EFFECTIVENESS OF TREATMENT WITH A BRACE IN GIRLS WHO HAVE ADOLESCENT IDIOPATHIC SCOLIOSIS - A PROSPECTIVE, CONTROLLED-STUDY BASED ON DATA FROM THE BRACE STUDY OF THE SCOLIOSIS-RESEARCH-SOCIETY

In a prospective study by the Scoliosis Research Society, 286 girls wh o had adolescent idiopathic scoliosis, a thoracic or thoracolumbar cur ve of 25 to 35 degrees, and a mean age of twelve years and seven month s (range, ten to fifteen years) were followed to determine the effect of treatment with observation only (129 patients), an underarm plastic brace (111 patients), and nighttime surface electrical stimulation (f orty-six patients), Thirty-nine patients were lost to follow-up, leavi ng 247 (86 per cent) who were followed until maturity or who were drop ped from the study because of failure of the assigned treatment, The e nd point of failure of treatment was defined as an increase in the cur ve of at least 6 degrees, from the time of the first roentgenogram, on two consecutive roentgenograms. As determined with use of this end po int, treatment with a brace failed in seventeen of the 111 patients; o bservation only, in fifty-eight of the 129 patients; and electrical st imulation, in twenty-two of the forty-six patients. According to survi vorship analysis, treatment with a brace was associated,vith a success rate of 74 per cent (95 per cent confidence interval, 52 to 84) at fo ur years; observation only, with a success rate of 34 per cent (95 per cent confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33 per cent (95 per cent confidence interval, 12 to 60). The thirty-nine patients who were lost to follow-up were include d in the survivorship analysis for the time-period that they were in t he study. Treatment with a brace was successful (p < 0.0001) in preven ting 6 degrees of increase or more until the patients were sixteen yea rs old. Even a worst-case analysis, in which the twenty-three patients who were dropped from the study after management with a brace were co nsidered to have had failed treatment, showed that the brace prevented progression and that this effect was significant (p = 0.0005). There was no difference in the degree of increase in the curve between the p atients who were managed with observation only and those who were mana ged with electrical stimulation.