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.
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:
- Overall for the entire study population
- Impact of brace-wear compliance
- Impact of curve size
- 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
- Overall rate of progression was 0.7 degrees from weaning to last follow-up.
- 3 phases of progression
- Immediate: mean 7 degree increase
- Short-term (within 5 years of brace removal): 0.8 degrees/yr
- Long-term (>5 years brace removal): 0.2 degrees/yr
- More effective in-brace correction results in less rapid progression at weaning and at final-follow-up.
What are MY Take-Away messages from our publication?
- Starting bracing at 20-25 degrees, optimize brace correction, and maximize brace wear compliance
- 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.
- To minimize likelihood of Short-term progression: wean braces when at a Sanders 7B (at the earliest)
- Long-term curve progression can occur (0.2 degrees/yr)