Boston Brace in the Treatment of Idiopathic Scoliosis

Ólafsson, Yngvi; Saraste, Helena; Söderlund, Veli; Hoffsten, M

doi:10.1097/01241398-199507000-00023

Cited by 75 publications

(46 citation statements)

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“…However, the correction was below the 50 to 60% correction in brace reported in idiopathic scoliosis (Willner 1984, Olafsson et al 1995. The percentage correction was reduced in patients ≥ 15 years old, in keeping with the common clinical impression that the curves are flexible until the end of growth and thereafter are quite structural (Fisk and Bunch 1979).…”

Section: Discussionmentioning

confidence: 55%

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

Terjesen¹,

Lange²,

Steen³

2000

Develop Med Child Neuro

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To evaluate the clinical results of the treatment and to assess the factors that influenced the rate of scoliosis progression, a retrospective study of spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy was performed. The mean age of the patients was 13.8 years (range 5 to 33 years). Their scoliotic deformities were treated with custom-moulded, polypropylene thoraco-lumbar-sacral orthoses. Cobb angles were measured on radiographs taken in a sitting position before treatment, in orthosis, and during follow-up. The mean initial Cobb angle was 68.4˚ (range 25 to 131˚). The mean correction in orthosis was 25˚ (range 3 to 60˚). Seventytwo patients had a follow-up period of more than 2 years. At the latest follow-up, average 6.3 years (range 2 to 14 years) after the start of treatment, the mean Cobb angle without orthosis was 93.1˚ (range 40 to 145˚). The mean progression per year was 4.2˚ (range -3 to 21˚). Linear multiple regression revealed that age and initial correction in orthosis were the only variables that significantly influenced the rate of progression. Twenty-two patients had no progression or progression <1.0˚ per year. Correction in orthosis was the only variable that predicted progression <1.0˚ per year in both age groups (<15 years and ≥15 years). Of the 57 patients who were still alive and had not undergone surgical fusion, 72% used their orthoses at a mean age of 22 years. Parents and caregivers expressed satisfaction with the use of orthosis, mainly because of improved sitting stability which gave better overall function.Scoliosis occurs frequently in patients with cerebral palsy (CP), especially in those with spastic quadriplegia (Madigan and Wallace 1981). Although surgical treatment is usually indicated when scoliosis exceeds 45 to 50˚, there are certain risk factors that must be taken into consideration before operation is recommended. Many patients with quadriplegia with large curvatures of the spine have impaired general health, epilepsy, and reduced respiratory capacity, making them poor candidates for major surgery like spine fusion. Moreover, the complication rate after such surgery is substantial (Lonstein and Akbarnia 1983, Boachie-Adjei et al. 1989, Cassidy et al. 1994. Therefore, other treatment alternatives should be available.The role of spinal orthosis in those with quadriplegia with scoliosis has not been frequently studied and reports have rather short follow-up periods (McMaster and Clayton 1980, Letts et al. 1992). We have used this type of treatment for several years, based on clinical evidence that it has a beneficial effect in many patients.This study aimed to evaluate the clinical effects of spinal bracing in quadriplegic patients with scoliosis and to assess the progression of the scoliosis and factors that might influence the rate of progression. MethodDuring the period 1982 to 1996, treatment with spinal orthosis was initiated in 99 patients with CP and scoliosis. To obtain more homogenous material, seven patients with diplegia or hemiplegia were excl...

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Section: Discussionmentioning

confidence: 55%

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

Terjesen¹,

Lange²,

Steen³

2000

Develop Med Child Neuro

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“…Thoracic braces have been widely used in the conservative management of patients with mild progressive idiopathic scoliosis [6,17,19,21]. As long as scoliosis is a restrictive respiratory condition, the clinician should focus on the pulmonary function consequences of a treatment, which acts as an additional external restriction.…”

Section: Discussionmentioning

confidence: 99%

The immediate effect of a Boston brace on lung volumes and pulmonary compliance in mild adolescent idiopathic scoliosis

