Effect of preoperative brace treatment on quality of life in adolescents with idiopathic scoliosis following corrective surgery.
ABSTRACT Bracing is frequently used for the treatment of adolescent idiopathic scoliosis. Such treatment is not always effective, and corrective surgery may be warranted. Brace treatment has been suggested to negatively affect quality of life. This study assessed postoperative quality of life and surgical outcome in Chinese patients with adolescent idiopathic scoliosis and failed brace treatment. Ninety-four patients with adolescent idiopathic scoliosis who underwent simple posterior corrective surgery and pedicle screw fixation were studied. The patients were divided into 2 groups: brace and surgery treatment (BS group) and surgery with no brace treatment (S group). Radiological parameters were assessed preoperatively, immediately postoperatively, and >2 years postoperatively. Postoperative quality of life was determined using the Scoliosis Research Society-22 (SRS-22) questionnaire. The preoperative minor curve Cobb angle was significantly greater in the BS group (34.9 degrees vs 29.4 degrees ; P=.037). Postoperative radiological parameters in the coronal and sagittal planes were similar. There were a significantly higher number of fused vertebrae in BS compared to S group patients (10.3 vs 9.6; P=.044). There were no significant postoperative differences between groups in function/activity, pain, mental health, or satisfaction of management as determined by the SRS-22. Self-image/appearance scores were significantly higher in BS compared to S group patients (4.0 vs 3.8; P=.010). Preoperative brace treatment may be a risk factor for minor curve progression but does not appear to significantly influence surgical outcome. Postoperative self-perceived quality of life is not negatively affected by preoperative brace treatment.
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ABSTRACT: The SRS-22 questionnaire is specifically designed for the assessment of quality of life in spinal deformity patients. This study is the first to use it to assess the quality of life of adolescent idiopathic scoliosis patients under brace treatment and compares the results with an observational group matched by age and curve magnitude. Forty-six patients were enrolled into each group. Overall, it was found that patients under observation had a significantly better quality of life than braced patients. Specifically, the domains for function/activity and self-image were most affected. This effect was most apparent in those with a curve magnitude of under 20 degrees . The scores did not improve significantly with the duration of brace wear, suggesting little adaptation. This study has implications for treatment, and more attention will need to be given to those with mild but progressive curves to help improve patients' understanding of their treatment and hence their compliance and satisfaction.International Orthopaedics 09/2007; 31(4):507-11. · 2.32 Impact Factor
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ABSTRACT: : Systematic review of clinical studies. : To develop a pooled estimate of the prevalence of surgery after observation and after brace treatment in patients with adolescent idiopathic scoliosis (AIS). : Critical analysis of the studies evaluating bracing in AIS yields limited evidence concerning the effect of TLSOs on curve progression, rate of surgery, and the burden of suffering associated with AIS. Many patients choose bracing without an evidence-based estimate of their risk of surgery relative to no treatment. Therefore, such an estimate is needed to promote informed decision-making. : Multiple electronic databases were searched using the key words "adolescent idiopathic scoliosis," "observation," "orthotics," "surgery," and "bracing." The search was limited to the English language. Studies were included if observation or a TLSO was evaluated and if the sample closely matched the current indications for bracing (skeletal immaturity, age <15 years, Cobb angle between 20 degrees and 45 degrees ). One reviewer (L.A.D) selected the articles and abstracted the data, including research design, type of brace, minimum follow-up, and surgical rate. Additional data concerning inclusion criteria and risk factors for surgery included gender, Risser, age and Cobb angle at brace initiation, curve type, and dose (hours of recommended brace wear). : Eighteen studies were included (observation = 3, bracing = 15). All were Level III or IV clinical series. Despite some uniformity in surgical indications, the surgical rates were extremely variable, ranging from 1 surgery of 72 patients (1%) to 51 of 120 patients (43%) after bracing, and from 2 surgeries of 15 patients (13%) to 18 of 47 patients (28%) after observation. When pooled, the bracing surgical rate was 23% compared with 22% in the observation group. Pooled estimates for surgical rate by type of brace, curve type, Cobb angle, Risser sign, and dose were also calculated. : Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in AIS. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by "troublingly inconsistent or inconclusive studies of any level." The decision to brace for AIS is often difficult for clinicians and families. An evidence-based estimate of the risk of surgery will provide additional information to use as they weigh the costs and benefits of bracing.Spine 09/2007; 32(19 Suppl):S91-S100. · 2.16 Impact Factor
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ABSTRACT: Historically, the treatment options for AIS, the most common form of scoliosis are: Exercises, in-patient rehabilitation, braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no review on prospective controlled trials for surgical treatment. The aim of this review was to perform a systematic search of the Pub Med literature to reveal the evidence on scoliosis surgery. A systematic review has been performed using the Pub Med database. Literature has been searched for the outcome parameter; 'rate of progression' and only prospective controlled studies that have considered the treatment versus the natural history have been included. No controlled study, not in the short, mid or long term, searched within the review, has been found to reveal evidence to support the hypothesis that the effects of surgery as a treatment option for AIS is superior to natural history. No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that such evidence exists, there can be no medical indication for surgery. The indications for surgery are limited for cosmetic reasons in severe cases and only if the patient and the family agree with this.Disability and Rehabilitation 02/2008; 30(10):799-807. · 1.54 Impact Factor