Bracing - Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis

The effectiveness of spinal bracing in the treatment of adolescent idiopathic scoliosis has been controversial. Some studies have shown that bracing is only as effective as observation, whilst others have shown that bracing is superior to observation, halting progression and effectively reducing progression to surgical threshold. Recently, some studies have even shown improvement of curves with bracing. Yet, many of these studies have been judged to be of low methodological quality. In 2005, the Scoliosis Research Society (SRS) attempted to standardize the inclusion criteria and outcome measurements for bracing studies, to enable comparison among studies. In the guidelines, progression of ≤ 5 o is regarded as success. It is apparent that SRS did not regard improvement of curves probable. Improvement which is defined as a decrease of ≥ 6 owas not proposed until 2009. This may reflect an improvement in outcome with bracing in the last one to two decades. The present review attempts to determine if there is a trend of improvement in outcome with bracing in the last 3 decades. Manual literature search was made in the PubMed using the keywords of brace, conservative treatment and adolescent idiopathic scoliosis. Relevant English articles on the outcome of wearing rigid braces from 1990-2016 were retrieved and reviewed to determine if there is a trend towards improvement in outcome with bracing and if bracing halts progression and improves curves. Results show that there has been an apparent improvement in the effectiveness of bracing in reducing surgical rate since 2005. Close inspection shows that the reduction in surgical rate is not due to an improvement over time, but is related to the types of brace. The effectiveness of Boston brace is not consistent over the years. The surgical rates vary and no consistent trend of improvement can be discerned in the last 2-3 decades. The surgical rate reported in 2007 for TLSO was as high at 79% and that in 2014 for Boston brace was 28%. The surgical rates with European braces (Progressive Action Short Brace (PASB), Cheneau derivatives and Lyon/Sforzesco braces), however, are consistently lower, at less than 8%. Similarly, the European braces have been found to be able to improve curves in over 50% of the at risk patients. Bracing does not therefore only halt progression of curves. Given a well-constructed brace, with good patient compliance, improvement of curves in over 50% of the patients is possible, particularly when used in conjunction with scoliosis specific exercises