Bracing effectiveness in idiopathic early onset scoliosis followed to skeletal maturity: a systematic review and meta-analysis.

IF 1.6 Q3 CLINICAL NEUROLOGY Spine deformity Pub Date : 2025-01-22 DOI:10.1007/s43390-025-01043-w

Matthew Bellamy, Wei Shao Tung, Raveen Jayasuriya, Daniel Hind, Lizzie Swaby, Nikki Totton, Ashley Cole

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Abstract

Purpose: Treating idiopathic Early Onset Scoliosis (idiopathic EOS) is challenging due to ongoing growth and extensive follow-ups. While bracing is effective for Adolescent Idiopathic Scoliosis (AIS), its value for children under 10 remains debated. This systematic review and meta-analysis evaluates the effectiveness of spinal bracing in idiopathic EOS, followed to skeletal maturity.

Methods: We searched Ovid Medline and Web of Science until November 1st, 2023. Studies included idiopathic EOS patients between the ages of 3 and 10 (corresponding to Juvenile Idiopathic Scoliosis), followed to skeletal maturity, with no more than 25% initiating bracing after age 11. The primary outcome was the percentage undergoing scoliosis surgery. Pooled outcomes were calculated using a random effects model and 95% confidence intervals.

Results: Out of 417 studies, 15 met the inclusion criteria, encompassing 868 patients. All were observational with a high risk of bias. The pooled percentage of patients undergoing surgery was 40% (95% CI 27-55%). The percentage of patients with a 5-degree progression or more and those progressing beyond 45 degrees were 44% (95% CI 24-66%) and 33% (95% CI 17-54%), respectively. Factors including larger initial Cobb angles, younger age, smaller in-brace correction, and poor compliance were identified as progression risk factors.

Conclusions: Bracing may prevent progression to surgery in idiopathic EOS when initiated early, but progression and surgery are still more common compared to adolescents. This is the first systematic review and meta-analysis looking at the success of bracing in idiopathic EOS, followed up to skeletal maturity. The high bias and variability of included studies limit the strength of these conclusions, highlighting the need for high-quality research with innovative trial designs.

Level of evidence: IV (systematic review of level IV studies).

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支撑物对特发性早发性脊柱侧凸的治疗效果：一项系统回顾和荟萃分析。

目的：治疗特发性早发型脊柱侧凸（特发性EOS）是具有挑战性的，由于持续的生长和广泛的随访。虽然支具对青少年特发性脊柱侧凸（AIS）有效，但其对10岁以下儿童的价值仍存在争议。本系统综述和荟萃分析评估了脊柱支具治疗特发性EOS的有效性，随访至骨骼成熟。方法：检索Ovid Medline和Web of Science，检索截止日期为2023年11月1日。研究包括年龄在3 - 10岁之间的特发性EOS患者（对应于青少年特发性脊柱侧凸），随访至骨骼成熟，不超过25%的患者在11岁后开始使用支具。主要结果是接受脊柱侧凸手术的百分比。合并结果采用随机效应模型和95%置信区间计算。结果：在417项研究中，15项符合纳入标准，共纳入868例患者。所有研究都是观察性的，偏倚风险高。接受手术的患者总百分比为40% （95% CI 27-55%）。5度及以上进展和45度以上进展的患者比例分别为44% （95% CI 24-66%）和33% （95% CI 17-54%）。包括初始Cobb角较大、年龄较小、支架内矫正较小、依从性差等因素被确定为进展危险因素。结论：如果早期开始使用支具，可以防止特发性EOS进展到手术，但与青少年相比，进展和手术仍然更常见。这是第一个系统回顾和荟萃分析，着眼于特发性EOS中支具的成功，随访到骨骼成熟。纳入研究的高偏倚和可变性限制了这些结论的强度，突出了对具有创新试验设计的高质量研究的需求。证据等级：IV级（IV级研究的系统评价）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.