Background

Adolescents with idiopathic scoliosis who are receiving brace and/or therapy treatment may undergo several X-rays during the course of their treatment. This has raised some concern in the clinical and academic literature. So, just how important are these X-rays and could some children avoid them? Recently Alvarez and colleagues investigated the outcomes of a lack of in-brace x-rays in compliant patients with AOS who were wearing their thoraco-lumbo-sacral orthosis (TLSO) (2021) (1).

The Study

In this study the authors investigated skeletally immature (Risser 0-2) patients with AOS (25-45 degrees) with full time TLSO braces that had compliance temperature monitors. The patients all wore their braces at least 12 hours per day. 

What Was Considered ‘Brace Failure’?

The authors defined brace failure as a progression of the curve to 50 degrees or more. Keep in mind that means that any patients that had significant progression but remained under 50 degrees would not be classified as ‘brace failure’. The patients were followed until brace discontinuation. 

What Were the Results? 

Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace being issued were more at risk of brace failure. In fact, they were 3.21 (95% CO1.2-7.6) times more likely to fail bracing than patients who had a new in-brace x-ray with major brace changes or a new brace being issued.

Take Home Message

The authors of this paper demonstrated that patients who did not have a new in-brace x-ray taken when a new brace was issued, or when their current brace had a major alteration, were more likely to have their curve progress to 50 degrees or more.

Reference: 

1. Alvarez, I., Poppino, K., Karol, L. et al. Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure. J Orthop Surg Res 16, 540 (2021). https://doi.org/10.1186/s13018-021-02650-9