Full-time bracing to treat juvenile idiopathic scoliosis (JIS), which requires children to wear a brace for 16 to 20 hours a day, can be physically and emotionally taxing for both patients and families. But new research led by Benjamin D. Roye, M.D., MPH, pediatric orthopedic surgeon at NewYork-Presbyterian and Columbia, found that introducing part-time bracing earlier in the disease course reduced the need for full-time bracing later on.
“Bracing is a challenging treatment,” says Dr. Roye, who was the senior author of the study published in Spine Deformity. “Most kids don’t want to wear it. It’s uncomfortable, and it can pose a major challenge to sticking with the prescribed treatment plan.”
The retrospective study included 83 pediatric patients aged 4 to 10 years old who were treated at NewYork-Presbyterian Morgan Stanley Children’s Hospital of Children’s Hospital of New York for skeletally immature JIS with curves of 15 degrees to 24 degrees. Of these patients, 59% were managed with observation alone, and 41% underwent bracing for 8 to 12 hours per day.
After two years of follow-up, patients treated with part-time bracing experienced an average 3.2-degree improvement in curve magnitude, compared with a 3.4-degree curve progression among observed patients. Nearly 70% of braced patients improved by more than 5 degrees, and only 17% of them ultimately required full-time bracing. Conversely, 63% of patients managed with observation alone required full-time bracing later.
Before and after: Imaging showing a 6-year-old patient's scoliosis curve improvement following two years of part-time bracing.
“The standard teaching has been that bracing can prevent progression but does not improve curves,” says Dr. Roye. “I had seen curve improvement anecdotally, but I was surprised by how frequently it occurred in this group of younger patients with smaller curves.”
Challenging Conventional Bracing Guidelines
The practice of bracing for curves less than 25 degrees has been inconsistent. Current recommendations prescribe bracing for curves of 25 degrees or more, but that advice was made decades ago before other approaches had been studied, Dr. Roye says.
Many orthopedic surgeons have embraced the 25-degree curve threshold because getting children to adopt the brace takes time and effort. Additionally, some small curves never progress, making it difficult to determine which patients would benefit from early intervention. For instance, Dr. Roye says a child with a 15-degree curve and no family history of scoliosis likely warrants observation. But there are also scenarios, such as a patient with a small curve who has a parent who needed scoliosis surgery, where being more aggressive about bracing helped potentially avoid more serious later intervention.
Dr. Roye’s study adds to a growing body of research that appears to support earlier intervention through part-time bracing. “We found that the kids who were treated had much better outcomes, and this has been reproduced in other institutions around the country,” he says.
We found that the kids who were treated with part-time bracing had much better outcomes.
— Dr. Benjamin Roye
Dr. Roye’s study adds to a growing body of research that appears to support earlier intervention through part-time bracing. “We found that the kids who were treated had much better outcomes, and this has been reproduced in other institutions around the country,” he says.
Continuing Efforts to Evaluate Early Bracing Intervention
Dr. Roye is furthering his research through a multicenter, real-world study conducted through the Pediatric Spine Study Group, a global research collaborative dedicated to studying data on pediatric spine disorders. The study has enrolled approximately 150 brace patients prospectively to date, and early results could be published within the next two years.
The study will help determine in a larger cohort whether earlier part-time bracing can prevent curve progression and reduce the need for full-time bracing. If Dr. Roye’s earlier findings are confirmed, the results could help popularize a less burdensome and more effective treatment pathway for appropriately selected patients.
“There has been growing interest in this space because full-time bracing causes so much stress in families. Parents are constantly reminding their kids to wear the brace, and the impact on mental health is real,” Dr. Roye says. “We have powerful single-center evidence. Now we want to show that prospective bracing can be broadly applicable so we can help more patients reproduce the outcomes we have seen.”
