Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements

Négrini, Stefano; Negrini, Francesco; Fusco, Claudia; Zaina, Fabio

doi:10.1016/j.spinee.2010.12.001

Cited by 44 publications

(46 citation statements)

References 33 publications

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“…With respect to SRS-22 scores, the differences in self-image and satisfaction with treatment were significantly greater in our CST group than in our CE group. Our results are similar to those of Negrini et al, who reported increased satisfaction with treatment in SEAS groups at 4.10 ± 1.2 treatment years [27].…”

Section: Discussionsupporting

confidence: 92%

Effects of novel corrective spinal technique on adolescent idiopathic scoliosis as assessed by radiographic imaging

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Koh

et al. 2014

BMR

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Section: Discussionsupporting

confidence: 92%

Effects of novel corrective spinal technique on adolescent idiopathic scoliosis as assessed by radiographic imaging

Noh

You

Koh

et al. 2014

BMR

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“…All therapeutical choices were taken according to specific needs following a thorough clinical and radiographical evaluation, made by scoliosis experts, in agreement with the SOSORT guidelines [13]. The therapeutic approach has already been described in previous papers [14,15]; the therapy protocol was a full time prescription of brace wear at the beginning, (18 to 23 hours per day) decided by the specialist according to specific clinical needs of each patients and related to the main goal of the therapy shared by all the team members. Association with physiotherapeutic specific exercises was systematically prescribed to all patients and for the entire duration of treatment, SEAS exercises have to be updated every three months, then a regular exercise performance, at home or followed by a personal trainer, is required with at least two sessions per week (minimum 90 minutes per week).…”

Section: Methodsmentioning

confidence: 99%

In favour of the definition "adolescents with idiopathic scoliosis": juvenile and adolescent idiopathic scoliosis braced after ten years of age, do not show different end results. SOSORT award winner 2014

et al. 2014

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BackgroundThe most important factor discriminating juvenile (JIS) from adolescent idiopathic scoliosis (AIS) is the risk of deformity progression. Brace treatment can change natural history, even when risk of progression is high. The aim of this study was to compare the end of growth results of JIS subjects, treated after 10 years of age, with final results of AIS.MethodsDesign: prospective observational controlled cohort study nested in a prospective database. Setting: outpatient tertiary referral clinic specialized in conservative treatment of spinal deformities. Inclusion criteria: idiopathic scoliosis; European Risser 0–2; 25 degrees to 45 degrees Cobb; start treatment age: 10 years or more, never treated before. Exclusion criteria: secondary scoliosis, neurological etiology, prior treatment for scoliosis (brace or surgery). Groups: 27 patients met the inclusion criteria for the AJIS, (Juvenile Idiopathic Scoliosis treated in adolescence), demonstrated by an x-ray before 10 year of age, and treatment start after 10 years of age. AIS group included 45 adolescents with a diagnostic x-ray made after the threshold of age 10 years. Results at the end of growth were analysed; the threshold of 5 Cobb degree to define worsened, improved and stabilized curves was considered. Statistics: Mean and SD were used for descriptive statistics of clinical and radiographic changes. Relative Risk of failure (RR), Chi-square and T-test of all data was calculated to find differences among the two groups. 95% Confidence Interval (CI) , and of radiographic changes have been calculated.ResultsWe did not find any Cobb angle significant differences among groups at baseline and at the end of treatment. The only difference was in the number of patients progressed above 45 degrees, found in the JIS group. The RR of progression of AJIS was, 1.35 (IC95% 0.57-3.17) versus AIS, and it wasn't statistically significant in the AJIS group, in respect to AIS group (p = 0.5338).ConclusionThere are no significant differences in the final results of AIS and JIS, treated with total respect of the SRS and SOSORT criteria, in adolescence. Brace efficacy can neutralize the risk of progression.

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“…The association of polycarbonate and asymmetry through a digital cast allows an average hyper correction of 70% against 33% for most current braces [2]. The digital cast, the keystone of the hyper-correction is a transposition of the know-how of the correction by Abbott or EDF cast [3].…”

Section: Biomechanical Actions Can Be Obtainedmentioning

confidence: 99%

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2017

OPROJ

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OpinionRecent advances in surgery have masked conservative treatments to the point that many patients have no alternative. Below 40° braces are often prescribed to waiting for surgery. Over 40°, "only surgery can stabilize a scoliosis". There are many reasons for this: the rapidity and effectiveness of surgery, but above all, the lack of knowledge and training for the conservative treatment. Brace prescription is more a matter of local habits and possibilities than a precise objective. However, all braces are not identical and they require a better knowledge of biomechanics. Modern technology combining the very high rigidity of polycarbonate and the hypercorrection of asymmetrical braces can replace plaster casts, but not all orthotists are equipped and trained. 3D correction in sagittal plane and detorsion is possible, but evaluation by systems such as EOS remains limited in some countries. Before definitively blocking the spine under 40°, it is necessary to prescribe the most effective brace adapted to the situation. The effectiveness of the brace should be checked radiologically before payment. For scoliosis more than 40°, modern technologies can be a credible alternative for patients who wish to avoid surgery. Biomechanical actions can be obtaineda. Guide growth during night as the support of a tree. Almost all existing rigid braces achieve this goal.b. Adjust the ligament tensions along the spine. Only the asymmetric braces allow the "rope of the bow" to be stretched. The creep is maximal if the brace is worn full-time like a plaster at the beginning of treatment. 3. Reverse growth asymmetry at the apical vertebra when growth cartilage is still active. Only the hyper-correcting braces worn during the day make it possible to restore a rectangular vertebral body and to break the vicious circle of scoliosis during the growth period. The very high rigidity of the polycarbonate has proved its effectiveness to replace the plaster cast for scoliosis of more than 45° and thus stabilize without surgery [1].The association of polycarbonate and asymmetry through a digital cast allows an average hyper correction of 70% against 33% for most current braces [2]. The digital cast, the keystone of the hyper-correction is a transposition of the know-how of the correction by Abbott or EDF cast [3]. The corrections are made in the frontal plane and in the sagittal plane successively for the block of pelvis and shoulders, the lumbar block and the thoracic block. The correction in the horizontal plane is obtained automatically by the law of the coupled motions of the spine. The overlay of the 3 blocks produces a torso column or a circled helicoid with a horizontal generating circle, in the opposite direction to the scoliotic spine. However, digital cast requires a quite instantaneous scan because the child cannot maintain the asymmetrical position for more than a few seconds, which excludes all the low-cost scanners currently used.The very precise protocol of the digital cast facilitates the correction in the 3 planes of the spa...

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Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements

Cited by 44 publications

References 33 publications

Effects of novel corrective spinal technique on adolescent idiopathic scoliosis as assessed by radiographic imaging

Effects of novel corrective spinal technique on adolescent idiopathic scoliosis as assessed by radiographic imaging

In favour of the definition "adolescents with idiopathic scoliosis": juvenile and adolescent idiopathic scoliosis braced after ten years of age, do not show different end results. SOSORT award winner 2014

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