Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010-2020 in a National Spinal Centre

Abstract

Bracing can reduce curve progression in order to prevent or delay scoliosis surgery in growing children. Brace treatment is effective in adolescent idiopathic scoliosis (AIS), but there is less evidence of its efficacy in early-onset or non-idiopathic scoliosis. We assessed the outcome of bracing at the end point of treatment, including the patients' perception of clinical results. We reviewed 480 patients treated using Boston brace from 2010-2020 (70% female); 249 patients completed bracing (52%) and 118 patients (47.4%) did not require surgery, with 83% having idiopathic scoliosis. Brace success was considered scoliosis below 50° at the end of bracing, with the patient skeletally mature. A total of 131 patients required scoliosis surgery after bracing (64% had idiopathic scoliosis; adolescents 57% and juveniles 43%). All patients had a minimum two-year follow-up after bracing or after scoliosis correction, with the quality of life assessment questionnaires. A total of 98 out of 182 patients with idiopathic scoliosis did not require surgery (54%). Thoracic scoliosis improved with bracing by a mean of 3.4° and thoracolumbar/lumbar scoliosis by a mean of 6.8°. A total of 85 patients with AIS (64%) but only 9 patients with JIS (20%) did not need surgery. In the AIS group, 97 patients had scoliosis of 20-40°; 71 of these patients (73.2%) did not require scoliosis correction at the end of bracing. In total, 84 patients with idiopathic scoliosis had surgery at a mean of 14 years (surgery was delayed by a mean of 3.2 years). In total, 20 of 67 patients with non-idiopathic scoliosis did not need surgery (30%). Thoracic scoliosis improved with bracing by a mean of 8.4° and thoracolumbar/lumbar scoliosis by a mean of 0.8°. A total of 47 patients with non-idiopathic scoliosis required surgery at a mean of 13.1 years (surgery was delayed by a mean of 5.2 years). Multivariate regression analysis showed that idiopathic scoliosis, AIS, closed triradiate cartilage, post-menarche status, higher Risser grade and smaller scoliosis angle at initial presentation predicted brace success. Patients reported good function and self-image, reduced pain and high satisfaction after treatment in both the bracing-only and the bracing followed by surgery groups.

Keywords: SRS-22 questionnaire; adolescent idiopathic scoliosis; brace treatment; bracing; early-onset scoliosis; idiopathic scoliosis; non-idiopathic scoliosis; outcomes; scoliosis.

Figure 1

SRS-22r questionnaire results among patients with IS who completed brace treatment and did not require scoliosis surgery (95 of 98 patients completed the questionnaire).

Figure 2

SRS-22r questionnaire results among patients with non-IS who completed brace treatment and did not require scoliosis surgery (14 of 20 patients completed the questionnaire).

Figure 3

SRS-22r questionnaire results among 84 patients with IS who completed bracing and underwent scoliosis surgery (preoperative compared to 2-year postoperative follow-up).

Figure 4

SRS-22r questionnaire results among patients with non-IS who completed bracing and underwent scoliosis surgery (preoperative compared to 2-year postoperative follow-up). A total of 22 of 47 patients completed the SRS-22r questionnaire (47%).