Intervention Review

Braces for idiopathic scoliosis in adolescents

  1. Stefano Negrini1,*,
  2. Silvia Minozzi2,
  3. Josette Bettany-Saltikov3,
  4. Fabio Zaina1,
  5. Nachiappan Chockalingam4,
  6. Theodoros B. Grivas5,
  7. Tomasz Kotwicki6,
  8. Toru Maruyama7,
  9. Michele Romano1,
  10. Elias S. Vasiliadis8

Editorial Group: Cochrane Back Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 29 DEC 2008

DOI: 10.1002/14651858.CD006850.pub2

How to Cite

Negrini S, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Vasiliadis ES. Braces for idiopathic scoliosis in adolescents. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006850. DOI: 10.1002/14651858.CD006850.pub2.

Author Information

  1. 1

    ISICO (Italian Scientific Spine Institute), Milan, Italy

  2. 2

    ASL RM/E, Department of Epidemiology, Rome, Italy

  3. 3

    University of Teeside, School of Health and Social Care, Middlesbrough, Cleveland, UK

  4. 4

    Staffordshire University, Faculty of Health, Stoke on Trent, UK

  5. 5

    "Tzanio" General Hospital of Piraeus, Orthopaedic and Trauma Department, Piraeus, Attica, Greece

  6. 6

    University of Medical Sciences, Department of Pediatric Orthopedics and Traumatology, Poznan, Poland

  7. 7

    Saitama Medical University, Department of Orthopaedic Surgery, Kawagoe, Saitama, Japan

  8. 8

    Thriasio General Hospital, Athens, Greece

*Stefano Negrini, ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, Milan, 20141, Italy. stefano.negrini@isico.it.

Publication History

  1. Publication Status: New
  2. Published Online: 20 JAN 2010

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé

Background

Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Braces are traditionally recommended to stop curvature progression in some countries and criticized in others. They generally need to be worn full time, with treatment extending over years.

Objectives

To evaluate the efficacy of bracing in adolescent patients with AIS.

Search methods

The following databases (up to July 2008) were searched with no language limitations:  the Cochrane Central Register of Controlled Trials, MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982) and reference lists of articles. An extensive handsearch of the grey literature was also conducted.

Selection criteria

Randomised controlled trials and prospective cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces.

Data collection and analysis

Two review authors independently assessed trial quality and extracted data.

Main results

We included two studies. There was very low quality evidence from one prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth (success rate 74% (95% CI: 52% to 84%)), better than observation (success rate 34% (95% CI:16% to 49%)) and electrical stimulation (success rate 33% (95% CI:12% to 60%)). There is low quality evidence from one RCT with 43 girls that a rigid brace is more successful than an elastic one (SpineCor) at curbing curve progression when measured in Cobb degrees, but there were no significant differences between the two groups in the subjective perception of daily difficulties associated with wearing the brace.

Authors' conclusions

There is very low quality evidence in favour of using braces, making generalization very difficult. Further research could change the actual results and our confidence in them; in the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short and long-term patient-centred outcomes, in addition to measures such as Cobb angles. RCTs and prospective cohort studies should follow both the Scoliosis Resarch Society (SRS) and Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) criteria for bracing studies.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé

Braces for idiopathic scoliosis in adolescents

Scoliosis is a condition where the spine is curved in three dimensions (from the back the spine appears to be shaped like an "s"). It is often idiopathic, or having an unknown cause. The most common type of scoliosis is discovered at 10 years of age or older, and is defined as a curve that measures at least 10° (called a Cobb angle; measured on x-ray). Because of the unknown cause and age of diagnosis, it is called Adolescent idiopathic scoliosis (AIS).

While there are usually no symptoms, the appearance of AIS frequently has a negative impact on adolescents. Increased curvature of the spine can present health risks in adulthood and in the elderly. Braces are one intervention that may stop further progression of the curve. They generally need to be worn full time, with treatment lasting for two to four years. However, bracing for this condition is still controversial, and questions remain about how effective it is.

