|
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.
|
