Tag: scolibrace

A scoliosis Journey – Week 3

This week, we round out our journey with Patient X – having correctly diagnosed scoliosis and chosen an appropriate treatment methodology, it’s now time to explore her progress and eventual results using the Scolibrace system.

 

5. Treating scoliosis with scolibrace – the results

As you will remember from previous instalments of this series, there are two main categories of scoliosis brace – active correction and “passive” braces. Active correction braces are the type now used by most scoliosis specialist clinics, and have been shown to be highly effective in treating scoliosis.[1] While scolibrace is certainly not the only active correction brace on the market, we firmly believe it is the best available today.

There are two main reasons we believe this – firstly, scolibrace is highly user-friendly. Unlike some braces, scolibrace can be put on and taken off by the wearer without any assistance, it’s also easy to secure, requiring just a couple of Velcro straps to hold it in place. Scolibrace also has a low form factor, meaning it can be worn under clothes without being visible in most cases – and a wide variety of colour choices goes to make this even easier. Being made from the latest materials, and fabricated using CAD/CAM technology scolibrace is also lightweight and so easy to move in that many wearers even leave their brace on to participate in sports activities. Taken as a whole this makes life during bracing very much more comfortable (and far preferable to surgery!).

Perhaps more important in the long term, however, are scolibrace’s results. In the case of patient X (who began treatment with a 33-degree Cobb angle), a one-month in-brace x-ray showed that the curve had reduced to 13 degrees. At the 3 month out of brace x-ray, the curve had reduced to 26 degrees. In just three months the out of brace curve had reduced by 7 degrees.

At this point, the flexibility of the scolibrace design was once again important since, where other systems may require a whole new brace, scolibrace allows extra corrective padding to easily be added to the brace to increase the 3-dimensional corrective action and keep up the progress. At the 12-month mark, an out-of-brace x-ray was taken – The results of which showed that the spine was down to just 11 degrees without using the brace – a reduction of 22 degrees which brought patient X within one degree of “normal” measurement.

The final x-ray for patient X was taken 22 months after the start of treatment after a period of weaning off the brace. This x-ray was an out-of-brace x-ray where the patient was required to be out of the brace for at least 6 hours. The results of the final X-ray showed her spine to have a 6-degree curvature, which according to definition (greater then 10 degrees cobb) cannot be classified as a scoliosis.

The combination with scoliosis specific exercise assisted in speeding the correction of the Cobb angle[2], but also made a substantial contribution to the overall postural correction which scoliosis treatment also provides. Postural assessments showed continuous improvement of her posture with her body showing good balance after 4 months of treatment, with improvements continuing so that she was visually symmetrical by the 12-month mark. The postural improvements were then maintained throughout the treatment period.

One potential risk of scoliosis bracing which has been highlighted is the potential for loss of mobility or deterioration of fitness, however the incorporation of exercises in the program also assisted in this regard[3], such that a functional assessment of fatigue ability and strength of her core muscles, together with the flexibility of her spine showed no deterioration of strength, endurance or flexibility at the end of treatment.

 

6. After scoliosis

After just 22 months of treatment, patient X no longer suffered from scoliosis – an unmitigated success for scolibrace, but what about in the future, could scoliosis reoccur?

While a patient is continuing to grow, there is always the chance that scoliosis could begin to develop again – scoliosis patients should, therefore, be monitored until they have reached adulthood and their skeleton has finished growth. Having said this, recent research has indicated that continuing with some targeted scoliosis specific exercises after bracing can be effective in preventing any loss of correction[4].

So what now for patient X? Having completed her treatment and with a handful of ongoing exercise to keep her on track she’s free to get on with the rest of her life, scoliosis free!

 

scoliosis braces

Scoliosis braces have come a long way!

Could ScoliBrace be right for you?

We hope that this series of articles has been informative and has given you an outline as to the path that a typical non-surgical scoliosis treatment can take. If you have concerns about scoliosis, or would like to find out if ScoliBrace might be right for you, why not get in touch today, and arrange a one to one consultation with our specialists.

 

 

 

 

 

 

[1] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

 

[2] Negrini S, Negrini A, Romano M, Verzini N, Parzini S: A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis. Stud Health Technol Inform 2006, 123:519-522.

 

[3] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys 2005, 41(2):183-201

[4] Fabio Zaina et al. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT’s 2008 Award for Best Clinical Paper,  Scoliosis 2009, 4:8

 

A Scoliosis Journey: Week 2

Last week we began to explore the case of Patient X – a scoliosis patient who, after successful treatment with a ScoliBrace, avoided the need for corrective surgery and now lives scoliosis free.  This week, we learn about her treatment prescription. If you missed week one, we suggest reading it here first.

 

3. The best treatment?

Having confirmed a scoliosis case and with that case being below the surgical threshold, it was possible to move forward with a non-surgical approach for patient x – but which is the best treatment methodology on offer?

In dealing with any scoliosis case, there are at least three elements to treatment which need to be considered – firstly, the Cobb angle (that is to say, the angle of the scoliotic curvature) needs to be reduced. Secondly the angle of trunk rotation (rib hump) and thirdly, muscular imbalances which have developed alongside the scoliosis, need to be addressed and balanced.

In terms of Cobb angle reduction, Scoliosis braces are the most effective non-surgical approach.[1] There are many different kinds of scoliosis brace and many work slightly differently. Broadly speaking braces can be classified as either active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position). Passive braces which are typically provided by hospitals, once the only option available, obviously do nothing to reduce cobb angle – so bracing with an active correction brace is the recommended approach.

The angle of trunk rotation or the “rib hump” is best addressed by a active scoliosis brace such as Scolibrace which addresses the scoliosis in a 3-dimensional manner, helping to de-rotate the spine to reduce rib hump progression, whilst preserving the spines natural curves in the low and mid-back.

The best approach to correcting the muscular and postural imbalances associated with scoliosis are specialised exercise methodologies which have been designed for scoliosis treatment. There are two main approaches to consider. The first is SEAS or the “Scientific Exercise Approach to Scoliosis”. SEAS consists of an individualised exercise program adapted for the purpose of treating an individual’s scoliosis. Different exercises are used to correct different types and elements of scoliosis, so by combining them in the correct way, an ideal exercise plan can be produced.

SEAS treatment is often used as a stand-alone approach when treating smaller curves and as a compliment to bracing with large curves and where there is a significant risk of progression.

The other main exercised based method, Schroth therapy, is a well-established and easy to use treatment methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis.[2]  As an independent treatment, some studies have shown a reduction of Cobb angle of 10-15 degrees over the course of a year[3] – however, Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly than either approach alone.[4]

Patient x’s scoliosis, being 33 degrees cobb, was already beyond the point where exercise alone would have been an ideal treatment. As the patient was still growing and the curve was already greater than 30 degrees, she was also considered a high risk for her scoliosis to worsen. While this specific combination of factors meant that hers was a high-risk case overall, she was an ideal candidate for correction with a highly advanced scoliosis brace – the ScoliBrace. (This is the brace we offer at the UK Scoliosis Clinic)

In this case, scoliosis specific rehabilitation exercises and use of a scoliosis orthotic device, a Scolibrace, were therefore recommended.

 

4. Treatment with ScoliBrace

ScoliBrace, unlike many braces, is a totally customised, 3D designed, rigid active correction brace. ScoliBrace isn’t just customised for your scoliosis case, you can also choose a colour or pattern which suits your style – or opt for something which matches your skin tone to blend in well.

A ScoliBrace is not like most braces which use 3 point pressure. It uses a 3D inverse correction of the spine ie it shifts the spine into the opposite direction by moving the spine towards the correct position

For Patient X, the scoliosis brace was initially to be worn full-time. This is 23 hours per day with up to a maximum of 4 hours out of the brace if the patient was actively participating in sports during those out of brace hours. Brace wear was started at 2 hours on the first day, followed by adding another 2 hours every subsequent day until the required full-time hours were attained. Time in brace is often adjusted throughout scoliosis treatment period -but is generally high at the start in order to arrest the curve development and begin to reduce it as soon as possible.

Patient X was also given a program of scoliosis specific exercises, which were initially taught in the clinic as twice a week for 3 weeks, followed by once per month. The patient was required to complete the exercises each day out of the brace, but this was easy to do at home and it was included as brace time wear.  A  ScoliRoll (scoliosis orthotic device) was also used daily for 20 minutes to stretch the spine into the opposite direction of the curve, to help improve the spines mobility back to a normal position.

Next week, we’ll focus on Patient X’s progress with ScoliBrace!

 

 

[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine (2018) [Publish Ahead of Print]

[2] Steffan K, Physical therapy for idiopathic scoliosis,  Der Orthopäde, 44: 852-858; (2015)

[3] Kuru T, et al. The efficacy of three-dimensional Schroth  exercises  in   adolescent idiopathic scoliosis: A randomised controlled clinical trial, Clinical  Rehabilitation,  30(108); (2015)

[4] Marinela, Rață;Bogdan, Antohe, Efficiency  of the Schroth and Vojta Therapies in Adolescents with Idiopathic Scoliosis. Gymnasium, Scientific Journal of Education, Sports, and Health Vol. XVIII, Issue 1/2017

Why choose ScoliBrace?

When thinking about the right scoliosis treatment there are many options to consider. This is what you would expect since scoliosis itself is a complex and often highly variable condition which requires a treatment plan specifically designed for each patient.

The two main approaches used in non-surgical scoliosis treatment are scoliosis specific exercise methodologies and bracing. Of the two, bracing is probably the more effective, although a scoliosis specific exercise program can sometimes be sufficient. In some instances, patients might prefer bracing over exercise due to the improved results which can be obtained without conscious efforts.

At the UK Scoliosis clinic, we often use both approaches to achieve the best possible outcome for patients – but today let’s consider bracing.

 

Why is bracing so popular?

Today, scoliosis patients can benefit from the latest and most technologically advanced braces available through our clinic. Unlike some older brace designs, modern braces present a high likelihood of a successful non-surgical outcome.

To take just a few points, recent research has shown that…

  1. Specialised scoliosis bracing when prescribed for high-risk patients, can prevent the need for surgery in most cases[1]
  2. Patients who wear scoliosis braces get better results the longer they wear the brace each day[2]
  3. Part-time bracing in adults significantly reduces progression of curvatures and improves quality of life[3]
  4. Conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, with most patients reaching a complete curve correction[4]
  5. Bracing is an effective treatment method for AIS cases, characterized by positive long-term outcomes[5]

Today, research is therefore clear – scoliosis bracing is an effective, affordable and safe alternative to surgery. But which brace should you choose? With the growth in interest in non-surgical scoliosis treatment, various brace designs have become popular – while each have their own benefits, here at the UK Scoliosis Clinic, we offer the ScoliBrace active correction brace – which we believe to be the most modern an effective brace on the market. Let’s see why:

 

Why choose ScoliBrace?

Scolibrace

ScoliBrace is comfortable, low profile and easy to use!

When choosing a new treatment option for our clinic, our scoliosis specialists scrutinise each aspect of a candidate product, both from a clinical and patient comfort perspective. To date, ScoliBrace is (in our opinion) the best scoliosis braces we have seen, that’s why it’s our go-to treatment in many cases. Originally developed in Australia we are one of only a handful of internationally approved ScoliBrace providers.

ScoliBrace improves upon many previous braces, and avoids some of the most common pitfalls – it is:

 

Highly effective

A ScoliBrace is an over-corrective brace – unlike braces which simply try to halt the progression of scoliosis, ScoliBrace works by guiding the body and spine into a posture that is the opposite of how the scoliosis is shaped. This means that all the time you are wearing a ScoliBrace, you are treating your scoliosis – not just slowing it down. A ScoliBrace can also help to improve the overall appearance of the body.

 

Comfortable

Most Scoliosis braces are quite tricky to get into and can sometimes have a less than optimal construction for your body shape. ScoliBrace opens and closes at the front making it easy to wear and remove without assistance. Thanks to our advanced manufacturing process, your brace will be custom made to fit you like a glove.

