Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010–2020 in a National Spinal Centre
Abstract
:1. Introduction
2. Material and Methods
Statistical Analysis
3. Results
3.1. Patients with IS
3.1.1. Patients with IS at the End of Bracing/No Need for Scoliosis Surgery (98 Patients; 85 AIS, 9 JIS, 4 IIS)
3.1.2. Patients with IS at the End of Bracing Who Underwent Scoliosis Surgery (84 Patients; 48 AIS, 36 JIS)
3.2. Patients with Non-IS
3.2.1. Patients with Non-IS at the End of Bracing/No Need for Scoliosis Surgery (20 Patients; 5 with Congenital Scoliosis, 5 with NM Scoliosis, 6 with Syndromic Scoliosis, 4 with Secondary Scoliosis)
3.2.2. Patients with Non-IS at the End of Bracing Who Underwent Scoliosis Surgery (47 Patients; 9 with Congenital Scoliosis, 3 with NM Scoliosis, 21 with Syndromic Scoliosis, 14 with Secondary Scoliosis)
3.3. Multivariate Logistic Regression Analysis
3.4. Patient Reported Outcomes (End of Bracing and after Scoliosis Surgery)
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Diagnosis | Neuromuscular (10 Patients) | Syndromic (24 Patients) | Secondary (19 Patients) |
---|---|---|---|
Hemiplegic cerebral palsy | 5 | - | - |
Charcot–Marie–Tooth disease | 3 | - | - |
Congenital hypotonia | 2 | - | - |
Scoliosis with Chiari I malformation and syringomyelia | - | - | 7 |
Scoliosis with syringomyelia | - | - | 5 |
Scoliosis with congenital cardiac disease | - | - | 5 |
Scoliosis with intraspinal tumour | - | - | 2 |
Chromosome abnormality | - | 10 | - |
Marfan syndrome | - | 4 | - |
Neurofibromatosis type-1 | - | 2 | - |
Pierre Robin syndrome | - | 2 | - |
Prader–Willi syndrome | - | 2 | - |
Ehlers–Danlos syndrome | - | 1 | - |
Hurler syndrome | - | 1 | - |
Cleidocranial dysostosis | - | 1 | - |
Carey–Fineman–Ziter syndrome | - | 1 | - |
Data | AIS (85 Patients) | JIS (9 Patients) | IIS (4 Patients) |
---|---|---|---|
Type of scoliosis | TH: 10; TH and L: 41; double TH: 4; TL/L: 21 | TH: 2; TH and L: 6; double TH: 1 | TH: 1; TL/L:3 |
TH scoliosis pre-brace | 28° (range: 16–43°) | 32° (range: 13–56°) | 56° |
TH scoliosis in 1st brace | 19° (range: 0–38°) | 16° (range: 0–24°) | 24° |
TH scoliosis at last follow-up | 26° (range: 0–42°) | 20° (range: 0–40°) | 17° |
Mean TH scoliosis improvement | 7° | 5° | 41° |
TL/L scoliosis pre-brace | 28° (range: 13–44°) | 21° (range: 20–35°) | 43° (range: 36–50°) |
TL/L scoliosis in 1st brace | 17° (range: 0–34°) | 11° (range: 0–22°) | 26° (range: 19–36°) |
TL/L scoliosis at last follow-up | 21° (range: 0–40°) | 16° (range: 0–20°) | 2° (range: 0–5°) |
Mean TL/L scoliosis improvement | 7° | 5° | 41° |
Triradiate cartilage | Open: 28 Closed: 48 | Open: 9 | Open: 4 |
Risser grade (start of bracing) | 0.4 (range: 0–2) | 0 | 0 |
Risser grade (end of bracing) | 4.8 (range: 0–5) | 4.7 (range: 3–5) | 0 (range: 0–1) |
Age (start of bracing); years | 12.9 (range: 10.1–15.9) | 7.2 (range: 3.3–10) | 2.3 (range: 1.9–2.4) |
Age (end of bracing); years | 16.1 (range: 12.8–18.4) | 15.5 (range: 13.6–18.1) | 8.8 (range: 6.4–12.2) |
Years in brace treatment | 3.2 (range: 0.5–9.1) | 8.4 (range: 4.1–14.4) | 6.4 (range: 3.8–9.6) |
Follow-up (after bracing); years | 2.2 (range: 2–2.5) | 2.1 (range: 2–2.3) | 2 (range: 2–2.1) |
Data | AIS (48 Patients) | JIS (36 Patients) |
---|---|---|
Type of scoliosis | TH: 9; TH and L: 31; double TH: 3; TL/L: 5 | TH: 10; TH and L: 21; double TH: 4 |
TH scoliosis pre-brace | 35.4° (range: 15–64°) | 41° (range: 22–70°) |
TH scoliosis in 1st brace | 27.7° (range: 8–51°) | 27.7° (range: 10–70°) |
TH scoliosis at end of bracing | 48.9° (range: 17–84°) | 59.8° (range: 11–97°) |
