Brace wear control of curve progression in adolescent idiopathic scoliosis.
BACKGROUND
The efficacy of brace treatment for patients with adolescent idiopathic scoliosis remains controversial, and effectiveness remains unproven. We accurately measured the number of hours of brace wear for patients with this condition to determine if increased wear correlated with lack of curve progression.


METHODS
Of 126 patients with adolescent idiopathic scoliosis curves measuring between 25 degrees and 45 degrees , 100 completed a prospective study in which they were managed with a Boston brace fitted with a heat sensor that measured the exact number of hours of brace wear. Orthopaedic teams prescribed either sixteen or twenty-three hours of brace wear and were blinded to the wear data. At the completion of treatment, the number of hours of brace wear were compared with the frequency of curve progression of > or =6 degrees and with curve progression requiring surgery.


RESULTS
The total number of hours of brace wear correlated with the lack of curve progression. This effect was most significant in patients who were at Risser stage 0 (p = 0.0003) or Risser stage 1 (p = 0.07) at the beginning of treatment and in patients with an open triradiate cartilage at the beginning of treatment. Logistic regression analyses showed a "dose-response" curve in which the greater number of hours of brace wear correlated with lack of curve progression. Brace wear to school and immediately afterward was most successful. Curves did not progress in 82% of patients who wore the brace more than twelve hours per day, compared with only 31% of those who wore the brace fewer than seven hours per day (p = 0.0005). The number of hours of brace wear also correlated inversely with the need for surgical treatment (p = 0.0005). The number of hours of wear were similar for the patients who were advised to wear the brace sixteen or twenty-three hours daily.


CONCLUSIONS
The Boston brace is an effective means of controlling curve progression in patients with adolescent idiopathic scoliosis when worn for more than twelve hours per day.
Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA.
Donald E
DE
Katz
J Anthony
JA
Herring
Richard H
RH
Browne
Derek M
DM
Kelly
John G
JG
Birch
D000293:Adolescent; D001915:Braces; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012600:Scoliosis / Q000628:therapy*; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome