Brace treatment in infantile/juvenile patients with progressive scoliosis is worthwhile

Little information exists about successful brace treatment of progressive early onset scoliosis. Even less information is available about the early treatment of scoliosis patients with Marfan's syndrome at age < 6 years. Purpose of this case report is to demonstrate the possibility of successful brace treatment in a patient with early onset scoliosis due to Marfan's syndrome.

A two year old girl diagnosed with Marfan's syndrome presented with a double major scoliosis of 20°. After a follow-up of 6 months she showed a rapid progression to 46° (November 2008) and was braced immediately. In-brace correction in the first Chêneau brace (RSC TM) was moderate due to the stiffness mainly of the lumbar curve. A new brace was made after significant growth (Gensingen braceTM in October 2009). An in-brace correction to 12° thoracic and 12° lumbar has been achieved. In October 2010 she also has outgrown her second brace to some extent. Due to clinical overcorrection (ATR lumbar -5°) brace wearing time has been reduced to 12 hrs. / day at first. In January 2011 at the age of 4 and a half she presented again with an ATR lumbar of -6° still overcorrected clinically, so we decided to leave off the brace for 3 months time. The deformity returned and we had to make a new brace in April 2011. For brace construction a new x-ray has been made showing the curve meanwhile has been reduced to 24° Cobb, however still with significant wedging of the apical vertebra.

(1) Successful brace treatment in infantile / juvenile patients with scoliosis is possible. (2) When treated during periods of rapid growth corrections can be achieved with high correction braces. (3) Before early surgery is performed high quality conservative management seems indicated.