 

Stylish

Unlike most braces which are only available in white, ScoliBrace is available in a variety of colours and patterns which allow you to personalise the look of your brace. We can offer exciting patterns for younger children (featuring everything from dinosaurs to football, and butterflies to love hearts) as well as stylised looks from a Demin pattern to Zebra print!  ScoliBrace is also available in a wide variety of natural skin tones, to match your own completion if you prefer.

 

Adjustable

Many scoliosis braces are manufactured to a single size and shape, meaning that over the course of treatment some patients may require three or even four individual braces. ScoliBrace has a wide range of adjustment, meaning that in most cases patients require no more than two braces during treatment – which can save a great deal of money in the long term.

 

Low profile

ScoliBrace has been designed with everyday people living everyday lives in mind – this means the brace is as unobtrusive as possible and can even be worn during sports and other physical activities. ScoliBrace is intentionally low profile, so that it can be worn almost invisibly under even light clothing.

 

Totally customised

Many scoliosis braces today claim to be a custom design – but ScoliBrace braces take this principle a step further. ScoliBrace braces are planned out using brace Scan technology, which combines 3D full-body laser scanning, x-rays and posture photographs.  Each brace is then custom designed for the individual with Computer Aided design (CAD) and then created with Computer Aided Manufacture (CAM) to create a brace which is perfect both in terms of fit and correction. Thanks to this process our measuring and manufacturing tolerances are as low as 0.5mm.

 

scolibrace

Modern scoliosis braces like ScoliBrace are highly effective

 

 

 

[1]   ‘Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements’
Negrini S, Negrini F, and Zaina F, 2011, Spine J. 2011 May;11(5):369-80. doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

Effects of Bracing in Adolescents with Idiopathic Scoliosis’   [Results of the BrAIST Clinical Trial]
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[2]Effects of Bracing in Adolescents with Idiopathic Scoliosis
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[3]Effects of Bracing in Adult With Scoliosis: A Retrospective Study
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019

[4]Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

[5] Curve progression after long-term brace treatment in adolescent idiopathic scoliosis: comparative results between over and under 30 Cobb degrees
Aulisa et al,  Scoliosis and Spinal Disorders 2017 12:36 https://doi.org/10.1186/s13013-017-0142-y

Catch scoliosis early, and don’t “wait and see”!

Catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the cobb angle is the key to a successful outcome. Our message today, to parents in particular, is to have your children screened regularly and act on any concerns you may have. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.

 

Scoliosis school screening is vital

children

3 – 4 % of children will develop Scoliosis

Since Scoliosis usually develops in children and should be treated as soon as possible to maximise the chances of a successful outcome, school scoliosis screening has been a topic of much debate and is something that we strongly advocate here at the clinic.

Studies have shown that school screening can effectively reduce the risk of requiring invasive spinal

fusion surgery[1]. Although there has been debate about the effectiveness of school screening in the past, it is now clear that screening does improve outcomes for children affected by scoliosis. The clinical effectiveness of scoliosis screening has been assessed in numerous studies of different designs, which have been synthesized in a systematic review with clear results.  The review covered 28 studies

published between 1977 and 2004 and concluded that there was sufficient evidence to suggest that school scoliosis screening is safe, may detect cases of Adolescent idiopathic Scoliosis (AIS) at early stages, and may reduce the risk of surgery[2].

Despite this, school screening is still not commonplace in the UK, although this is not the case everywhere. In Hong Kong, for example, scoliosis screening has been conducted as a routine health service since 1995, thereby making it one of the regions with the longest history of routine scoliosis screening in the world. Hong Kong’s screening protocol was demonstrated to be clinically effective for children who studied in the fifth grade during the first two academic years after the program was started; however, no longer term evaluation was attempted[3][4]. In response to this, a longer term study has now been undertaken, in which a total of 306,144 students participated in scoliosis screening. Clearly, screening is considered valuable around the world!

 

Why does early detection matter?

Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[5]

The 2015 study included patients aged between 4 to 10 years at the beginning of treatment and with a curve magnitude of 20°-40° Cobb. Curves between 20° and 25° Cobb degrees were included only in the presence of documented curve progression. Patients were prescribed an appropriate scoliosis brace and wear time, based on their individual cases.

