Long-term results after Boston brace treatment in late-onset juvenile and adolescent idiopathic scoliosis

Abstract

Background: It is recommended that research in patients with idiopathic scoliosis should focus on short- and long-term patient-centred outcome. The aim of the present study was to evaluate outcome in patients with late-onset juvenile or adolescent idiopathic scoliosis 16 years or more after Boston brace treatment.

Methods: 272 (78%) of 360 patients, 251 (92%) women, responded to follow-up examination at a mean of 24.7 (range 16 - 32) years after Boston brace treatment. Fifty-eight (21%) patients had late-onset juvenile and 214 had adolescent idiopathic scoliosis. All patients had clinical and radiological examination and answered a standardised questionnaire including work status, demographics, General Function Score (GFS) (100 - worst possible) and Oswestry Disability Index (ODI) (100 - worst possible), EuroQol (EQ-5D) (1 - best possible), EQ-VAS (100 - best possible), and Scoliosis Research Society - 22 (SRS - 22) (5 - best possible).

Results: The mean age at follow-up was 40.4 (31-48) years. The prebrace major curve was in average 33.2 (20 - 57)°. At weaning and at the last follow-up the corresponding values were 28.3 (1 - 58)° and 32.5 (7 - 80)°, respectively. Curve development was similar in patients with late-onset juvenile and adolescent start. The prebrace curve increased > 5° in 31% and decreased > 5° in 26%. Twenty-five patients had surgery. Those who did not attend follow-up (n = 88) had a lower mean curve at weaning: 25.4 (6-53)°. Work status was 76% full-time and 10% part-time. Eighty-seven percent had delivered a baby, 50% had pain in pregnancy. The mean (SD) GFS was 7.4 (10.8), ODI 9.3 (11.0), EQ-5D 0.82 (0.2), EQ-VAS 77.6 (17.8), SRS-22: pain 4.1 (0.8), mental health 4.1 (0.6), self-image 3.7 (0.7), function 4.0 (0.6), satisfaction with treatment 3.7 (1.0). Surgical patients had significantly reduced scores for SRS-physical function and self-image, and patients with curves ≥ 45° had reduced self-image.

Conclusion: Long-term results were satisfactory in most braced patients and similar in late-onset juvenile and idiopathic adolescent scoliosis.

Figure 1

Longitudinal development of the major curve in late-onset juvenile (N = 58) and adolescent idiopathic scoliosis (N = 214). Mean Cobb angle ± 1 SD prebrace, at brace weaning, and at long-term follow-up in 272 patients.

Figure 2

Longitudinal development of the major curve in late-onset juvenile and adolescent idiopathic scoliosis classified according to the status at follow-up. Mean Cobb angle ± 1 SD prebrace, at brace weaning, and at long-term follow-up in patients with final major curve < 45° (N = 215), final major curve ≥ 45° (N = 32), and operated patients (N = 25).

Figure 3

Quality of life at long-term follow-up in late-onset juvenile and adolescent idiopathic scoliosis treated with the Boston brace. Box-plot showing median with 25- and 75 percentiles and outliers for each domain of the SRS-22 (1 = worst possible, 5 = best possible).

Figure 4

Quality of life at long-term follow-up in late-onset juvenile and adolescent idiopathic scoliosis treated with the Boston brace. Percentages of patients are given for each domain (mobility, pain and discomfort, usual activities, self-care, and anxiety and depression) in patients with brace and final curve < 45°, brace and final curve ≥ 45°, and brace and surgery. Significantly (p < 0.01) more patients in the two latter groups reported moderate and severe pain.