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Results of Bracing for Juvenile Idiopathic Scoliosis
Nanjundappa S Harshavardhana1, John E Lonstein2
1Golden Jubilee National Hospital, Clydebank G51 4DY, United Kingdom.
Study Design:
Retrospective comparative therapeutic clinical study evaluating the results of bracing for juvenile idiopathic scoliosis (JIS).
Objectives:
To evaluate if bracing has a role in treatment of JIS and, if so, to report its success rate and factors associated with successful bracing.
Summary Of Background Data:
Patients with JIS have higher mortality and morbidity in comparison to those with adolescent idiopathic scoliosis (AIS) or general population. Untreated JIS may cause severe cardiorespiratory compromise.
Methods:
All children treated at our institute and followed up until either skeletal maturity or surgeries between 1956 and 1999 with JIS were included. Those who had an incomplete set of radiographs or those treated by mere observation were excluded.
Results:
One hundred twenty-five patients, comprising of 93 who were braced as juveniles and 32 who were braced in adolescence, met the inclusion criteria. Fifty-six of them were successfully treated by bracing (32 juveniles and 24 adolescents) and 69 patients needed surgery despite bracing. When final curves greater than 45° were regarded as failure of bracing, the success rate was 41%. The braces used were Milwaukee brace (MB) and thoraco-lumbo-sacral orthosis (TLSO) and no statistically significant difference was found between the two. None of the patients had surgery of any kind during the juvenile phase (ie, at age <10 years).
Discussion:
The overall success rate with bracing was 41%. A third of them (ie, 18/56) could be safely weaned prior to skeletal maturity without risking curve progression. The odds of needing a surgery when braced as a juvenile was 2-in-3 (34% success), which fell to almost 1-in-4 for an adolescent (75% success) and was statistically significant (p = .001). Curves with Cobb angle ≤29° when braced progressed to a degree warranting surgery at a lower rate as compared to those ≥30°, this difference was not statistically significant (p = .22).
Conclusion:
Bracing obviated the need for surgery during juvenile years in all patients and was a successful delaying strategy.
