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Prestigiacomo FG, Hulsbosch MHHM, Bruls VEJ, Nieuwenhuis JJ. Intra- and inter-observer reliability of Cobb angle measurements in patients with adolescent idiopathic scoliosis. Spine Deform 2022; 10:79-86. [PMID: 34383285 DOI: 10.1007/s43390-021-00398-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 08/07/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The Cobb angle method is used to determine the severity of scoliosis. Therapeutic decisions for adolescent idiopathic scoliosis (AIS) are guided by the Cobb angle. Therefore, high reliability is crucial. The objective of this study was to determine the intra- and inter-observer reliability of the digital Cobb angle measurements and the definition of end vertebrae in patients with AIS. Moreover, the influence of the observer's medical specialty and experience on Cobb angle measurement was evaluated. METHODS Intra- and inter-observer reliability of the digital Cobb angle and end vertebrae is assessed in postero-anterior radiographs of 39 patients with AIS. Measurements were performed blinded and twice by six observers, with a two to 3 week interval. Intra- and inter-observer reliability was analysed by means of intraclass correlation coefficients (ICC). RESULTS Both intra- and inter-observer reliability analyses resulted in ICC's higher than 0.864 for the Cobb angle and definition of end vertebrae. In addition, for the observer's experience and medical specialty group the inter-observer ICC's were higher than 0.984. The average inter-observer variability for the Cobb angle were 3°, and 1.1-1.6 levels for the cranial and caudal end vertebrae selection. The variability in measured Cobb angle was 1° for the experience group and 2° for the medical specialty group. Cronbach's alpha varied from 0.990 to 0.996. Bland-Altman plots showed moderate variation with a few outliers. CONCLUSIONS The digital Cobb angle measurement as well as the definition of end vertebrae show excellent reliability. According to our results, medical specialty and experience do not affect Cobb angle measurements and definition of end vertebrae.
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Affiliation(s)
- F G Prestigiacomo
- Orthopaedic Department, VieCuri Medical Centre, Venlo, The Netherlands.
| | - M H H M Hulsbosch
- Orthopaedic Department, VieCuri Medical Centre, Venlo, The Netherlands
| | - V E J Bruls
- Orthopaedic Department, VieCuri Medical Centre, Venlo, The Netherlands
| | - J J Nieuwenhuis
- Orthopaedic Department, VieCuri Medical Centre, Venlo, The Netherlands
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Sung PS, Park MS. Lumbar spine coordination during axial trunk rotation in adolescents with and without right thoracic idiopathic scoliosis. Hum Mov Sci 2020; 73:102680. [PMID: 32920294 DOI: 10.1016/j.humov.2020.102680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/10/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
Adolescent idiopathic scoliosis (AIS) is a complex deformity that often leads to loss of coordination and dynamic posture. However, there is a lack of understanding on inter-segmental coordination in AIS. The purpose of this study was to compare spinal range of motion (ROM), as well as the relations to coupling angles (CA) in the spinal region during trunk rotation, between AIS and control subjects. There were 14 subjects with right thoracic AIS and 18 control subjects who participated in the study. All subjects were asked to perform five repeated axial trunk rotations in standing while holding a bar. The outcome measures included ROM at the first thoracic spinous process (T1), the seventh thoracic spinous process (T7), the twelfth thoracic spinous process (T12), and the first sacrum spinous tubercle (S1) by the motion capture system. The CA in each spinal region (trunk, lumbar spine, and lower and upper thoraces) were analyzed while considering age and body mass index (BMI). The Cobb angle demonstrated positive moderate relationships with ROM at T7 (r = 0.62, p = 0.04) and the CA in the upper thorax (r = 0.69, p = 0.02) in the AIS group. There was no CA difference at the spinous processes between groups; however, the lumbar spine ROM significantly decreased in the AIS group (t = 2.40, p = 0.02). The BMI demonstrated moderate relationships on the lumbar spine (r = -0.67, p = 0.02) in the AIS group and the lower thorax (r = 0.59, p = 0.01) in the control group. The lumbar spine was significantly dissociated in the AIS group during trunk rotation, although the Cobb angle demonstrated positive relationships with ROM at T7. Collectively, the inter-segmental CA indicated that the AIS group compensated more independently to the right thoracic convexity. MINI ABSTRACT: The coordinated trunk rotations in the adolescent idiopathic scoliosis (AIS) group were compared with the control subjects. The lumbar spine motion was dissociated with the thorax in the AIS group and was negatively correlated with body mass index. Clinicians need to consider thorax convexity and dissociated lumbar motion for compensatory and rehabilitation strategies.
