Adolescent Idiopathic Scoliosis (AIS) and Brace Treatment

Melanie Donnelly, M.P.H. Graduate Research Assistant Department of Orthopaedic Surgery Lori Dolan, M.A., Ph.D.C. Nurse Clinical-Specialist Department of Orthopaedic Surgery Stuart L. Weinstein, M.D. Ignacio V. Ponseti Professor & Chair of Orthopaedic Surgery Department of Orthopaedic Surgery The University of Iowa Peer Review Status: Internally Peer Reviewed First Published: May 2002 Last Revised: May 2002

Who gets braced and why?

Right now, most adolescents diagnosed with AIS are prescribed bracing treatment if their curve is between 25 and 40 degrees. The purpose behind bracing is to prevent the curve from progressing to a point (usually 45 degrees) where surgery might be considered. If the curve progresses to 45 degrees, most doctors would consider performing surgery to straighten out the curve and to prevent progression of the curve in adult life. Therefore, patients who are braced should have lower rates of surgery than those who are not braced

Curve Degree	Treatment Options
Below 20 degrees	Watchful waiting
25-40 degrees	Brace or watchful waiting
45 degrees or more	Surgery

What have research studies shown?

Past studies comparing braced and unbraced patients have shown a variety of results. Some show that bracing prevents the curve from getting larger. Others show that the brace may not help at all.

• Recent review article (American Family Physician, May 2002) discussing many past articles http://www.aafp.org/afp/20020501/1817.html
• For a brief overview of some studies that are often discussed in the scoliosis literature
• The United States Preventive Health Services Task Force has concluded that "Beyond temporary correction of curves, there is inadequate evidence that braces limit the natural progression of the disease." The disease they are talking about is AIS. Their full report can be found at the following link. The report talks a lot about whether or not to screen for AIS, but also talks about the effectiveness of bracing as a treatment. http://odphp.osophs.dhhs.gov/pubs/guidecps/text/CH47.txt

There was a study published in January, 2001 in the journal SPINE (Goldberg et al, Volume 26, Number 1) that studied the effect of bracing in AIS. The main finding from this study was that bracing DID NOT reduce the number of surgeries in patients with AIS. The study compared the rates of surgery in patients who were braced and in those who were not. The data for this study came from 2 sources. The brace patients' data came from numerous past studies done with braced patients. The unbraced data came from a center in Dublin, Ireland where bracing is no longer prescribed for AIS. When the surgery rates between the Dublin center and other centers were done some of the results were:

	Goldberg et al. (2001) (unbraced)	Lonstein & Winter (1994) (braced)	Fernandez-Feliberti et al. (1995) (braced)	Noonan et al. (1996) (braced)
% of patients requiring surgery	31%	22.4%	25.9%	31%

The differences between these rates are not large enough to show a clear advantage of bracing in the prevention of surgery.

Watchful Waiting as a treatment

• Some doctors don't believe bracing prevents progression of the curve. They believe that patients who end up having surgery would have needed surgery whether or not they used a brace. They think that bracing does not alter the natural history of the disease. Doctors who don't believe that bracing alters natural history will often offer watchful waiting as an alternative.
• "Watchful waiting" means that you have x-rays approximately every 6 months to see if there are changes in your curve.
• Doctors offer watchful waiting as an alternative to bracing because of studies like Dr. Goldberg's that show that many patients do not benefit from wearing a brace.
• For a more detailed explanation of the method of treatment please see Doing nothing is sometimes best treatment.

What does this mean for me or my child with AIS?

Because the use of a brace is somewhat controversial, you want to talk with your doctor in detail about these issues. It is important for you to discuss the benefits and risks of wearing a brace, or conversely, of participating in watchful waiting. Some studies report a negative psychological impact of wearing a brace, and others don't. These types of issues are important to bring up with your doctor.

See related Patient Textbooks about Orthopaedic Surgery.

See related Patient Topics Bones, Joints and Muscles, Orthopaedic Surgery or Scoliosis.

See related Provider Textbooks about Orthopaedic Surgery.

See related Provider Topics Bones, Joints and Muscles, Orthopaedic Surgery or Scoliosis.

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