The Effectiveness of Part-Time Bracing

Study Design. A retrospective review of 34 patients with juvenile idiopathic scoliosis (JIS) treated with a nighttime bending brace. Objective. To determine the effectiveness of part-time bracing in JIS. Summary of Background Data. Although previous bracing studies have focused on adolescent idiopathic scoliosis, no authors have dealt specifically with part-time bracing for JIS. Methods. Twenty-three patients included in the study met the following criteria: curves greater than 20° and Risser zero at initiation of bracing, brace wear more than 12 months, completion of the bracing program and Risser sign greater than or equal to 4 at final follow-up. Patients were analyzed according to 3 groups: (1) success (progression equal or less than 5°), (2) progression more than 5° (but not requiring surgery and achieving curve stabilization at skeletal maturity), and (3) surgery (curve progressing to greater than 45°) with failure of bracing treatment during skeletal immaturity. Results. Seven boys and 16 girls with a total of 37 curves were analyzed. The average age at referral and initiation of bracing was 8.3 and 10.3 years, respectively. Average curve magnitude at time of bracing was 30°. Length of bracing averaged 3.7 years with follow-up after brace discontinuation of 2.5 years. Nine patients met the criteria for success, with 7 patients progressing and 7 patients eventually requiring spinal fusion. Of the 37 curves, 19 (51%) were successfully managed in the brace. The magnitude of curvature at initiation of bracing did not relate to a successful outcome, whereas success did correlate with higher radiographic in-brace correction. Given the longer course of treatment for JIS patients, part-time bracing offers potential psychosocial and compliance benefits. Conclusion. Part-time bracing in JIS is successful and is better than the natural history.