Don't put off treatment that is due just to “wait until exams are over”; some windows follow bone age, not the exam calendar
- High value
- Evidence A
- Buys life
- For: Child aged 3–18
- Free
- Takes minutes
- Long-term effort
In plain words
Scoliosis is a sideways curve of the spine. A brace is a hard-shell vest worn on the body to hold the spine in place. Worn while the bones are still growing, it kept 75% of children from curving to the point of needing surgery, versus only 42% of children who were just watched without a brace. The time when a brace can work follows when the bones finish growing, not the middle-school or college entrance exams. If you wait until after the exams, surgery is often the only option left.
- Cost
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Free. The only thing to decide is whether to do it sooner or later. Time off and follow-up visits take time, and the treatment itself costs extra. The hard part is that a brace has to be worn at least 18 hours a day, and the child has to put up with it the whole time.
- What you get
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A multi-hospital trial enrolled 242 adolescents with idiopathic scoliosis who were eligible for a brace. Of these, 116 were assigned by lottery and 126 chose for themselves whether to wear one. Success was defined in advance: a curve that grew past 50 degrees counted as treatment failure, and a curve that had not reached that by the time the bones stopped growing counted as success. Results were counted by the group each child was first assigned to, whether or not the brace was actually worn enough. Success was 75% in the lottery brace group and 42% in the lottery watch-only group (OR 4.11, 95% CI 1.85–9.16), so the chance of success was about 4 times that of watching only. Combining the lottery and self-chosen groups gave 72% versus 48% (OR 1.93, 1.08–3.46 after evening out the differences between the two groups, still about 1.9 times). The more hours a day the brace was worn, the higher the success rate (P<0.001, meaning this link is unlikely to be chance). The trial was stopped early because the brace clearly worked.
- Notes
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Scoliosis is used here as the example because there is a trial with lottery assignment, a clear time window, and it happens to be one of the main items in school checkups (see §30.7). Similar cases include crossed eyes, lazy eye, tooth decay, and heart surgery for congenital heart disease where the timing can be chosen. What they share is that the later the treatment, the worse the result or the higher the cost. Ask the specialist about the exact window. If you worry about missing classes, a student in compulsory education can take a leave of absence of up to 1 year, with the school keeping the student's enrollment record; see §30.11.
- Evidence grade
- A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
- Sources
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- Weinstein SL, et al. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1307337
Mentioned in
Translated from the Chinese original. Original book, section 30, tip 2. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer