Scoliosis: Brace treatment - from the past 50 years to the future

This paper deals with scoliosis treatment over the past 50 years. The review of the literature from the point of view of the current formation of opinion. From conservative forms of treatment, the pendulum has swung to surgical measures. To visualize this temporarily rejection of conservative treatment is the goal of this article.

A review of the literature over the last 50 years was performed from the perspective of current opinion, this with a pinch of personal experience in bracing and scoliosis surgery since 1972. The MESH terms (scoliosis, idiopathic scoliosis, adolescent idiopathic scoliosis) are presented in their number in a flow diagram and the publications on conservative therapies (brace, physiotherapy) are compared to surgical therapies (surgery).Opinions of "eminences" in the 1980s have been replaced by the rules of evidence-based medicine (EBM) at end of the 1990s. This transition will be visualized in the graph of PubMed statistics. In a statement, the future scoliosis treatment is derived from history.

The total number of publications shows a ratio of brace to surgery of 13.9% and physiotherapy to surgery of 6.7% for the MESH terms "scoliosis". When "scoliosis" is supplemented with "idiopathic", the brace to surgery ratio changes from 24.5% and physiotherapy to surgery 8.2%. Focusing on adolescent scoliosis the addition of "adolescent" changes the brace to surgery ratio from 24.8% and physiotherapy to surgery 8.1%. In the total number of publications, "adolescent idiopathic scoliosis" is treated by 25.26%. The patient numbers of our own scoliosis outpatient clinic (1482 patients) over the last 15 years show a ratio of brace (Cobb angle 20°-50° brace-indication) to surgery (Cobb angle >50° indication to surgery) of 1 to 0.06. The scientific focus on surgical therapy is evident from the figures of PubMed mentioned. The number of conservative publications shows a depression in the 1990s. In the remainder of this article, opinion-forming developments are outlined and supported by literature citations, responsible for the recovery of publications on conservative scoliosis treatment. New technologies provide additional treatment options.

In this sense, brace therapy is a success story with a future in the digital world of AI (artificial intelligence), mathematical model calculations, and production perhaps from the 3D printer. The central message from the history of the last 50 years is: "The scientific review of treatment results is essential for the further acceptance of brace treatment."