Detorsion night-time bracing for the treatment of early onset XXXX .

@entity1 @entity2112 @entity1615 @entity1635
BACKGROUND: Management for early onset @entity1635 has recently changed, with the development of new surgical procedures. However, multiple surgeries are often required and high complication rates are still reported. Conservative management remains an alternative, serial casting achieving excellent results in young @entity1 . Better compliance and improvement over natural history have been reported with night-time bracing in @entity1615 ( @entity1615 ), but this treatment has never been reported in early onset @entity2112 (EIOS). METHODS: All @entity1 treated for progressive EOIS by detorsion night-time bracing (DNB), and meeting the @entity1635 ( @entity1635 ) criteria for brace studies were reviewed. Recommendations were given to wear the DNB 8h/night and no restriction was given regarding sports activities. Radiological parameters were compared between referral and latest follow-up. Based on the @entity1635 criteria defined for @entity1615 , a similar classification was used as follows to analyze the course of the curves: success group: @entity1 with a progression of 5   or less; unsuccess group (progression or failure): @entity1 with a progression>5  , @entity1 with curves exceeding 45   at maturity, or who have had recommendation for/undergone surgery, or @entity1 who changed orthopaedic treatment, or who were lost to follow-up. RESULTS: Thirty-three @entity1 were included (21 @entity1 and 12 @entity1 ), with a median Cobb angle of 31   (Q1-Q3: 22-40). Age at brace initiation averaged 50months (Q1-Q3: 25-60). Median follow-up was 102-months (Q1-Q3: 63-125). Fifteen @entity1 (45.5%) had reached skeletal maturity at last follow-up. The success rate was 67% (22 @entity1 ), with a median Cobb angle reduction of 15   (P<0.001). Four @entity1 stopped DNB due to an important regression. Eleven @entity1 were in the unsuccessful group (33%). Only one had surgery. All @entity1 remained balanced in the frontal plane and normokyphotic. Initial curve magnitude and age at brace initiation appeared to be important prognostic factors. CONCLUSIONS: DNB is an effective conservative treatment, which can be considered a delaying tactic in the management of EOIS. This brace offers potential psychosocial and compliance benefits, and allows unconstrained spinal and chest wall growth, resulting in normokyphosis at maturity. LEVEL OF EVIDENCE: Therapeutic study (retrospective consecutive case series): Level IV.
