A study was conducted whereby Swedish patients had been involved in an SRS brace study had been invited for a long term follow up. The objective of this study had been the investigation of the rate of scoliosis surgery and its link to the progression of curves from baseline, as well as after maturity. In this study, brace treatment was concluded to be superior to electrical muscle stimulation. It was found to be superior to observation alone, as in the original brace study. There have been very few other studies that have been able to show that brace treatment is indeed effective in the treatment of scoliosis.
The method used in this bracing study involved both the Boston brace treatment (this was applied to 41 patients in Malmö) and observation alone as a treatment method (applied to 65 patients in Göteborg). The total number of patients was 106, out of which only 87% attended the follow-up in which radiography and chart review was included. The radiographs were all measured for curve size using the Cobb method. This was done by an unbiased examiner. Patients who had undergone the surgery after maturity were identified from the mandatory national database.
The mean age at the first follow-up time was 16 years, and 32 years was the mean age at the second follow-up. Both treatment groups were shown to have equal curve size at the inclusion. The patients who were treated with a brace from the start, had their curve size reduce by 6 degrees during the course of the treatment. The curve size returned to the same level over the follow-up period.
The primarily braced patients underwent surgery. In the observation alone group, 20% due to progression were braced during adolescence. The other 10% underwent surgery, and the remaining 70% of the patients were observed alone, with an increased by 6 degrees from inclusion till now. Surgery after maturity was not performed on any of the patients, and progression was related to premenarchal status.
The conclusion of the study showed that the moderate or smaller size curves of patients with adolescent idiopathic scoliosis did not show deterioration beyond their original curve size in this 16-year follow up. Patients treated with a brace did not need surgery; however, 6 patients, which was a 10% of the total in the observation group, needed surgery during their adolescence. Thus, it was concluded that curve progression was related to immaturity.
Danielsson AJ, Hasserius R, Ohlin A, et al.