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Journal ArticleDOI

Early night-time-bracing - an alternative in scoliosis management

15 Jan 2009-Scoliosis (BioMed Central)-Vol. 4, Iss: 1, pp 1-1

TL;DR: The results of 22 early treated scoliosis patients treated with a Dresdner night-time brace at one institution show improvement in the curve or up to a maximum progression of 5° and if there was no progression above an absolute value of 25° COBB.

AbstractMethods We present the results of 22 early treated scoliosis patients, treated all with a Dresdner night-time brace at one institution. The average age was 11.9 years and the average follow up was 24.9 months after brace discontinuation. Treatment was considered successful if there was improvement in the curve or up to a maximum progression of 5° and if there was no progression above an absolute value of 25° COBB.

Topics: Scoliosis (53%), Brace (51%)

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References
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Journal ArticleDOI
15 Sep 1999-Spine
TL;DR: In cases of different orthoses of proven similar effectiveness in controlling the scoliotic curves, the use of bracing with the lowest impact on the quality of life should be recommended.
Abstract: Study design A group of 102 brace-treated adolescents, aged 10-19 years with spine deformities participated in a cross-sectional study. Objectives To determine the effect of various types of orthoses on self-perceived health status. Summary of background data Spinal orthosis is an effective means of controlling progressive scoliosis, but bracing has shown a considerable impact on several aspects of adolescent functioning. Methods Skeletally immature patients with spine deformities (75% with idiopathic scoliosis) who visited consecutively for routine biannual follow-up evaluations of orthotic treatment were studied. Twenty-five patients used the Milwaukee brace, 30 the Boston brace, 13 the thoracolumbosacral orthosis (TLSO), and 34 the Charleston bending orthosis. Patients completed the Quality of Life Profile for Spine Deformities (QLPSD), a specific instrument that measures quality of life in five areas labeled psychosocial functioning, sleep disturbances, back pain, body image, and back flexibility. Higher QLPSD scores mean a high level of impairment of quality of life. Results Milwaukee brace-treated patients scored significantly higher than Boston brace-treated and TLSO-braced patients and patients with Charleston bending orthosis in the overall QLPSD score (mean +/- SD, 53.60 +/- 13.26 vs. 45.65 +/- 12.81 and 42.79 +/- 12.99, respectively) and in back flexibility and psychosocial functioning. Other quality-of-life-related variables selected in multivariate analysis were the Risser sign, clinical diagnosis, duration of brace treatment, and degrees of correction. Conclusion In cases of different orthoses of proven similar effectiveness in controlling the scoliotic curves, the use of bracing with the lowest impact on the quality of life should be recommended.

158 citations


Journal Article

152 citations


Journal ArticleDOI
15 Sep 2001-Spine
TL;DR: Compared with previous natural history and the prospective study data, the Providence brace is effective in preventing progression of adolescent idiopathic scoliosis for curves <35° and was effective for larger curves with a low apex.
Abstract: Study design A prospective study was conducted of 102 consecutive female patients with adolescent idiopathic scoliosis. Those patients with Risser 0, 1, and 2 met the criteria for inclusion and were treated only with the Providence brace. Objectives To report the authors' experience with a hypercorrective nighttime brace and to evaluate the results with respect to risk factors for progression. Second, the study compares results with expectations from the natural history as reported by others. Summary of background data Compliance with full-time brace treatment for adolescent idiopathic scoliosis has been a problem. Since the introduction of the Milwaukee brace, alternatives such as low-profile braces, reduced wearing schedules, and nighttime only bracing have been tried. However, many factors influence the success or failure besides compliance. These include in-brace correction, brace design, and the orthotist's skills. This is the first report of the results of treatment with a new nighttime brace that is made with CAD/CAM technology that can achieve higher initial in-brace corrections than other reported methods. Methods Results were analyzed with respect to curve size, curve pattern, maturity, and level of the primary curve apex. Both compliant and noncompliant patients were included in the analysis. A univariate analysis was done on those factors thought to influence success with bracing using the Pearson chi2 test. Results The average initial in-brace correction with a supine radiograph was 96% for major curves and 98% for minor curves. Seventy-five patients (74%) did not progress >5 degrees and 27 patients (26%) progressed > or =6 degrees or went on to surgery. Twenty-nine percent of Risser 0 or 1 patients progressed and 17% of patients Risser 2 progressed. The risk of progression anticipated by natural history data, which included all curve patterns, was 68% for Risser 0 and 1 and 23% for Risser 2. Risser 3 and 4 patients were excluded from the study. Seventy-six percent of patients with curve apexes between T8 and L1 had successful outcomes using the Providence brace. This is compared with a 74% success rate in the prospective Scoliosis Research Society study of patients wearing a thoraco lumbar sacral orthosis for 16 hours per day with curve apexes between T8 and L1. With the Providence brace, 63% of thoracic curves and 65% of double curves were successful. Ninety-four percent of lumbar curves and 93% of thoracolumbar curves were successful. Conclusion Excellent initial in-brace correction of adolescent idiopathic scoliosis was observed with this computer-designed and manufactured recumbent brace. Patients with high apex curves cephalad to T8 (n = 31) had a success rate of 61% compared with a success rate of 79% (n = 71) if the apex was at or below T9. Compared with previous natural history and the prospective study data, the Providence brace is effective in preventing progression of adolescent idiopathic scoliosis for curves 35 degrees (n = 8) is too small to validate its effectiveness for larger curves with a higher apex.

123 citations