Braces Seem to Benefit Many Kids With High-Risk Scoliosis09/19/13
THURSDAY, Sept. 19 (HealthDay News) -- For most children who
otherwise might need surgery for scoliosis -- curvature of the
spine -- having them wear a brace helps prevent their condition
from worsening to the point where an operation is needed, a new
In fact, the study was stopped early because of the positive
results from bracing, when researchers found that 72 percent of the
children using the brace improved and surgery wasn't needed,
compared with 48 percent of the children not using one.
"Bracing significantly decreased the progression of patients who are at high risk for progression to the threshold where surgery would be indicated," said lead researcher Dr. Stuart Weinstein, a professor of orthopedic surgery at the University of Iowa.
"The study also showed that the more the children wore the brace -- the longer their brace hours -- the better the chances of success in avoiding surgery," he said. "We found children who wore the brace more than 13 hours a day have a significantly better outcome in preventing surgery than wearing it for less hours."
Many types of braces exist for kids, according to the Scoliosis
Research Society. Successful treatment requires regular physical
exams by an orthopedic surgeon, a well-fitted brace that's replaced
when outgrown, as well as patient cooperation and family support,
according to the society's website.
For the study, Weinstein's team randomly assigned 116 children
to wear a brace or not. In addition, another 126 children were
given the choice of wearing a brace or not. Patients with braces
were told to wear them at least 18 hours a day.
High-risk patients are those with a spinal curve between 20
degrees and 40 degrees, and whose spines are still growing,
Weinstein said. For these children between 10 and 15 years old,
bracing should begin as early as possible, he added. The brace is
designed to prevent the progression of the curve to around 50
degrees, which is when surgery is indicated.
It's not known why some children's scoliosis didn't progress
without a brace, nor why some children's scoliosis progressed while
wearing a brace, Weinstein said.
Bracing has been around since 1948, but doctors still disagree
whether it is helpful, and up to now there hadn't been a study done
to support or refute its value, he said.
The report was published online Sept. 19 in the
New England Journal of Medicine, to coincide with the
presentation of the findings at the annual meeting of the Scoliosis
Research Society in Lyon, France.
"This confirms our suspicion all along that bracing does change the outcome of scoliosis in adolescents," said Dr. Harry Shufflebarger, director of the division of spinal surgery at Miami Children's Hospital. He was not involved with the new study.
The problem is that there is no way of telling who needs a brace
and who doesn't, he said. "You can find a high-risk population and
offer it to all of them with the explanation that some of you guys
don't need a brace, some of you do and we can't differentiate."
Another doctor, Dr. Eugene Carragee, a professor of orthopedic
surgery at Stanford University School of Medicine, agreed that it's
not clear who actually benefits from bracing.
There are many types of spinal curves, including upper and lower
spine curves, double curves and curves that tilt right and those
that tilt left, said Carragee, who wrote an accompanying journal
"The study doesn't have enough people to be able to break it out to say which of these curves are going to do better with a brace," he said. "It is very likely there is a subgroup for whom the brace is highly effective, but there is also a subgroup where it's not effective," Carragee said.
"The research still needs to be done to separate the curves that are braceable from the curves that are not," he said.
To learn more about scoliosis, visit the
U.S. National Library of Medicine.
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