Video Essay Transcript:
Scoliosis, a condition in which the spine develops a curve of greater than ten degrees, can be found in two to four percent of adolescents (Kikanloo et al. 2019). Although most cases of scoliosis cause no harm to the patient, some are severe and can be disabling if not treated properly (Kikanloo et al. 2019). There are many different treatment methods for correcting a scoliosis curvature, including surgery, physical therapy, and wearing a brace. The methods are tailored to each individual patient and their needs. The degree of the curve and amount of growth left in a scoliosis patient plays an important role in what treatment options work best (Karol et al 2016). Prevention is key to a successful recovery; however, of all the different treatment options back braces are the most common method used in patients with a curvature less than thirty and when growth plates have not yet closed (Karol et al. 2016).
Doctors and patients will find that little research has been conducted in this field (Karol et al. 2016). The unique individuality of each patient’s case makes it difficult to come to a solid solution, leaving patients confused on what the best possible treatment methods are. However, studies such as “The Effect of the Risser Stage on Bracing Outcome in Adolescent Idiopathic Scoliosis” can assist scoliosis patients with a better understanding of the benefits of certain treatment methods. In this study, which was conducted by researchers at Texas Scottish Rite Children’s Hospital, one hundred and sixty-eight patients who had been diagnosed with scoliosis were observed until their bones had matured and the back brace could no longer be worn, or if surgery was needed. To qualify for the experiment, the clinicians looked at the patients’ Risser Stage. The Risser Stage, which helps doctors determine what treatment method would be most beneficial for a scoliosis patient, can be found using the patient’s x-rays (Hacquebord et al. 2012). A Risser Stage of zero, one, or two, implies that bone growth is still going to occur. In this study, participants’ x-rays must have indicated that the patient had a twenty-five-to-forty-five-degree curvature, as well as be in a Risser Stage of zero, one, or two. Participants, who consisted of both males and females, wore a back brace with a thermal monitor attached. The monitor measured heat from the body, which indicated how many hours a day the brace was being worn.
The researchers were further investigating another study, BRAIST, which had concluded that wearing a back brace was beneficial for scoliosis patients, even though the experiment was incomplete and cut short by the National Institutes of Health (Bracing in Idiopathic Scoliosis Trial). The researchers at Texas Scottish Rite Children’s Hospital found this result to have error, as there was no way of knowing if the patients were wearing the braces for the appropriate amount of time (Karol et al. 2016). Because of this, they wanted to come to a reliable conclusion on the outcomes of bracing.
The results indicated that a patient at a Risser Stage of zero is still at risk of needing surgery if they wear a back brace for less than thirteen hours a day (Karol et al. 2016). However, wearing a back brace for more than eighteen hours significantly reduced patients needing surgery at the end of bone growth development (Karol et al. 2016). This outcome differed from the original BRAIST experiment, which determined wearing a back brace for thirteen hours a day would have a successful outcome for the patient (Weinstein et al. 2013). It was concluded by the research at Texas Scottish Rite Children’s Hospital that the BRAIST experiment was not well conducted, even though it is frequently cited by clinicians. Similarly, the study conducted at Texas Scottish Rite Children’s Hospital had shortcomings. The authors admit that multiple different styles of braces were worn by the patients, which had no notable impact on the experiment but could potentially alter the results (Karol et al. 2016). They also noted that they did not measure the quality of brace wear (which was how well the straps were tightened on the patient) in the experiment.
