Downloaded from http://journals.lww.com/spinejournal by BhDMf5ePHKbH4TTImqenVE5wmW8EcRnjC6QnUOuyk+AgzLXbJpfq2cuKVdPxPE1TjI7GiFqJVp8= on 07/05/2020 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. Spinal Growth in Patients With Juvenile Idiopathic Scoliosis Treated With Boston Brace A Retrospective Study Johan L. Heemskerk, MD, a Sebastiaan P.J. Wijdicks, MD, b Mark C. Altena, MD, a Rene ´ M. Castelein, MD, PhD, b Moyo C. Kruyt, MD, PhD, b and Diederik H.R. Kempen, MD, PhD a Study Design. Retrospective comparative cohort. Objective. The aim of this study was to determine whether spinal growth is restricted by brace treatment in patients with juvenile idiopathic scoliosis (JIS). Summary of Background Data. Spinal fusion can negatively affect spinal growth if performed before the growth spurt. Brace treatment is often given in this young population to control the spinal deformity while allowing spinal growth. It is unknown whether the applied pressure of brace treatment on spine results in growth restriction. The aim of the study is to evaluate spinal growth in braced JIS patients. Methods. A total of 49 JIS patients treated with Boston brace were retrospectively selected from a scoliosis database. T1-T12/ T1-S1 perpendicular and freehand (height following the curva- ture of the spine) height were measured on radiographs of patients that had reached skeletal maturity and were matched with 49 controls without scoliosis. Spinal growth was calculated from brace initiation until cessation and was compared with normal spinal growth values as reported by Dimeglio. Results. The mean age of diagnosis was 7.4 years. The age of the braced scoliosis patients at skeletal maturity was 17.5 years. The average T1-T12 and T1-S1 freehand height measured by following the curvature of the scoliosis was 29.3 cm (2.4) and 47.2cm (4.0), respectively, and was not significant different from the control group. Brace treatment was initiated at a mean age of 11.2 and the mean age of cessation was 14.8. Spinal growth (freehand) during brace treatment was 1.10 cm/year for the thoracic spine and 1.78 cm/year for the full spine and was not significant different from normal values. Conclusion. No significant influence of bracing on spinal growth could be detected in this cohort of JIS patients. The spinal height measurements at skeletal maturity were similar to matched controls. In addition, spinal growth did not significantly differ from Dimeglio normal growth data, indicating that the effect of bracing on spinal growth is absent or minimal. Key words: Boston brace, bracing, early onset scoliosis, growing spine, height, JIS, juvenile idiopathic scoliosis, normal spinal growth, orthosis, spinal deformity, spinal growth restriction, spinal growth. Level of Evidence: 3 Spine 2020;45:976–982 C hildren with juvenile idiopathic scoliosis (JIS) have a high risk for progression of their scoliosis during growth. In the past, early scoliosis correction and spinal fusion were performed in children with severe pro- gression. However, this inevitably reduced spinal and tho- racic growth, which resulted in poor pulmonary outcome. 1– 5 Therefore, the goal in JIS is to control the spinal deformity while allowing growth of the spine. JIS is often progressive and requires intervention, brac- ing, or growth-friendly surgery. Growing rods have become the surgical standard of care for severe EOS. 6,7 However, growing rods have an increased risk on wound infection and implant-related complications. 8 Bracing can stabilize pro- gressive curves and prevent or delay the need for surgery. To minimize treatment duration, while optimizing treatment effect in the growing spine, brace treatment in juvenile patients is often delayed until the start of the growth spurt. Braces are meant to exert pressure on growing structures. So far, it is unknown whether the applied pressure by the brace on the trunk and spine influences growth of the spine. Therefore, we performed a retrospective radiographic study to evaluate whether brace treatment leads to spinal growth restriction. The primary aim is to compare the length of the spine (T1-S1) in mature brace-treated juvenile scoliosis From the a Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands; and b Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Acknowledgment date: October 7, 2019. First revision date: December 11, 2019. Acceptance date: January 7, 2020. The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication. No funds were received in support of this work. Relevant financial activities outside the submitted work: grants. Johan L. Heemskerk and Sebastiaan P.J. Wijdicks Joint first authorship, the first and second author contributed equally to the manuscript Address correspondence and reprint requests to Diederik H.R. Kempen, MD, PhD, ORCID: 0000-0002-4504-7756, Department of Orthopaedic Surgery, OLVG hospital, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands; E-mail: D.H.R.Kempen@olvg.nl. DOI: 10.1097/BRS.0000000000003435 976 www.spinejournal.com July 2020 SPINE Volume 45, Number 14, pp 976–982 ß 2020 Wolters Kluwer Health, Inc. All rights reserved. DEFORMITY