Bracing for scoliosis found less effective for overweight
teens
A recent study at Johns Hopkins Children’s Center
has shown that bracing treatment for scoliosis is
significantly less effective for teenagers who are overweight. At present,
wearing a back brace is the only non-operative treatment
for adolescent idiopathic scoliosis that is currently
advocated by the spine medical community.
In the study,
which included 276 adolescents with adolescent idiopathic
scoliosis, the teenagers who were overweight
were 2.5 times more likely than those of normal-weight
teens to have scoliosis curvatures that progressed
despite wearing a brace. Of the 34 overweight teens in
the study,
44 percent eventually needed surgery to correct the
curve.
This is an important finding, as the spine fusion
surgery required to correct a scoliosis curve is an
extensive surgery. The findings from this study support
existing
literature, which suggests that extra weight (extra
soft tissue between the brace and the spine) may
compromise the brace's ability to exert the biomechanical
forces
on the spine necessary to prevent curve progression.
This study included adolescents ranging in age from
10 to 17 years, who were treated for scoliosis at
the Johns
Hopkins Children's Center and the Texas Scottish
Rite Hospital for Children between 1991 and 2001.
Thirty-four
children participating in the study were considered
to be clinically overweight.
The patients in the
study were all prescribed the Thoraco-lumbo-sacral-orthosis
(TLSO) brace, which
is custom-molded to fit under the
child’s arm and around the rib cage, lower
back and hips. On average the patients wore the
brace for
about 14 hours per day.
The goal of using a back
brace for idiopathic scoliosis is primarily to stop
the spinal curve from progressing.
In general, treatment with a back brace is recommended
for patients with a curve that measures 25 to 40
degrees and who are still skeletally immature (i.e.
still have
a lot of growth left).
Overall, almost half of all
teens in the scoliosis study had a successful outcome
following brace treatment
(no
more than a five-degree increase in the primary
curve). For the overweight patients, however, only 29
percent
were treated successfully, and 44 percent required
surgery to correct the curve.
By: John Dormans, MD,
and Leslie Moroz, Research Coordinator
October 17, 2003
Sources: Paper #5 at the Scoliosis
Research Society 38th Annual meeting, September 2003
and Johns Hopkins
Children’s
Center.
|
