Effect of a thoracolumbosacral orthosis on lateral trunk shift in idiopathic scoliosis

The effect of the Wilmington brace on lateral trunk shift in adolescent idiopathic scoliosis was studied in 80 patients. With an average follow-up of 1 year 10 months after completion of brace treatment, improvement was seen in 58% of those patients with thoracic curves, 65% with thoracolumbar-lumbar curves, and 88% with double major curves. Lateral trunk shift decreased an average of 0.8 cm in patients with thoracic curves and 1.0 cm in patients with thoracolumbar-lumbar or double major curves. Improvement of existing lateral trunk shift was an additional consideration for instituting brace treatment in idiopathic scoliosis.     

Results of treatment of idiopathic scoliosis with the Charleston bending orthosis

The authors present a preliminary retrospective review of the treatment of 32 patients with idiopathic scoliosis with the Charleston bending thoracolumbosacral orthosis (TLSO), a new, low-profile spinal orthosis. At the onset of treatment, the patients' mean age was 12.5 years and the mean Risser stage was 0.4. Females achieved menarche at an mean of 1.8 months after starting orthotic treatment. Single structural curves were treated in all patients. At this time, 2 patients have failed treatment, their curves progressing 12 degrees and 8 degrees, respectively. An additional 11 patients have successfully completed treatment, having reached skeletal maturity with no more than 5 degrees of curve progression. Their mean curve change was a 2.2 degrees decrease. The other 19 patients remain under treatment. The Charleston bending TLSO is worn only during nighttime sleeping hours. It is well tolerated, with excellent patient compliance and low psychological stress, and it may be as successful at curve control as other orthoses. Experience with more patients and longer follow-up is needed.     

青少年特发性脊柱侧凸支具治疗研究分析

[目的]探讨胸腰骶支具治疗青少年特发性脊柱侧凸的临床疗效,为开展青少年特发性脊柱侧凸的筛查和临床治疗提供参考依据。[方法]对2004年10月~2012年2月在云南部分地区筛查中确诊为青少年特发性脊柱侧凸的132例患者进行Lenke分型,并予胸腰骶支具治疗,比较治疗前后Cobb角。[结果]Lenke1型治疗前后Cobb角平均减小9°,差异具有统计学意义(P0.05),Lenke3型治疗前后胸弯Cobb角平均减小5.2°,胸腰弯Cobb角平均减小6.4°,差异均具有统计学意义(P0.05),Lenke5型治疗前后Cobb角平均减小12.7°,差异具有统计学意义(P0.05),Lenke6型治疗前后胸弯Cobb角平均减小2.0°,胸腰弯Cobb角平均减小6.8°,差异没有统计学意义(P0.05)。[结论]12~16岁是青少年特发性脊柱侧凸重点普查对象,胸腰骶支具对减缓或阻止Lenke1型、Lenke3型和Lenke5型畸形具有显著作用,而对Lenke6型没有明显效果,支具治疗对阻止或减缓病情发展不受年龄、性别和分型的影响。     

Efficacy of a new computer-aided design/computer-aided manufacture orthosis in the treatment of adolescent idiopathic scoliosis

To report on the initial experience with the Los Angeles brace, a new computer-aided design/computer-aided manufacture brace used in the treatment of idiopathic scoliosis. This was a retrospective review of 40 idiopathic scoliosis patients who completed treatment with this new computer-aided design/computer-aided manufacture brace. In-brace correction averaged 51% for the primary curves, with corrections of 53 and 22% for girls and boys, respectively. Only six patients (15%) had curve progression at brace completion. This preliminary study suggests that the new Los Angeles brace is effective in the treatment of scoliosis in girls, while avoiding some obstacles involved in traditional bracing.     

