Today's News

Saturday, February 15, 1997

Boston brace gets high marks in treating scoliosis

The Boston brace received high markets in treating adolescent idiopathic scoliosis, according to two scientific papers presented on Friday.

In scientific paper 211, orthopaedic surgeons at Texas Scottish Rite Hospital for Children compared the effectiveness of a Boston-brace to a Charleston brace. Three hundred and nineteen patients were included in the study; 153 patients with a Boston brace and 166 with a Charleston brace.

The orthopaedic surgeons concluded the Boston brace was more effective than the Charleston brace in preventing curve progression and the need for surgical correction in treating adolescent idiopathic scoliosis. "Overall successful outcomes resulted in 101 patients who had a Boston brace, and 72 patients with a Charleston brace," said study co-author Donald E. Katz, BS, CO, orthotics department, Texas Scottish Rite Hospital for Children, Dallas, Texas.

Katz reported "the findings were most notable for patients with curves between 36 to 45 degrees. Forty-three percent of the Boston brace patients demonstrated curve progression greater than five degrees as compared to 83 percent of the Charleston-brace patients."

In patients with smaller curves (between 25 to 35 degrees), Katz noted "Only 29 percent of those treated with the Boston brace progressed greater than five degrees as compared to 47 percent of the Charleston-brace patients."

The authors also reported the need for surgical correction was significantly less in the Boston brace group; only 24 patients required surgery. Forty-six patients with a Charleston brace needed surgery.

The study included 288 females and 31 males. All patients in the study met certain criteria such as being skeletally immature with idiopathic scoliosis; 10 years old or greater at the time of the brace prescription; had curves from 25 to 45 degrees; and were given no prior treatment for their medical condition.

Co-authors of the study, all from the orthotic and orthopaedic department, Texas Scottish Rite Hospital for Children, are B. Stephens Richards, MD; Richard H. Browne, PhD; and John A. Herring, MD.

Scientific paper 212 determined the effectiveness of a Boston brace in treating adolescents with idiopathic curves greater than 35 degrees. It also determined its effectiveness based upon the actual hours the brace was worn by patients.

Fifty-four patients (49 females and five males) with curves ranging from 35 to 52 degrees were included in the study. Average age of each patient was 13 years old.

The adolescents were instructed to wear the Boston brace for 23 hours per day. Most patients wore the brace for at least two years, said study co-author Thomas M. Mitchell, MD, division of orthopaedic surgery, Dartmouth-Hitchcock Medical Center, Lebanon, N.H.

"Three patient groups were identified based upon the actual hours of brace wear-noncompliant, part- and full-time groups," Dr. Mitchell said.

Dr. Mitchell and his colleagues reported "noncompliance in patients who wore the brace less than 12 hours per day. These patients were associated with an average curve progression from 41.3 to 56.3 degrees. Patients who wore the brace 12 to 18 hours per day (part-time) progressed from 37.6 to 41.2 degrees. Significant curve improvement was noted in the full-time patient group who wore their brace from 18 to 23 hours per day. Their curves measured 35.7 degrees at final follow-up compared to 39.3 degrees at brace fitting.

"We also found only two patients in the full-time brace group underwent spinal fusion," Dr. Mitchell said. "In contrast, 69 percent of the noncompliant group and 35 percent of the part-time group needed surgery."

According to Dr. Mitchell, the study proved "the Boston brace was effective in halting curve progression beyond skeletal maturity in adolescents with idiopathic curves greater than 35 degrees who are complaint with its use."

Co-authors of the study, all from the department of orthopaedics, Connecticut Childrens Medical Center, Hartford, Conn., are Brian G. Smith, MD and Jeffrey D. Thomson, MD.