We appreciate the comments from D. Schlenzka and T. Yrjonen. We thank you for your
interest in our article.
We agree that the article by Mannherz et al does cover a younger age group of patients,
but given the difficulty finding prospective follow-up in bracing treatments, it was
included as it showed failure in long-term follow-up.[1]
The illustrative case demonstrates a patient with high compliance in that she was
highly motivated to be braced, and continued to wish to be braced, despite earlier
advice to the contrary that the brace treatment was failing to maintain the curve.
The patient was premenarche at the time of treatment commencement. Continuation of
treatment was purely at patient request.
In our institution, we have adopted the shared decision-making model for patient consent
to treatment.[2] All forms of treatment options are discussed with patients. Complications of observation,
bracing, and surgical treatment are discussed. The clinician role is to allow patients
to make the best individual decisions for their particular circumstances and this
does vary between individuals and caregivers. Bracing is offered to patients at our
institution, but the scientific evidence to support its use is compounded by the lack
of large-scale multicenter and international trials to show that the brace will prevent
curve deterioration and/or surgical intervention. We know that there is significant
variation in cultural and regional patterns to brace compliance. Greg Houghton, in
an article that would be difficult to replicate, placed electrodes within the brace
that showed poor compliance.[3] Patients often are psychologically affected by brace wearing in that it may turn
a disease that is invisible to most visible to the majority. No treatment is without
complication, and we need high-quality evidence to support and advocate and mentor
patients in the use of any technology and treatment. Current, scientific literature
is not as helpful as we would wish it to be in helping patients and caregivers make
the best selection of care and decision making for their individual cases. The EBSJ offers a unique opportunity for the development of an appropriate, helpful, and scientifically
validated randomized controlled trial in the use of bracing in idiopathic adolescent
scoliosis (IAS). I would welcome such a development and an opportunity to help make
better, more informed decision making in brace treatment in IAS.
