Long-term follow-up of adolescent idiopathic scoliosis in women treated with the Wilmington brace

Long-term follow-up of adolescent idiopathic scoliosis in women treated with the Wilmington brace
September 2002
Peter Gabos, MD1, John Bojescul, MD2, Lillian Rich, MS3, Richard Bowen, MD1
The Spine Journal
Elsevier Inc.

Abstract
Purpose of study: Adolescent idiopathic scoliosis is the most common spinal deformity in children and is often treated with bracing. The goals of this study are to determine whether an underarm spinal orthosis (Wilmington, DE) worn during adolescence can halt the progression of idiopathic scoliosis into adulthood and to assess the long-term functional and cosmetic outcome of patients treated with a brace for adolescent idiopathic scoliosis.

Methods used: We retrospectively reviewed the results of 55 skeletally immature women treated successfully for adolescent idiopathic scoliosis with the Wilmington brace. The average age at follow-up was 31 years (range, 26 to 37 years) at an average follow-up of 15 years (range, 10 to 19 years) after discontinuation of the brace. Each patient was evaluated with a physical examination and full-length spinal radiographs. Each patient filled out a comprehensive questionnaire assessing their ability to perform 26 activities of daily living, their over-all physical appearance, their cosmetic appearance, self-image and the severity of any back pain. The questionnaire was also administered and compared with a control group of women without scoliosis matched for age, number of children and type of occupation.

of findings: Curve progression measuring greater than 5 degrees (range, 6 to 18 degrees) occurred in 22% of the patients after skeletal maturity and discontinuation of the brace. None of these patients have required surgical intervention. Progression did not correlate with age, occupation, duration of brace treatment or curve pattern. However, curves measuring 30 or more degrees at the end of brace treatment did have a significantly greater increase in curvature. There was no significant difference between the braced group and the control group in terms of back pain, functional activities, self-care activities or physical activities. The treated patients reported a significantly greater difficulty with positional activities. Ninety-three percent of the treated patients rated their physical and cosmetic appearance and their self-image unchanged or improved since discontinuation of the brace.

Relationship between findings and existing knowledge: Curve magnitude is maintained into adulthood in the majority of patients treated with the Wilmington brace for adolescent idiopathic scoliosis. Curves measuring greater than 30 degrees at the end of brace treatment had a higher likelihood of progression after the brace was discontinued. Back pain and difficulties with function, self-care or physical activities were similar between patients and controls, although braced patients reported significantly greater difficulties with positional activities. The majority of patients reported no deterioration of physical or cosmetic appearance or self-image since discontinuation of the brace.

Overall significance of findings: We performed a retrospective study of the results of the Wilmington brace at 15 years of follow-up for adolescent idiopathic scoliosis. Our study showed that curve magnitude is maintained into adulthood in the majority of patients treated and there was no increased incidence in back pain compared with a control group.

Disclosures: No disclosures.

Conflict of interest: No conflicts.

© 2002 Published by Elsevier Inc.

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