Sunday, May 21, 2023

 

Blog Topic:                                                                      5-21-2023

 



 

First, I want to recognize Daphna Zaaroor-Regev for all of her hard work on this project and without her initiative and drive would not have been possible.

 

Second, why do this project?

To help answer the common parent question, “What will happen to my daughter’s scoliosis, now that we are stopping her bracing?”




 

To review one published study is helpful, but do review of all relevant literature and try to compile a high-level view, is optimal. 

 

How was this carried out?

Systematic literature search of Medline (PubMed)

Searched AIS & bracing & removal/weaning

30 year time period: Identified 75 publications

Only 18 relevant publications satisfied inclusion criteria (listed in paper as Table 1)

 

So what did we report?

We broke the analysis into 4 parts:

1.    Overall for the entire study population

2.    Impact of brace-wear compliance

3.    Impact of curve size

4.    Impact of curve type

 

Part 1: Overall for the entire population

After brace removal, the year progression rate ranges from 0.2 to 2.2 degrees/year.

The majority of the overall progressing occurs during the initial years after brace weaning.

 

Part 2: Impact of brace-wear compliance

There was no support for concept that brace-wear compliance is associated with curve progress after bracing weaning.

 

Part 3: Impact of curve size

The association between Cobb angle at weaning and magnitude of curve progression.

         Average curve increase after brace weaning is 7 degrees

         Average curve increase at last follow-up is 11 degrees

         Curves </= 15 degrees in brace have less progression immediately after brace removal

         From weaning to last follow-up:

Curves < 25 degrees, no change (20 degrees)

Curve >/= 25 degrees, increased to 36 degrees

         Rate of progression:

         Short-term: 0.8 degrees/year

Overall: 0.7 degrees/year

 

Part 4: Impact of curve type

Overall, curve progression from most likely to least likely:

         Double Major > Thoracic > Thoracolumbar > Lumbar

 

Study Conclusion

1.    Overall rate of progression was 0.7 degrees from weaning to last follow-up.

2.    3 phases of progression

a.    Immediate: mean 7 degree increase

b.    Short-term (within 5 years of brace removal): 0.8 degrees/yr

c.    Long-term (>5 years brace removal): 0.2 degrees/yr

3.    More effective in-brace correction results in less rapid progression at weaning and at final-follow-up.

 

 

 

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What are MY Take-Away messages from our publication?

1.    Starting bracing at 20-25 degrees, optimize brace correction, and maximize brace wear compliance

2.    The “progression” of 7 degrees is likely not “progression” but sagging against gravity now that the person does not have a brace on in the upright position, and likely has deconditioned truncal musculature.

3.    To minimize likelihood of Short-term progression: wean braces when at a Sanders 7B (at the earliest)

4.    Long-term curve progression can occur (0.2 degrees/yr)

 

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