CORR Insights®: Does Curve Regression Occur During Underarm Bracing in Patients with Adolescent Idiopathic Scoliosis?

Abstract

Underarm bracing can prevent 25° to 40° curves in patients with adolescent idiopathic scoliosis (AIS) from progressing to the point where surgery may be indicated [2, 7]. While the main goal of bracing for AIS is to prevent the need for surgery, the study by Cheung and colleagues [1] provides the best evidence so far that curve regression can sometimes occur. The authors found that some scoliosis curves may be partially reversed with bracing, and that, in some patients, reversal of vertebral wedging may occur at the apical vertebrae of major curves, which implies that the vertebrae were sufficiently relieved of axial load to allow recovery of their native growth potential. This is an important and rather exciting finding because it definitively demonstrates that bracing may potentially reverse one of the primary elements of the spine deformity which constitutes scoliosis [6]. In the current study, patients wore a brace for mean 3.8 years and SRS 22r scores were better for those who experienced correction. Notably, the authors’ practice setting is a dedicated scoliosis clinic including an orthotist who fits their patients with customized braces, a physical therapist who assists with exercise training and a psychologist [1]. A multidisciplinary team such as theirs could potentially influence patient perceptions and behavior. While many have an orthotist immediately available, few, if any scoliosis practices have immediate access to a psychologist and a therapist. Cheung and colleagues [1] also found that the benefits of bracing were not dependent on sex. This is an important and new finding because no previous studies have unequivocally demonstrated brace efficacy in males. Where Do We Need To Go?