Long-term follow-up of female patients with idiopathic scoliosis treated with the Wilmington orthosis

BACKGROUND: A spinal orthosis is commonly utilized in the nonoperative treatment of idiopathic scoliosis. The purpose of this study was to evaluate the long-term radiographic and functional outcomes of female patients with idiopathic scoliosis who had completed a program of treatment with the Wilmington thoracic-lumbar spinal orthosis. METHODS: We retrospectively reviewed the clinical records and radiographs of all female patients who had successfully completed a course of treatment with the orthosis between 1973 and 1983. Ninety-one patients met the criteria for inclusion, and fifty-five women returned for a follow-up evaluation. Their mean age was thirty-one years at the time of follow-up, which was carried out at a mean of 14.6 years after the completion of treatment. The patients were evaluated clinically and radiographically, and they each completed a comprehensive questionnaire assessing their ability to perform twenty-six activities of daily living, their overall physical appearance, the cosmetic appearance of the back, their self-image, and the severity of any back pain. The questionnaire was also administered to a control group of fifty-five women without scoliosis matched for age, number of children, and occupation. RESULTS: Seven patients (13%) demonstrated >or=5 degrees of progression of the curve, compared with the curve at the start of treatment, after discontinuing use of the orthosis. No curve progressed >17 degrees compared with the deformity at the time of the initial treatment. There was no significant overall difference between the orthotic treatment group and the control group in terms of back pain, physical activities, functional activities (with the exception of shopping) or self-care activities. As a group, the patients reported significantly greater difficulty with selected positional activities (p = 0.007). Fifty-one (93%) of the fifty-five treated women reported no subjective deterioration in their physical appearance, the cosmetic appearance of the back, or their self-image in the period since they discontinued using the brace. CONCLUSIONS: The majority of patients who successfully complete treatment with a Wilmington thoracic-lumbar spinal orthosis for idiopathic scoliosis with an initial magnitude of between 20 degrees and 45 degrees can anticipate that the curve will remain stable into middle adulthood. Any apparent correction of the curve that occurs during treatment can be expected to be lost over time, resulting in a deformity that is equal or nearly equal in magnitude to that measured at the initiation of the orthotic management. Because some patients did demonstrate some progression of the curve by the third or fourth decade of life, it is reasonable to recommend a spinal radiograph during that time to monitor the status of the curve.     

Soft Boston orthosis in management of neuromuscular scoliosis: a preliminary report.

Collapsing neuromuscular spinal curvature is extremely difficult to manage with standard rigid orthoses owing to skin breakdown and patient intolerance. Experience with a new, more malleable type of spinal brace (the "soft Boston orthosis") has been very rewarding in 55 children with neuromuscular scoliosis with an average curvature of 42 degrees. Patient tolerance was improved in 38%, patient handling was facilitated in 68%, and postural positioning was enhanced in 79%. Although improvement in the scoliosis averaged only 15 degrees, the major advantage of this orthosis was a marked improvement in sitting stability in 80% of patients.     

Use of the Universal Clamp in adolescent idiopathic scoliosis

European Spine Journal - The Universal Clamp (UC) equipped with a soft sublaminar band is a relatively new thoracic anchor that can be used in hybrid constructs. A dedicated reduction tool that...     

Correlation between quantity and quality of orthosis wear and treatment outcomes in adolescent idiopathic scoliosis

Orthotic treatment is the most commonly used non-surgical treatment method for adolescent idiopathic scoliosis (AIS). This study determined whether treatment outcome correlates with how often and how well children with AIS wear their orthoses. Eighteen (18) subjects (3M, 15F) who were diagnosed with idiopathic scoliosis and had worn their orthoses from 6 months up to 1 year participated in this study. All subjects were prescribed Boston braces to be worn full time (23 hrs/day). Twelve (12) subjects who completed their brace treatment were included in the data analysis. Three (3) treatment outcomes were classified as improvement, no change and deterioration. The quality of the brace wear was assessed by how often the brace was worn with zero force, below 80%, between 80 to 120%, and above 120% of the load level prescribed in the clinic. The quantity of brace wear was determined by how many hours per day they wore their brace. Subjects who wear their braces tighter and for more hours per day seem to have better outcomes.     

