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Scoliosis In Teenagers: To Brace Or Not To Brace Is Still A Question

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Scoliosis In Teenagers: To Brace Or Not To Brace Is Still A Question

http://www.medicalnewstoday.com/articles/176505.php

The use of braces to correct excessive curvature of the spine, or scoliosis, in

adolescents is still an area of controversy and is likely to remain that way

until there is better evidence, concludes a new review of published research.

Although some evidence points toward a benefit from using braces, research has

failed to prove definitively that they work.

Adolescent idiopathic scoliosis curvature of the spine in which the cause is

unknown affects about 1 percent to 12 percent of the general population.

Scoliosis is much more common in girls and is more likely to be severe in girls.

About 10 percent of children and teenagers who have scoliosis will require

treatment, based on the severity of the spinal curvature. Others can have

monitoring without treatment to see if the spinal curve worsens. In severe

scoliosis that remains untreated, lung, heart and spine damage might occur in

adulthood.

" Bracing is regarded as effective by some and as useless by others, " says

Stefano Negrini, M.D., lead author of the review. Negrini is the scientific

director of the ISICO (Italian Scientific Spine Institute) in Milan.

A variety of braces is used to slow the worsening of spinal curvature in

adolescent scoliosis. Originally, braces were made from rigid metal, but most

now are made from lightweight molded plastic. Still, such treatment can

profoundly affect a teenager's life. Braces, which often must be worn 16 to 20

hours a day, can cause decreased ability to move, sleep disturbances, poor body

image, emotional problems and social difficulties. Some health care providers

say bracing is no more effective than the " wait-and-see " approach.

However, if a patient's scoliosis worsens, surgical fusion of the spine using

rods might be the only alternative, a procedure that can cause potentially

serious side effects, such as nerve damage and loss of mobility.

The review appears in the latest issue of The Cochrane Library, a publication of

the Cochrane Collaboration, an international organization that evaluates medical

research. Systematic reviews draw evidence-based conclusions about medical

practice after considering both the content and quality of existing medical

trials on a topic.

Although there are many studies on bracing in scoliosis, Negrini and colleagues

found only two studies that actually enrolled participants into different

treatment groups and then compared how they did. This is because designing this

type of study called a randomized controlled trial to test bracing in scoliosis

is no easy undertaking. " Bracing is a very long-term treatment, " Negrini said.

" Moreover a complete committed team made up of physicians, orthotist [a person

who fits braces], physiotherapist, parents and the patient is required. "

Researchers found that in one study of 286 girls, braces slowed worsening of the

scoliosis in 74 percent of participants, compared with about 33 percent in

groups that did not receive treatment or underwent electrical stimulation. A

second study of 48 girls, found that a rigid brace slowed scoliosis more than an

elastic one did.

" The studies included in the review are not able to provide strong evidence, "

that will affect how scoliosis is treated, Negrini concluded.

Despite this lack of evidence, Negrini said his clinic frequently prescribes

braces in conjunction with exercises for patients with scoliosis. Teamwork with

orthotists and physiotherapists is key, he said.

" We are aware of the very good results it is possible to obtain with

high-quality bracing and making sure there is good patient compliance with

wearing the brace, " Negrini said. " For us, the 'wait and see' option is not a

possibility. " Avoiding any eventual need for spinal fusion is the goal. " Just

one patient not fused is worth all our clinical efforts, " he said.

Dormans, M.D., chief of orthopedic surgery at the Children's Hospital of

Philadelphia and president of the Pediatric Orthopedic Society of North America,

shares a similar attitude toward bracing.

" If you ask a skydiver if a parachute works, there's no randomized controlled

study, but they know from experience it works, " Dormans said. " If you polled the

orthopedists who treat the vast majority of patients with adolescent idiopathic

scoliosis, the overwhelming opinion would be that bracing is effective, that it

does alter the natural history of the disease. "

However, getting teenagers to actually wear braces is another issue, Dormans

added. " There are studies that show big discrepancies between how many hours

patients say they are wearing the brace and the hours the actually wear them. "

Questions about the effectiveness of bracing in adolescent idiopathic scoliosis

might soon be answered by more definitive research: a five-year,

multimillion-dollar study funded by the National Institute of Arthritis and

Musculoskeletal and Skin Diseases is currently under way.

The Cochrane Library contains high quality health care information, including

Systematic Reviews from The Cochrane Collaboration. These reviews bring together

research on the effects of health care and are considered the gold standard for

determining the relative effectiveness of different interventions. The Cochrane

Collaboration is an international nonprofit, independent organization that

produces and disseminates systematic reviews of health care interventions and

promotes the search for evidence in the form of clinical trials and other

studies of interventions.

Negrini S, et al. Braces for idiopathic scoliosis in adolescents (Review).

Cochrane Database of Systematic Reviews 2010, Issue 1.

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