Adolescent idiopathic scoliosis - The effect of brace treatment on the incidence of surgery

Study Design. Retrospective analysis of outcome in terms of incidence of su rgery for adolescent idiopathic scoliosis during a period when bracing was not practiced. Objectives. To determine whether centers with an active bracing policy have lower numbers undergoing surgery for adolescent idiopathic scoliosis than a center where nonintervention is the practice. Background Data. Two major recent publications have claimed that bracing si gnificantly improves the outcome in adolescent idiopathic scoliosis. Howeve r, one had no control subjects and the other did not examine the final stat us of the subjects under review. While statistically significant difference s in progression have been observed, what wilt convince patients to submit to an onerous treatment is the conviction that it will make a substantial d ifference, such as the avoidance of surgery. Methods. Since 1991, bracing has not been recommended for children with ado lescent idiopathic scoliosis at this center. The scoliosis database was sea rched for patients with adolescent idiopathic scoliosis who were at least 1 5 yea rs of age at last review and who had adequate documentation of curve parameters. The incidence of surgery was compared with that of published da ta from other centers. Results. A total of 153 children, 11 boys and 142 girls, fitted the criteri a. Forty-three of these (28.1%) have undergone surgery. This was not statis tically different from the surgery rate reported from an active bracing cen ter. Conclusions. if bracing does not reduce the proportion of children with ado lescent idiopathic scoliosis who require surgery for cosmetic improvement o f their deformity, it cannot be said to provide a meaningful advantage to t he patient or the community. Recent studies notwithstanding, the question o f the efficacy of orthoses in idiopathic scoliosis remains unresolved.