Night-time detorsion brace can help avoid surgery in almost half of juvenile idiopathic scoliosis patients followed until skeletal maturity.

Abstract

Many surgeons have regained interest in conservative options for the treatment of idiopathic early onset scoliosis due to the significant complication rates and risks of unplanned returns to the operating room. Most treating physicians usually opt for serial casting or full-time bracing. However, there is very scarce data regarding night-time bracing in idiopathic early onset scoliosis patients (I-EOS). The aim was to evaluate the efficacy of the detorsion night-time bracing (DNB) in a cohort of juvenile I-EOS patients followed until skeletal maturity. This is a retrospective study of all consecutive patients diagnosed with juvenile I-EOS treated until skeletal maturity by DNB between January 2008 and January 2023. All patients underwent low-dose, biplanar, standing full-spine radiographs and pulmonary function tests (PFTs), and filled the EOSQ-24 at final follow-up. Patients were divided into 3 groups according to the success of the treatment: group 1: success, group 2: progression, group 3: surgery. 80 patients were included, and surgery was avoided in 49% of the cases. Compliance was high, and patients were able to maintain their sagittal alignment during growth, as mean T4T12TK remained stable in group 3 (14.5° ±9) or increased in groups 1 and 2 (24° ±11 and 19° ±10, respectively) at mean follow-up. A correlation was found between the initial hypokyphosis and the Cobb at follow-up (r=-0.39, p < 0.001). Exclusive night-time bracing is a reasonable well-accepted alternative for the conservative management of juvenile I-EOS This treatment does not flatten the spine and allows trunk growth and lung development.