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Excerpt
I read with interest the article “Results of Charleston Bracing in Skeletally Immature Patients with Idiopathic Scoliosis” by Trivedi and Thompson (3). The conclusion that Charleston Bracing is effective in preventing progression of idiopathic scoliosis curves is hopeful, but I question whether this is actually true. We published the article “A Meta-Analysis of the Efficacy of Non-Operative Treatment for Idiopathic Scoliosis” in the Journal of Bone and Joint Surgery in 1997 (2), which was not cited by the authors. We concluded that the Charleston Brace had a 60% effectiveness rate, the same rate claimed by the authors in their article. However, we could not demonstrate in meta-analysis that this was statistically better than no treatment at all. It may be that with the inclusion of these authors' data we could make it statistically significant. However, the authors have not actually proven significance in their article.
The authors of this article relate their numbers to the article on natural history and bracing by Nachemson and Peterson (1). It should be noted that the number quoted for success with no treatment in a “worse case scenario” was 48% of those observed. All patients who were treated were included, even those who had dropped out. In the authors' calculations, if we use the same techniques, the total number of patients would be 53, not 42; therefore with 26 successes, their success rate would be 49%. Using the “worse case scenario” described by Nachemson and Peterson, there is no difference between the Charleston Brace and observation.
I am not convinced that this article offers substantial evidence that the Charleston Brace changes the natural history of idiopathic scoliosis. Furthermore, in both the Nachemson and Peterson article and our meta-analysis, there are bracing regimens that are convincingly better than the Charleston Brace. These regimens provide better results, but they do require more time using the brace.
