Pulmonary restrictive effect of bracing in mild idiopathic scoliosis.

Abstract

The use ofbracing in the treatment ofmild idiopathic scoliosis is controversial. A study of 33 adolescents showed that bracing significantly decreased lung volumes. Functional residual capacity was reduced by a mean of 26%, 18% of children showing a reduction of greater than 40%. The mean reduction in total lung capacity was 16% and in forced vital capacity 18%. This restriction of lung function by bracing might have a deleterious effect on lung growth or might impose an additional risk factor in the presence ofother disorders, such as asthma and diaphragmatic weakness. The use of bracing in individuals with mild scoliosis should be judiciously reassessed. age was 13-3 years and the mean thoracic Cobb angle 290. In five children the thoracic curve had improved with bracing and at the time of testing was less than 20 degrees. The mean age of onset was 11 7 years (range 6-16 years) and the mean duration ofbracing 1 4 years (range I month-5 years). None of the patients had cardiopulmonary symptoms at the time of testing. Functional residual capacity (FRC) and total lung capacity (TLC) were measured in the sitting position by means of body plethysmography (Jaeger Bodyscreen 2) both with and without the brace. The order of testing-that is, whether the brace was on or offfor the first measurements was randomly selected to allow for a learning effect. All spirometric volumes were corrected to BTPS. The non-deformed height was taken as equal to arm span. In our laboratory the armspan:height ratio estimated from 2368 measurements of 8-18 year old subjects is close to unity (0999 (SD 0 023) for girls and 1 006 (0 022) for boys).The Milwaukee brace reduces lumbar lordosis with a polypropylene pelvic girdle and attempts to correct the thoracic curve with a metal vertical suprastructure on which are mounted pressure pads. The Boston bracing system also uses a polypropylene girdle, which, unlike the former, extends to enclose the lower thorax, again attempting to correct the spinal curve by means of pressure pads mounted on the inner surface, acting on the apices of the curve.Six children with a brace induced reduction in FRC of over 30% were further studied to assess the effect of bracing on oxygen saturation during sleep. Oxygen saturation was monitored overnight with a Nelcor pulse oximeter; studies were performed on two nights, one with and the other without the brace. 959

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

“…A first report [23] indicated a nonsignificant reduction of VC, whereas more recent ones [10,11,13,18,20] suggest that decreases in lung volumes are significant. Our results are in agreement with the latter findings, although, we noted a smaller reduction of lung volumes.…”

“…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. Many authors have described the influence of thoracic bracing on some lung function parameters using different types of braces [10,11,18,23]. The Boston brace is a widely used type, which affects not only the lung volumes, but also the elastic pulmonary behavior and rib cage-spine coupling [1].…”

“…In addition, the effects of bracing on lung volumes are unclear in the literature. In previous studies, most authors have reported significant lung volume reduction [10,11,18], whereas others have not found considerable changes in vital capacity (VC) [23].The purpose of our study was to measure the immediate effect of Boston brace treatment on lung volumes and Abstract 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.…”

Respiratory failure in the child

“…Produzem uma deficiência ventilatória restritiva com redução na capacidade vital e na capacidade pulmonar total. Clinicamente, isso pode ser expresso por modificações no padrão da respiração, com aumentos na freqüência respiratória e em volumes correntes subnormais 3,5,8,39 .…”

“…Nos casos de doença da parede torácica, insuficiência respiratória tipo II (hipercapnia) ocorre quando o trabalho de respiração excede a capacidade intrínseca normal dos músculos respiratórios em manter níveis adequados de ventilação. Nas doenças neuromusculares, a insuficiência respiratória tipo II resulta da incapacidade dos músculos respiratórios em manter um trabalho respiratório normal 3,5,8,39 .…”