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Dysport ® as an Adjunctive Treatment to Bracing in the Management of Adolescent Idiopathic Scoliosis

  • identifier


  • Recruitment Status


  • First Posted

    May 2, 2019

  • Last update posted

    September 16, 2020

Study Description

Brief summary:

This study evaluates the combined effect of botulinum toxin A (administered as Dysport® (Ipsen Pharmaceuticals)) and bracing in children with adolescent idiopathic scoliosis. Two thirds of patients will be treated with Dysport® and bracing, while the remaining patients will be treated with placebo and bracing.

  • Condition or Disease:Adolescent Idiopathic Scoliosis
  • Intervention/Treatment: Drug: AbobotulinumtoxinA
    Drug: Placebos
    Device: Custom Thoracolumbosacral Orthosis
  • Phase: Phase 4

Detailed Description

Adolescent idiopathic scoliosis (AIS) is lateral curvature of the spine with an unknown cause in children 10-16 years old. Without treatment, skeletally immature children with idiopathic curves of 20°-40° risk curve progression. Treatment of these patients is focused on either observation or bracing. Although bracing has been shown to be more effective than observation, success is contingent on patient adherence and has the potential for further optimization with adjunct therapies. Little research is available concerning adjunct therapies that may be used during bracing of AIS patients. One therapy in particular, abobotulinumtoxinA (BTX) injection, has been poorly studied. Injection of BTX into the paraspinal musculature of the concave aspect of the major curve may result in a more malleable curve and thus optimize brace treatment. If BTX injections are found to improve outcomes in this way, a new standard of nonoperative care could be established for AIS patients, potentially reducing the number of patients who undergo surgery. The aim of this study is to assess whether BTX injections (administered as Dysport® (Ipsen Pharmaceuticals)) in the paraspinal musculature at the site of the major scoliotic curve decrease curve progression in skeletally immature AIS patients who are concurrently treated with bracing. Dysport® will be evaluated primarily as an adjunct treatment to bracing. Hypotheses 1. Dysport® injections into the concave-side paraspinal muscles will decrease the rate of curve progression, with a lower rate of curve progression in patients treated with both Dysport® injections and bracing compared with those treated with only bracing. 2. Quantitative physical and mental health scores will improve to a greater extent in patients treated with Dysport® and bracing compared with patients treated with only bracing.

Study Design

  • Study Type: Interventional
  • Estimated Enrollment: 90 participants
  • Allocation: Randomized
  • Intervention Model: Parallel Assignment
  • Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
  • Primary Purpose: Treatment
  • Official Title: Dysport ® (abobotulinumtoxinA) as an Adjunctive Treatment to Bracing in the Management of Adolescent Idiopathic Scoliosis
  • Actual Study Start Date: September 2020
  • Estimated Primary Completion Date: April 2023
  • Estimated Study Completion Date: April 2023

Arms and interventions

Arm Intervention/treatment
Experimental: Botulinum Toxin
The investigators plan to administer approximately 1000 U Dysport ® in the concave-sided paraspinal musculature of the major curve, based on an estimated total dose of 1000 U, the maximum allowable dose. The total dose per treatment session will not exceed 15 units/kilogram or 1000 units, whichever is lower. If two curves are equivalent within 3˚, both will be treated, however, the dosing (described above) will be divided equally across both curves. There will be two cycles of injections. Patients will be treated at time 0 (baseline) and 4 months.
Drug: AbobotulinumtoxinA
Paraspinal abobotulinumtoxinA injections (compared to placebo)

Device: Custom Thoracolumbosacral Orthosis
Non-operative external bracing for scoliosis curves
Placebo Comparator: Placebo
Control patients will receive an injection of placebo specifically prepared as a control for this study. The same volumes as indicated in the "experimental" arm description will be injected. These will be administered during two cycles of injections. Patients will be treated at time 0 (baseline) and 4 months.
Drug: Placebos
Placebo prepared by Ipsen for use as control

Device: Custom Thoracolumbosacral Orthosis
Non-operative external bracing for scoliosis curves

Outcome Measures

  • Primary Outcome Measures: 1. Change in scoliotic curve as assessed by the Major Curve Cobb Angle [ Time Frame: Assessed at baseline (time 0), 6 weeks, 4 months, 4 months + 6 weeks, 8 months ]
    Change in scoliotic curve will be assessed using by the Major Curve Cobb Angle with measurement of standing scoliosis radiographs. Cobb angle refers to a radiographic measurement of side to side spinal curvature, measured in angle degrees.
  • Secondary Outcome Measures: 1. Change in Patient Reported Outcomes [ Time Frame: Assessed at baseline (time 0), 6 weeks, 4 months, 4 months + 6 weeks, 8 months ]
    This will be assessed by Scoliosis Research Society (SRS) 22 Survey; The SRS-22 questionnaire is a validated measure used to assesses quality of life in patients with idiopathic scoliosis. It consists of five domains that assess: function, pain, mental health, self-image, and satisfaction with treatment. Higher scores indicate increased satisfaction. Each of the 22 questions are scored on a scale of 1 to 5.

Eligibility Criteria

  • Ages Eligible for Study: 10 to 16 Years (Child)
  • Sexes Eligible for Study: All
  • Accepts Healthy Volunteers: No


Inclusion criteria:

- Clinically determined idiopathic nature of scoliosis

- Age 10-16 years

- Risser stage 0,1,or 2

- major curve of 20°-40°

- curve apex caudal to T7 vertebra

- ability to adhere to bracing protocol

- Botulinum toxin naïve or previously treated greater than 6 months prior to study entry

Exclusion criteria:

- Diagnosis of congenital scoliosis, neuromuscular scoliosis, or other "reason" for
scoliosis - Previous surgery at any segment of the spine

- Current need for surgery at any level of the spine

- Treatment with any drug known to interfere with neuromuscular function

- Any other medical condition, laboratory or diagnostic procedure finding that might
preclude administration of BTX

- Ongoing infection at the injection sites

- Diagnosis as either resistant or sensitive to botulinum toxin treatment of any type or
to any components of the BTX formulation

- Cow milk protein allergy

Contacts and Locations


Contact: Vivian Tran, BS 4109553136

Contact: Varun Puvanesarajah, MD 9193605646


United States, Maryland
Johns Hopkins University

Sponsors and Collaborators

Johns Hopkins University


Principal Investigator: Paul Sponseller, MD, MBA Johns Hopkins Hospital Department of Orthopaedic Surgery

Principal Investigator: Varun Puvanesarajah, MD Johns Hopkins Hospital Department of Orthopaedic Surgery

More Information