There are many different treatment methods for patients with scoliosis. It is important for doctors to know a scoliosis patient’s individual case before deciding on a method of treatment. Surgery is beneficial for patients who have no bone growth left and have a curvature of forty-five degrees or larger. However, surgery should not be taken lightly as it involves fusion of the spine, which is a delicate and important structure to the body (McConnell 2017). Operation on the spine can also be harmful to the well-being of a patient as it can cause pain immediately after surgery and decreases long-term spinal mobility (McConnell 2017). The question that remains then is if scoliosis back braces are an effective alternative to surgery. Although a back brace cannot always stop scoliosis from progressing, especially when bone growth still needs to occur and the curvature is greater than thirty degrees, it is considered an acceptable prevention option for surgery. If a patient is prescribed a back brace, they should wear it with the straps fastened properly and for the designated hours recommended by their physician. Ultimately, it is up to the doctor to determine what course of action would be more beneficial for each patient’s individual case. Regardless of the treatment plan chosen it is essential that communication between doctor and patient needs to occur for the best possible outcome.
References
Ashleigh’s scoliosis surgery. 2019 July 8, 4:23. YouTube, Scottish Rite for Children. https://www.youtube.com/watch?v=84tp-cHycRE.
Bracing for scoliosis. 2016 November 16, 1:09. YouTube, Scottish Rite for Children. https://www.youtube.com/watch?v=IWFIIiUXVOc.
Ch. 1 – what is scoliosis?. 2019 March 8, 3:45. YouTube, Setting Scoliosis Straight Foundation. https://www.youtube.com/watch?v=TJVttRZ9qU8.
Ch. 3 – what is scoliosis back bracing? 2019 March 8, 5:06. YouTube, Setting Scoliosis Straight Foundation. https://www.youtube.com/watch?v=_nLXf5jEn5k.
[Digital image of x-ray of risser stage]. European Society of Radiology. https://epos.myesr.org/poster/esr/browse?q=risser+stage. [Digital image of risser stage]. Posturetek. https://www.posturetek.com/en/pediatric-treatment.html.Hacquebord J.H, Leopld, S.S. 2012. In brief: the Risser classification: a classic tool for the clinician treating adolescent idiopathic scoliosis. Clinal Orthopedics and Related Research. 470(8):2335-2338. doi: 10.1007/s11999-012-2371-y.
Karol, L.A MD; Virostek, D CPO; Felton, K CPO; Jo, C.H PhD; Butler, L MPH. 2016. The effect of the Risser stage on bracing outcome in adolescent idiopathic scoliosis. The Journal of Bone and Joint Surgery: 98(15):1253-1259. doi: 10.2106/JBJS.15.01313.
Kikanloo S.R, Tarpada S.P, Cho, W. 2019. Etiology of adolescent idiopathic scoliosis: a literature review. Asian Spine Journal. 13(3): 519-526. Doi: 10.316/asj.2018.0096.
McConnell J. (2017). Long-term outlook for adolescents who have scoliosis surgery. Spine-Health. https://www.spine-health.com/conditions/scoliosis/long-term-outlook-adolescents-who-have-scoliosis-surgery.
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Non-surgical management of scoliosis – Boston Children’s Hospital – Orthopedic Center. 2012 September 4, 3:25. YouTube, Boston Children’s Hospital. https://www.youtube.com/watch?v=fZ67danKhGo.
Preparing for scoliosis surgery at scottish rite hospital. 2017 July 20, 6:51. YouTube, Scottish Rite for Children. https://www.youtube.com/watch?v=knGlBWw13to&t=3s.
Rahman T, Borkhuu B, Littleton AG, Sample W, Moran E, Campbell S, Rogers K, Bowen JR [digital image of thermal monitor attached to brace]. (2010). Electronic monitoring of scoliosis brace wear compliance. Journal of Children’s Orthopedics. 4 (4), 343–347. doi:10.1007/s11832-010-0266-6.
Royalty free inspirational background music no copyright. 2020 September 11, 3:22. YouTube, MFCC – BACKGROUND MUSIC FOR VIDEOS. https://www.youtube.com/watch?v=Iy_Reg1Xjxs.
Ruth’s story – success with bracing for scoliosis. 2019 June 19, 3:10. YouTube, Scottish Rite for Children. https://www.youtube.com/watch?v=IgIXV9yIKPg.
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