Detorsion night-time bracing for the treatment of early onset idiopathic scoliosis

Background: Management for early onset scoliosis has recently changed, with the development of new surgical procedures. However, multiple surgeries are often required and high complication rates are still reported. Conservative management remains an alternative, serial casting achieving excellent results in young children. Better compliance and improvement over natural history have been reported with night-time bracing in adolescent idiopathic scoliosis (AIS), but this treatment has never been reported in early onset idiopathic scoliosis (EIOS). Methods: All patients treated for progressive EOIS by detorsion night-time bracing (DNB), and meeting the Scoliosis Research Society (SRS) criteria for brace studies were reviewed. Recommendations were given to wear the DNB 8 h/night and no restriction was given regarding sports activities. Radiological parameters were compared between referral and latest follow-up. Based on the SRS criteria defined for AIS, a similar classification was used as follows to analyze the course of the curves: success group: patients with a progression of 5 degrees or less; unsuccess group (progression or failure): patients with a progression >5 degrees patients with curves exceeding 45 degrees at maturity, or who have had recommendation for/undergone surgery, or patients who changed orthopaedic treatment, or who were lost to follow-up. Results: Thirty-three patients were included (21 girls and 12 boys), with a median Cobb angle of 31 degrees (Q1-Q3: 22-40). Age at brace initiation averaged 50 months (Q1-Q3: 25-60). Median follow-up was 102-months (Q1-Q3: 63-125). Fifteen patients (45.5%) had reached skeletal maturity at last follow-up. The success rate was 67% (22 patients), with a median Cobb angle reduction of 15 degrees (P < 0.001). Four patients stopped DNB due to an important regression. Eleven patients were in the unsuccessful group (33%). Only one had surgery. All patients remained balanced in the frontal plane and normokyphotic. Initial curve magnitude and age at brace initiation appeared to be important prognostic factors. Conclusions: DNB is an effective conservative treatment, which can be considered a delaying tactic in the management of EOIS. This brace offers potential psychosocial and compliance benefits, and allows unconstrained spinal and chest wall growth, resulting in normokyphosis at maturity. Level of evidence: Therapeutic study (retrospective consecutive case series): Level IV. (C) 2014 Elsevier Masson SAS. All rights reserved.