A Conversation about Pediatric Spine Bracing

One benefit of our digital age is that it allows virtually real-time “conversations” to be published between authors of orthopaedic studies and their colleagues, without the lag time imposed by print.

Case in point is the engaging back-and-forth between James Sanders, MD (co-author of the April 16, 2014 JBJS study titled “Bracing for Idiopathic Scoliosis: How Many Patients Require Treatment to Prevent One Surgery?”) and Hans-Rudolf Weiss, an orthopaedic surgeon from Germany.

The original study found that bracing for idiopathic adolescent scoliosis substantially decreased the risk of curve progression to a surgical range—but only when patients wore the brace at least 10 hours a day. Among those “highly compliant” patients, the number needed to treat to prevent one surgery was 3. However, only 31% of the 126 subjects in the study were highly compliant. The authors also noted that current bracing indications include many curves that would not have progressed to surgical range even if the patient had not worn a brace.

In an eLetter (click on the  “eLetters” tab under the article citation), Dr. Weiss stressed that patient compliance with bracing is largely influenced by the physician, but that half of the members of the Scoliosis Research Society do not believe in bracing. He additionally suggested that the findings pertain to the brace designs used in the study and may not be generalizable to other brace types. Dr. Weiss concluded that “long-term corrections can be achieved when recent bracing standards are applied.”

In a response to Dr. Weiss’s eLetter, Dr. Sanders suggested that the recent publication of the BrAIST study, which provided high-level evidence that bracing can prevent progression to a surgical range, has bolstered the ranks of bracing “believers” among orthopaedists. Despite that, Dr. Sanders points out that even strong physician proponents of bracing are “likely to have patients for whom bracing is unacceptable and their compliance poor.” That fact, he says, “makes it our imperative to develop bracing which is effective while still being both comfortable and psychosocially acceptable to patients.”

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