EFFECTIVENESS OF TLSO BRACING IN THE CONSERVATIVE TREATMENT OF IDIOPATHIC SCOLIOSIS

A clear understanding of the effectiveness of the thoracolumbosacral o rthosis (TLSO) as a conservative treatment for idiopathic scoliosis is still necessary. In the past few years, the review of pertinent liter ature has emphasized the lack of properly matched control studies and erroneous interpretations of results due to the use of univariate anal ysis. Also, in a previous controlled study evaluating the bracing of i diopathic scoliosis, the researchers mixed different types of braces a nd patients. Therefore, their findings were not specific to any kind o f orthosis. In our study, we responded to these criticisms by providin g a homogeneous group of patients with a control group and by conducti ng a multivariate analysis to assess the effectiveness of the TLSO. Al l the patients at the University Pediatric Hospital Scoliosis Clinic a ged 8 through 15 with initial Cobb's angle between 20 and 40 degrees a nd evidence of progression were assessed. All the patients who used th e TLSO and showed full compliance with treatment (n = 54) were compare d with a control group. The control group consisted of the patients wh o needed the treatment with the brace but did not use it for several r easons (n = 47). Neither group showed significant differences in sex, initial age, initial Cobb's angle, menarche, Risser sign, or curve pat tern. The mean follow-up period was 3.3 years after skeletal maturity. The results were analyzed using a multivariate analysis because the n atural history of scoliosis is determined by multiple factors. The ana lysis showed that the control group had a threefold increase in the od ds of ending with surgery compared to the treatment group (OR = 3.24, 95% CI, 1.09-9.60). The curve was more likely to progress >40 degrees in the control group (OR = 2.83, 95% CI, 0.98-8.17).