Effectiveness of braces in mild idiopathic scoliosis

Despite the wide use of bracing for the treatment of idiopathic scoliosis, controlled studies apparently have not been performed to examine whether bracing, in fact, alters the natural history of spine lateral curves. We studied 255 female patients, ages 8-17 years, with idiopathic scoliosis who had curves with initial Cobb measures from 15-30 degrees. They were divided into two groups: one group consisted of 144 patients who had received a Milwaukee or Boston brace; and the other, a control group, consisted of 111 patients who remained untreated through a mean period of 1.9 years. The groups had similar mean ages, ages of menarche and curve severities. The results showed a slight but nonsignificant trend, suggesting that bracing reduced the overall probability of progression in the braced curves. However, noting that nearly 75% of the control group curves were nonprogressive, it is possible that a similar proportion of the braced curves need not have been braced. Moreover, bracing failed to prevent eight curves in seven patients (5%) from progressing. These curves progressed at a mean rate of 8 degrees per year. Our retrospective results suggest that bracing probably is not necessary in a large proportion of patients who meet current, clinical criteria for bracing. Given the limitations of retrospective studies like this one, a controlled prospective trial of bracing effectiveness in idiopathic scoliosis seems warranted.