ABSTRACT

•Introduction : Scoliosis before 6 years ofage are usually managed with serial casting to reduce the curve then thoraco-lumbar orthosis to maintain the reduc- tion. Our strategy was to use only bracing, without prelim- inary serial casting. The goal of this study was to analyse the results of this strategy. Material and method : We re- trospectively reviewed the data of all children who had been treated for idiopathic scoliosis diagnosed before the age of 6 years with CTM brace, between 1999 and 2015 at a single institution. The minimal follow-up was 18 months. Secondary scoliosis were excluded. Daily brace time was 22 hours, decreased to 12 h in case of satisfac- tory correction without progression. Bracing was interrupt- ed when the spine was balanced and the curve showed no progression at 6-month interval. Bracing time, Cobb angle and rib vertebra angle difference (RVAD) were recorded.

Results : Forty-six patients were included (27 girls and 19 boys). Mean age at diagnosis was 35 months (9-71). Cobb angle at onset of treatment was 35° (13-70) and RVAD was 20.5° (0-60). Forty patients had a satisfactory result. Mean age at diagnosis was 35 months (9-71), RVAD was 18° (0-55). Cobb angle at the onset of treat- ment was 32° (13-60) and 27° (0-60) at latest follow-up. Mean full time bracing was 25.2 months (4-42) and half time 18.5 months (0-72). Mean follow-up after bracing was 47 months (0-145). In six patients scoliosis progressed despite bracing. Five were managed with serial casting and one with a Milwaukee brace. Discussion : Non oper- ative management is well accepted since excellent re- sults have been reported for curves below 60°. Plaster cast requires specific frame and often general anesthesia. It can be a burden for the patient and his family. Brace treatment alone stands as an alternative in case of satis- factory curve correction. Brace treatment alone has been reported as less effective, resulting in progression of the curve in up to 52% of patients. However, recent studies showed that casting and/or bracing is effective for the management of juvenile scoliosis. The results with bracing alone were similar to results of serial casting from the lit- erature.

Conclusion : Bracing alone is an interesting alternative to serial casting for idiopathic scoliosis. It pro- vides in most of cases satisfactory correction which allows stopping the treatment before skeletal maturity. In case of failure serial casting can be performed.

Keywords : early onset scoliosis ; bracing ; infantile scoliosis ;orthopaedic treatment.