Long-term anatomic and functional changes in patients with adolescent idiopathic scoliosis treated with the Milwaukee brace.
Ninety-five patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: adolescent idiopathic scoliosis, completion of Milwaukee brace treatment before age 20, a minimum follow-up period of 5 years thereafter, minimum age of 22 years at final follow-up examination. Of these, 85 (90%) were examined personally by an independent investigator, including anteroposterior and lateral full-length spinal roentgenograms. The average length of follow-up was 7.5 years (range, 5-12 yrs). These patients who successfully completed the brace treatment program, in their mid-twenties ended up with curves that were of equal size (33 degrees +/- 3 degrees) as when the treatment started (30 degrees +/- 3 degrees). In the sagittal plane, the spines were normal; none exhibited hypokyphosis (less than 20 degrees). Compared with the straight control group and to a previously reported group of operated patients, the brace group functioned at the same level in regard to marriage, child bearing, sports activities, and job performance. Overall back pain was also reported at a normal rate, with low-back pain significantly less frequent than the control group. Ten patients showed an increase of their curves exceeding 5 degrees; eight of these had been pregnant multiple times before age 25. None of the patients pregnant after that age increased their curve size. This study demonstrates that those patients who complete a Milwaukee brace treatment for adolescent idiopathic scoliosis from a functional and social point of view do very well. Early pregnancy is a significant risk factor for progression after maturity.(ABSTRACT TRUNCATED AT 250 WORDS)
Cochran
T
T
Nachemson
A
A
D000203:Activities of Daily Living; D000328:Adult; D001416:Back Pain / Q000503:physiopathology; D001915:Braces / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013131:Spine / Q000000981:diagnostic imaging / Q000503:physiopathology