Boston Brace controlled curve progression in patients with adolescent idiopathic scoliosis

Katz DE. J Bone Joint Surg Am. 2010;92(6):1343-1352. doi:10.2106/JBJS.I.01142.

Many patients with adolescent idiopathic scoliosis had a successful outcome — defined as less than 6· of curve progression — when they wore the Boston Brace for more than 12 hours a day, according to Texas researchers.

“The efficacy of brace treatment for patients with adolescent idiopathic scoliosis remains controversial, and effectiveness remains unproven,” wrote Donald E. Katz, BS, CO, and colleagues at Texas Scottish Rite Hospital for Children. “We accurately measured the number of hours of brace wear for patients with this condition to determine if increased wear correlated with lack of curve progression.”

In their prospective study, the researchers enrolled 126 patients with adolescent idiopathic scoliosis curves measuring between 25° and 45° 100 patients completed the prospective study. All patients wore a Boston Brace fitted with a heat sensor that tracked the exact number of hours of brace wear.

Katz and colleagues correlated the total number of brace wear hours with the lack of curve progression, which they found was most significant in patients who at the start of treatment were Risser stage 0 (P=.0003) or stage 1 (P=.07) and those patients with open triradiate cartilage.

Logistic regression analyses revealed an association between a greater number of hours of brace wear and a lack of curve progression. Results showed that 82% of patients who wore the brace more than 12 hours a day had no curve progression vs. 31% of those who wore it less than 7 hours a day (P=.0005). The researchers found an inverse correlation with the number of hours of brace wear and the need for surgery (P=.0005).

Defining the optimal timing for brace wear remains an elusive goal. Theoretically, finding the shortest time required for brace wear would increase compliance without compromising results.

Previous studies relied upon patient reports to determine usage time of the brace. Through an ingenious temperature monitoring system, these authors have developed an effective means of monitoring compliance, gaining a more accurate picture of wear patterns. Their results suggest that the Boston Brace may be effective even when used for fewer hours than prescribed.

This paper provides data both in favor of bracing as well as in support for “part time” bracing regimens. It is worth noting that prescribed wear time and actual wear time were not the same. Future studies, using available genetic markers to predict which patients have progressive curves and thus would potentially benefit from bracing, will continue to define the role of bracing in adolescent idiopathic scoliosis.

– Craig P. Eberson, MD
Division Chief,
Pediatric Orthopaedics and Scoliosis
Hasbro Children's Hospital
Assistant Professor of Orthopaedic Surgery
Alpert Medical School/Brown University