Juvenile idiopathic scoliosis: the effectiveness of part-time bracing.

摘要

STUDY DESIGN: A retrospective review of 34 patients with juvenile idiopathic scoliosis (JIS) treated with a nighttime bending brace. OBJECTIVE: To determine the effectiveness of part-time bracing in JIS. SUMMARY OF BACKGROUND DATA: Although previous bracing studies have focused on adolescent idiopathic scoliosis, no authors have dealt specifically with part-time bracing for JIS. METHODS: Twenty-three patients included in the study met the following criteria: curves greater than 20 degrees and Risser zero at initiation of bracing, brace wear more than 12 months, completion of the bracing program and Risser sign greater than or equal to 4 at final follow-up. Patients were analyzed according to 3 groups: (1) success (progression equal or less than 5 degrees), (2) progression more than 5 degrees (but not requiring surgery and achieving curve stabilization at skeletal maturity), and (3) surgery (curve progressing to greater than 45 degrees ) with failure of bracing treatment during skeletal immaturity. RESULTS: Seven boys and 16 girls with a total of 37 curves were analyzed. The average age at referral and initiation of bracing was 8.3 and 10.3 years, respectively. Average curve magnitude at time of bracing was 30 degrees. Length of bracing averaged 3.7 years with follow-up after brace discontinuation of 2.5 years. Nine patients met the criteria for success, with 7 patients progressing and 7 patients eventually requiring spinal fusion. Of the 37 curves, 19 (51%) were successfully managed in the brace. The magnitude of curvature at initiation of bracing did not relate to a successful outcome, whereas success did correlate with higher radiographic in-brace correction. Given the longer course of treatment for JIS patients, part-time bracing offers potential psychosocial and compliance benefits. CONCLUSION: Part-time bracing in JIS is successful and is better than the natural history.