Abstract
Introduction: A comparison of the success of the thoracolumbosacral orthosis (TLSO) and the Providence orthosis in the treatment of adolescent idiopathic scoliosis (AIS) using the new Scoliosis Research Society’s (SRS) Committee on Bracing and Nonoperative Management inclusion and assessment criteria for bracing studies.
Methods: A retrospective study of brace patients with AIS between 1992 and 2004. We have used a custom TLSO (22 hour/day) and the Providence orthosis (8–10 hour/night) to control progressive curves. A total of 83 patients met the new inclusion criteria: 10 years of age and older at initiation of bracing; initial curve of 25 to 40 degrees; Risser sign 0–2; females, premenarchal or less than one year post menarchal; and no prior treatment. There were 48 patients in the TLSO group and 35 in the Providence group. The new SRS assessment criteria of effectiveness included the percentage of patients who had 5 degrees or less and 6 degrees or more of curve progression at maturity; the percentage of patients whose curve progressed beyond 45 degrees; the percentage of patients who had surgery recommended or undertaken; and a minimum of two years of follow-up beyond maturity in those patients who were felt to have been successfully treated. All patients are analyzed irregardless of compliance (“intent to treat”).
Results: There were no significant differences in age at brace initiation, initial primary curve magnitude, gender, or initial Risser sign between the two groups. In the TLSO group, only 7 patients (15%) did not progress (5 degrees or less), while 41 patients progressed 6 degrees or more (85%), including 30 patients that exceeded 45 degrees. Thirty-eight patients (79%) ultimately required surgery. In the Providence group, 11 patients (31%) did not progress, while 24 patients (69%) progressed 6 degrees or more, including 15 patients that exceeded 45 degrees. Twenty-one patients (60%) required surgery. However, when the initial curve at initiation of bracing was 25 to 35 degrees, the results improved. Five of 34 patients (15%) in the TLSO group and 10 of 24 patients (42%) in the Providence group did not progress, while 29 patients (85%) and 14 patients (58%) progressed 6 degrees or more and 26 patients (76%) and 11 patients (46%) required surgery, respectively.
Conclusions: Using the new SRS criteria, the Providence orthosis was more effective for avoiding surgery and preventing curve progression than the TLSO when the primary initial curves were 35 degrees or less. However, the overall success in both groups was inferior to previous studies. Our results raises the question of the effectiveness of orthotic management in AIS and supports the need for a multicenter, randomized study utilizing the new SRS inclusion and assessment criteria.
Correspondence should be addressed to: Dr Caroline Goldberg, The Research Centre, Our Lady’s Children’s Hospital Crumlin, Dublin 12, Ireland.