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Affiliation(s)
- Paul S Sung
- Department of Physical Therapy/Motion Analysis Center, Herbert H. and Grace A. Dow College of Health Professions, Central Michigan University, Health Professions Building 1220, Mt. Pleasant, MI 48859, United States of America.
| | - Moon Soo Park
- Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Medical College of Hallym University, 22 beon-gil, Gwanpyeong-ro170, Dongan-gu, Anyang-si, Gyeonggi-do 14068, Republic of Korea
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Zaborowska-Sapeta K, Giżewski T, Binkiewicz-Glińska A, Kamelska-Sadowska AM, Kowalski IM. The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2019; 53:61-67. [PMID: 30459102 PMCID: PMC6424669 DOI: 10.1016/j.aott.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/01/2018] [Accepted: 10/08/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the loss of truncal rotation over 54 hours after removing Chêneau brace. METHODS The studied groups consisted of 39 girls aged 10-18 years old, diagnosed with adolescent idiopathic scoliosis (AIS) and treated with Chêneau brace (CAST) and 20 AIS girls aged 10-18 years old, not treated with bracing. Posterior-anterior radiographs were obtained from the clinical assessment of all subjects and were subsequently used to determine Cobb angles. The measurements of the angle of trunk rotation (ATR) were taken with the Scoliometer® and back-contour device during Adams forward bending test by the two evaluators. The changes in ATRs during 54 hours of observation were performed after the brace had been taken off (0, 2, 24, 30, 48 and 54 hours after debracing). This was described using VATR variable, defined as the change in the absolute Scoliometer® readings in the time intervals against the time interval Δt between the measurements. During back-contour assessment the differential factor (kra) has been used for the digital analysis. The changes in kra over 54 hours of observation were expressed as Vkra factor, defined as the difference in the absolute value of the amplitude differential factor (kra) in the time intervals against the time interval Δt between the measurements. RESULTS The highest changes were observed in the thoracic as well as in lumbar spine in patients with Cobb angle ≥30°, axial rotation of the apical vertebrae within 5-15°, Risser sign 0-2. The biggest change in the trunk rotation after Chêneau brace had been taken off was noted within the first two hours of observation. CONCLUSION The patients should be advised to take the brace off for a minimum of two hours before the scheduled x-ray, to allow full relaxation of the trunk in order to obtain reliable radiological images of the deformation. LEVEL OF EVIDENCE Level III Therapeutic study.
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Affiliation(s)
| | - Tomasz Giżewski
- Department of Material Science and Metallurgy, University of Cambridge, Cambridge, United Kingdom
| | | | - Anna M Kamelska-Sadowska
- Clinic of Rehabilitation, Provincial Specialist Children's Hospital in Olsztyn, Olsztyn, Poland.
