Does brace treatment impact upon the flexibility and the correctability of idiopathic scoliosis in adolescents?
OBJECTIVE
Brace treatment has served as a vital non-surgical procedure for immature adolescent idiopathic scoliosis (AIS) patients with a mild or moderate curve. For the patients who fail in bracing and resort to surgery, it is unclear whether prior full-time brace treatment significantly influences outcomes. This study aims to investigate whether prior brace treatment has a negative impact upon the flexibility and correctability of the main curve in patients with AIS.


METHODS
The participants were collected from female AIS patients who underwent posterior correction surgery with pedicle screw instrumentation from August 2006 to December 2010, with or without prior brace treatment. Patients included in Group A had prior brace treatment over a 1-year period, and underwent surgery within 6 months after cessation of bracing; those in Group B received no prior treatment and were randomly selected from our database. Curve flexibility pre-surgery and curve correctability post-surgery were computed and compared between both groups and subgroups according to the curve location.


RESULTS
Each group consisted of 35 patients. Age, curve magnitude and location were comparable between the two groups. Before surgery, patients in Group A had a slightly lower curve flexibility than those in Group B (52 vs. 60 %, P = 0.036). After surgery, satisfactory correction results were observed in both groups, but the average post-operative main curve magnitude of patients in Group B was 4° less than that of Group A (10° vs. 14°, P = 0.010). The curve correctability in Group B was significantly higher than that in Group A (80 vs. 74 %, P = 0.002). No matter what curve pattern the patient had, having a prior history of brace treatment resulted in a trend of lower flexibility and correctability of their scoliosis.


CONCLUSIONS
Good surgical correction can be achieved in AIS patients who have been unsuccessful with prior brace treatment. However, a history of prior brace treatment leads to a trend of lowering the curve flexibility, and in turn, negatively impacts upon the curve correctability.
Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing 210008, China.
Xu
X
Sun
Wen-jun
WJ
Liu
Lei-lei
LL
Xu
Qi
Q
Ding
Sai-hu
SH
Mao
Bang-ping
BP
Qian
Ze-zhang
ZZ
Zhu
Yong
Y
Qiu
D000293:Adolescent; D001863:Bone Screws; D001915:Braces; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D018583:Pliability; D012600:Scoliosis / Q000601:surgery / Q000628:therapy*; D013123:Spinal Fusion / Q000295:instrumentation*; D013904:Thoracic Vertebrae / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome