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24 November 2009

Back braces may not be best remedy for scoliosis

1 in 1,000 teens has curved spine
St. Louis Post-Dispatch
Updated: 11/22/2009 01:37:12 AM PST

Scoliosis screenings in middle schools find thousands of teenagers with curved spines each year.

But treatment for scoliosis hasn't changed in five decades — if the spine is curved to a certain degree, the teenager gets a back brace. Research, however, has not conclusively proved the benefits of the braces.

Some young people who don't wear a brace never have problems and their curves never worsen. Others wear the braces for years and still end up needing back surgery.

A long-term study at Washington University and more than 20 other research centers hopes to figure out why.

"If we can say that bracing doesn't change (the progression of a spinal curve), then it's a treatment regimen that we shouldn't offer," said Dr. Matthew Dobbs, a pediatric orthopedic surgeon and lead investigator at Washington University. "Why do school screenings? Why identify a child with a small curve and put them through years of bracing if it's not going to alter natural curve?"

Half of the participants in the study will receive back braces to wear at least 18 hours a day, and the other half won't wear braces. Both groups will receive regular X-rays to check their spinal curves.

Braces aren't thought to correct the curves but to prevent progression.

"But again we have no data to support that, despite all of us doing this for years and years and years," Dobbs said. "We don't know what the best treatment is; we don't know who's going to progress."

Curves that progress to 50 degrees — about 10percent of cases — are generally thought to require spinal fusion surgery.

Dobbs predicts the research will show that certain patients benefit from bracing and others don't, depending on the type of spinal curve.

Adolescent idiopathic scoliosis occurs in about one in 1,000 teenagers, and is 10 times more common in girls. It can cause back pain, and in severe cases can affect heart and lung function.

The cause is unknown, although Dobbs and other researchers are studying the disorder's genetic factors.

Most states conduct scoliosis screenings by checking students' backs, typically in sixth and eighth grades.

Smaller spinal curves are typically monitored by a doctor, but patients whose curves reach between 20 and 40 degrees are usually recommended for back braces.

If it's found that fewer teens need braces, the research could save money on treatments plus spare some teenagers the psychological stress of wearing a brace. That's why patients in the study are also monitored psychologically to see how they're handling the brace.

"If we see a child in the study who dips on their mood and mental health during the study, we need to figure out what's going on," Dobbs said.

Kelli Sargent of Belleview, Mo., has worn a brace for 20 hours every day since January, after doctors measured a 27-degree curve in her spine.

The seventh-grader hasn't let scoliosis keep her from activities including volleyball and basketball, which she plays without the brace.

But starting middle school this fall was sometimes tough when new kids asked her about the brace.

But "if you just act like it's no big deal," then other kids will too, she said.

Kelli does have a difficult time picking up books from the bottom of her locker and tying her shoes, because the brace can dig into her upper thighs when she bends. And now she has to buy jeans and tops a little bit bigger to fit over the brace.

Otherwise, she's gotten used to it and even nicknamed the brace "Shelly" since it feels like she's wearing a shell.

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