A Prospective Study of Brace Treatment Versus Observation Alone in Adolescent Idiopathic Scoliosis: A Follow-up Mean of 16 Years After Maturity

Aina J. Danielsson, MD, PhD; Ralph Hasserius, MD, PhD; Acke Ohlin, MD, PhD; Alf L. Nachemson, MD, PhD

Disclosures

Spine. 2007;32(20):2198-2207. 

In This Article

Abstract and Introduction

Abstract

Study Design: The Swedish patients included in the previous SRS brace study were invited to take part in a long-term follow-up.
Objective: To investigate the rate of scoliosis surgery and progression of curves from baseline as well as after maturity.
Summary of Background Data: Brace treatment was shown to be superior to electrical muscle stimulation, as well as observation alone, in the original SRS brace study. Few other studies have shown that brace treatment is effective in the treatment of scoliosis.
Methods: Of 106 patients, 41 in Malmö (all Boston brace treatment) and 65 in Göteborg (observation alone as the intention to treat), 87% attended the follow-up, including radiography and chart review. All radiographs were (re)measured for curve size (Cobb method) by an unbiased examiner. Searching in the mandatory national database for performed surgery identified patients who had undergone surgery after maturity.
Results: The mean follow-up time was 16 years and the mean age at follow-up was 32 years The 2 treatment groups had equal curve size at inclusion. The curve size of patients who were treated with a brace from the start was reduced by 6° during treatment, but the curve size returned to the same level during the follow-up period. No patients who were primarily braced went on to undergo surgery. In patients with observation alone as the intention to treat, 20% were braced during adolescence due to progression and another 10% underwent surgery. Seventy percent were only observed and increased by 6° from inclusion until now. No patients underwent surgery after maturity. Progression was related to premenarchal status.
Conclusion: The curves of patients with adolescent idiopathic scoliosis with a moderate or smaller size at maturity did not deteriorate beyond their original curve size at the 16-year follow-up. No patients treated primarily with a brace went on to undergo surgery, whereas 6 patients (10%) in the observation group required surgery during adolescence compared with none after maturity. Curve progression was related to immaturity.

Introduction

The effectiveness of conservative treatment in the treatment of adolescent idiopathic scoliosis (AIS) has been the subject of debate for many years.[1,2,3,4] The Scoliosis Research Society (SRS) brace study was set up in the early 1980s with the aim of solving this problem. Three methods of treatment were investigated: observation alone, brace treatment, and electrical stimulation. The study design was multicenter and prospective, and the patients were treated according to contemporary treatment protocols at each center. To sum up, the study demonstrated that bracing was more effective than observation alone and electrical stimulation, which was not effective.[5,6]

The 2 participating centers in Sweden used different treatment regimens. One of the centers treated all patients with a brace as soon as they were included in the study, while the other observed the patients until progression was found on 2 consecutive radiographs. Depending on curve magnitude and remaining growth, patients received continued observation, brace treatment, or surgery. This constituted an ideal base for a long-term follow-up, especially in combination with the very good opportunities offered by the Swedish healthcare system to retrieve patients for follow-up. The study should therefore not be regarded as a continuation of the original SRS brace study.

The aim of the present study was to elucidate the outcome from baseline to the 10-year follow-up at the very least and to compare the results in terms of curve progression and rate of surgery after maturity between patients treated with a brace and patients who were only observed. To the best of our knowledge, observation periods of this kind have not previously been published.

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