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Brace Treatment Controls Progression in Adolescent Idiopathic Scoliosis: Paper #2

Katz, Donald E. BS, CO; Herring, John A. MD; Browne, Richard PhD; Kelly, Derek M. MD; Birch, John G. MD, FRCS(C)

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United States

Summary: In 100 patients treated with monitored Boston Braces we found a direct correlation between hours of brace wear and control of curve progression with greatest effect in those with open triradiates who were most likely to progress.

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Introduction: The ability of a brace to control progression of idiopathic scoliosis is unproven. Estimates of brace compliance are unreliable. We compared exactly measured hours of brace wear with curve progression to determine treatment efficacy.

Methods: 100 patients with AIS with initial curves 25‐45 degrees at Risser 0 (n=75), 1 (n=15), or 2 (n=10) were treated with Boston Braces with high accuracy heat sensors which recorded actual brace wear throughout the treatment period. Treating teams prescribed either 16 or 23 hours of wear. Failure was defined as >6 degrees of progression.

Results: The hours of brace wear correlated highly with lack of curve progression. 82% of patients who wore braces >12 hours per day did not progress while only 31% of those wearing braces <7 hours per day did not progress,p=0.0005. The correlations were strongest in those at Risser 0 and open triradiate cartilage status. Consistent wear at school and between school and bedtime resulted in better curve control than night wear. 72 patients who did not progress to surgery had 8.1 hours per day of wear compared to 28 patients who had surgery who had 4.3 hours per day average wear, p‐0.0005

Conclusion: Therer is a linear relationship between actual hours of wear of a Boston Brace and the prevention of curve progression in AIS. We conclude that progression of idioathic scoliosis is prevented by consistent brace wear.

Significance: We now can counsel patients about treatment with data which shows not only that bracing works but also with knowledge of the amount of wear‐time required for success.

© 2010 Lippincott Williams & Wilkins, Inc.

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