Monday, 23 September 2013

Study supports use of back braces to treat scoliosis

Adolescents with scoliosis – curvature of the spine – may be able to benefit from treatment with a back brace and avoid surgery, according to a study published in the Sept. 19 online edition of the New England Journal of Medicine.

A new study from the NIH suggests that back bracing is an effective treatment for curvature of the spine and may help patients avoid surgery.

More likely to occur in girls than in boys, adolescent idiopathic scoliosis (AIS) is a curvature of the spine with no clear underlying cause. Doctors have recommended bracing as a treatment for more than 50 years, but until now, studies of its effectiveness have produced mixed results.

A new study from the National Institutes of Health (NIH), however, should help to clear up any doubts about the efficacy of bracing.

According to an NIH news release, researchers set out to compare the risk of curve progression in adolescents who had AIS and wore a brace with those who did not wear one. The study team, led by Stuart Weinstein, MD, a professor of orthopedic surgery at the University of Iowa, recruited patients who – based on their age, skeletal immaturity and curve severity – were at high risk for continued worsening of their spinal curves.

Study investigators analyzed data on 242 patients at 25 sites across the U.S. and Canada between March 2007 and February 2011. The children in the study were aged 10 to 15, still growing, and had spinal curvatures of 20 to 40 degrees.

In the study group, 116 patients were randomly assigned to observation or bracing for at least 18 hours a day. Because some parents did not want to wait and see how their child’s curve progressed, a group of 126 patients were allowed to choose for themselves if they wanted bracing or observation.

Bracing was considered a failure if a child’s spinal curvature progressed to 50 degrees or more, when surgery, which entails putting screws and rods in the spine to straighten it, is often suggested. Bracing was deemed a success if the child reached skeletal maturity without this degree of curve progression.

Study results showed that in the combined randomized and preference groups, 72 percent of the patients who wore braces reduced the risk of curve progression and the need for surgery. Wearing a brace more than an average of 13 hours a day was associated with success rates of 90 to 93 percent. Results showed that the more hours the brace was worn, the higher the success rate.

In addition, the researchers found that 48 percent of patients in the observation group, and 41 percent of the patients in the bracing group who wore a brace infrequently also had positive outcomes.

“There are a lot of doctors like me who treat scoliosis as the primary focus of their practice who had doubts about whether bracing was effective. Now the jury is in,” Weinstein told the New York Times.

For one doctor, the study helps prescribe bracing for image-conscious teens.

“When you have a teenager who is anxious about wearing a brace to school or what their friends will say, it gave us a bit of heartache to try to convince them if we weren’t certain ourselves,” said Dr. Paul Sponseller, the director of orthopedic surgery at Johns Hopkins Children Center, in the New York Times article.

“In light of this new evidence, we can say we really do have a basis for putting them through bracing,” added Sponseller, who was not involved in the study.

Source : Examiner.com , 19th September 2013