The Efficacy of Brace Treatment for Thoracolumbar Kyphosis in Patients With Achondroplasia

Xu, Leilei; Li, Yetian; Sheng, Fei; Xia, Chao; Qiu, Yong; Zhu, Zezhang

doi:10.1097/brs.0000000000002586

Cited by 14 publications

(18 citation statements)

References 15 publications

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“…Pauli et al developed treatment for those in whom more than a mild, fixed component of the kyphotic curve develops, using a modified thoracolumbosacral orthosis (TLSO) [17] . Similarly, in a retrospective evaluation, Xu et al showed that bracing initiated early enough in life may be effective in reversing kyphotic curves that otherwise might subsequently require surgery [21] . In individuals whose parents were not counseled on preventive strategies, or in whom prevention and bracing fails, surgery is appropriate [ 6 , 7 , 22 ].…”

Section: Discussionmentioning

confidence: 98%

Sagittal alignment at 3 years old determines future thoracolumbar kyphosis in achondroplasia: A prospective study with minimum 5-year follow-up from infancy

Ando

Kobayashi

Nakashima

et al. 2021

North American Spine Society Journal (NASSJ)

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Background:Little is known about the progression of Thoracolumbar kyphosis (TLK) in achondroplasia. The aim of the study was to evaluate natural progression of TLK and establish risk factors for progression. Methods:We reviewed 21 patients (11 males, 10 females) diagnosed clinically and radiographically with achondroplasia as infants and followed for a minimum of 5 years from infancy, and analyzed to compare differences between data at 0, 1, 3, 5, 7-10, and 11-18 years old. Subjects (n = 21) were divided into two groups with and without TLK > 20°at the thoracolumbar junction on lateral standing radiographs at age 3.Results: TLK > 20°occurs in 76.2% of infants in the first 7 months of life. Sagittal parameters at 0, 1, 3, 5, 7-10, and 11-18 years old differed significantly for cervical lordosis (CL), thoracic kyphosis (TK), TLK, lumbar lordosis (LL), pelvic tilt (PT), and sacral slope (SS). TK, LL, and SS increased significantly with increasing age, whereas CL, TLK, and PT were significantly lower in older age groups ( P < 0.05). In 6 of 7 patients with TLK > 20°at age 3, TLK had progressed or was still > 20°at age 5. The prevalence of TLK > 20°at age 3 was 33.3% (7/21). There was a significant difference in age at independent walking among subjects with and without TLK at age 3 (31.4 ± 17.1 vs. 16.1 ± 3.4 months, P < 0.01). Radiologic parameters associated with TLK showed significant differences between subjects with and without TLK at age 3, including TLK, TK, TLK, LL, and SVA at age 5; and TLK at ages 7-10 and 11-18.Conclusions: These results suggest that sagittal alignment at 3 years old determines future TLK in achondroplasia. Progression of deformity and neurological impairments require consideration in treatment planning.

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Section: Discussionmentioning

confidence: 98%

Sagittal alignment at 3 years old determines future thoracolumbar kyphosis in achondroplasia: A prospective study with minimum 5-year follow-up from infancy

Ando

Kobayashi

Nakashima

et al. 2021

North American Spine Society Journal (NASSJ)

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“…В случаях, когда не наблюдается спонтанной регрессии деформации и возрастает риск ее прогрессирования, ортопеды часто прибегают к назначению корсетов, что зачастую оправданно и приводит к положительному результату [7,15,16]. Как и при любом другом виде лечения, при назначении корсета врач должен максимально объективно оценивать возможные исходы, опираясь на клинические и рентгенологические параметры, однако только в одном исследовании авторы предприняли попытку определить оптимальные показания для использования корсета на основании статистического анализа [16]. Не вызывает сомнения, что оценка клинических и рентгенологических параметров, влияющих на результат корсетного лечения, позволит более обоснованно назначать лечение в каждом конкретном случае, а при неблагоприятных прогностических признаках отбирать пациентов для оперативного лече-ния, не дожидаясь прогрессирования деформации.…”

Section: Discussionunclassified

Thoracolumbar kyphosis in achondroplasia: literature review

Koganova

Pershin

2020

Hir. pozvonoč.

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Objective. To detect and summarize the existing data on the prevalence, diagnostic methods, prevention and treatment strategies of the thoracolumbar kyphotic deformities in patients with achondroplasia.Material and Methods. Study design: literature review. The literature search was conducted in electronic databases: PubMed, CrossRef, Google Scholar and eLIBRARY.ru. The review includes articles in English and Russian languages. There were no limitations regarding the level of evidence and the year of publication.Results. The selected 22 articles included 13 retrospective studies and 9 case reports. After dividing all studies into categories related to methods of diagnosis, prevention and treatment of thoracolumbar kyphosis, the following results were obtained: the definition of the border between the norm and pathology was reported only in two articles, and the prevalence rates could be counted based on the data of four articles. The identification of risk factors for the progression of deformity based on statistical analysis was presented in two articles. Three articles were devoted, among others, to the risk of neurological deficit. The description of brace treatment was found in four studies, and six retrospective studies and all selected case reports described surgical treatment. Conclusion.There are very few publications devoted to the problem of thoracolumbar kyphosis in achondroplasia, despite possible poor prognosis of such deformities. Further research should be aimed at searching a consensus among experts in all issues concerning this type of deformity, from prevention to surgical correction of this pathology.

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“…Borkhuu et al reported that progressive curves were significantly associated with developmental motor delay (walkers after 24 months compared to 18 months), apical vertebral wedging and apical vertebral translation. Bracing with thoraco-lumbar-sacral orthoses (TLSOs) has been used in this population and is commonly employed in persistent deformity [31]. Unsupported sitting is discouraged to eliminate anterior vertebral body compression [31].…”

Section: Medical Managementmentioning

confidence: 99%

“…Bracing with thoraco-lumbar-sacral orthoses (TLSOs) has been used in this population and is commonly employed in persistent deformity [31]. Unsupported sitting is discouraged to eliminate anterior vertebral body compression [31]. To minimize the likelihood of vertebral body wedging, anticipatory guidance regarding posture in the care of these infants is recommended in early infancy [32].…”

Section: Medical Managementmentioning

confidence: 99%

Best practice guidelines for management of spinal disorders in skeletal dysplasia

White

Bober

Cho

et al. 2020

Orphanet J Rare Dis

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Background: Disorders of the spine present a common and difficult management concern in patients with skeletal dysplasia. Due to the rarity of these conditions however, the literature, largely consisting of small, single institution case series, is sparse in regard to well-designed studies to support clinical decision making in these situations. Methods: Using the Delphi method, an international, multidisciplinary group of individuals, with significant experience in the care of patients with skeletal dysplasia, convened to develop multidisciplinary , "best practice" guidelines in the care of spinal disorders in patients with skeletal dysplasia. Results: Starting with 33 statements, the group a developed a list of 31 "best practice" guidelines. Conclusions: The guidelines are presented and discussed to provide context for clinicians in their decision making in this often-challenging realm of care.

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The Efficacy of Brace Treatment for Thoracolumbar Kyphosis in Patients With Achondroplasia

Abstract: 4.

Cited by 14 publications

References 15 publications

Sagittal alignment at 3 years old determines future thoracolumbar kyphosis in achondroplasia: A prospective study with minimum 5-year follow-up from infancy

Sagittal alignment at 3 years old determines future thoracolumbar kyphosis in achondroplasia: A prospective study with minimum 5-year follow-up from infancy

Thoracolumbar kyphosis in achondroplasia: literature review

Best practice guidelines for management of spinal disorders in skeletal dysplasia

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