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Flexible Orthosis Provides Effective Bracing in Adolescents With Scoliosis: Presented at AAP

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- October 21, 2009 -- Adolescents diagnosed with idiopathic scoliosis (AIS) benefit from the use of a flexible orthosis as much as from the conventional rigid orthosis, according to a 2-year-long comparative study reported here at the 2009 American Academy of Pediatrics (AAP) National Conference & Exhibition.

"SpineCor is a relatively new bracing system that utilises dynamic bracing in the treatment of adolescent idiopathic scoliosis (AIS)," said Steven R. Gammon, MD, Division of Pediatric Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

The added advantage of SpineCor, the flexible orthosis, over the conventional rigid thoracolumbosacral orthosis resides in its flexibility and convenience, as it can fit under clothing, as opposed to conventional bracing, noted Dr. Gammon in his presentation here October 18.

However, limited data is currently available regarding the effectiveness of SpineCor orthosis, said the investigators.

The study evaluated treatment outcomes of 2 groups of patients with AIS treated either via the conventional rigid thoracolumbosacral orthosis (TLSO) approach (n = 36) or with a flexible SpineCor orthosis (n = 32).

The Scoliosis Research Society (SRS) inclusion criteria (age >=10 years; Risser test 0-2; Cobb 25-40 degrees; no prior treatment; <1 year post-menarchal) were applied for all AIS patients on study.

In the TLSO group, the 36 AIS patients (33 girls) had an average age of 13 years (range, 11.1-15.1 years) and an average primary curve magnitude of 33 degrees (range, 25-40 degrees). The average follow-up from the beginning of brace treatment was 24 months (range, 7-60 mo).

The 32 AIS patients (28 girls) in the SpineCor group had an average age of 13 years (range, 11-14.9 years) and an average primary curve magnitude of 31 degrees (range, 25-40 degrees). For this group, follow-up was on average 29 months (range, 13-69 mo).

"All patients were followed through the completion of brace treatment or attainment of other treatment endpoints," said Dr. Gammon.

Outcomes were SRS standardised, with failure defined as curve progression >=6 degrees or ever reaching 45 degrees, explained Dr. Gammon. Statistical analysis was performed using the Yates corrected Chi Square test.

No significant difference (P = .95) was found using the more strict outcome measure (<5 degrees curve progression) as the success rates were 55.6% (n = 20) for AIS patients in the TLSO group and 56.3% (n = 18) for those in the SpineCor group.

Similarly, no significant difference (P = 1.00) was found using the more liberal outcome measure (never reach 45 degrees), with success rates of 75.0% (n = 27) for AIS patients using TLSO and 75.0% (n = 24) for those using SpineCor.

"Our study was powered to identify only a rather large difference if one existed," explained Dr. Gammon, adding that they were not able to identify "any significant differences in brace treatment outcomes when comparing TLSO and SpineCor treated patients."

[Presentation title: A Comparison of TLSO and SpineCor Treatment of Adolescent Idiopathic Scoliosis Patients Using SRS Standardized Criteria. Abstract 6419]

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