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NIGHT‐TIME PROVIDENCE BRACING COMPARED TO FULLTIME BOSTON BRACING IN ADOLESCENT IDIOPATHIC SCOLIOSIS. A PROSPECTIVE RANDOMIZED STUDY: SP23.

Wessberg, Per MD; Rune, Hedlund MD Prof; Anders, Nordwall MD PhD

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Spine Journal Meeting Abstracts: October 2011 - Volume - Issue - [no page #]
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INTRODUCTION: Boston bracing is the gold standard in non‐operative treatment of adolescent idiopathic scoliosis (AIS). Effective treatment requires bracing more than 20 hours per day until skeletal maturity, typically for 1‐3 years. Failure to comply with the regime is a major reason for unsatisfactory treatment effect. Long time follow‐up studies have shown negative psychological experiences of brace treatment. It is probable that night‐time bracing would improve compliance and impose less negative psychological effects on AIS patients.

MATERIAL AND METHODS: A prospective randomized (based on day of birth) study was started in 2004. Regimes were Boston full time bracing aiming at 23 hours per day and the Providence night‐time brace concept for 8 hours every night. AIS girls 10—16 years of age with curves 20°—40° and apex at T7 or below were invited. 66 girls were included until end of 2007 (30 Boston and 36 Providence). Mean age (13), menarche status and curve characteristics (Cobb, location, apex) were similar in both groups.

RESULTS: By the end of 2009 all brace treatments were completed. There were 7 failures in the Boston group, 4 requiring surgery. In the Providence group there were 8 failures, 3 requiring surgery. Thoracic curve location, poor in‐brace correction (<50%) and pre‐menarchal status predicted 71% of the failures in the Boston group but none in the Providence group.

DISCUSSION: Night time bracing (Providence concept) is safe for thoracic and lumbar AIS curves at or below T7 and for Cobb angles close to 40°. The success rate, 77%, is comparable to full time bracing. Failures seem unpredictable.

© 2011 Lippincott Williams & Wilkins, Inc.