The results from the study showed that curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early. [6]

 

Juvenile scoliosis almost never resolves without treatment

Scolibrace

Scolibrace is a comfortable and effective advanced brace

Unfortunately, “wait and see” is still a common approach here in the UK – unfortunately this approach is outdated and fails to recognise the outcome of research which has clearly shown that juvenile scoliosis tends to worsen, sometimes aggressively and almost never resolves.

Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability[7].

A 2006 study followed (but did not treat) 205 patients of which 99 (48.3%) were operated on. Of 109 curves less than or equal to 20 degrees at onset of puberty, 15.6% progressed to greater than 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves greater than 30 degrees[8].

This research is particularly troubling, in light of the above study, which showed a very high likelihood of total curve correction up to and including 30-degree angles, had these cases been screened, caught early and treated with a corrective brace.

 

How we can help

At the UK Scoliosis clinic, we offer free screening to anyone concerned about Scoliosis. If you have already had a diagnosis and have been advised to wait and see, we especially urge you to book an appointment to see our specialists in order to avoid compromising your chances at a highly effective treatment plan.

 

[1] Richards BS, Vitale MG. Screening for idiopathic scoliosis in adolescents. An information statement. J Bone Joint Surg Am 2008;90: 195–8.

[2] Sabirin J, Bakri R, Buang SN, Abdullah AT, Shapie A. School scoliosis screening programme—a systematic review. Med J Malaysia

2010;65:261–7.

[3] Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine

2010;35:1607–14.

[4] Yawn BP, Yawn RA, Hodge D, Kurland M, Shaughnessy WJ, Ilstrup D, et al. A population-based study of school scoliosis screening.

JAMA 1999;282:1427–32.

[5]  ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘

Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

[6] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘

Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

[7] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[8] Ibid.

Is bracing an effective treatment for Adolescent Idiopathic Scoliosis? BRAIST study says yes!

Adolescent idiopathic scoliosis is characterized by a lateral curvature of the spine, with a Cobb angle of more than 10 degrees and vertebral rotation. Scoliosis develops in approximately 3% of children younger than 16 years of age, although rates of Scoliosis are typically much higher amongst at-risk groups such as dancers and gymnasts.  Curves larger than 50 degrees are typically associated with a high risk of continued worsening throughout adulthood and thus are most likely to be recommended for a surgical procedure.[1]

Scolibrace

Our Scolibrace is comfortable, effective and low-profile

Treatment with rigid bracing (thoracolumbosacral orthosis or TLSO) is the most common non-surgical treatment for the prevention of curve progression. There are many different brace designs, but with all of them, the objective is to restore the normal contours and alignment of the spine while preventing scoliosis progression. The most effective designs (like our Scolibrace system) seek to deliver superior outcomes by providing active correction of the curve.

But is bracing effective?  – Today you’ll still find some practitioners who are unclear on the outcomes you can expect from bracing. This is because although historical studies of bracing in adolescent idiopathic scoliosis had suggested that bracing decreases the risk of curve progression.[2] in some of these earlier studies results were inconsistent, the studies were observational, and only one prospective study enrolled both patients who underwent bracing and those who did not.[3] Thus, for some time the effect of bracing on curve progression and rate of surgery was unclear. This all changed thanks to the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST), which finally determined the effectiveness of bracing – as compared with observation – in preventing progression of the curve to 50 degrees or more.

The BRAIST study was a large-scale endeavour, conducted in 25 institutions across the United States and Canada. Enrolment began in March 2007.  The target population for this study was patients with high-risk adolescent idiopathic scoliosis who met current indications for brace treatment – specifically this meant an age of 10 to 15 years, skeletal immaturity and a Cobb angle for the largest curve of 20 to 40 degrees.[4] To be eligible, patients could not have received previous treatment for adolescent idiopathic scoliosis.

