What is the research on medical therapy for idiopathic scoliosis?

Updated: Dec 02, 2020
  • Author: Charles T Mehlman, DO, MPH; Chief Editor: Jeffrey A Goldstein, MD  more...
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Answer

The first widely used scoliosis brace with proven effectiveness was the Milwaukee brace. This brace was developed by Walter Blount and Albert Schmitt and introduced at a meeting of the American Academy of Orthopaedic Surgeons in 1946. [105] It was originally designed to be used as part of the surgical treatment of scoliosis and only later evolved into a standalone nonoperative treatment.

Lonstein and Winter studied 1020 patients with adolescent idiopathic scoliosis treated with the Milwaukee brace. They reported that this orthosis was effective in preventing significant curve progression in patients with 20-39° curves. [106] These same authors recommended that adolescents with a curve of 25° and a Risser sign of 0 be braced immediately and not wait for evidence of curve progression. Other authors have shown that an average curve correction of 20% in the brace (Milwaukee brace) is associated with bracing success. [107, 108]

Rowe et al performed a meta-analysis aimed at evaluating the efficacy of nonoperative treatments for idiopathic scoliosis. [109] They calculated the weighted mean proportion of success for three nonoperative treatments: observation, electrical stimulation, and bracing. They were able to successfully combine data on 1910 patients from 20 different studies for purposes of meta-analysis and reported the following main results:

  • Observation, 49% success rate
  • Electrical stimulation, 39% success rate
  • Bracing 8 hr/day, 60% success rate
  • Bracing 16 hr/day, 62% success rate
  • Bracing 23 hr/day, 93% success rate

In a prospective multicenter study from the Scoliosis Research Society, Nachemson et al found brace treatment (an underarm plastic brace worn for at least 16 hr/day) to be successful 74% of the time (95% confidence interval [CI], 52-84%). [110] Some authors have not been able to identify a major difference between full-time bracing (23 hr/day) and part-time bracing (12-16 hr/day). [111]


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