Aim

The primary aim of this pilot study was to assess and evaluate the SpineCor Pain Relief Brace as a method of reducing the pain experienced by patients diagnosed with degenerative scoliosis

Background

In the USA more than half the states have legislated scoliosis school screening with the remaining states having either voluntary screening or no recommendations. The four primary care providers for adolescents with idiopathic scoliosis in the USA (AAOS, SRS, POSNA, AAP) do not support any recommendation against scoliosis screening, given the available literature. In Australia a national self detection program is implemented but in the UK school screening has been abolished since the 1980's. Opponents to scoliosis screening have focused on concerns about a low predictive value of screening, the cost effectiveness of referral, the possibility of unnecessary brace treatment and the effect of exposure to radiation when radiographs are obtained.

Scoliosis school screening is either mandatory or recommended in 32 states in the USA. The remaining states having either got voluntary screening or no recommendations. The four primary care providers for adolescents with idiopathic scoliosis in the USA do not support any recommendation against scoliosis screening, given the available literature. In Australia a national self detection program is implemented but in the UK school screening has been abolished since the 1980's. Opponents to scoliosis screening have focused on concerns about a low predictive value of screening, the cost effectiveness of referral, the possibility of unnecessary brace treatment and the effect of exposure to radiation when radiographs are obtained.

The purpose of this review was to evaluate the evidence for and against scoliosis screening.

The following databases were searched: Cochrane Library, ARIF, TRIP, MEDLINE, EMBASE and CINAHL. Reference lists of articles were searched for relevant systematic reviews and research articles.

One systematic review (2008)¹ suggests that there is evidence (level 1B) that intensive scoliosis specific exercise methods can reduce the progression of mild scoliosis (<30 degrees Cobb). Further a Cochrane review (2010) suggests that there is low quality evidence for the effectiveness of bracing.

Based on the evidence of this review, a 4 tier model for school screening is proposed that addresses the “opponents” concerns. The model includes the distribution of information leaflets, screening by a school nurse, topographical assessment, referral to the primary care doctor and finally if the patient is still screening positive, referral to a scoliosis surgeon.

Exercises reduce the progression rate of adolescent idiopathic scoliosis:

Department of Epidemiology, ASL RM/E, Rome, Italy

School of Health and Social Care, University of Teesside, Middlesbrough, UK

Faculty of Health, Staffordshire University, Stoke on Trent, UK

Orthopaedic and Trauma Department, “Tzanio” General Hospital of Piraeus, Greece

University of Medical Sciences, Poznan, Poland

Department of Orthopaedic Surgery, Saitama Medical University, Kawagoe, Japan

Thriasio General Hospital, Athens, Greece

To evaluate the efficacy of bracing in adolescent patients with AIS.

Cochrane systematic review

The following databases were searched with no language limitations: the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINHAL and reference lists of articles. Extensive hand searching of grey literature was also conducted. RCT's and prospective cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces were included. Two review authors independently assessed trial quality and extracted data.

Two studies were included. There was very low quality evidence from one prospective cohort study including 286 girls¹indicating that braces curbed curve progression, at the end of growth, (success rate 74%), better than observation, (34%) and electrical stimulation (33%). Another low quality evidence from one RCT with 43 girls indicated that a rigid brace is more successful than an elastic one (SpineCor) at limiting curve progression when measured in Cobb degrees². No significant differences between the two groups in the subjective perception of daily difficulties associated with brace wearing were found.

There is very low quality evidence in favour of using braces, making generalization very difficult. The results from future studies may differ from these results. In the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short and long-term patient-centred outcomes as well as measures such as Cobb angles. RCTs and prospective cohort studies should follow both the SRS and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) criteria for bracing studies.