According to Shriners Hospitals for Children, as many as .5 percent of children develop scoliosis severe enough to warrant treatment, and adolescent idiopathic scoliosis (AIS) affects up to four percent of children-particularly girls-who are between the ages of ten and 16. Bracing has long been the most common treatment for youth with moderate curves, according to Shriners, but no strong scientific data exists to demonstrate whether bracing actually prevents or slows the condition’s progress.
Matthew Dobbs, MD, an orthopaedic surgeon at Shriners Hospitals for Children, St. Louis, and associate professor of pediatric orthopaedic surgery at Washington University School of Medicine, St. Louis, emphasizes that bracing is not an ideal treatment.
“Bracing a child with scoliosis is not an easy task,” he stated on shrinershq.org. “Adolescents do not want to wear a brace that makes them look and feel different from their friends. Bracing has been the accepted treatment for years for adolescents with a curve of 20 to 40 degrees, but there is no hard data to support that it works. We honestly don’t know what the right treatment is for patients with curves in this range. Some with braces do fine, as do some without. This is definitely a medical question that needs to be answered.”
To answer the question of bracing’s effectiveness, Shriners and the National Institutes of Health (NIH) are conducting a multi-center research study titled Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). The study, on which Dobbs is the lead investigator, has two main goals: to determine which patients actually benefit from bracing, and to help improve screening and treatment protocols and quality of life for AIS patients.
“Bracing is very expensive, as are the school screening programs,” Dobbs commented. “If we find that bracing is not effective, then screening programs to identify scoliosis in early stages could be stopped. On the other hand, if bracing is found to be effective, then more effort and resources could be employed toward improved screening programs to identify children with curves early enough that they can benefit from bracing.
Compliance is a major issue in bracing, Shriners noted. Patients are commonly advised to wear their brace 20 hours a day, but the braces are uncomfortable and awkward, especially for teens who want to fit in with their peers. In the BrAIST study, a heat sensor implanted in participants’ braces will monitor compliance.
Shriners also noted that it has studies under development toward determining whether children with other conditions that lead to scoliosis, including spinal cord injuries, cerebral palsy, and osteogenesis imperfecta, actually benefit from spinal bracing for the condition.
