THE LONG TERM RESULTS OF CHARLESTON BRACING IN SKELETALLY IMMATURE PATIENTS WITH IDIOPATHIC SCOLIOSIS

Jayesh Trivedi M.D.,
Jeffrey Thomson M.D;
John V. Banta M.D

BACKGROUND:
Previous studies have reported varying success with the use of the Charleston brace in idiopathic scoliosis. However, these studies have included patients from multiple centers, those with double curves, as well as patients still undergoing treatment. We present the long term results of Charleston bracing in 40 skeletally immature patients followed for a mean period of 3.5 years after brace termination. AIM: To study the efficacy of the Charleston brace in skeletally immature patients (Risser 0/1) with idiopathic scoliosis treated at one institution.

MATERIALS AND METHODS:
We conducted a retrospective review of the medical records and radiographs of all patients who attended the scoliosis clinic at our hospital between 1985 and 1995 and were treated with a Charleston brace. Selection criteria included: a diagnosis of idiopathic scoliosis, Risser stage 0 or 1 at bracing, female gender, age 10 years or older at bracing, a single curve between 25 and 40 degrees and no prior treatment.

RESULTS:
The average age at bracing was 12.5 years (range 10– 15 years) and the average curve was 30.3 degrees (range 25–40 degrees). Outcome was considered a failure if the curve had increased more than 5 degrees at last follow–up, if operative intervention was required or if there was a change of orthosis during treatment (e.g Charleston to Boston). In twenty–four out of forty patients (60%) the brace was successful in preventing progression of the curve (mean follow–up 3.5 years; range 2 years to 11.8 years). For patients with smaller curves (25–29 degrees) a successful outcome was obtained in 9 of the 18 patients (50%) whereas for the larger curves (30–40 degrees) the brace was successful in 15 of the 22 patients (68%). The mean correction in brace was 104% (range 71% to 163%). Pre–brace progression of curve had no influence on the final outcome. Thoracic curves had the same success as thoraco–lumbar and lumbar curves.

CONCLUSIONS:
Based on this long term follow–up we conclude that the Charleston brace is effective in preventing progression of the curve. Proper patient selection is important.