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Journal ArticleDOI

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

05 Mar 2014-Scoliosis (BioMed Central)-Vol. 9, Iss: 1, pp 2-2
TL;DR: The biomechanical changes consequent to modifications in brace design and pad placements appeared to have improved the scoliosis and reduced the Cobb angles in the case of an 11-year-old girl diagnosed with IS.
Abstract: 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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Citations
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Journal ArticleDOI
TL;DR: Based on the results, children on either end of the BMI spectrum are more likely to fail brace treatment for scoliosis than their mid-BMI counterparts, while a low BMI appears to be an independent risk factor for brace failure.
Abstract: 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.

38 citations

Journal ArticleDOI
TL;DR: The results provide clinical support to finite element studies that refute traditional recommendations of brace design and advocate for a revision of these guidelines to optimize non-operative treatment of AIS.
Abstract: 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.

9 citations

Journal ArticleDOI
28 Feb 2014
TL;DR: The asymmetric of trunk inclination influenced the pain, but the diminution in thoracic kyphosis and lumbar lordosis are potential sources of pain.
Abstract: 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

5 citations

Journal ArticleDOI
04 Dec 2018
TL;DR: The Scoliosis Analog Model was developed to provide first time measures of the multidirectional forces applied to the spine by a thoracolumbar brace and could be used as a future design and testing tool for scoliosis brace technology.
Abstract: 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...

3 citations

04 Jun 2019
TL;DR: In this article, the authors evaluated the position optimale of the thoracic main d'appui thoracique for scoliose idiopathique of l’adolescent.
Abstract: 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.
References
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Journal ArticleDOI
TL;DR: These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method, and it is possible to understand the lack of research in general on CTIS.
Abstract: The International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS). All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

334 citations


"Brace modifications that can result..." refers methods in this paper

  • ...These qualities can be checked by the orthotist in many ways, according to rigorous standards set either by the individual orthotist with many years of experience in the conservative treatment of scoliosis as listed below or, for some practitioners, in accordance with standards established by the 2011 SOSORT guidelines [3]....

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Journal ArticleDOI
01 Oct 1986-Spine
TL;DR: A strong correlation between best, or initial in-brace correction, and follow-up correction was noted and young age at the initiation of bracing and higher degrees of pre-brace curvature increased the incidence of surgery.
Abstract: A total of 295 patients treated with the Boston bracing system with follow-up of at least 1 year after completion of bracing are reviewed. Pre-brace curves ranged from 20-59 degrees Cobb. Mean age at brace initiation was 13.2 years with a mean treatment time of 2.9 years and mean follow-up of 1.4 years. Mean best in-brace correction averaged 50% with correction averaging 23% at the initiation of weaning from the brace. By the time of brace discontinuance, average curve correction was 15%. At follow-up, average correction was 11%. A comparison of follow-up with pre-brace values of major curves showed that 49% were unchanged +/- 5 degree, 39% achieved final correction of 5-15 degrees, 4% achieved final correction of 15 degrees or more, 4% of patients lost 5-15 degrees, and 3% lost more than 15 degrees by the time of follow-up. Eleven percent of patients underwent surgery during the period of bracing; 1% had surgery during follow-up period. Correction and control of major curves with apexes below T8 and above L2 were best. A strong correlation between best, or initial in-brace correction, and follow-up correction was noted. Young age at the initiation of bracing and higher degrees of pre-brace curvature increased the incidence of surgery. Those curves that had corrected most at the end of bracing were most at risk for loss of correction after bracing. Partial compliance with brace wear appeared as effective as full-time wear. Boston braces without superstructure appeared to be as effective as braces with superstructure for curves with apexes below T7.

326 citations


"Brace modifications that can result..." refers background in this paper

  • ...The ribs below the apex actually push the curve above that point, therefore a brace pad placed below the apex pushes on the ribs that push and correct the curve at the apex [4]....

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Journal ArticleDOI
TL;DR: A specific scoliosis classification which correlates with brace treatment has been proposed with an acceptable intra-and inter-observer reliability.
Abstract: Spinal classification systems for scoliosis which were developed to correlate with surgical treatment historically have been used in brace treatment as well. Previously, there had not been a scoliosis classification system developed specifically to correlate with brace design and treatment. The purpose of this study is to show the intra- and inter- observer reliability of a new scoliosis classification system correlating with brace treatment. An original classification system ("Rigo Classification") was developed in order to define specific principles of correction required for efficacious brace design and fabrication. The classification includes radiological as well as clinical criteria. The radiological criteria are utilized to differentiate five basic types of curvatures including: (I) imbalanced thoracic (or three curves pattern), (II) true double (or four curve pattern), (III) balanced thoracic and false double (non 3 non 4), (IV) single lumbar and (V) single thoracolumbar. In addition to the radiological criteria, the Rigo Classification incorporates the curve pattern according to SRS terminology, the balance/imbalance at the transitional point, and L4-5 counter-tilting. To test the intra-and inter-observer reliability of the Rigo Classification, three observers (1 MD, 1 PT and 1 CPO) measured (and one of them, the MD, re-measured) 51 AP radiographs including all curvature types. The intra-observer Kappa value was 0.87 (acceptance >0.70). The inter-observer Kappa values fluctuated from 0.61 to 0.81 with an average of 0.71 (acceptance > 0.70). A specific scoliosis classification which correlates with brace treatment has been proposed with an acceptable intra-and inter-observer reliability.

80 citations


"Brace modifications that can result..." refers methods in this paper

  • ...The Cheneau-Rigo handmade type brace [1] was a B1 type model using the Rigo classification of scoliosis [2]....

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