Adolescent idiopathic scoliosis: modern management guidelines

Adolescent idiopathic scoliosis (AIS), a structural lateral curvature of the spine of uncertain etiology, is the most common cause of spinal deformity in adolescents. In its most severe form, AIS is characterized by progressive spinal curvature that may lead to a permanent deformity. Thus, the goal of treatment is early detection and prevention of progression. This article provides a review of general spinal anatomy relevant to AIS and its etiology, describes several proposed methods of classifying curves in AIS, delineates the natural history of AIS, and discusses the nonoperative and operative treatment options.     

Pre-and postoperative psychological characteristics in mothers of patients with idiopathic scoliosis

The purpose of the present study was to clarify changes in the psychological state of mothers of patients with idiopathic scoliosis, and to clarify relationships between the psychological states of the mothers and patients. The Maudsley personality inventory (MPI) was administered to 30 patients with idiopathic scoliosis who underwent surgery and their mothers preoperatively and at about 1 year postoperatively. We investigated the relationships between preoperative MPI scores and postoperative scores in patients and their mothers, respectively, and the relationships between MPI scores for patients and mothers. The results of the present study revealed that patients became more extroverted following surgery, while mothers displayed reduced neurotic tendencies. In conclusion, the mothers of patients who undergo corrective treatment for scoliosis may have experienced a substantial psychological burden before surgery, and doctors who treat patients with scoliosis should bear this point in mind.     

Delayed postoperative paralysis in adolescent idiopathic scoliosis: management with partial removal of hardware and staged correction

A delayed spinal epidural hematoma following scoliosis surgery is relatively uncommon but well recognized by clinical and radiographic findings. A 12-year-old girl with scoliosis measuring 80 degrees lower thoracic curve underwent anterior (T6-T12) and posterior fusion with posterior instrumentation from T2 to L1. She developed bilateral leg weakness and progressive left lower leg paralysis 24 hours later. Emergent decompression and partial removal of hardware was performed. Reinsertion of segmental instrumentation and correction of her curve was performed 2 weeks later. The patient had complete recovery of her neurologic deficits, and her correction was maintained at 85% at 4-months follow-up. The authors recognized that there should be no delay in returning the patient to surgery if neurological deficits are noticed. Exploration and decompression of "an occupying lesion" and release of cord tension by partial removal of hardware and re-instrument can achieve appropriate original correction of scoliosis and satisfactory clinical outcome.     

Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

Purpose:To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis.Methods:In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data.Results:The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73).Conclusion:High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis.Level of Evidence:III     

The management of progressive infantile idiopathic scoliosis.

Twenty-seven children with progressive infantile idiopathic scoliosis have been reviewed after long-term management. Twenty-two children had single thoracic curves which were diagnosed at an early age and treated in a modified Milwaukee brace until the age of ten years when the spine was corrected and fused. The mean correction after operation was 40 per cent of the initial degree of curvature seen in early childhood before treatment. Solid spinal fusion led to a further moderate loss in correction due to bending of the fusion mass before the spine became stable several years later. Five children had double structural curves and were treated only in a brace. This provided less satisfactory control of these curves but because of the minimal cosmetic deformity, extensive spinal fusion was avoided.     

青少年特发性脊柱侧凸术后住院时间延长的危险因素

青少年特发性脊柱侧凸(AIS)是一种常见的脊柱畸形,发生率为1.0％ ～ 5.2％[1-2].大部分AIS患者可以进行非手术治疗,对于畸形角度大、进展速度快的患者,则需要手术矫形[3].近年来,随着手术技术的发展和内固定器械的改良,越来越多的医师掌握了后路脊柱侧凸矫形技术,手术量迅速扩大,随之而来的是住院费用的增长.有...