Dr. Matt Schmitz, JBJS Senior Editor for Pediatrics and Social Media, spotlights a new study in the current issue of The Journal.
The use of bracing for adolescent idiopathic scoliosis (AIS) has been shown to slow and prevent curve progression. However, the effectiveness is “dose-dependent,” increasing with the amount of time using the brace. In some patients with autism spectrum disorder and AIS, sensory and communication challenges may affect brace adherence. In a new study performed at Texas Children’s Hospital in Houston, Amaral et al. sought to determine the impact of autism spectrum disorder on bracing success, curve progression, and patient-reported outcomes.
Access the study at JBJS.org: Bracing Outcomes and Risk of Curve Progression in Adolescents with Idiopathic Scoliosis and Autism Spectrum Disorder
The retrospective study included patients 10 to 18 years of age who were treated for AIS with bracing. A total of 58 patients with autism spectrum disorder (ASD) were matched to 116 controls without ASD (mean age of the total cohort, 12.8 years; 51% male).
The findings revealed that adolescents with ASD were >3 times more likely to progress to the surgical threshold of a major curve of ≥45˚compared with their counterparts without ASD. The rate of progression to the surgical threshold was 40% among those with ASD versus 20% among the controls. The patients with ASD also exhibited higher rates of noncompliance with brace wear (36% vs. 22%) and brace-related issues (22% vs. 8%). Notably, a greater initial curve magnitude and noncompliance were significant predictors of progression to the surgical threshold.
Nevertheless, the findings demonstrated that 60% of the patients with ASD avoided progression to the surgical threshold, indicating that bracing can still be an effective treatment. Furthermore, patients with ASD showed significant improvements over time in self-reported quality-of-life (SRS-22r) scores, in particular, self-image, management, and total scores, with no significant differences in change scores between the 2 patient groups.
The authors concluded that, while ASD may increase the risk of bracing failure potentially related to sensory or behavioral intolerance, bracing remains a viable treatment option when paired with individualized care and closer follow-up. They note that future research should focus on improving brace tolerance and adherence, emphasizing the importance of tailored support strategies for adolescents with autism spectrum disorder undergoing bracing for scoliosis.
You can find the study and a related video abstract at JBJS.org: Bracing Outcomes and Risk of Curve Progression in Adolescents with Idiopathic Scoliosis and Autism Spectrum Disorder
Additional perspective is provided in a new commentary article by Pablo Castañeda, MD : Beyond the Curve and on the Spectrum
Matthew R. Schmitz, MD
JBJS Senior Editor for Pediatrics and Social Media