Effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: results according to the SRS criteria for bracing studies - SOSORT Award 2009 Winner

Abstract

BackgroundThe SRS criteria give the methodological reference framework for the presentation of bracing results, while the SOSORT criteria give the clinical reference framework for an appropriate bracing treatment. The two have not been combined in a study until now. Our aim was to verify the efficacy of a complete, conservative treatment of Adolescent Idiopathic Scoliosis (AIS)according to the best methodological and management criteria defined in the literature.MethodsStudy Design. Retrospective study. Population. We included all AIS patients respecting the SRS inclusion criteria (age 10 years or older; Risser test 0-2; Cobb degrees 25-40°; no prior treatment; less than one year post-menarchal) who had reached the end of treatment since our institute database start in 2003. Thus we had 44 females and four males, with an age of 12.8 ± 1.6 at the commencement of the study. Methods. According to individual needs, two patients have been treated with Risser casts followed by Lyon brace, 40 with Lyon or SPoRT braces (14 for 23 hours per day, 23 for 21 h/d, and seven for 18 h/d at start), and two with exercises only (1 male, 1 female): these were excluded from further analysis. Outcome criteria. SRS (unchanged; worsened 6° or more; over 45° at the end of treatment; surgically treated; two years' follow-up); clinical (ATR, Aesthetic Index, plumbline distances); radiographic (Cobb degrees); and ISICO (optimal; minimal). Statistics. Paired ANOVA and t-test, Tukey-Kramer and chi-square test.ResultsMedian reported compliance during the 4.2 ± 1.4 treatment years was 90% (range 5-106%). No patient progressed beyond 45°, nor was any patient fused, and this remained true at the two-year follow-up for the 85% that reached it. Only two patients (4%) worsened, both with single thoracic curve, 25-30° Cobb and Risser 0 at the start. We found statistically significant reductions of the scoliosis curvatures (-7.1°): thoracic (-7.3°), thoracolumbar (-8.4°) and lumbar (-7.8°), but not double major. Statistically significant improvements have also been found for aesthetics and ATR.ConclusionRespecting also SOSORT management criteria and thus increasing compliance, the results of conservative treatment were much better than what had previously been reported in the literature using SRS criteria only.

Serial elongation, derotation and flexion (EDF) casting under general anesthesia and neuromuscular blocking drugs improve outcome in patients with juvenile scoliosis: preliminary results

“…In particular, Tolo and Gillespie [3] found 27.2 % of their patients treated with the Milwaukee brace needed surgery. Dabney and Browen [19], found the similar results with 33 % of surgery recommendations. Coillard et al in 2010 using a SpineCor orthosis reported 37.1 % of patients needed surgery [20].…”

“…Although good results can be achieved in patients with JS treated conservatively, there is no known conservative technique able to completely arrest curve progression and to erase the potential need for surgery for this patients population [16][17][18][19][20][21][22]. In particular, Tolo and Gillespie [3] found 27.2 % of their patients treated with the Milwaukee brace needed surgery.…”

Functional Disorders in the Spine Deformations and Methods for their Correction

“…Хорошие результаты лечения обеспечиваются при комплексном подходе [41] с использованием упражне-ний [42], ношением корсета [43] и, возможно, компла-ентностью пациента [44]. Вполне вероятно, что высо-кокачественное управление процессом лечения может компенсировать риски, коррелирующие с задержкой начала лечения [45].…”

A Review of Non-Invasive Treatment Interventions for Spinal Deformities

“…16 Braces such as the Cheneau, Sforzesco and others are used in continental Europe. 17 The TLSO is a custom molded back brace that applies three-point pressure to the curvature to prevent its progression. It can be worn under loose fitting clothing, and is usually worn 23 hours a day.…”