Straightening Out Adolescent Scoliosis: Does Bracing Help?
Scoliosis is a side-to-side curvature of the spine. When it shows up for no aparent reason during youth, doctors call it adolescent idiopathic scoliosis. If your child has this problem, your doctor may prescribe a brace. Braces are usually suggested for people whose bones are still growing, to keep spinal curves from progressing further. While braces seem to have good results for smaller curves, the results for larger curves (greater than 35 degrees) are less predictable. How can you tell whether bracing will work?
Doctors look to X-rays for answers. From X-rays, doctors can see the pattern of the curve or curves, and monitor changes over time. These authors wanted to see whether X-rays could predict the results of bracing for teens with large spinal curves (36 to 45 degrees).
Fifty-one teens were treated with braces. Girls have scoliosis more often than boys, and this was reflected in this study, with 47 girls and four boys participating.
Sixty percent of these teens had good results from bracing. But 40 percent had curves that worsened five or more degrees even with bracing. Half of these teens went on to have surgery. Three years later, a few teens who were initially thought to have good results showed further curvature of the spine and had surgery. This reduced the overall success rate to 45 percent.
Maturity as measured by age and the timing of growth spurt or first period did not affect whether bracing worked. This suggests that bracing may be appropriate for youth at all stages of development.
Some of the teens had a single curve in their upper or low backs. Others had two curves in an S-shape. Bracing had about the same success rate for these groups. For teens with one curve, X-rays didn't predict treatment results. But for those with double curves, there were a few interesting findings.
The exact pattern of the two curves predicted results from bracing. So did the position of the pelvis with regard to the low back. When the pelvis tilted more than 12 degrees from the low back, teens were less likely to have good results from bracing. The authors suspect that a tilted pelvis creates a poor base of support for a spine that's already thrown off balance by curves, and this makes treatment tricky. Braces designed to correct the position of the pelvis as well as the spine may help, but more research is needed.
Can doctors tell whether the brace will prevent further curvature of the spine when the teen is first wearing it? The authors found that, for teens with two curves, a 25 percent correction of the bigger curve during treatment predicted good results from bracing. The amount of time teens wore the brace also made a difference. Teens who wore the brace for more than 18 hours a day avoided further curvature over 80 percent of the time. When time in the brace was reduced just a few hours a day (12-18 hours total), the success rate fell to 50 percent.
The authors hope this information will help doctors decide the best course of treatment for teens with large spinal curves from scoliosis. Depending on the position of the vertebrae and pelvis, bracing may be successful about half of the time. For other patients with large curves, surgery may be necessary.
Donald E. Katz, BS, CO, and A. A. Durrani, MD. Factors That Influence Outcome in Bracing Large Curves in Patients With Adolescent Idiopathic Scoliosis. In Spine. October 1, 2001. Vol. 26. No. 21. Pp. 2354-2361.
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