The Sforzesco brace can replace cast in the correction of adolescent idiopathic scoliosis: A controlled prospective cohort study.
BACKGROUND
The conservative treatment of adolescent idiopathic scoliosis (AIS) has traditionally been divided into two phases-correction and stabilisation-and casts, even if less used today, can be considered the best standard in the correction phase. Till the present, however, no comparison between cast and brace efficacy has been proposed.


METHODS
This is a prospective cohort study with a retrospective control group. The aim was to verify if it is possible to obtain with a specifically developed rigid brace results comparable to a cast. We considered fifty AIS patients who had refused surgery, aged 14.1 +/- 1.5 years, with 46.7 +/- 7.8 degrees Cobb scoliosis. Thirty-two consecutive patients (with no drop-outs) were prospectively followed up with the Sforzesco brace (SBG), and compared against a retrospective group of eighteen patients treated with the Risser cast (RCG). The treatment time (the total correction phase) was 19 +/- 3 months. Out-of-brace x-rays were compared, as well as clinical results.


RESULTS
Compliance and hours of treatment were higher in the RCG while all the other parameters were not different. We observed a reduction of 6 degrees Cobb and an important aesthetic gain in both groups (P<0.05). Three patients (6%) worsened, while 56% improved (36% at least 10 degrees , and 14% 15 degrees or more). The SBG did show results comparable to the RCG, with only minor differences in terms of scoliosis correction. On the contrary, straightening of the spine (decrease of the sagittal physiological curves) was much higher in the RCG but was not clinically significant in the SBG.


CONCLUSIONS
In the corrective phase of AIS treatment it is possible with a specific rigid brace (Sforzesco - SPoRT concept) to obtain scoliosis correction similar to cast. Due to the human and social costs of casting, and worst sagittal profile results, Sforzesco brace should be the preferred method wherever possible.
Negrini
Stefano
S
ISICO (Italian Scientific Spine Institute), Via R, Bellarmino 13/1, 20121 Milan, Italy. stefano.negrini@isico.it.
Atanasio
Salvatore
S
Negrini
Francesco
F
Zaina
Fabio
F
Marchini
Gianfranco
G