Braces for Idiopathic Scoliosis in Adolescents

ISICO (Italian Scientific Spine Institute), Milan, Italy.
Spine (Impact Factor: 2.45). 06/2010; 35(13):1285-93. DOI: 10.1097/BRS.0b013e3181dc48f4
Source: PubMed

ABSTRACT Cochrane systematic review.
To evaluate the efficacy of bracing in adolescent patients with adolescent idiopathic scoliosis (AIS).
AIS is a 3-dimensional deformity of the spine. Although AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Braces are traditionally recommended to stop curvature progression in some countries and criticized in others. They generally need to be worn full time, with treatment extending over years.
The following databases (up to July 2008) were searched with no language limitations: the Cochrane Central Register of Controlled Trials, MEDLINE (from January 1966), EMBASE (from January 1980), and CINHAL (from January 1982), and reference lists of the articles. An extensive handsearch of the gray literature was also conducted. Randomized controlled trials (RCTs) and prospective cohort studies were searched for comparing braces with no treatment, other treatment, surgery, and different types of braces. Two review authors independently assessed trial quality and extracted data.
We included 2 studies. There was very low quality evidence from 1 prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth (success rate, 74% [95% confidence interval {CI}: 52%-84%]), better than observation (success rate, 34% [95% CI: 16%-49%]) and electrical stimulation (success rate, 33% [95% CI: 12%-60%]). There is low-quality evidence from 1 RCT with 43 girls that a rigid brace is more successful than an elastic one (SpineCor) at curbing curve progression when measured in Cobb degrees, but there were no significant differences between the 2 groups in the subjective perception of daily difficulties associated with wearing the brace.
There is very low quality evidence in favor of using braces, making generalization very difficult. Further research could change the actual results and our confidence in them; in the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short- and long-term patient-centered outcomes, in addition to measures such as Cobb angles. RCTs and prospective cohort studies should follow both the Scoliosis Research Society and Society on Scoliosis Orthopedic and Rehabilitation Treatment criteria for bracing studies.

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Available from: Nachiappan Chockalingam, Aug 24, 2015
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    • "The challenge of orthotic treatment is to stop or slow down the progression of the spinal curvature prior to skeletal maturity, in order to avoid surgery. Orthotic treatments are widely used for progressive curves; their effectiveness have often been questioned [3] [4], but a recent by Weinstein et al. [5] showed that bracing could significantly reduce scoliosis progression, especially in those patients with high level of compliance to brace wear. "
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    ABSTRACT: Retrospective validation study.
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    • "The main aims of all clinical interventions in the treatment of adolescent idiopathic scoliosis (AIS) are to limit curve progression, restore trunk balance and prevent long-term consequences of the deformity. Two separate Cochrane reviews have already reviewed the effects of non-surgical interventions (Negrini, 2010 and Romano, 2012). A further scoping search identified four systematic reviews, however full methodological appraisals within these reviews were very limited (Weiss, 2008), indicating the need for a high-quality Cochrane review focusing on surgical interventions. "
    Cochrane database of systematic reviews (Online) 07/2013; DOI:10.1002/14651858.CD010663. · 5.94 Impact Factor
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    • "The literature on the effectiveness of brace treatment is vast and requires a systematic review of its own. As a very good starting point, one could consider the three published systematic reviews: Negrini et al. 2010 [24], Lenssinck et al. 2005 [39] and Rowe et al. 1999 [40]. Despite the publication of numerous case series and a certain number of comparative studies, best evidence on brace effectiveness is still pending. "
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    ABSTRACT: Literature on scoliosis screening is vast, however because of the observational nature of available data and methodological flaws, data interpretation is often complex, leading to incomplete and sometimes, somewhat misleading conclusions. The need to propose a set of methods for critical appraisal of the literature about scoliosis screening, a comprehensive summary and rating of the available evidence appeared essential. To address these gaps, the study aims were: i) To propose a framework for the assessment of published studies on scoliosis screening effectiveness; ii) To suggest specific questions to be answered on screening effectiveness instead of trying to reach a global position for or against the programs; iii) To contextualize the knowledge through expert panel consultation and meaningful recommendations. The general methodological approach proceeds through the following steps: Elaboration of the conceptual framework; Formulation of the review questions; Identification of the criteria for the review; Selection of the studies; Critical assessment of the studies; Results synthesis; Formulation and grading of recommendations in response to the questions. This plan follows at best GRADE Group (Grades of Recommendation, Assessment, Development and Evaluation) requirements for systematic reviews, assessing quality of evidence and grading the strength of recommendations. In this article, the methods developed in support of this work are presented since they may be of some interest for similar reviews in scoliosis and orthopaedic fields.
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