Long Term Follow-Up of Adolescent Idiopathic Scoliosis in Females Treated with the Wilmington Brace

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.