Purpose
Bracing is a common treatment for patients with adolescent idiopathic scoliosis (AIS) and is recommended for most skeletally immature patients with a curve of 25–45° in order to prevent or delay curve progression. The aim of this study was to determine at which body habitus orthotic management for AIS becomes less effective. We hypothesize that overweight children are more likely to fail brace treatment.

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It’s not just the big kids: both high and low BMI impact bracing success for adolescent idiopathic scoliosis

Introduction The vertical position of the thoracic pad is a subject of controversy in brace design. Traditional recommendations dictate a maximal force applied at the level of the apical rib, about 2 levels below the apical vertebra. We sought to evaluate the optimal vertical position of the brace thoracic pad using fulcrum bending radiographs. Hypothesis A lateral force applied at the apical vertebra of a thoracic curve is more efficient at correcting coronal deformity than a force placed the apical rib. Patients and methods In this prospective study, we recruited patients presenting with adolescent idiopathic scoliosis (AIS) and Risser stage 0-2 over a period of 12 months. Patients with a history of spine or thoracic surgery were excluded. Two fulcrum bending radiographs were performed for each patient: one with the center of the fulcrum placed under the most lateral part of the apical rib and another with the fulcrum centered below the apical vertebra. Cobb angles were measured on each fulcrum radiograph and compared using a paired t test. Results Fifty-two patients were included, with a mean age of 12.4 years and mean thoracic Cobb angle of 39.4˚. Placing a fulcrum under the apical vertebra reduced the Cobb angle to a mean of 11.5˚, which was significantly lower than a fulcrum placed under the apical rib (14.3˚, p = 0.001). This corresponded to a 20% relative loss in the absolute correction angle when placing the fulcrum under the apical rib. The difference between the 2 Cobb angles was not significantly correlated to patient age (p = 0.896) or curve apex (p = 0.813). Discussion This is the first clinical study addressing the vertical position of the thoracic pad in braces for AIS. A lateral force applied at the level of the apical vertebra was significantly more efficient at reducing thoracic curve deformities than one applied at the apical rib. Our results provide clinical support to finite element studies that refute traditional recommendations of brace design, advocating for a revision of these guidelines to optimize non-operative treatment of AIS. Level of evidence II, prospective comparative study.

Optimizing the vertical position of the brace thoracic pad: Apical rib or apical vertebra?

PURPOSE: This study was to investigate of pain and spine shape in elementary school students. The aim of this study was to prevent pain and spinal misalignment is to provide basic data and the need for regular screening for elementary school students. METHODS: This study had a survey research about pain and spine shape by using questionnaires and Formetric 4D. Subjects were 301 Elementary School Students RESULTS: In the presence or absence of pain and the presence of pain was in a high proportion and many of them indicated the back as a pain area, As a result of the spine shape contour, pelvic tilt was normal and trunk inclination was asymmetric as well as thoracic kyphosis and lumbar lordosis were diminished. There was a significant difference in relationship of trunk inclination according to pain CONCLUSION: The asymmetric of trunk inclination influenced the pain, In contrast, the pain did not influence thoracic kyphosis and lumbar lordosis in diminished. but, the diminution in thoracic kyphosis and lumbar lordosis are potential sources of pain. Regular checkups are necessary to

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The Investigation of Pain and Spine Shape in Elementary School Students

IntroductionThoracolumbar braces are used to treat Adolescent Idiopathic Scoliosis. The objective of this study was to design and validate a mechanical analog model of the spine to simulate a thora...

https://journals.sagepub.com/doi/pdf/10.1177/2055668318809661

A mechanical analog thoracolumbar spine model for the evaluation of scoliosis bracing technology

Resume Introduction La position verticale de la main d’appui thoracique fait objet de controverse dans la confection des corsets. Les recommandations traditionnelles placent la force maximale au niveau de la cote-sommet, soit 2 niveaux en-dessous de la vertebre-sommet. Nous avons voulu evaluer la position optimale de la main d’appui thoracique au sein d’un corset par une etude clinique basee sur les radiographies sur billot. Hypothese Une force laterale appliquee au niveau de la vertebre-sommet d’une courbure thoracique est plus efficace pour corriger la deformation frontale qu’une force appliquee au niveau de la cote-sommet. Materiel et methode Dans cette etude prospective, nous avons recrute des patients se presentant pour scoliose idiopathique de l’adolescent avec un stade Risser 0–2 sur une periode de 12 mois. Les patients ayant une histoire de chirurgie rachidienne ou thoracique ont ete exclus. Deux cliches radiographiques sur billot furent obtenus pour chaque patient : l’un avec le centre du billot place en-dessous de la cote-sommet et l’autre avec le billot centre sous la vertebre-sommet. Les angles de Cobb furent mesures sur chaque cliche et ensuite compares en utilisant un test de Student avec appariement. Resultats Cinquante-deux patients furent inclus avec un âge moyen de 12,4 ans et un angle de Cobb moyen de 37,5° pour la courbure thoracique. La mise en place d’un billot sous la vertebre-sommet a reduit l’angle de Cobb a une moyenne de 11,5, une valeur significativement inferieure au billot place sous la cote-sommet (14,3, p = 0,001). Ceci correspond a une perte relative de 20 % de l’angle de correction lorsque le billot est place sous la cote-sommet. La difference entre les 2 angles de Cobb ne fut pas significativement correlee a l’âge du patient (p = 0,896) ou a l’apex de la courbure thoracique (p = 0,896). Discussion Ceci est la premiere etude clinique adressant la position verticale de la main d’appui thoracique dans les corsets pour scoliose idiopathique de l’adolescent. Une force laterale appliquee en regard de la vertebre-sommet fut significativement plus efficace pour reduire une courbure thoracique qu’une force appliquee a la cote-sommet. Nos resultats soutiennent les etudes de modelisation en elements finis qui remettent en cause les recommandations traditionnelles pour la confection de corsets et preconisent ainsi la revision de ces recommendantions afin d’optimiser le traitement orthopedique de la scoliose idiopathique de l’adolescent. Niveau d’evidence II, etude prospective comparative.

Iconographies supplémentaires de l'article : Optimisation de la position verticale de la main d’appui thoracique du corset : côte-sommet ou vertèbre-sommet ?

The purpose of this paper is to share with scoliosis professionals the X-rays of different pad placement levels associated with improved curve correction in a case of idiopathic scoliosis (IS). Scoliosis braces of all types and brands utilize common principles of construction that ensure good fit and function. Equally important to the end result is good patient follow-up care and brace quality control by the orthotist. This report reviewed the case of an 11-year-old girl diagnosed with IS, focusing on the in and out-of-brace x-rays, as well as the fit and function of the braces. The first brace was a TLSO-type, the second a Cheneau-type brace using a B1 model following the Rigo classification of scoliosis. The first TLSO-type brace presented an in-brace X-ray that showed a curve increase. The Cheneau-type scoliosis brace reduced the Cobb angles over 50%. The biomechanical changes consequent to modifications in brace design and pad placements appeared to have improved the scoliosis and reduced the Cobb angles in this case. An orthotist must provide optimal fit and function of the brace which was prescribed by the referring physician. Adherence to certain basic design principles, and close follow up by the orthotist-especially during growth spurts - are critical to its effectiveness. Specifically, a skilled orthotist must be experienced with the particular brace-type, apply these principles, maintain a good working relationship with both physician and patient to ensure timely brace adjustments essential to continued brace comfort and efficacy.

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Grant Wood

Papers

Brace modifications that can result in improved curve correction in idiopathic scoliosis.