| | - Ireneusz M Kowalski
- Department of Rehabilitation, University of Warmia and Mazury, Olsztyn, Poland; Clinic of Rehabilitation, Provincial Specialist Children's Hospital in Olsztyn, Olsztyn, Poland
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Larson JE, Meyer MA, Boody B, Sarwark JF. Evaluation of angle trunk rotation measurements to improve quality and safety in the management of adolescent idiopathic scoliosis. J Orthop 2018; 15:563-565. [PMID: 29881194 DOI: 10.1016/j.jor.2018.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/06/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose The evaluation, management and follow-up of adolescent idiopathic scoliosis (AIS) occur frequently within a pediatric orthopedic surgery practice. Curve status can be assessed with Scoliometer measurements of angle trunk rotation (ATR), which are reliable and reproducible to within 3°. This study assessed the longitudinal efficacy, safety and cost savings of integrating ATR measurements to monitor curve status and progression in AIS, and suggests a quality-based management strategy. Methods A retrospective review of medical records between 2004 and 2014 included patients with AIS between 10-17 years, excluding those with Cobb angle >52° at presentation. Two cohorts were analyzed based on presentation prior to menarche (PRE) or after menarche (POST). The PRE groups was further classified based on whether the curve was Stable or Unstable. The cost of a single PA thoracolumbar radiograph was defined based on the 2015 CMS fee schedule ($36.27). Safety was defined based on the effective radiation dose avoided (0.14 millisieverts/radiograph). Results A total of 59 children were included with 45 in PRE and 14 in the POST cohort. The use of ATR measurements provided a cost benefit in both the PRE Stable and Unstable cohorts, by avoiding radiographs with an average savings of $161.76 and $147.50 respectively. Similarly in POST, there was an average cost savings of $105.18 per patient. The safety benefit of using ATR measurements included avoiding an average of 0.62, 0.56 and 0.4 millisieverts of radiation in the PRE Stable, PRE Unstable and POST groups respectively. Conclusions An evaluation strategy with ATR measurements provides for a reliable, cost-effective and safety advantage in the monitoring of curve progression in both skeletally mature and immature patients with AIS. These findings suggest that stable ATR measurements are a safe and cost effective alternative to serial radiographs in the clinical monitoring of AIS. Recent evidence from 25 years of scoliosis treatment in Denmark noted a cancer rate 17 times that of an age-matched population. Thus, reducing radiation exposure during scoliosis monitoring using ATR measurements has important clinical significance for cancer risk reduction.
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Affiliation(s)
- Jill E Larson
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States
| | - Maximilian A Meyer
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Barrett Boody
- Department of Orthopaedic Surgery, The Rothman Institute, Philadelphia, PA, United States
| | - John F Sarwark
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital, Chicago, IL, United States
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Negrini S, Minozzi S, Bettany‐Saltikov J, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Zaina F. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2015; 2015:CD006850. [PMID: 26086959 PMCID: PMC10616811 DOI: 10.1002/14651858.cd006850.pub3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Idiopathic scoliosis is a three-dimensional deformity of the spine. The most common form is diagnosed in adolescence. While adolescent idiopathic scoliosis (AIS) can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. OBJECTIVES To evaluate the efficacy of bracing for adolescents with AIS versus no treatment or other treatments, on quality of life, disability, pulmonary disorders, progression of the curve, and psychological and cosmetic issues. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE, five other databases, and two trials registers up to February 2015 for relevant clinical trials. We also checked the reference lists of relevant articles and conducted an extensive handsearch of grey literature. SELECTION CRITERIA Randomized controlled trials (RCTs) and prospective controlled cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces for adolescent with AIS. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included seven studies (662 participants). Five were planned as RCTs and two as prospective controlled trials. One RCT failed completely, another was continued as an observational study, reporting also the results of the participants that had been randomized.There was very low quality evidence from one small RCT (111 participants) that quality of life (QoL) during treatment did not differ significantly between rigid bracing and observation (mean difference (MD) -2.10, 95% confidence interval (CI) -7.69 to 3.49). There was very low quality evidence from a subgroup of 77 adolescents from one prospective cohort study showing that QoL, back pain, psychological, and cosmetic issues did not differ significantly between rigid bracing and observation in the long term (16 years).Results of the secondary outcomes showed that there was low quality evidence that rigid bracing compared with observation significantly increased the success rate in 20° to 40° curves at two years' follow-up (one RCT, 116 participants; risk ratio (RR) 1.79, 95% CI 1.29 to 2.50). There was low quality evidence that elastic bracing increased the success rate in 15° to 30° curves at three years' follow-up (one RCT, 47 participants; RR 1.88, 95% CI 1.11 to 3.20).There is very low quality evidence from two prospective cohort studies with a control group that rigid bracing increases the success rate (curves not evolving to 50° or above) at two years' follow-up (one study, 242 participants; RR 1.50, 95% CI 1.19 to 1.89) and at three years' follow-up (one study, 240 participants; RR 1.75, 95% CI 1.42 to 2.16). There was very low quality evidence from a prospective cohort study (57 participants) that very rigid bracing increased the success rate (no progression of 5° or more, fusion, or waiting list for fusion) in adolescents with high degree curves (above 45°) (one study, 57 adolescents; RR 1.79, 95% CI 1.04 to 3.07 in the intention-to-treat (ITT) analysis).There was low quality evidence from one RCT that a rigid brace was more successful than an elastic brace at curbing curve progression when measured in Cobb degrees in low degree curves (20° to 30°), with no significant differences between the two groups in the subjective perception of daily difficulties associated with wearing the brace (43 girls; risk of success at four years' follow-up: RR 1.40, 1.03 to 1.89). Finally, there was very low quality evidence from one RCT (12 participants) that a rigid brace with a pad pressure control system is no better than a standard brace in reducing the risk of progression.Only one prospective cohort study (236 participants) assessed adverse events: neither the percentage of adolescents with any adverse event (RR 1.27, 95% CI 0.96 to 1.67) nor the percentage of adolescents reporting back pain, the most common adverse event, were different between the groups (RR 0.72, 95% CI 0.47 to 1.10). AUTHORS' CONCLUSIONS Due to the important clinical differences among the studies, it was not possible to perform a meta-analysis. Two studies showed that bracing did not change QoL during treatment (low quality), and QoL, back pain, and psychological and cosmetic issues in the long term (16 years) (very low quality). All included papers consistently showed that bracing prevented curve progression (secondary outcome). However, due to the strength of evidence (from low to very low quality), further research is very likely to have an impact on our confidence in the estimate of effect. The high rate of failure of RCTs demonstrates the huge difficulties in performing RCTs in a field where parents reject randomization of their children. This challenge may prevent us from seeing increases in the quality of the evidence over time. Other designs need to be implemented and included in future reviews, including 'expertise-based' trials, prospective controlled cohort studies, prospective studies conducted according to pre-defined criteria such as the Scoliosis Research Society (SRS) and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria. Future studies should increase their focus on participant outcomes, adverse effects, methods to increase compliance, and usefulness of physiotherapeutic scoliosis specific exercises added to bracing.
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Affiliation(s)
- Stefano Negrini
- University of Brescia ‐ IRCCS Fondazione Don Gnocchi MilanPhysical and Rehabilitation MedicineViale EuropaBresciaItaly25121
| | - Silvia Minozzi
- Lazio Regional Health ServiceDepartment of EpidemiologyVia di Santa Costanza, 53RomeItaly00198
| | - Josette Bettany‐Saltikov
- University of TeessideSchool of Health and Social CareVictoria RoadMiddlesbroughClevelandUKTS13BA
| | | | - Theodoros B. Grivas
- "Tzanio" General Hospital of PiraeusDepartment of Trauma and OrthopaedicsPiraeusAtticaGreece18536
| | - Tomasz Kotwicki
- University of Medical SciencesDepartment of Pediatric Orthopedics and Traumatologyul. 28 Czerwca 1956 nr 135PoznanPoland61‐545
| | - Toru Maruyama
- Saitama Medical UniversityDepartment of Orthopaedic Surgery1981 KamodaKawagoeSaitamaJapan350‐8550
| | - Michele Romano
