A METAANALYSIS OF THE EFFICACY OF NONOPERATIVE TREATMENTS FOR IDIOPATHIC SCOLIOSIS

With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society condu cted a meta-analysis of 1910 patients who had been managed with bracin g (1459 patients), lateral electrical surface stimulation (322 patient s), or observation (129 patients) because of idiopathic scoliosis. Thr ee variables - the type of treatment, the level of maturity, and the c riterion for failure - were analyzed to determine which had the greate st impact on the outcome, We also examined the effect of the type of b race that was used and the duration of bracing on the success of treat ment, The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable prog ression of the curve (as defined in the study), who could not comply w ith or tolerate treatment, or who had an operation, The percentage of patients who completed a given course of treatment without failure, ad justed for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatm ent. The weighted mean proportion of success was 0.39 for lateral elec trical surface stimulation, 0.49 for observation only 0.60 for bracing for eight hours per day 0.62 for bracing for sixteen hours per day, a nd 0.93 for bracing for twenty-three hours per day The twenty-three-ho ur regimens were significantly more successful than any other treatmen t (p <0.0001). The difference between the eight and sixteen-hour regim ens was not significant, with the numbers available, Although lateral electrical surface stimulation was associated with a lower weighted me an proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstra tes the effectiveness of bracing for the treatment of idiopathic scoli osis. The weighted mean proportion of success for the six types of bra ces included in this review was 0.92, with the highest proportion (0.9 9) achieved with the Milwaukee brace. We found that use of the Milwauk ee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve, Bracing for eigh t or sixteen hours per day was found to be significantly less effectiv e than bracing for twenty-three hours per day (p <0.0001).