Bracing the spine in teens with a curvature is more effective than watching and waiting in preventing the need for surgical correction, Canadian and U.S. surgeons have found.
Scoliosis is a type of spinal curvature that now affects mainly girls beginning in adolescence. If the curvature worsens to more than 50 degrees after maturity it increases the risk of severe deformity and compromising lung function.
In Thursday's online issue of the New England Journal of Medicine, orthopedic surgeons from the Hospital for Sick Children in Toronto and three U.S. institutions said bracing significantly decreased progression to needing surgery.
"I won't be so much telling kids that I don't know whether it works," said study co-author Dr. James Wright, surgeon in chief at the Hospital for Sick Children. "I'm going to be saying, it does work and I'm afraid you have to wear it."
The researchers concluded that in adolescents with idiopathic scoliosis who were considered to be at high risk for curve progressing that would eventually warrant surgery, bracing was associated with a significantly greater likelihood of reaching skeletal maturity with a curve of less than 50 degrees, compared with watching and waiting.
The findings will have a direct impact on clinical practice in assessing orthopedic patients for bracing, Wright said.
The rate of treatment success in terms of preventing the need for surgery was 72 per cent in the bracing group compared with 48 per cent in the untreated group. In the bracing group, 41 per cent also had a successful outcome even though they spent little time wearing the brace. The braces contained a device that indicated when they were being worn.
But wearing a brace has financial, emotional and social burdens that need to be considered, Dr. Eugene Carragee of Stanford University School of Medicine in California and Dr. Ronald Lehman of Walter Reed National Military Medical Center in Bethseda, Md., said in a journal commentary published with the study.
"We agree with the authors that the equally important finding of this study is that so many growing children with adolescent idiopathic scoliosis seem to do just fine with no treatment at all; the challenge for the field going forward is to identify children who are most likely to benefit from bracing," the commentators said.
Mary-Louise Palogan of Toronto started wearing a brace after she was diagnosed with scoliosis at the age of 12. Wearing the brace wasn't easy, she said.
"I couldn't hide it properly within my clothes," Palogan recalled. "My friends started to question like, 'Oh what do you got under there?'"
Palogan participated in the study and avoided surgery, which she says was worth the initial frustration of the brace.
The trial of 242 patients was designed as a randomized trial but 126 ended up choosing their care. The study's authors said they minimized but did not eliminate the potential bias from the nonrandomized patients.
Scoliosis develops in about three per cent of children younger than 16 but less than one per cent have progressive curves that need treatment, previous research suggests.
The study was funded by the U.S.National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Shriners Hospitals for Children, the Canadian Institutes of Health Research, Children’s Mercy Hospitals and Clinics, the University of Rochester and SickKids Foundation.