TH scoliosis preoperatively | 50.4° (range: 17–84°) | 64.3° (range: 46–97°) |
TH scoliosis at last follow-up | 18.1° (range: 4–41°) | 24.9° (range: 4–50°) |
Mean TH scoliosis improvement | 17.3° | 16° |
TL/L scoliosis pre-brace | 32.4° (range: 18–51°) | 33.6° (range: 17–54°) |
TL/L scoliosis in 1st brace | 24.4° (range: 14–51°) | 24.4° (range: 9–46°) |
TL/L scoliosis at end of bracing | 45.1° (range: 22–66°) | 47.8° (range: 12–69°) |
TL/L scoliosis preoperatively | 48.8° (range: 28–66°) | 54.4° (range: 31–69°) |
TL/L scoliosis at last follow-up | 17.6° (range: 2–45°) | 19.1° (range: 4–29°) |
Mean TL/L scoliosis improvement | 14.8° | 14° |
Triradiate cartilage | Open: 32 Closed: 16 | Open: 36 |
Risser grade (start of bracing) | 0.1 (range: 0–2) | 0 |
Risser grade (end of bracing) | 4 (range: 4–5) | 3.5 (range: 0–5) |
Age (start of bracing); years | 12.5 (range: 10.2–15.8) | 7.8 (range: 3.1–10) |
Age (end of bracing); years | 14.6 (range: 11.2–17.7) | 12.5 (range: 9.8–16.8) |
Age at scoliosis surgery; years | 14.9 (range: 11.6–18.4) | 12.8 (range: 10.2–16.8) |
Years in brace treatment | 2.4 (range: 0.6–5.1) | 5 (range: 1.6–9.4) |
Follow-up (post-surgery); years | 2.8 (range: 2–3.5) | 3.5 (range: 2.6–4.8) |
Data | AIS without Surgery (71 Patients) | AIS with Surgery (26 Patients) |
---|---|---|
Type of scoliosis | TH: 9; TH and L: 37; double TH: 4; TL/L: 21 | TH: 3; TH and L: 15; double TH: 3; TL/L:5 |
TH scoliosis pre-brace | 26.3° (range: 16–40°) | 29.1° (range: 15–39°) |
TH scoliosis in 1st brace | 18.2° (range: 0–38°) | 22.8° (range: 8–36°) |
TH scoliosis at end of bracing | 25.4° (range: 0–45°) | 44° (range: 17–65°) |
TH scoliosis preoperatively | - | 47° (range: 17–65°) |
TH scoliosis at last follow-up | - | 18.4° (range: 4–38°) |
Mean TH scoliosis improvement | 0.9° | 10.7° |
TL/L scoliosis pre-brace | 25.1° (range: 13–40°) | 30.8° (range:18–40°) |
TL/L scoliosis in 1st brace | 16.3° (range: 0–34°) | 22.8° (range: 14–32°) |
TL/L scoliosis at end of bracing | 21° (range: 0–38°) | 40° (range: 22–66°) |
TL/L scoliosis preoperatively | - | 44.3° (range: 28–66°) |
TL/L scoliosis at last follow-up | - | 17.2° (range: 2–45°) |
Mean TL/L scoliosis improvement | 4.1° | 13.6° |
Triradiate cartilage | Open: 27 Closed: 44 | Open: 15 Closed: 11 |
Risser grade (start of bracing) | 0.4 (range: 0–2) | 0.19 (range: 0–2) |
Risser grade (end of bracing) | 4.7 (range: 4–5) | 4.2 (range: 1–5) |
Age (start of bracing); years | 12.9 (range: 9.9–15.9) | 12.6 (range: 10.3–15.8) |
Age (end of bracing); years | 16 (range: 14.8–18.4) | 15 (range:11.9–17.6) |
Age at scoliosis surgery; years | - | 15.4 (range: 12.6–17.8) |
Years in brace treatment | 3.2 (range: 0.5–9.1) | 2.1 (range: 0.2–4.2) |
Follow-up (after bracing); years | 4 (range: 0.9–8.7) | - |
Follow-up (post-surgery); years | - | 5 (range: 1.8–8.9) |
Data | Congenital Scoliosis (9 Patients) | NM Scoliosis (3 Patients) | Syndromic Scoliosis (21 Patients) | Secondary Scoliosis (14 Patients) |
---|---|---|---|---|
Type of scoliosis | TH: 2; TH and L: 7 | TH and L: 2; TL/L: 1 | TH: 8; TH and L: 9; double TH: 1; TL/L: 3 | TH: 6; TH and L: 7; TL/L: 1 |
TH scoliosis pre-brace | 40.4° (range: 25–59°) | 32° (range: 27–37°) | 35.8° (range: 20–65°) | 47.2° (range: 21–78°) |
TH scoliosis in 1st brace | 32.3° (range: 15–46°) | 26.5° (range: 24–29°) | 28.2° (range: 15–54°) | 33.9° (range: 14–51°) |
TH scoliosis at end of bracing | 50.1° (range: 10–72°) | 53° (range: 46–60°) | 72° (range: 43–98°) | 74° (range: 34–117°) |