This review included two studies; one multicenter international cohort study (a study where treatment groups were defined according to the centre where patients were treated) of 286 girls and a randomised controlled study (an experimental study that randomised the participants to treatment groups) of 43 girls. There is very low quality evidence that braces are more effective than observation (wait-and-see) or electrical stimulation in curbing the increases in the curves of the spine. There is low quality evidence that rigid braces are more effective than a soft, elastic one. Adverse effects of braces were not discussed.

Limitations of this review include the sparse data and studies available, and the fact that available studies only included girls (even if there is only one male with scoliosis for every seven females), making it very difficult to generalize the results to males. Due to the very low quality of the evidence in favour of bracing, patients and their parents should regard these results with caution and discuss their treatment options with a multi-professional team.

Further research is very likely to change the results and our confidence in them.

 

Résumé

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Résumé

Contexte

La scoliose idiopathique de l’adolescent (SIA) est une déformation rachidienne tridimensionnelle.

Même si la SIA peut progresser durant la croissance et créer une difformité de surface, elle est habituellement asymptomatique. Toutefois, à l’âge adulte, si la courbure scoliotique finale dépasse un certain seuil critique, les risques de problèmes de santé et de la progression de la courbure scoliotique sont augmentés. Dans certains pays, les corsets sont traditionnellement recommandés pour enrayer la progression de la courbure, mais leur usage est critiqué dans d’autres pays. Leur utilisation nécessite généralement qu’ils soient portés en tout temps et le traitement peut s’étendre sur plusieurs années.

Objectif

Évaluer l’efficacité des corsets chez les patients adolescents atteints de SIA.

Stratégie de recherche

Les bases de données suivantes ont été explorées (jusqu’en juillet 2008), sans restrictions de langue: le «Cochrane Central Register of Controlled Trials», MEDLINE (à partir de janvier 1966), EMBASE (à partir de janvier 1980), CINHAL (à partir de janvier 1982) auxquelles s’ajoutent des listes d’articles de référence. Une fouille manuelle complète de la «littérature grise» (documents éphémères émis en quantités limitées en dehors des circuits formels de la publication et de la distribution) a également été faite.

Critères de sélection

Ont été retenus, les essais contrôlés randomisés (ECR) et les études prospectives de cohortes comparant le port de corset avec l’absence de traitement, un autre type de traitement, une chirurgie ou différents types de corsets.

Collecte de données et analyse

Deux des auteurs de cette revue ont indépendamment évalué la qualité des essais cliniques et les données extraites.

Principaux résultats

Nous avons inclus deux études. Nous avons noté une très faible qualité de preuves provenant d’une étude prospective portant sur une cohorte de 286 jeunes filles à l’effet qu’un corset pouvait freiner la progression de la courbure à la fin de la croissance (taux de succès 74%; IC: 95%; 52% à 84%), ce qui est mieux que l’observation clinique (taux de succès 34%; IC: 95%; 16% à 49%) et la stimulation électrique (taux de succès 33%; IC: 95%; 12% à 60%)). Nous avons noté une faible qualité des preuves d’un ECR portant sur une cohorte de 43 jeunes filles à l’effet qu’un corset rigide donne de meilleurs résultats qu’un corset souple (SpineCor) pour freiner la progression de la courbure lorsque mesuré avec l'angle de Cobb, mais il n’y avait pas de différence significative entre les deux groupes quant à la perception subjective des difficultés quotidiennes associées au port du corset.

Conclusions des auteurs

Il y a une très faible qualité de preuves en faveur de l’utilisation des corsets, ce qui rend toute généralisation difficile. Des recherches subséquentes pourraient changer les résultats actuels et notre confiance en eux. Entretemps, les choix des patients devraient être éclairés par des discussions interdisciplinaires. Les recherches futures devraient être centrées sur les résultats à court et long termes tenant compte des patients, en plus des mesures standardisées comme l'angle de Cobb. Les essais cliniques randomisés et les études prospectives de cohortes devraient utiliser les critères proposés par la Société de recherche sur la scoliose (SRS) et la Société de scoliose et de réadaptation orthopédique (SOSORT) sur le port de corsets.

Traduction

La traduction française de cet examen Cochrane a été financée par le groupe Cochrane sur les maux de dos et a été effectuée par Arlette Missiha et Bernard Soucy.