When and how to discontinue bracing treatment in adolescent idiopathic scoliosis: results of a survey.

Q1 Medicine

Scoliosis and Spinal Disorders Pub Date : 2018-10-26 eCollection Date: 2018-01-01 DOI:10.1186/s13013-018-0158-y

Lucas Piantoni, Carlos A Tello, Rodrigo G Remondino, Ida A Francheri Wilson, Eduardo Galaretto, Mariano A Noel

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引用次数: 4

Abstract

Background: Currently, there is little consensus on how or when to discontinue bracing in adolescent idiopathic scoliosis (AIS). An expert spine surgeon national survey could aid in elucidate discontinuation of the brace.Few data have been published on when and how to discontinue bracing treatment in patients with AIS resulting in differences in the management of the condition. The aim of this study was to characterize decision-making of surgeons in the management of bracing discontinuation in AIS.

Methods: An original electronic survey consisting of 12 multiple choice questions was sent to all the members of the National Spine Surgery Society (497 surveyed). Participants were asked about their type of medical practice, years of experience in the field, society memberships, type of brace they usually prescribed, average hours of daily brace wearing they recommended, and how and when they indicated bracing discontinuation as well as the clinical and/or imaging findings this decision was based on. Exclusion criteria include brace discontinued because of having developed a curve that warranted surgical treatment.

Results: Of a total of 497 surgeons, 114 responded the survey (22.9%). 71.9% had more than 5 years of experience in the specialty, and 51% mainly treated pediatric patients. Overall, 95.5% of the surgeons prescribed the thoracolumbosacral orthosis (TLSO), indicated brace wearing for a mean of 20.6 h daily. Regarding bracing discontinuation, indicated gradual brace weaning, a decision 93.9% based on anterior-posterior (AP) and lateral radiographs of the spine and physical examination, considered a Risser ≥ IV and ≥ 24 months post menarche.

Conclusions: The results of this study provide insight in the daily practice of spine surgeons regarding how and when they discontinue bracing in AIS. The decision of bracing discontinuation is based on AP/lateral spinal radiographs and physical examination, Risser ≥ IV, regardless of Tanner stage, and ≥ 24 months post menarche. Gradual weaning is recommended.

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青少年特发性脊柱侧凸何时及如何停止支具治疗:一项调查结果。

背景:目前，对于青少年特发性脊柱侧凸(AIS)如何或何时停止支具治疗，几乎没有共识。一项脊柱外科专家全国调查可以帮助阐明支架的停用。关于AIS患者何时以及如何停止支具治疗的数据很少，这导致了病情管理的差异。本研究的目的是描述外科医生在处理AIS患者支具中断时的决策。方法:向全国脊柱外科学会所有会员(497名)发送一份包含12道选择题的原始电子调查。参与者被问及他们的医疗实践类型，在该领域的多年经验，社会会员资格，他们通常处方的支架类型，他们建议的平均每天佩戴支架的时间，以及他们如何以及何时表示支架停止以及这一决定是基于临床和/或成像结果。排除标准包括支架因发生弯曲需要手术治疗而停用。结果:497名外科医生中，有114名回复调查，占22.9%。71.9%的医生有5年以上的专业经验，51%的医生主要治疗儿科患者。总的来说，95.5%的外科医生开了胸腰骶矫形器(TLSO)，指示支架佩戴平均每天20.6小时。关于支架的停用，93.9%的决定基于脊柱的前后位(AP)和侧位x线片以及体格检查，考虑Risser≥IV和≥24个月的月经初潮。结论:本研究的结果为脊柱外科医生在AIS中如何以及何时停止支具的日常实践提供了见解。支具停用的决定是基于AP/侧位脊柱x线片和体格检查，Risser≥IV，不论Tanner分期，月经初潮后≥24个月。建议逐渐断奶。

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来源期刊

Scoliosis and Spinal Disorders Medicine-Orthopedics and Sports Medicine

CiteScore

5.60

自引率

0.00%

发文量

期刊介绍： Cessation.Scoliosis and Spinal Disorders is an open access, multidisciplinary journal that encompasses all aspects of research on prevention, diagnosis, treatment, outcomes and cost-analyses of conservative and surgical management of all spinal deformities and disorders. Both clinical and basic science reports form the cornerstone of the journal in its endeavour to provide original, primary studies as well as narrative/systematic reviews and meta-analyses to the academic community and beyond. Scoliosis and Spinal Disorders aims to provide an integrated and balanced view of cutting-edge spine research to further enhance effective collaboration among clinical spine specialists and scientists, and to ultimately improve patient outcomes based on an evidence-based spine care approach.