Gabrielle Rogie

Introduction. Adolescent idiopathic scoliosis (AIS) is defined as an abnormal lateral curvature of the spine, greater than 10* Cobb angle, without any underlying cause. Scoliosis presents as an abnormal shape of the back and waistline, uneven shoulders, and rib protrusion when instructed to bend forward. Further diagnosis is confirmed with X-ray⁸. There are many theories that exist but no definitive answer thus far on the pathogenesis of AIS. Biomechanical studies have evaluated possible causes involving uneven growth of the vertebrae, overgrowth of one side of the spinal column, and intervertebral disc growth. Decreased leptin, increased calmodulin, decreased melatonin, decreased estrogen, and increased growth hormone were observed in patients with AIS⁴. Methods. Two types of braces are used for treating AIS- TLSOs are used for thoracic scoliosis with an apex at or below T-8 while CTLSOs are used for thoracic scoliosis with an apex above T-8 ³.  The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) and Italian Scientific Spine Institute (ISICO) protocols were compared with bracing failure defined as Cobb ≥40 before Risser 4. Sex, age, BMI, Risser, Cobb angle, and curve type were evaluated in order to further understand what may effect the success rate of TLSOs.  Results. BrAIST had 39% treatment failure while ISICO had 12%. The largest difference between the studies was found to be average daily hours of wear with an odds ratio of 0.86-hrs in ISICO versus 76 hrs in BrAIST ¹. Patients that were more adherent to brace wear were more likely to report an impact on quality of life⁶. Another study of 43 AIS patients, with a mean of 1.7 yrs in brace, were administered a quality of life survey; 72% reported psychological effects, 56% reported basic motor activity impairment, 54% reported difficulty with socialization, 46% considered decreased quality of life due to pain, and 40% reported issues with peers at school ⁵. Conclusion. Bracing is successful but limited in effectiveness due to decreased compliance due to impact on patient quality of life. Current and newer braces in clinical trials are aiming to increase quality of life in order to increase compliance and therefore brace success rates. These braces include the Green Sun Medical Dynamic Brace, a flexible brace in clinical trial² and the Chêneau- an asymmetric, high-correction method ⁷. Further studies need to be conducted in order to best improve AIS brace compliance.

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