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Effects of Bracing in Adolescents with Idiopathic Scoliosis *
Published in Alexander R. Vaccaro, Charles G. Fisher, Jefferson R. Wilson, 50 Landmark Papers, 2018
Robert J. Ames, Amer F. Samdani
Several other reports document the efficacy of bracing. In 1986, Emans et al.25 reported results with the Boston brace on 295 patients. Curve progression of 5° or more was noted in only 7% of the patients during treatment, and only 11% of the patients went on to surgery. A large study by Lonstein and Winter in 199426 showed that bracing had a significant positive effect on the natural history of AIS, with a failure rate of 43% in braced patients versus 68% in nonbraced children. Studies utilizing the Wilmington brace have displayed favorable results as well, with only 10%–28% curve progression rates.27–29
The Back
Published in Louis Solomon, David Warwick, Selvadurai Nayagam, Apley and Solomon's Concise System of Orthopaedics and Trauma, 2014
Louis Solomon, David Warwick, Selvadurai Nayagam
Bracing has been used for many years in treating progressive curves of 20–30 degrees. The Milwaukee brace consists of a pelvic corset connected by adjustable steel supports to a cervical ring carrying occipital and chin pads; its purpose is to reduce the lumbar lordosis and encourage active stretching and straightening of the thoracic spine. The Boston brace is a snug-fitting underarm brace that provides lumbar or low thoracolumbar support. Corrective pads may be added to these devices to apply pressure at a particular site. A wellmade brace does not preclude full daily activities, including sport and exercises.
Paediatric orthopaedic disorders
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Infants with idiopathic scoliosis that is prone to progression usually display a rib–vertebral angle difference of greater than 20 degrees on spine radiographs. Most patients are boys with left thoracic curves. If treatment is started early serial cast correction for infantile scoliosis often results in full correction in infants with idiopathic curves. Scoliosis should not be considered idiopathic until a complete history, physical and radiological examination has excluded other diagnosis. A 12-year-old postmenarcheal female with idiopathic scoliosis and a Cobb angle measuring more than 50 degrees on AP spine radiographs is a candidate for an instrumented spinal fusion (curve 50 degrees or greater in mature patients and greater than 40 degrees in immature patients). A curve of this magnitude will progress regardless of the growth remaining in the affected individual. Depending on location of the curve in the spine the surgery can be done either by the anterior or posterior approach with instrumentation and fusion. The number of segments fused will also depend on the extent, the flexibility and location of the deformity in the spine. On the other hand, an 11-year-old premenarcheal female with idiopathic scoliosis and a Cobb angle measuring 25 degrees on AP spine radiographs is treated with bracing (less than 40 degrees with growth remaining). Common braces used are the Boston brace, which is recommended to be worn 23 hours a day, and the Providence brace, which is worn only at night; the latter has been shown to be effective and has a much better compliance rate for obvious reasons. Bracing does not correct the deformity but has been shown to prevent progression if used appropriately. Scheuermann’s kyphosis should be considered in a 12-year-old male with kyphosis that measures 60 degrees on lateral spine radiographs that also show wedged vertebrae. A year of remaining growth is usually adequate to begin bracing. Brace treatment usually must be continued for a minimum of 18 months to have an effect on vertebral wedging. Approximately one-third of patients with initial curves greater than 75 degrees require surgery.
Evaluation of the efficiency of Boston brace on scoliotic curve control: A review of literature
Published in The Journal of Spinal Cord Medicine, 2020
Mohammad Taghi Karimi, Timon Rabczuk
Scoliosis is one of the spinal deformities with high incidence of occurrence. Various treatment approaches have been used for patients with scoliosis, especially braces. Boston brace is one of the new designs of braces recommended for the subjects with scoliosis deformity. The aim of this study was to collect all available evidence published on Boston brace to determine its efficiency to control scoliotic curve progression compared to other available braces. Moreover, it was aimed to determine the parameters which influence the efficiency of Boston brace (Tables 4 and 5).