with IS ≥ 40° were identified. 80 were adolescent IS (80%) and 20 juvenile IS (20%). The Risser plus score was used to evaluate skeletal maturity. 66 children were Risser 0 (66%). SRS-SOSORT outcome guidelines were used: > 5° progression, stabilization between − 5° and 5° and, > 5° improvement.

Results

Mean initial Cobb was 45° ± 3.9° (range 40°–59°), with in-brace and  % correction of 30° ± 8.7° (range 7°–48°) and 34 ± 17.5% (range 2–84%), respectively. 57 progressed (57%), 32 stabilized (32%), and 11 improved (11%) after a median of 1.8 years (IQR 1.2–2.9). Open triradiate cartilage at presentation (p = 0.005) and less in-brace correction (p = 0.009) were associated with progression. 58 children (58%) underwent surgery after a mean of 3.0 years (range 0.7–7.3). Surgical patients were younger (11.2 vs. 12.7 years; p = 0.003), more often Risser 0 (79% vs. 48%; p < 0.001); however, presented with similar curves (45° vs. 44°; p = 0.31). Open triradiate cartilage at presentation (OR 15.3; 95% CI 4.3–54.6; p < 0.001) and less in-brace correction (p = 0.03) increased the likelihood of surgery. All 20 JIS patients avoided temporary growth rods, with 18 (90%) eventually requiring surgery.

Conclusion

Non-operative treatment was successful in 42% of children. Risk factors for surgery were younger age, open triradiates, and less in-brace correction. Bracing can be effective in delaying surgery until skeletal maturity in patients with curves ≥ 40°. Patients should be counseled on the risks and benefits of bracing and surgery.

Level of evidence

Level IV.

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Funding

No funding, grants, or financial compensation was received for this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School Teaching Hospital, Hunnewell 2, 300 Longwood Ave HU 221, Boston, MA, 02115, USA

    Bram P. Verhofste, Patricia E. Miller, Lawrence I. Karlin, Daniel J. Hedequist, John B. Emans & Michael Timothy Hresko

  2. Department of Orthopaedic Surgery, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Amanda T. Whitaker

  3. Department of Orthopaedic Surgery, Rainbow Babies and Children’s Hospital, 11100 Euclid Ave, Cleveland, OH, 44106, USA

    Michael P. Glotzbecker

Authors
  1. Bram P. Verhofste
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  2. Amanda T. Whitaker
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  3. Michael P. Glotzbecker
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  4. Patricia E. Miller
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  5. Lawrence I. Karlin
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  6. Daniel J. Hedequist
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  7. John B. Emans
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  8. Michael Timothy Hresko
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Contributions

Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work: BPV, ATW, MPG, PEM, LIK, DJH, JBE, MTH. Drafting the work or revising it critically for important intellectual content: BPV, ATW, MPG, PEM, LIK, DJH, JBE, MTH. Final approval of the version to be published: BPV, ATW, MPG, PEM, LIK, DJH, JBE, MTH.

Corresponding author

Correspondence to Michael Timothy Hresko.

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Approval was gained for this study (IRB00013498).

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Verhofste, B.P., Whitaker, A.T., Glotzbecker, M.P. et al. Efficacy of bracing in skeletally immature patients with moderate–severe idiopathic scoliosis curves between 40° and 60°. Spine Deform 8, 911–920 (2020). https://doi.org/10.1007/s43390-020-00131-3

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  • DOI: https://doi.org/10.1007/s43390-020-00131-3

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