Treating adolescent scoliosis without a brace may be considered unethical

There are many conflicting opinions about whether or not braces are valuable in the treatment of scoliosis. Some conservative treatment methods still advertise in their advertising that “Braces are not needed,” or that braces are obsolete or even harmful. Many orthopedic surgeons seem to have little confidence in a brace’s ability to help, and may recommend it with a “fingers crossed” attitude of “maybe we’ll get lucky.” However, some specialists insist that scoliosis patients should wear a brace 23 hours a day. Who has the reason? How can you determine who is giving you the best advice?

What would be really helpful in answering this question is a mega-study to compare the outcomes of patients who DO wear a brace with scoliosis patients who DO NOT wear a brace. This is exactly what the editors of the “BRAIST” study (Bracing in Adolescent Idiopathy Scoliosis Trial) set out to do, and they did. The results of this study may surprise you.

The first sentence of the BRAIST study states: “The role of braces in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial.” That is why the study was done. To target those “at risk for curve progression,” the study specifically focused on growing adolescents ages 10 to 15 with curves between 20 and 40 degrees. Such a group is known to be at extremely high risk of progressing beyond 50 degrees. A “successful” outcome was defined as: the curve remained below 50 degrees in size when the child finished growing. A failed outcome was defined as: “Any child who progressed beyond the 50 degree mark. This threshold was chosen because progression of the curve as an adult is highly likely when the Cobb angle has become so severe in adolescence. This is the point at which most surgeons recommend surgery.

By dividing these children into two groups: those who received a brace and those who did not, the study was able to confidently measure the difference in success between wearing a brace and not wearing a brace. It is also important to note that only rigid braces were allowed in this study. Soft brakes did not qualify. The surprising result of the study is this: Wearing a brace had a much higher success rate than not wearing a brace, which the ethics review board felt was unethical to continue with the study. The study had to be stopped well ahead of schedule because the results were overwhelmingly obvious: denying children without braces in the study a rigid brace was harming the children and making it unethical to treat high-risk scoliosis cases without a brace. suspenders!

Two strong conclusions emerged from the BRAIST study and one shocking number:

Rigid brace significantly reduces worsening of curves in the 20 to 40 degree range (high risk curves as defined above)

The more you wear the brace, the better it will work! Imagine: the kids who actually wore their brace had the best results.

There was a FAILURE RATE of 58% in the watch-and-wait-for-watch group. So what’s the shocking number? Fifty-eight percent of the non-braced “observation only” group progressed to needing surgery, worsening beyond the 50-degree mark at which surgery is considered “necessary.” Fifty-eight percent is huge: that’s more than half of the kids in the 20-40 degree range, who are still growing, ended up needing surgery! Previously, the number had been reported to be as low as 22%2, the BRAIST authors had predicted it to be as high as 30%, but no one realized that the “watch and wait, just watch” failure rate! was as high as 58%! This is a massive failure in the current “Observation – wait and see” standard of care for managing scoliosis!

One would think that such strong findings in favor of rigid braces would send shock waves throughout the orthopedic world and throughout the non-surgical camps treating scoliosis. Controversy is dead… isn’t it? What is left to discuss? Shouldn’t everyone recommend rigid braces? Shouldn’t all doctors now agree that this is clearly the best course of action?

It has been almost 5 years since the publication of the BRAIST study and sadly clinics and non-surgical methods are still telling parents that wearing a rigid brace is harmful, outdated and/or doesn’t work. It would appear that they did not receive the BRAIST memo or perhaps they simply refuse to see the evidence. Whatever the reason, the confusion that anti-bracket messages bring to the public is hurting children with scoliosis. Don’t let your child fall victim to misinformation. Read about the BRAIST study and you’ll find that the jury is out that rigid braces work, and remarkably so, especially when patients wear them.

A final note on the BRAIST study: while we know that wearing the brace more than 18 hours a day produces a better outcome, the study did not provide data on the quality of the brace itself; meaning the study didn’t track how straight the brace made each spine. Logically, the straighter the brace can hold the spine, the greater the chance that the spine will grow straighter. There is emerging research suggesting that focusing on developing braces that provide better correction within the brace will result in better clinical outcomes (straighter spines).3-6

If you want to know how you can get the most benefit from a brace for your child, we invite you to learn about our Silicon Valley MethodTM and how it is possible to have a surgical straightening of the spine, without surgery.

References

https://scoliosiscarecenters.com/2018/05/02/adolescentscoliosisbracing/

Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of braces in adolescents with idiopathic scoliosis. N Engl J Med 2013;369:1512-21.

Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review. Spine (Phila Pa 1976) 2007;32:S91-S100.

Negrini S, Marchini G, Tessadri F. Brace Technology Thematic Series – The Sforzesco and Sibilla braces, and the SPoRT (Symmetrical, Patient Oriented, Rigid, Three-Dimensional, Active) concept. Scoliosis 2011;6:8.

Aulisa AG, Mastantuoni G, Laineri M, et al. Orthodontic Technology Thematic Series: The Short Progressive Action Brace (PASB). Scoliosis 2012;7:6.

Mauroy JC de, Pourret S, Barral F?d?r. Immediate brace correction with the new Lyon brace (ARTbrace), Results of 141 consecutive patients according to the SRS criteria for brace studies. Ann Phys Rehabilitation Med 2016;59:e32.

Minsk MK, Venuti KD, Daumit GL, Sponsor PD. Effectiveness of Rigo Cheneau versus Boston style orthoses for adolescent idiopathic scoliosis: a retrospective study. Scoliosis Spinal Disorder 2017;12:7.