Bracing for Scoliosis Found Less Effective for Overweight Teens

A recent study at Johns Hopkins Children's Center has shown that bracing treatment for scoliosis is significantly less effective for teenagers who are overweight. At present, wearing a back brace is the only non-operative treatment for adolescent idiopathic scoliosis that is currently advocated by the spine medical community.

In the study, which included 276 adolescents with adolescent idiopathic scoliosis, the teenagers who were overweight were 2.5 times more likely than those of normal-weight teens to have scoliosis curvatures that progressed despite wearing a brace. Of the 34 overweight teens in the study, 44 percent eventually needed surgery to correct the curve.

This is an important finding, as the spine fusion surgery required to correct a scoliosis curve is an extensive surgery. The findings from this study support existing literature, which suggests that extra weight (extra soft tissue between the brace and the spine) may compromise the brace's ability to exert the biomechanical forces on the spine necessary to prevent curve progression.

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This study included adolescents ranging in age from 10 to 17 years, who were treated for scoliosis at the Johns Hopkins Children's Center and the Texas Scottish Rite Hospital for Children between 1991 and 2001. Thirty-four children participating in the study were considered to be clinically overweight.

The patients in the study were all prescribed the Thoraco-lumbo-sacral-orthosis (TLSO) brace, which is custom-molded to fit under the child's arm and around the rib cage, lower back and hips. On average the patients wore the brace for about 14 hours per day.

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The goal of using a back brace for idiopathic scoliosis is primarily to stop the spinal curve from progressing. In general, treatment with a back brace is recommended for patients with a curve that measures 25 to 40 degrees and who are still skeletally immature (i.e. still have a lot of growth left).

Overall, almost half of all teens in the scoliosis study had a successful outcome following brace treatment (no more than a five-degree increase in the primary curve). For the overweight patients, however, only 29 percent were treated successfully, and 44 percent required surgery to correct the curve.

References:

  1. Paper #5 at the Scoliosis Research Society 38th Annual meeting, September 2003 and Johns Hopkins Children's Center.
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Written by John Dormans, MD and Leslie Moroz