Katsaris

Loukos

Valavanis

et al. 1999

European Spine Journal

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Idiopathic scoliosis (IS) is known to result in lung volume and pulmonary compliance reduction. Boston brace treatment of IS is an additional factor causing restrictive respiratory syndrome due to external chest wall compression. Nevertheless, the immediate effect of Boston bracing on the pulmonary compliance of scoliotic patients has not been studied systematically. Spirometric and plethysmographic lung volumes, static lung compliance (C(ST)(L)) and specific lung compliance (C(ST)(L)/functional residual capacity) of 15 scoliotic adolescents (14 females and 1 male, of mean age 14.1+/-1.67 years, with mean Cobb angle 24.1 degrees+/-7.88 degrees) were recorded twice, in a random sequence: once without the Boston brace (nBB) and once immediately after wearing the brace (BB). Our findings showed that bracing reduced vital capacity, residual volume, functional residual capacity (FRC), total lung capacity, and forced expiratory volume in 1s in a proportional and significant way (P < 0.001). C(ST)(L) was also significantly reduced (P < 0.001), but C(ST)(L)/FRC remained unaltered. All BB and nBB indices were highly correlated. We concluded that Boston bracing in IS patients results in an immediate, predictable, and uniform reduction of lung volumes and pulmonary compliance. The reduction of C(ST)(L) under bracing conditions was related to the decrease of lung volume; the C(ST)(L)/FRC remained unaltered.

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“…As the main non-operative treatment for adolescent idiopathic scoliosis (AIS) patients, brace treatment has proved to be effective in preventing curve progression by many studies conducted in different areas or with different ethnic groups [1][2][3]. Nevertheless, wearing brace is always associated with excessive radiographic exposure, anxiety and indirect costof-care caused by absence from work or travel expenses [4,5].…”

Section: Introductionmentioning

confidence: 99%

Potential genetic markers predicting the outcome of brace treatment in patients with adolescent idiopathic scoliosis

Qiu

Sun

et al. 2011

Eur Spine J

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Purpose To investigate whether the predisposition genes previously reported to be associated with the occurrence or curve severity of adolescent idiopathic scoliosis (AIS) play a role in the effectiveness of brace treatment. Method A total of 312 AIS patients treated with bracing were enrolled in this study. The Cobb angle of the main curve was recorded at the beginning of brace treatment as well as at each follow-up. The patients were divided into two groups according to the outcome of brace treatment (success/failure). The failure of brace treatment was defined as a curve progression of more than 5°compared to the initial Cobb angle or surgical intervention because of curve progression. Single nucleotide polymorphism (SNP) sites in the genes for estrogen receptor a (ERa), estrogen receptor b (ERb), tryptophan hydroxylase 1 (TPH-1), melatonin receptor 1B (MTNR1B) and matrillin-1 (MATN1), which were previously identified to be predisposition genes for AIS, were selected for genotyping by the PCR-RFLP method. Differences of genotype and allele distribution between the two groups were compared by the v 2 test. A logistic regression analysis was used to figure out the independent predictors of the outcome of brace treatment. Results There were 90 cases (28.8%) in the failure group and 222 cases (71.2%) in the success group. Patients in the failure group were associated with the genotype GA (50.9 vs. 17.9% p \ 0.001) and the G allele (27.1 vs. 12.0%, p \ 0.001) at SNP rs9340799 of the ERa gene. Similarly, they were also associated with the genotype AT (33.3 vs.13.0%, p = 0.002) and the A allele (16.7 vs. 9.6%, p = 0.033) at SNP rs10488682 of the TPH-1 gene. For MTNR1B, the difference of genotype distribution between the two groups was found to be statistically significant, while the difference of allele distribution between the two groups was found to be marginally statistically significant; for the MATN1 and ERb genes, we found no significant differences of the genotype or allele distribution between the two groups. In the logistic regression analysis, ERa and TPH-1 were demonstrated to be independent factors predictive of bracing effectiveness. Conclusions ERa and TPH-1 might be potential genetic markers that could predict the outcome of brace treatment. Patients with the G allele at the rs9340799 site of the ERa gene and the A allele at the rs10488682 site of the TPH-1 gene are prone to be resistant to brace treatment.

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Boston Brace in the Treatment of Idiopathic Scoliosis

Cited by 75 publications

References 0 publications

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy

The immediate effect of a Boston brace on lung volumes and pulmonary compliance in mild adolescent idiopathic scoliosis

Potential genetic markers predicting the outcome of brace treatment in patients with adolescent idiopathic scoliosis

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