Good idiopathic scoliosis correction seen through use of bracing, rehabilitation

With medical team involvement, investigators saw improved bracing outcomes, compliance in a study of an adolescent idiopathic scoliosis database.

ORLANDO, Fla. — Based on Scoliosis Research Society criteria, few adolescent patients with idiopathic scoliosis had their curves progress with bracing, based on a study by investigators at the ISICO (Italian Scientific Spine Institute) in Milan.

Bracing along with exercises and physician involvement are recommended by the Society of Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) for treating adolescent idiopathic scoliosis, although bracing effectiveness has been questioned and few positive results appear in the literature, according to the researchers.

Rehabilitation specialist Stefano Negrini, MD, presented the findings here at the 2010 Annual Meeting of the North American Spine Society, noting compliance was about 90% among the 48 patients he and his colleagues studied. “According to this study, it is possible following the SOSORT criteria to obtain reduction of the scoliosis,” he said in his presentation.

A Cochrane review that Negrini and colleagues recently did concluded there is weak evidence in support of bracing with adolescent idiopathic scoliosis bracing rates of 10% to 40%. Cochrane reviews form a database of systematic investigations that interpret medical research and are a resource for evidence-based medical practices.

Stefano Negrini

Since one methodology study that used Scoliosis Research Society (SRS) criteria and another clinical study that used SOSORT criteria had the best overall results compared the others in the literature, Negrini and colleagues decided to combine the two approaches in their study.

The goal was “to verify the efficacy of a complete treatment of adolescent idiopathic scoliosis by following the SRS and SOSORT criteria,” Negrini said.

Individualized treatment

Subjects studied had 30° average Cobb curves, Risser test scores of 0 to 2 and a mean age of 12.5 years. They underwent individualized treatments which typically involved wearing either a Risser cast (for the first 8 to 12 months) or a brace, such as a Lyon or the recently developed SPoRT concept braces (Sforzesco or Sibilla braces), 18 to 23 hours per day until Risser 3 bone growth stage and for the next 2 to 3 years gradually reducing the wearing time.

“All patients performed stabilizing exercises twice a week,” Negrini said.

The Sforzesco brace. Image: Negrini S

SOSORT management calls for physician-based bracing where the physician works together with the certified prosthetist orthotist and both have a commitment to quality care, patient compliance and motivation, he explained.

Lumbar-only curves

During the follow-up, none of the patients’ curves progressed beyond 45° based on SRS criteria and none of them was fused.

“This remained true in the 85% of patients who reached the 2-year follow-up,” Negrini noted.

Investigators observed a 6° improvement in most curves.

Only two patients with thoracic curves worsened (8° and 12°). At the start of bracing both were Risser 0 and their curves were 25° and 30°, respectively.

“We found statistically significant clinical and radiographic improvements, but we had a negative impact on the sagittal profile,” he said, noting patients with double curves or just thoracic curves tended to do worse than those with curves in the lumbar spine alone.

To study this further, the researchers recently began a prospective study that will enable them to perform an intent-to-treat analysis. – by Susan M. Rapp

References:

• Negrini S. Atanasio S, Fusco C, Zaina F. Effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: Results according to the SRS criteria for bracing studies. Paper #215. Presented at the 2010 Annual Meeting of the North American Spine Society. Oct. 5-9, 2010. Orlando, Fla.
• Negrini S, Atanasio S, Fusco C, Zaina F. Effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: results according to the SRS criteria for bracing studies - SOSORT Award 2009 Winner. Scoliosis. 2009 Sep 4;4:19. (www.scoliosisjournal.com/content/4/1/19)
• Negrini S, Minozzi S, Bettany-Saltikov J, et al. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006850. DOI: 10.1002/14651858.CD006850.pub2.

• Stefano Negrini, MD, can be reached at ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino, 13, 20141 Milan, Italy; 39-2-58320947; e-mail: stefano.negrini@isico.it.
  Disclosure: Negrini owns stock of the Italian Scientific Spine Institute.