 

Methods

During the BRAIST study, patients in the observation group received no specific treatment, whereas patients in the bracing group received a rigid brace, prescribed to be worn for a minimum of 18 hours per day. Participating centres prescribed the type of brace used in their normal clinical practice. Wear time was determined by means of a temperature logger embedded in the brace and programmed to log the date, time, and temperature every 15 minutes. A temperature of 28.0°C (82.4°F) or higher[5] indicated that the brace was being worn.

Both patients and clinicians were aware of the assigned treatment. However, all radiographic (x-ray) evaluations and outcome determinations which were made at the conclusion of the study were performed by experts without knowledge of the treatment protocol, to avoid bias.

 

Results

During the study, a total of 146 patients (60%) received a brace, and 96 (40%) underwent observation only. The two study groups were generally similar with respect to baseline characteristics, except that the patients in the bracing group were slightly taller on average than those in the observation group (156.5 cm vs. 153.6 cm).

The results shown at the end of the study were conclusive – the rate of treatment success was 72% in the bracing group and 48% in the observation group. By contrast, the rate of treatment failure was only 25% with bracing, but 58% with observation alone.[6]

Therefore, given a large sample set and a study carried out across reputable institutions, it was determined that adolescents with idiopathic scoliosis who were considered to be at high risk for curve progression that would eventually warrant surgery, bracing was associated with a significantly greater likelihood of reaching skeletal maturity with a curve of less than 50 degrees, as compared with observation alone.

The study also showed a significant association between the average hours of daily brace wear and the likelihood of a successful outcome. These findings corroborate those of previous prospective observational studies, which have shown a significantly lower rate of surgery among patients who wore a brace than among those who were untreated[7]and a strong relationship between wear time and outcome.[8]

 

Our analysis

The BRAIST study is without a doubt one of the most important pieces of research which informs our work here at the clinic. Since we’re strongly committed to providing the latest, most up to date treatment methodologies available we welcome any and all research which can assist us in fine turning our approach to non-surgical scoliosis treatment.

BRAIST has shown conclusively that bracing is an effective way to treat scoliosis non-surgically, and also confirms a link between correctly prescribed wear time and positive outcomes. At the UK scoliosis clinic, we’re also committed to helping to find ways to treat the 25% of individuals who didn’t get the result they would have liked from the BRAIST study. One of the ways we do this is by offering what we believe is the best scoliosis bracing system available, the Scolibrace system – which is an active correction, individually customised brace designed for maximum correction. Since a variety of braces were used during this study, we hypothesise that the successful treatment figures could have been even higher if more modern concepts in brace design had been adopted for the study. You can learn more about scolibrace here.

 

[1] Weinstein SL, Ponseti IV. Curve progression in idiopathic scoliosis. J Bone Joint Surg Am 1983;65:447-455

[2] Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine (Phila Pa 1976;32:Suppl:S91-S100

Dolan LA, Weinstein SL. Best treatment for adolescent idiopathic scoliosis: what do current reviews tell us? In: Wright JG, ed. Evidence-based orthopaedics: the best answers to clinical questions. Philadelphia: Saunders, 2009.

Focarile FA, Bonaldi A, Giarolo MA, Ferrari U, Zilioli E, Ottaviani C. Effectiveness of nonsurgical treatment for idiopathic scoliosis: overview of available evidence. Spine (Phila Pa 1976;16:395-401

Lenssinck ML, Frijlink AC, Berger MY, Bierman-Zeinstra SM, Verkerk K, Verhagen AP. Effect of bracing and other conservative interventions in the treatment of idiopathic scoliosis in adolescents: a systematic review of clinical trials. Phys Ther 2005;85:1329-1339

Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2010;1:CD006850-CD006850

Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D. A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am 1997;79:664-674

Screening for idiopathic scoliosis in adolescents. Rockville, MD: Preventive Services Task Force, June 2004 (http://www.uspreventiveservicestaskforce.org/uspstf/uspsaisc.htm).

[3] Nachemson AL, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis: a prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995;77:815-822

Danielsson AJ, Hasserius R, Ohlin A, Nachemson AL. A prospective study of brace treatment versus observation alone in adolescent idiopathic scoliosis: a follow-up mean of 16 years after maturity. Spine (Phila Pa 1976;32:2198-2207)

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DOI: 10.1056/NEJMoa1307337

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