Nighttime bracing versus observation for early adolescent idiopathic scoliosis

BACKGROUND:: Spinal bracing is widely utilized in patients with moderate severity adolescent idiopathic scoliosis with the goal of preventing curve progression and therefore preventing the need for surgical correction. Bracing is typically initiated in patients with a primary curve angle between 25 and 40 degrees, who are Risser sign 0 to 2 and <1-year postmenarchal. The purpose of this study is to determine whether nighttime bracing using a Charleston bending brace is effective in preventing progression of smaller curves (15 to 25 degrees) in skeletally immature, premenarchal female patients relative to current standard of care (observation for curves <25 degrees). METHODS:: Premenarchal, Risser 0 female patients presenting to 2 pediatric orthopaedic specialty practices for evaluation of idiopathic scoliosis with Cobb angle measurements between 15 and 25 degrees were selected. They were randomized by location to receive nighttime bending brace treatment or observation. Patients in the observation group were converted to fulltime TLSO wear if they progressed to >25 degrees primary curve Cobb angle. Curve progression was monitored with minimum 2-year follow-up. RESULTS:: Sixteen patients in the observation group and 21 patients in the bracing group completed 2-year follow-up. All patients in the observation group progressed to fulltime bracing threshold. In the nighttime bracing group, 29% of the patients did not progress to 25 degrees primary curve magnitude. Rate of progression to surgical magnitude was similar in the 2 groups. CONCLUSIONS:: Risser 0 patients presenting with mild idiopathic scoliosis are at high risk for progression to >25 degrees primary curve magnitude. Treatment with the Charleston nighttime bending brace may reduce progression to full-time bracing threshold. No difference in progression to surgical intervention was shown between nighttime bracing and observation for small curves.