Adolescent idiopathic scoliosis (AIS) is a curvature of the spine with no clear underlying cause. In mild cases, monitoring over time by a physician may be all that is needed. However, in more severe cases — especially when the child is still growing — the use of a brace, or even surgery, may be recommended. Left untreated, more serious curves can cause pain and disability.
Before and after bracing x-rays of a girl with adolescent idiopathic scoliosis.
“While bracing has been a mainstay of non-operative treatment for AIS for decades, evidence regarding its impact has been inconclusive,” said NIAMS Director Stephen I. Katz, M.D., Ph.D. “This study is certain to enhance clinical decision-making regarding the non-operative management of AIS.”
Researchers from the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) set out to compare the risk of curve progression in adolescents with AIS who wore a brace with those who did not. The study team, led by Stuart Weinstein, M.D., and Lori Dolan, Ph.D., of the University of Iowa, Iowa City, recruited patients who — based on their age, skeletal immaturity and curve severity — were at high risk for continued worsening of their spinal curves.
Investigators enrolled 383 subjects at 25 institutions in the United States and Canada between March 2007 and February 2011. Although the study began as a completely randomized study, the team eventually added a preference cohort, where patients and families could choose their own treatment. Treatment was randomly assigned for about 40 percent of study participants and based on preference for the remainder.
Patients in the observation arm received no specific treatment, while those in the bracing arm were instructed to wear a brace for 18 hours per day. Treatment was considered to be unsuccessful when a curve progressed to 50 degrees or greater – a point at which surgery is typically recommended. Treatment was considered a success when the child reached skeletal maturity without this degree of curve progression.
In January 2013, the trial was stopped early after finding that bracing significantly reduced the risk of curve progression and the need for surgery, and that more hours of brace wear was associated with higher success rates. In the combined randomized and preference cohorts, 72 percent in the bracing group achieved success. Wearing a brace more than an average of 13 hours per day was associated with success rates of 90 to 93 percent. Of note is the fact that 48 percent of patients in the observation group, and 41 percent of patients in the bracing group who wore the brace infrequently, also had positive outcomes.
“This study presents important evidence addressing the fundamental question facing families and clinicians dealing with the diagnosis of AIS – to brace or not to brace,” said Weinstein. “Now we can say with confidence that bracing prevents the need for surgery.”
For more information on scoliosis in children and adolescents, visit http://www.niams.nih.gov/health_info/scoliosis.
The study was supported by the NIAMS/NIH under Award Numbers R21AR049587 and R01AR052113. Additional support was provided by the Shriners Hospitals for Children, the Canadian Institutes of Health Research, the University of Rochester, the Children’s Mercy Hospital and Clinics, and the Children’s Miracle Network.
The http://www.clinicaltrials.gov identifier for the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) is NCT00448448.
The mission of the NIAMS, a part of the U.S. Department of Health and Human Services' National Institutes of Health, is to support research into the causes, treatment and prevention of arthritis and musculoskeletal and skin diseases; the training of basic and clinical scientists to carry out this research; and the dissemination of information on research progress in these diseases. For more information about the NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS website at http://www.niams.nih.gov.
NIH...Turning Discovery Into Health®
Trish Reynolds | EurekAlert!
Diagnoses: When Are Several Opinions Better Than One?
19.07.2016 | Max-Planck-Institut für Bildungsforschung
High in calories and low in nutrients when adolescents share pictures of food online
07.04.2016 | University of Gothenburg
Researchers from the Institute for Quantum Computing (IQC) at the University of Waterloo led the development of a new extensible wiring technique capable of controlling superconducting quantum bits, representing a significant step towards to the realization of a scalable quantum computer.
"The quantum socket is a wiring method that uses three-dimensional wires based on spring-loaded pins to address individual qubits," said Jeremy Béjanin, a PhD...
In a paper in Scientific Reports, a research team at Worcester Polytechnic Institute describes a novel light-activated phenomenon that could become the basis for applications as diverse as microscopic robotic grippers and more efficient solar cells.
A research team at Worcester Polytechnic Institute (WPI) has developed a revolutionary, light-activated semiconductor nanocomposite material that can be used...
By forcefully embedding two silicon atoms in a diamond matrix, Sandia researchers have demonstrated for the first time on a single chip all the components needed to create a quantum bridge to link quantum computers together.
"People have already built small quantum computers," says Sandia researcher Ryan Camacho. "Maybe the first useful one won't be a single giant quantum computer...
COMPAMED has become the leading international marketplace for suppliers of medical manufacturing. The trade fair, which takes place every November and is co-located to MEDICA in Dusseldorf, has been steadily growing over the past years and shows that medical technology remains a rapidly growing market.
In 2016, the joint pavilion by the IVAM Microtechnology Network, the Product Market “High-tech for Medical Devices”, will be located in Hall 8a again and will...
'Ferroelectric' materials can switch between different states of electrical polarization in response to an external electric field. This flexibility means they show promise for many applications, for example in electronic devices and computer memory. Current ferroelectric materials are highly valued for their thermal and chemical stability and rapid electro-mechanical responses, but creating a material that is scalable down to the tiny sizes needed for technologies like silicon-based semiconductors (Si-based CMOS) has proven challenging.
Now, Hiroshi Funakubo and co-workers at the Tokyo Institute of Technology, in collaboration with researchers across Japan, have conducted experiments to...
14.10.2016 | Event News
14.10.2016 | Event News
12.10.2016 | Event News
24.10.2016 | Power and Electrical Engineering
24.10.2016 | Life Sciences
24.10.2016 | Life Sciences