NIGHTTIME BRACING FOR ADOLESCENT IDIOPATHIC SCOLIOSIS WITH THE PROVIDENCE BRACE

Charles R. d’Amato, M.D., FRCS(C);
Sean Griggs, M.D.;
Barry McCoy, M.Ed., C.P.O.
Brown University School of Medicine,
University of Texas School of Medicine

STUDY DESIGN:
A minimum 2 year follow up study of 131 consecutive patients with adolescent idiopathic scoliosis who were treated with a recumbent nighttime bracing program at an academic medical center.

OBJECTIVES:
To report our experience with a unique hyper–corrective nighttime bracing program and to evaluate the outcome with respect to risk factors for progression and to compare to expectations from the natural history as studied by Lonstein and Carlson and the multi center prospective study of Nachemson et al.

METHODS:
Results were analyzed with respect to curve size, curve pattern, maturity, and compliance. Both compliant and non–compliant patients were included in the analysis. The results were compared to the anticipated progression in patients Risser 0 or I with the natural history data reported by Lonstein et al and the results of the prospective study of Nachemson et al in patients with 25–35 degree curves treated with full time bracing with a TLSO.

RESULTS:
The average initial in brace correction was 94.8% for major and 96.22% for secondary curves. Ninety–seven patients (74%) did not progress over five degrees and twenty–five patients (26%) progressed six degrees or more or went on to surgery. Only twenty percent of patients, Risser 0 or I progressed, and nine percent of patients Risser II, III, or IV progressed compared with a rate of progression anticipated by the natural history data of Lonstein et al of 68% and 23% respectively. Seventy percent of patients with curvatures with apices between T8 and L1 did not progress with the nocturnal Providence Brace compared with 74% in the prospective SRS study of patients wearing a TLSO for sixteen hours per day. Sixty–eight percent of thoracic curves and 64% of double curves did not progress. Ninety–five and 94% of lumbar and of thoracolumbar curves did not progress.

CONCLUSION:
Excellent initial in brace correction of adolescent idiopathic scoliosis was observed with this recumbent bracing program. Comparison with the natural history and the prospective study data of Nachemson et al, the Providence Brace may be effective in preventing progression of adolescent idiopathic scoliosis especially for curves under 35 degrees. Our success with curves of over 35 degrees is 67% which is similar to other studies. Our sample size for curves of this magnitude is too small to draw firm conclusions about this group of patients.