Choose bracing over wait-and-see with scoliosis

If you are wondering whether bracing really makes a difference over observation in adolescents with idiopathic scoliosis, a recent 25-center study finds that it does, and so much so that the study had to be stopped early.

The study is known as the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST). Researchers included 242 patients between the ages of 10 and 15 years with typical indications for bracing due to age, skeletal immaturity, and degree of scoliosis. The patients came from 25 institutions across the United States and Canada.

The investigators randomly assigned 116 study participants to either bracing or observation. They told the remaining 126 to choose bracing or observation. They instructed all the students in the bracing group to wear their braces at least 18 hours per day.

The number of patients in the bracing group with curve progression to 50 degrees or more (an indication for surgery) was far lower than in the observation group. In fact, the rate of treatment success (defined as reaching skeletal maturity without curve progression to 50 degrees or more) was 72% in the bracing group versus 48% in the observation group. In the intention-to-treat analysis, the rate of treatment success was 75% in the bracing group versus 42% in the observation group.

The investigators also found that the more hours a child wore his or her brace, the greater the likelihood of treatment success. Those who wore their braces 0 to 6 hours per day had rates of success that hovered around 41%, whereas those who wore their braces in excess of 12.9 hours per day had success rates of 90% to 93%.

Interestingly, no significant differences existed in quality of life as determined by PedsQL scores between the 2 groups.

The value of bracing was recently in doubt with studies producing mixed results. In fact, the US Preventive Services Task Force not too long ago recommended against routine screening of asymptomatic adolescents for idiopathic scoliosis.

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