Bracing for idiopathic adolescent scoliosis produces similar quality of life scores to the general population at 25-year follow-up

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A 25-year follow-up of the use of Boston braces to treat adolescent idiopathic scoliosis (AIS) has discovered that patients’ quality of life was similar to that of the general population, with no clinical progression of the deformity found.

The study, led by Ane Simony, University of Southern Denmark, Denmark, and published by Scoliosis is one of very few studies focusing on long-term outcomes of brace treatment.

“Since 1962 up until the mid-1980s, the Harrington Rod instrumentation was the Golden standard for surgical treatment of AIS,” the authors explain. The Boston braces were introduced in the 1970´s and are still used as a conservative treatment for curves less than 40 degrees. Brace treatment and surgical correction are the most common treatment modalities, and the ability of both treatments to correct deformity is well documented. However, there are a very few studies with a follow-up longer than 20 years that have been published.

The study cohort was made up of 170 patients treated with a Boston brace or posterior spinal fusion using Harrington-DDT instrumentation between 1983 and 1990 at Rigshospitalet Copenhagen, Denmark, who participated in a long-term evaluation study. A validated Danish version of the Scoliosis Research Society 22R (SRS–22R) and Short Form-36 (SF–36) were administrated to the patients two weeks before the clinical and radiological examination.

Simony and colleagues report that, “SRS–22R domain scores were within the range described as normal for the general population with no statistical difference between the groups except in the ‘Satisfaction’ domain, where the fusion group had better scores than the braced group.” The SF–36 physical and mental component scores in both cohorts were also similar to the scores for the general population.

In an earlier study on the same cohort of patients, ten years after the end of treatment, Anderson et al reported that the daily 23-hour brace treatment significantly decreased the patient’s daily activities, and that the brace treated patients experienced more back pain than the surgical treated patients. In this study, “Brace-related questions revealed a negative impact on the patients’ activity of daily living, participation in sport, and some kept their brace treatment as a secret to friends,” write Simony and colleagues. “This negative impact of brace wear may help explain the difference in the satisfaction with treatment domain in these patients. After 25 years, the rate of back pain was similar between the brace-treated and the surgically-treated patients with very few limitations due to their scoliosis,” Simony told Spinal News International. “The negative impacts of brace treatment, on activities of daily living, participation in sport and so on, are less significant after 25 years than after 10 years.”

“Spinal deformity correction is performed to prevent impaired pulmonary function and spine related disability later in life. Thus, longer term studies, when patients are in their fifth and sixth decade, are needed to determine whether these patients will have similar quality of life outcomes, pulmonary function and spine related problems as the general population,” concluded the authors.