Patients with juvenile idiopathic scoliosis (JIS) have higher mortality and morbidity compared to those with adolescent idiopathic scoliosis (AIS) or the general population. Without treatment, JIS can cause severe cardiorespiratory compromise. A study, published in the May-June issue of Spine Deformity, evaluated the role of bracing in treating JIS, and concluded that bracing obviated the need for surgery during all participants’ juvenile years and was a successful delaying strategy.
The retrospective comparative therapeutic clinical study included all children with JIS who were treated at Golden Jubilee National Hospital, Clydebank, Scotland, and followed up with until either skeletal maturity or surgery between 1956 and 1999. Those who had an incomplete set of radiographs or were treated only by observation were excluded.
One hundred twenty-five patients, 93 who were braced as juveniles and 32 who were braced in adolescence, met the inclusion criteria. Fifty-six of the patients were successfully treated by bracing (32 juveniles and 24 adolescents) and 69 patients needed surgery despite bracing. When final curves greater than 45 degrees were regarded as failure of bracing, the success rate was 41 percent. The braces used were the Milwaukee brace and a TLSO; no statistically significant difference was found between the two. None of the patients had surgery of any kind during the juvenile phase (i.e. at less than ten years of age).
One-third of the patients (18 of 56) could be safely weaned prior to skeletal maturity without risking curve progression. The odds of needing surgery when braced as a juvenile was two in three (34 percent success), which fell to almost one in four for an adolescent (75 percent success) and was statistically significant. Curves with Cobb angles less than or equal to 29 degrees when braced progressed to a degree warranting surgery at a lower rate as compared to those with Cobb angles of greater than or equal to 30 degrees; this difference was not statistically significant, according to the study’s authors.
