Early weaning in idiopathic scoliosis

Harald Steen, Johan Emil Lange, Jens Ivar Brox

Many years of bracing represent a burden to the patients. Early weaning may be the result of poor compliance, but may also be planned in patients with a long expected treatment time and a reduced stable primary curve during bracing. The aim of the present cohort study was to compare curve size, health related quality of life and surgical rates at long-term follow-up after ordinary bracing, planned and unplanned early weaning. Three hundred eighty-one patients (353 girls/28 boys) with late-onset juvenile (n = 30) and adolescent (n = 351) idiopathic scoliosis and a mean primary major curve of 33.1 (range 20-57)° were treated with Boston brace and followed prospectively. Ordinary brace treatment was completed in 290 (76 %) patients, planned early weaning at bone age <14 years in 59 (16 %), and unplanned early weaning in 32 (8 %), while 14 (5 %), 1 (2 %), and 12 (38 %) had surgery, respectively. Forty-eight (81 %) of the patients had a primary curve ≤ 25° at planned early weaning. Six-teen (27 %) of those who had planned early weaning, resumed bracing after a mean time of 2.0 years. The mean curve size at long-term follow-up in average 23.4 years after weaning, was smaller (p < 0.001) in patients with planned early weaning (25.1°) compared with ordinary bracing (34.0°) and unplanned early weaning (34.8°). Patient satisfaction and self-image at long-term was better in the planned early weaning group (p < 0.05), but differences were small. The benefit of planned early weaning was the shortened bracing time and good clinical results. This procedure may be attempted if curve reduction is stable over time and the primary curve is 25° or less in patients with several years of expected bracing. The patients should be monitored carefully and regularly at 4-6 months intervals until maturity, and a new brace should be prepared if the curve increases significantly.