P0845 - Part-Time Bracing for At-Risk Mild Juvenile Idiopathic Scoliosis Curves: A Preliminary Single Center Retrospective Investigation

Background/Purpose
Current standard of care for juvenile idiopathic scoliosis (JIS) is initiation of bracing at 25°; however, there are no established evidence based guidelines for bracing patients with JIS prior to this. The BrAIST study demonstrated that bracing is most effective with smaller curves, and several small studies have demonstrated effectiveness of part time bracing in JIS after curves have reached the 25° threshold. The purpose of this study is to assess the short-term effectiveness of part-time bracing (10-12 hours/day) at a single institution in preventing progression to full time bracing in patients with mild (15-25°) JIS curves.
Methods
This retrospective cohort study included skeletally immature patients (Risser 0, open triradiate cartilage, or Sanders stage 1-3) with JIS (age 16 hours/per day), as indicated by curve progression to >25°. A subgroup analysis of patients during their rapid growth phase (age ≥7 years old) was also conducted. Treatment with bracing or observation was determined by physician and family preference.
Results
38 patients met inclusion criteria (mean age 9 years old, 79% female) and patient characteristics did not differ between groups (Table 1). The mean major curve was 18° and the mean follow-up time was 2.2 years. 25 (65.8%) patients were observed and 13 (34.2%) were part-time braced. 10 observation patients (40%) progressed to full-time bracing whereas only 1 part-time bracing patient (7.7%) progressed to full-time bracing (P=0.037). When only patients that were ≥7 years old were analyzed, 10/22 (45.5%) patients in the observation group progressed to full-time bracing and 0/11 patients in the part-time bracing group progressed (P=0.007).
Conclusion
Skeletally immature patients with JIS and primary curve magnitudes of 15-25° are at a significant risk of progression to >25°, the standard criteria for full-time bracing. Treatment with a part-time bracing protocol of 10-12 hours per day in this group reduced the risk of progression to full-time bracing. This has the benefit of both minimizing the curve magnitude, and reducing the number of hours in the brace, which can alleviate anxiety and the challenges of compliance seen in full-time bracing. These results support a prospective study following patients to maturity to better define the longer term benefits of early, part-time bracing.