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The Journal of Bone and Joint Surgery (American) 86:1891-1899 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Long-Term Follow-up of Female Patients with Idiopathic Scoliosis Treated with the Wilmington Orthosis

Peter G. Gabos, MD1, John A. Bojescul, MD, Major2, J. Richard Bowen, MD1, Kathryn Keeler, MD1 and Lillian Rich, MD1

1 Department of Orthopaedic Surgery, Alfred I. duPont Hospital for Children, 1600 Rockland Road, P.O. Box 269, Wilmington, DE 19899. E-mail address for P.G. Gabos: pgabos{at}nemours.org
2 Orthopaedic Surgery Service, Department of Orthopaedic Surgery and Rehabilitation Services, Walter Reed Medical Center, Washington, DC 20307

Investigation performed at the Alfred I. duPont Hospital for Children, Wilmington, Delaware

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: A spinal orthosis is commonly utilized in the nonoperative treatment of idiopathic scoliosis. The purpose of this study was to evaluate the long-term radiographic and functional outcomes of female patients with idiopathic scoliosis who had completed a program of treatment with the Wilmington thoracic-lumbar spinal orthosis.

Methods: We retrospectively reviewed the clinical records and radiographs of all female patients who had successfully completed a course of treatment with the orthosis between 1973 and 1983. Ninety-one patients met the criteria for inclusion, and fifty-five women returned for a follow-up evaluation. Their mean age was thirty-one years at the time of follow-up, which was carried out at a mean of 14.6 years after the completion of treatment. The patients were evaluated clinically and radiographically, and they each completed a comprehensive questionnaire assessing their ability to perform twenty-six activities of daily living, their overall physical appearance, the cosmetic appearance of the back, their self-image, and the severity of any back pain. The questionnaire was also administered to a control group of fifty-five women without scoliosis matched for age, number of children, and occupation.

Results: Seven patients (13%) demonstrated ≥5° of progression of the curve, compared with the curve at the start of treatment, after discontinuing use of the orthosis. No curve progressed >17° compared with the deformity at the time of the initial treatment. There was no significant overall difference between the orthotic treatment group and the control group in terms of back pain, physical activities, functional activities (with the exception of shopping) or self-care activities. As a group, the patients reported significantly greater difficulty with selected positional activities (p = 0.007). Fifty-one (93%) of the fifty-five treated women reported no subjective deterioration in their physical appearance, the cosmetic appearance of the back, or their self-image in the period since they discontinued using the brace.

Conclusions: The majority of patients who successfully complete treatment with a Wilmington thoracic-lumbar spinal orthosis for idiopathic scoliosis with an initial magnitude of between 20° and 45° can anticipate that the curve will remain stable into middle adulthood. Any apparent correction of the curve that occurs during treatment can be expected to be lost over time, resulting in a deformity that is equal or nearly equal in magnitude to that measured at the initiation of the orthotic management. Because some patients did demonstrate some progression of the curve by the third or fourth decade of life, it is reasonable to recommend a spinal radiograph during that time to monitor the status of the curve.

Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.


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