A Comparative Analysis of Patients With Adolescent Idiopathic Scoliosis Treated With Rigo Cheneau, Boston-style, and Providence Braces: A Preliminary Report.

Abstract

Numerous brace choices exist for the management of adolescent idiopathic scoliosis (AIS); however, there is sparse literature comparing brace efficacy. Much of current bracing practice likely reflects institutional preferences rather than comparative data. A review of patients age 10 to 18 with AIS of 20 to 45 degrees who were Risser 0 to 2 at initiation of brace treatment treated at a single center was performed. Patients were included if they had completed brace treatment and had either a minimum of 6 month out of brace follow-up or had undergone surgery. Brace success was defined as curve progression ≤5 degrees without the need for surgery. Patients were treated with a Providence nighttime brace (PNB), Boston TLSO (BB), or Rigo-Cheneau (RC) custom brace. Patients treated with 32 PNB, 30 BB, and 37 RC braces met all inclusion criteria. 88% were female, with an average age at brace initiation of 12.0 years. Sixty-two percent of females were premenarchal at the onset of bracing and 66% were Risser 0. Thoracic, thoracolumbar, and lumbar curves averaged 27±7 degrees, 29±6 degrees, and 26±6 degrees at initiation. Thoracic in-brace curve correction was 46±34% compared with thoracolumbar curves (73±36%). Forty-four patients (44%) progressed >5 degrees and 19 patients (19%) progressed to surgery. Twenty-seven percent of patients treated with a BB progressed to surgery compared with 13% of RC and 13% of PNB patients (P=0.2). Among Risser 0 patients, 55% of BB patients progressed to surgery compared with 11% of RC and 10% of PNB patients (P=0.03). Multivariate regression analysis found that skeletally immature (R0) patients treated with a BB had a 5.6-fold higher risk of surgery than RC or PNB patients (P=0.04) and a 2.8-fold higher risk of curve progression (P=0.09); however, this difference was not seen in Risser 1 or 2 patients. Skeletally immature patients (Risser 0) treated with a BB were nearly 6x more likely to require surgery when compared with those treated with a RC or PNB. Patients who were Risser 1 or 2 were successfully treated in any of the 3 braces. Level III-retrospective comparative study.