Initial experience with the providence nighttime bracing in adolescent idiopathic scoliosis

Abstract

Background: Since 2008 the primary non-surgical treatment of adolescent idiopathic scoliosis (AIS) in the southern part of Denmark, went from full-time bracing with Boston brace, to Providence nighttime bracing. Aim: To evaluate the effectiveness of nighttime bracing, with the Providence brace, in AIS. Method: Patients diagnosed with AIS. With an apex from TH7 and below and with a cobb angel between 20-45 degrees. The patients were evaluated every 6 months with standing x-rays and the brace treatment was continued until two years post menarche. Cobb angle of the major curve pretreatment, in-brace correction and at last follow-up were determined and cross-measured. Overcorrection in the brace or if the curve at last follow-up was smaller than pre-treatment, these were recorded as zero. Curve progression of more than 5 degrees was considered brace failure and number of surgically treated cases was reported. Results: A total of 62 patients, 10 males and 52 females, mean age of 14 years with a mean Cobb of 31.3degree degrees were included. There were 31 primary thoracic curves, 19 thoracolumbar curves, 11 lumbar curves and 1 double curve. The mean length of brace treatment was 17.8 months (6-59 months). The mean in-brace correction was 81% (24-100%). After the end of bracing, the mean Cobb angle was 29.1degree (7-50), an average of no progression. There were 11 (18%) brace failures, but only 5 (10%) patients had surgery. (Figure Presented) Discussion & Conclusion : This study shows a good curve control with the Providence nighttime brace and an acceptable 18 % failure rate. The nighttime brace is an excellent alternative to standard conservative treatment, and reduces the need for physiotherapy after brace termination. The patients tolerate the nighttime brace treatment well, and compliance within the cohort is high. Larger studies are needed to establish the relationship between in-brace correction and curve progression.