Scientific article – treatment of scoliosis with the help of a night brace only –always remember to read the small print

As you will see in the chapter about scoliosis on this website (link here), scoliosis is a 3-dimensional structural problem in the vertebral column that occurs mostly in adolescents, usually without any specific cause, at a rate of about 3%.

Of all the adolescents that develop scoliosis, about 10% have a condition severe enough to require treatment. Two main types of treatments/interventions have been offered so far:

# Activities that help with improvement of posture using specific exercises – this has also been something that has been offered for mild to intermediate cases.
# Wearing a brace for most hours of the day (at least 22 hours per day).

However, wearing a brace throughout most of the day is difficult and very challenging for children. Therefore, children who are unable to wear the brace throughout the entire day have been encouraged to wear it only during the nighttime but there aren’t any studies that have assessed the efficacy of this treatment.

So, if someone could compare these two approaches – physical activity for posture repair versus wearing a bracing during the nighttime hours, this could seemingly be very helpful for children and allow them to receive better care and possibly prevent the discomfort of having to wear a brace throughout the entire day.

And this was the purpose of this study.

But please, bear with me till the very end, because the most important points are often found in the small print.

Methods – 6 public hospitals in Sweden, participants ages 9 to 18 years, with intermediate idiopathic scoliosis (no obvious medical cause).

The first group, the study group, was instructed to wear the brace only during the night, for a period of 8 consecutive hours.

The second group was instructed to perform specific physical activity, tailored to improve posture and strengthen muscles.

At the same time, the first two groups were also instructed to undertake regular physical activity for at least one hour a day, as recommended by the World Health Organization (WHO).

The third group received no additional instructions except at least 1 hour of regular physical activity per day.

At the end of the study period, images of the vertebral columns were taken, and the different angles used to assess the degree of scoliosis were measured. The results were compared between the different groups.

Results – following 6 years of study, there were only several tens of participants remaining in the different study groups, at an average age of 12.5 years, most of whom were girls, as expected (scoliosis is more common in adolescent girls than it is in adolescent boys).

What about successful treatment, defined as a cessation (or an insignificant increase) of scoliosis deterioration?

The first group: night brace and regular physical activity for a follow-up period of approximately 2 years – 76% success rate.

The second group: specific physical activity for scoliosis + regular physical activity for a follow-up period of approximately 1.5 years – 58% success rate.

The third group: only physical activity for a follow-up period of approximately 1.5 years – 53% success rate.

What else? In the group who wore the brace during the night, some children complained of skin irritation, but other than that, no significant side effects were reported in any of the children.

Some of the participating children went on to wear their brace throughout the entire day, but not so much in the night-wearing group. Nonetheless, the same number of children underwent surgery for scoliosis repair in all the different groups.

Discussion – this is a very important study in the field, the first to show efficacy in wearing a brace only during the night, in children with intermediate scoliosis, especially when compared to other therapies available such as specific physical activity or general physical activity. At the same time, it also demonstrates that physical activity tailored to improve posture, has no superiority over regular physical activity for children with scoliosis, and therefore it makes no sense to only offer the customized physical activity to children with intermediate scoliosis.

However, the study does not compare the use of a night brace to the use of a brace throughout the day, which is the only practice that has been proven to be effective in intermediate scoliosis.

And that is, in fact, the study’s inherent limitation, that you really cannot escape from, regardless of how appealing the results may seem at first glance.

So, what if wearing a brace during the night only helps more than one type of physical activity or another, but has not been proven to work better than wearing a brace for 22-hours per day?

In addition, the fact that at the end of the study period, the same number of children had to undergo surgery in all the different groups, could possibly imply that if these children wore their brace throughout the entire day (which is the standard of care nowadays) they may have been better off.

There is a pivotal study that was published in an even better journal, NEJM, in 2013, where a linear association was found between the number of hours the adolescent wore their brace to the cessation of scoliosis deterioration. You can see the study in the following link.

And so, as we say in medicine, the standard of care, should be to continue wearing the brace for at least 22 hours per day, as customary in all the leading centers in the world. And the conclusions of the study, in my opinion, only strengthen this standard.

What else can we offer a child with scoliosis? Find out everything you need to know in the link here.

Good luck!