Elsevier

The Spine Journal

Volume 19, Issue 12, December 2019, Pages 1917-1925
The Spine Journal

Review Article
Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review

https://doi.org/10.1016/j.spinee.2019.07.008Get rights and content
Under a Creative Commons license
open access

Abstract

Brace treatment is the most common nonoperative treatment for the prevention of curve progression in adolescent idiopathic scoliosis. The success reported in level 1 and 2 clinical trials is approximately 75%. The aim of this review was to identify the main risk factors that significantly reduce success rate of brace treatment.

A literature search using the MEDLINE and Embase databases was conducted. Studies were included if they identified specific risk factor(s) for curve progression. Studies that looked at nighttime braces, superiority of one type of brace over another, the effect of physical therapy on brace performance, cadaver or nonhuman studies were excluded. A total of 1,022 articles were identified of which 25 met all of the inclusion criteria. Seven risk factors were identified: Poor brace compliance (eight studies), lack of skeletal maturity (six studies), Cobb angle over a certain threshold (six studies), poor in-brace correction (three studies), vertebral rotation (four studies), osteopenia (two studies), and thoracic curve type (two studies). Three risk factors were highly repeated in the literature which identified specific subgroups of patients who have a much higher risk to fail brace treatment and to progress to fusion. This data demonstrates that 60% to 70% of the patients referred to bracing are Risser 0 and 30% to 70% of this group will not wear the brace enough to ensure treatment efficacy. Furthermore, Risser 0 patients who reach the accelerated growth phase with a curve ≥40° are at 70% to 100% risk of curve progression to the fusion surgical threshold despite proper brace wear. Skeletally immature patients with relatively large magnitude scoliosis who are noncompliant are at a higher risk of failing brace treatment.

Keywords

Adolescent idiopathic scoliosis (AIS)
Brace treatment
Curve progression
Risk-factors
Orthotic
Spine
TLSO

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FDA device/drug status: Not applicable.

Author disclosures: REH: Payment for Writing or Reviewing the Manuscript: ApiFix Ltd. (B); Consulting: ApiFix Ltd. (E), DePuy Synthes (B), Joint Solutions (B), Medtronic (C); Scientific Advisory Board/Other Office: ApiFix Ltd. (B); Grants: Atlantic Canada Opportunities Agency (I), DePuy Synthes (D), EOS Imaging (B), Scoliosis Research Society (B). DZ-R: Nothing to disclose. YF: Nothing to disclose. BSL: Stock Ownership: Paradigm Spine (D), Spine Search (E); Private Investments: Paradigm Spine (E); Consulting: DePuy Synthes (D), Zimmer Biomet (B), ApiFix (B), Unyq Align (B); Grants: DePuy Synthes to Setting Scoliosis Straight Foundation (D), John and Marcella Fox Fund Grant (B), OREF (C). YIA: Nothing to disclose. RRB: Consulting Fee of Honorarium: ApiFix (C), Other: ApiFix (A, stock options); Royalties: DePuy Synthes Spine (C), Globus Medical (C), SpineGuard (B), Thieme Medical Publishers (A); Stock Ownership: Abyrx (0), Electrocore (0), Medovex (0), Orthobond (0), SpineGuard (0), Wishbone Medical (0); Consulting: DePuy Synthes Spine (C), Globus Medical (C), SpineGuard (B), Wishbone Medical (B); Speaking and/or Teaching Arrangements: DePuy Synthes Spine (B), Globus Medical (C).