TH scoliosis preoperatively | 56.1° (range: 10–72°) | 56° (range: 52–60°) | 76.5° (range: 50–98°) | 74° (range: 34–117°) |
TH scoliosis at last follow-up | 32.6° (range: 11–43°) | 29.5° (range: 28–31°) | 31.8° (range: 17–45°) | 31.7° (range: 17–63°) |
Mean TH scoliosis improvement | 7.8° | 2.5° | 4° | 15.5° |
TL/L scoliosis pre-brace | 32.1° (range: 22–48°) | 35.5° (range: 31–40°) | 33.5° (range: 14–58°) | 41.8° (range: 24–51°) |
TL/L scoliosis in 1st brace | 24.2° (range: 16–33°) | 21° (range: 17–23°) | 20.8° (range: 10–35°) | 25.5° (range: 18–35°) |
TL/L scoliosis at end of bracing | 45.5° (range: 13–85°) | 57.8° (range: 36–67°) | 57.7° (range: 39–81°) | 38.4° (range: 27–70°) |
TL/L scoliosis preoperatively | 48.3° (range: 13–85°) | 60.3° (range: 46–67°) | 60° (range: 43–81°) | 48.4° (range: 38–70°) |
TL/L scoliosis at last follow-up | 22.7° (range: 8–50°) | 26.3° (range: 18–32°) | 22.9° (range: 8–30°) | 17.5° (range: 12–31°) |
Mean TL/L scoliosis improvement | 9.4° | 9.2° | 10.6° | 24.3° |
Triradiate cartilage | Open: 9 | Open: 3 | Open: 21 | Open: 13; Closed: 1 |
Risser grade (start of bracing) | 0.5 (range: 0–1) | 0 | 0 | 0 |
Risser grade (end of bracing) | 4.5 (range: 4–5) | 4.5 (range: 4–5) | 2.3 (range: 0–5) | 3.6 (range: 0–5) |
Age (start of bracing); years | 5.3 (range: 1.6–11.7) | 7.2 (range: 6.2–8) | 6.8 (range: 2.2–14.2) | 8.8 (range: 1.7–3.6) |
Age (end of bracing); years | 12.9 (range: 10.2–15.8) | 13.7 (range: 12.7–15.1) | 12.4 (range: 9.6–16.7) | 12.6 (range: 9.9–15.9) |
Age at scoliosis surgery; years | 13.3 (range: 10.6–16.1) | 13.9 (range: 12.7–15.6) | 12.7 (range: 10.4–16.7) | 12.6 (range: 10.3–5.9) |
Years in brace treatment | 5.2 (range: 2.1–8.8) | 6.7 (range: 5.3–7.7) | 5.8 (range: 2.4–11.8) | 4 (range: 1.2–7.3) |
Follow-up (post-surgery); years | 4.5 (2.5–5) | 4.5 (2–4.8) | 4.1 (2.4–4.5) | 4.2 (2.6–5) |
Characteristics | Odds Ratio | 95% Confidence Interval | p-Value |
---|---|---|---|
Scoliosis angle | 1.684 | 1.153–2.657 | 0.03 * |
Triradiate cartilage | 1.719 | 1.165–3.475 | 0.02 * |
Risser grade | 1.518 | 0.872–2.914 | 0.04 * |
Menarche | 1.894 | 1.243–3.576 | 0.03 * |
Idiopathic diagnosis | 3.982 | 2.771–4.956 | 0.008 * |
AIS | 2.365 | 1.917–3.867 | 0.01 * |
Mean Score | Range | Yes | No | |
---|---|---|---|---|
| - | 109 | 0 | |
| 9 | 100 | ||
| 4.8 | 3–5 | - | - |
| 4.9 | 3–5 | - | - |
| 4.9 | 4–5 | - | - |
| 4.8 | 3–5 | - | - |
| 4.6 | 3–5 | - | - |
| 3.1 | 0–5 | - | - |
| 2.0 | 0–5 | - | - |
| 4.6 | 1–5 | - | - |
| 4.5 | 3–5 | - | - |
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Tsirikos, A.I.; Adam, R.; Sutters, K.; Fernandes, M.; García-Martínez, S. Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010–2020 in a National Spinal Centre. Healthcare 2023, 11, 1491. https://doi.org/10.3390/healthcare11101491
Tsirikos AI, Adam R, Sutters K, Fernandes M, García-Martínez S. Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010–2020 in a National Spinal Centre. Healthcare. 2023; 11(10):1491. https://doi.org/10.3390/healthcare11101491
Chicago/Turabian StyleTsirikos, Athanasios I., Rachel Adam, Kirsty Sutters, Maureen Fernandes, and Silvia García-Martínez. 2023. "Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010–2020 in a National Spinal Centre" Healthcare 11, no. 10: 1491. https://doi.org/10.3390/healthcare11101491
APA StyleTsirikos, A. I., Adam, R., Sutters, K., Fernandes, M., & García-Martínez, S. (2023). Effectiveness of the Boston Brace in the Treatment of Paediatric Scoliosis: A Longitudinal Study from 2010–2020 in a National Spinal Centre. Healthcare, 11(10), 1491. https://doi.org/10.3390/healthcare11101491