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By Dr. Josh Woggon, DC

There are no definitive answers to the question in scoliosis treatment of "how many children are given scoliosis braces each year?  (most likely due to the wide variance in the types of scoliosis brace treatment used, and the lack of a formalized data collection practice amongst the various scoliosis brace companies).
 
However, The Burden of Musculoskeletal Disorders provides information that may help to come up with a reasonable estimate.  As stated in Chapter 3:
 
“In 2004, an estimated 1.26 million patients utilized health care resources for care of problems associated with a spinal deformity.  The majority (74%) of these care episodes were with a physician, and involved non-surgical and pre-surgical management of this complex patient population.”  It is also stated that: “The overall prevalence of spinal deformity in the total populations is projected to be much higher than current data implies.”
 
Approximately 134,500 persons were hospitalized with a diagnosis of spinal deformity; nearly all (93%) of these were diagnosed with scoliosis (so 125,085 people were hospitalized for scoliosis in 2004).  One in three persons hospitalized with a diagnosis of scoliosis underwent scoliosis surgery; this means 41,695 scoliosis surgeries were performed for scoliosis in 2004.
 
In total, 511,155 diagnoses of scoliosis were made in 2004; 153,578 males, and 367,577 females.  This represents 55% of the total number of spinal deformity diagnoses (Scheuermann’s kyphosis, etc).”
 
So, if 74% of 1.26 million visits made for spinal deformities were with a physician, and if 93% of patients with spinal deformities have scoliosis, that means roughly 867,132 visits to physicians were made by people with scoliosis.  If the total number of diagnoses were 511,155, it is reasonable to assume that 355,957 visits were repeat visits made by people diagnosed previously.
 
60% of 511,155 diagnoses were patients under 18; this equals 306,693.  Only children under 18 are eligible for scoliosis back bracing.  Because bracing requires repeat visits, if we take 60% of 355,957, we get the maximum number of cases that could have been scoliosis brace treated in 2004: 213,574.
 
So if 306,693 children were eligible for scoliosis back bracing in 2004, how many decided to undergo back bracing?  This is where it gets tricky.
 
As I stated earlier, the maximum number of cases of scoliosis patients under 18 that could have been braced was 213,574; this would mean 69.6%, or roughly two out of three cases, chose to undergo scoliosis bracing.  This seems unreasonable; I seriously doubt two out of three people would choose to undergo scoliosis brace treatment.
 
Returning to the earlier data about scoliosis surgery, if only one in three patients who were hospitalized underwent surgery for scoliosis, perhaps the other two were admitted to the hospital for back bracing procedures?  It’s unclear from the data if this is the case, but it’s a reasonable place to start.  So of the 125,085 people hospitalized for scoliosis, if 2/3rds were braced, that would mean roughly 83,390 cases of scoliosis were treated with a scoliosis brace in 2004.
 
306,693 children were eligible for back bracing; if 83,390 were braced, that would mean 27.2%, or roughly one-in-four, decided to undergo bracing.  This sounds reasonable to me.
 
However, it’s important to note that this data is only looking at hospital visits; scoliosis braces applied by private practices would not be included.  So 83,000 seems like a low estimate, but again, a reasonable one.

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Does bracing for scoliosis work?  In a word, No.  Here is yet another study that demostrates that bracing does not change the natural course of scoliosis.  This article even compared the bracing outcomes vs what the genetic testing (scoliscore) predicts.  The outcomes are exactly the same, which means back bracing for scoliosis had no effect.

Here is the article.

J Ogilvie , L Nelson, R Chettier and K Ward

Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA

author email corresponding author email

from 6th International Conference on Conservative Management of Spinal Deformities
Lyon, France. 21-23 May 2009

Scoliosis 2009, 4(Suppl 2):O59doi:10.1186/1748-7161-4-S2-O59

The electronic version of this abstract is the complete one and can be found online at: http://www.scoliosisjournal.com/content/4/S2/O59

Published: 14 December 2009

© 2009 Ogilvie et al; licensee BioMed Central Ltd.

Background

Orthotic treatment of children with AIS is a generally accepted treatment option. Failure of bracing to halt curve progression has been reported in 20% or more of patients, and it is known that some curves in children with AIS will not progress even if untreated. Success and failure rates of brace treatment vary considerably.

Purpose

We reviewed the response to brace treatment in patients who were also analyzed with a DNA-based adolescent idiopathic scoliosis progression test (AIS-PT) and compared this with the natural history of adolescent idiopathic scoliosis without treatment. Our purpose was to document the influence of orthotic care on the outcome at skeletal maturity.

Methods

Medical records and x-rays were reviewed, and DNA was collected with a saliva sample in two cohorts of Caucasian female AIS patients. A risk of progression score was calculated using 53 genetic markers with utility for calculating the risk of AIS curve progression from < 25° to > 40° before skeletal maturity or > 50° at maturity (1-200). Group A (2442 females) had no brace treatment and their outcome at maturity or surgery was known. Group B (308 females) were brace compliant for more than one year and their curve severity at maturity or surgery was known.

Results

There was little statistical difference in the curves representing risk of progression versus curve severity when the two groups were compared.

Conclusion

In this retrospective study of US Caucasian females, there was no statistically significant difference in the natural history of adolescent idiopathic scoliosis when comparing bracing treatment and no bracing treatment. At best, there was only a modest brace effect. Prospective trials with genotype homogeneity are needed to validate current assumptions about the efficacy of orthotic types and treatment regimens when bracing adolescent idiopathic scoliosis.