Researchers assessed the influence of nighttime bracing in patients with adolescent idiopathic scoliosis (AIS) and main curves exceeding a Cobb angle of 40 degrees at brace initiation. They found that the risk of progression in patients with curves exceeding 40 degrees treated with nighttime bracing was similar to those with smaller curves.
The researchers reviewed the records of AIS patients treated with nighttime braces between 2005 and 2018. Patients with curves of 25 degrees or more and estimated growth potential were included and monitored with radiographs from brace initiation until brace weaning at skeletal maturity.
The patients were grouped based on curve magnitude at initial evaluation: a control group (25-39 degrees) and a large-curves group (40 degrees or more). Progression was defined as an increase of more than 5 degrees.
The research included 299 patients (control group n = 125; large-curves group, n = 174).
In the control group, 52 percent of patients had a Cobb angle progression compared with 58 percent in the large-curves group.
The lower-end vertebra shifted distally after bracing in 23 percent of patients in the large-curves group, according to the study. Patients with progressive large curves were younger (13.2 years versus 13.9 years) and more premenarchal (42 percent version 9 percent) compared with non-progressive large curves.
The movement of the lower-end vertebra could affect fusion levels in cases of surgery, the authors concluded.
The study, “The influence of night-time bracing on curve progression is not affected by curve magnitude in adolescent idiopathic scoliosis: a study of 299 patients,” was published in Acta Orthopaedica.
