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Exhibit from the SRS 2002 Annual Meeting
Investigation performed at the Alfred I. duPont Institute, Wilmington,
Delaware.
BACKGROUND: Adolescent idiopathic scoliosis is the most common spinal
deformity in children and is often treated with
bracing. The goals of this study are to determine whether an underarm
spinal orthosis (Wilmington, Delaware) worn during
adolescence can halt the progression of idiopathic scoliosis into
adulthood and to assess the long-term functionaland cosmetic
outcome of patients treated with a brace for adolescent idiopathic
scoliosis.
METHODS: We retrospectively reviewed the results of fifty-five skeletally
immature females treated successfully for adolescent
idiopathic scoliosis with the Wilmington brace. The average age
at follow-up was thirty-one years (range, twenty-six to thirtyseven
years) at an average follow-up of fifteen years (range, ten to
nineteen years) after discontinuation of the brace. Each
patient was evaluated with a physical examination and full-length
spinal radiographs. Each patient filled out a comprehensive
questionnaire assessing their ability to perform twenty-six activities
of daily living, their over-all physical appearance, their
cosmetic appearance, self-image and the severity of any back pain.
The questionnaire was also administered and compared to
a control group of women without scoliosis matched for age, number
of children, and type of occupation.
RESULTS: Curve progression measuring greater than 5 degrees (range,
6 to 18 degrees) occurred in 22 percent of the
patients after skeletal maturity and discontinuation of the brace.
None of these patients have required surgical intervention.
Progression did not correlate with age, occupation, duration of
brace treatment or curve pattern. However, curves measuring
thirty or more degrees at the end of brace treatment did have
a significantly greater increase in curvature. There was no
significant difference between the braced group and the control
group in terms of back pain, functional activities, self-care
activities or physical activities. The treated patients reported
a significantly greater difficulty with positional activities.
Ninetythree percent of the treated patients rated their physical and cosmetic
appearance and their self-image unchanged or
improved since discontinuation of the brace.
CONCLUSIONS: Curve magnitude is maintained into adulthood in the
majority of patients treated with the Wilmington brace
for adolescent idiopathic scoliosis. Curves measuring greater
than thirty degrees at the end of brace treatment had a higher
likelihood of progression after the brace was discontinued. Back
pain and difficulties with functional, self-care or physical
activities were similar between patients and controls, although
braced patients reported significantly greater difficulties with
positional activities. The majority of patients reported no deterioration
of physical or cosmetic appearance or self-image since
discontinuation of the brace.
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