First results of the Maastricht brace in the treatment of adolescent idiopathic scoliosis

Abstract

Introduction: The Maastricht brace (M-brace) was developed to improve patient compliance and associated efficacy of brace treatment in adolescent idiopathic scoliosis (AIS). The main features are an anterior closure, elastic thoracic pelotte and comfortable material. The emphasis is on good wearability and comfort for the patient, whilst retaining corrective pressure function. In earlier studies initial pressure measurements in the M-brace revealed a higher corrective pressure as compared to the Boston brace, and a better patient reported quality of life as measured with the SRS 22 and Brace questionnaire. First results of the efficacy in terms of curve correction of the M-brace in AIS were promising, with an average in-brace primary curve correction of 48 %. The aim of this study was to evaluate the end-term radiological results of the first group treated with the Maastricht brace, with a minimum of one year follow up after stop of brace wearing. Methods: A total of 36 patients (mean age of 17 years, 6 boys) with mild to moderate AIS, who had been treated with the M-brace since January 2011, were included in this retrospective single-center study. The correction effectiveness of the brace was evaluated by comparing the primary curve on standard postero-anterior full spine radiographs, with and without M-brace, with the reduction on bending X-rays. The end-term correction of the Maastricht brace was defined as the primary curve measured on standard postero-anterior full spine radiographs taken one year after stop of brace wear. The success of bracing was defined as prevention of progression to surgical magnitudes. Results: There were 28 patients with a primary thoracic curve, and 8 patients with a primary lumbar curve. The predominant Lenke classification was type 1 and 3. The average primary curve Cobb angle was 35.8° ± 9.5°. The average primary curve angle in bending x-rays was 15.5° ± 8.3°. In the M-brace the primary curve was 24.3° ± 8.5°. This is an in-brace correction of 57 %. The average age at stop of bracing was 15.6 years old. The average primary curve Cobb angle one year after of bracing was 33.4 ± 8.2°. There were five patients in whom the curves progressed to surgical magnitudes during brace wear, all patients with a primary thoracic curve. The succes rate of bracing adolescent idiopathic scoliosis with the M-brace is therefore denoted as 86 %. Conclusions: These preliminary end-term results demonstrate an adequate in-brace and post-brace correction with the M-brace. With a probable better compliance because of a higher wearing comfort, the M-brace may be a promising new brace treatment for adolescent idiopathic scoliosis, without compromising treatment efficacy.