Scoliosis Brace Study
A recent study on the effectiveness of scoliosis bracing in adolescence in the New England Journal of Medicine titled Effects of Bracing in Adolescents with Idiopathic Scoliosis indicates that brace treatment for scoliosis works better than had been previously thought. Not surprisingly, they found that the more compliant a patient was with their brace treatment, the more likely they were to have a positive outcome. While it has been touted as having an impressive 79% success rate in keeping children from having to undergo surgery, let’s examine the details of the study to see what that really means.
The only type of scoliosis they used in the study was a rigid thoracolumbar orthosis. No other type of scoliosis brace was tested, including the more effective flexible tension orthosis like SpineCor. Monitoring of brace wearing compliance with the prescribed time to wear the brace (18 hours was recommended) was done used a temperature sensor on the brace to determine the average length of time the brace was worn.
Measure of Success
The only measure of success was not allowing the curve to progress past 50 degrees during the study! There was no discussion or measure of actually improving curves, only not letting it pass 50°. That would mean a child starting with a 30° curvature that progressed to a 49° would be considered a success in this study. The assumption was that if a curve can be held under 50° until the patient reached skeletal maturity they would not progress further.
Is This Good Enough?
While for some patients with particularly aggressive scoliosis stopping the progression before it reaches 50° is a good goal, but for most patients that isn’t good enough.
Yet for most patients this outcome isn’t good enough. Patient’s come in looking for improvement in the degrees in their scoliosis, not just keeping it under 50°.
What the study failed to acknowledge was that once a curve passes 30° gravity really takes advantage of it and can cause it to progress into adulthood. Research has shown that once a scoliosis curvature goes past this tipping point, a scoliosis can continue to progress at a rate of about 1° per year. That would mean that a 20 year old with a 30° scoliosis could potentially develop a 50° curve by the time she is 40 years old!
Risk Factors Not Addressed in This Scoliosis Study
The other major health risk for scoliosis in adulthood was not addressed by the study either. This is the fact that there are 3 times in a woman’s like that she has a risk of rapid progression of her scoliosis and they all have to do with hormonal changes.
- Puberty – When the spine is rapidly growing
- Pregnancy – The hormone Relaxin can trigger progression if the spine is not stable and the woman is resting on her ligaments
- Menopause – When hormonal changes weaken bones
Given these major risk factors later in life merely holding a spine with scoliosis under 50° during adolescence should not be the only clinical goal. Stabilizing and strengthening the particular weakened muscles in the spine so that the patient is not just resting on her ligaments as well as potentially reducing the curve should also be an outcome expected, especially with curvatures in the lower end of the spectrum.
Combination Scoliosis Therapy Found to Be More Effective
Past research studies by the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) titled Effectiveness of Complete Conservative Treatment for Adolescent Idiopathic Scoliosis (bracing and exercises) found a 96% success rate of the scoliosis patient’s curvatures did not progressing from where they started while many had a statistically significant reduction in their Cobb angles!
Clearly, the better long term outcome is spinal stabilization and correction, not just keeping a curve under 50°