- ISICO (Italian Scientific Spine Institute)Via Roberto Bellarmino 13/1MilanItaly20141
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute)Via Roberto Bellarmino 13/1MilanItaly20141
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De Korvin G, Randriaminahisoa T, Cugy E, Cheze L, de Sèze M. Detection of progressive idiopathic scoliosis during growth using back surface topography: A prospective study of 100 patients. Ann Phys Rehabil Med 2014; 57:629-39. [DOI: 10.1016/j.rehab.2014.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 09/03/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
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Weiss HR, Werkmann M. Soft braces in the treatment of Adolescent Idiopathic Scoliosis (AIS) - Review of the literature and description of a new approach. SCOLIOSIS 2012; 7:11. [PMID: 22640574 PMCID: PMC3479417 DOI: 10.1186/1748-7161-7-11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 04/23/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND The use of soft braces to treat scoliosis has been described by Fischer as early as 1876. With the help of elastic straps, as the authors suggested, a corrective movement for individual curve patterns should be maintained in order to inhibit curve progression. Today this concept has been revived besides soft 3 point pressure systems. Some shortcomings have been revealed in literature in comparison with hard braces, however the concept of improving quality of life of a patient while under brace treatment should furtherly be considered as valuable. Purpose of this review is to gather the body of evidence existent for the use of soft braces and to present recent developments. METHOD A review of literature as available on Pub Med was performed using the key words 'scoliosis' and 'soft brace' at first. The search was expanded using 'scoliosis' and the known trademarks (1) 'scoliosis' and 'SpineCor', (2) 'scoliosis' and 'TriaC', (3) 'scoliosis' and 'St. Etienne brace', (4) 'scoliosis' and 'Olympe'. The papers considered for inclusion were new technical descriptions, preliminary results, cohort studies and controlled studies. RESULTS When searching for the terms 'scoliosis' and 'SpineCor': 20 papers have been found, most of them investigating a soft brace, for 'scoliosis' and 'TriaC': 7 papers displayed, for 'scoliosis' and 'St. Etienne brace': one paper displayed but not meeting the topic and for 'scoliosis' and 'Olympe': No paper displayed. Four papers found on the SpineCor™ were of prospective controlled or prospective randomized design. These papers partly presented contradictory results. Two papers were on soft Boston braces used in patients with neuromuscular scoliosis. DISCUSSION There is a small but consistent body of evidence for the use of soft braces in the treatment of scoliosis. Contradictory results have been published for samples treated during the pubertal growth spurt. In a biomechanical analysis the reason for the lack of effectiveness during this period has been elaborated. Improved materials and the implementation of corrective movements respecting also the sagittal correction of the scoliotic spine will hopefully contribute to an improvement of the results achievable. CONCLUSIONS The treatment of scoliosis using soft braces is supported by some papers providing a small body of evidence. During the growth spurt the use of soft braces is discussed contradictory. There is insufficient evidence to draw definite conclusions about effectiveness and safety of the intervention.
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Affiliation(s)
- Hans-Rudolf Weiss
- Orthopedic Rehabilitation Services, Alzeyerstr. 23, Gensingen, D-55457, Germany
| | - Mario Werkmann
- Orthomed Scolicare, Orthopedic Technical Services, Alzeyerstr. 23, Gensingen, D-55457, Germany
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Caufriez M, Fernández-Domínguez JC, Brynhildsvoll N. Estudio preliminar sobre la acción de la gimnasia hipopresiva en el tratamiento de la escoliosis idiopática. ENFERMERIA CLINICA 2011; 21:354-8. [DOI: 10.1016/j.enfcli.2011.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 05/23/2011] [Accepted: 06/14/2011] [Indexed: 11/29/2022]
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Negrini S, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Vasiliadis ES. Cochrane Review: Braces for idiopathic scoliosis in adolescents. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/ebch.620] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace. J Child Orthop 2010; 4:211-8. [PMID: 21629374 PMCID: PMC2866847 DOI: 10.1007/s11832-010-0249-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2010] [Accepted: 02/25/2010] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Dynamic SpineCor was designed to overcome the disadvantages of rigid orthoses-bulkiness, physical constraint and warming-and to improve the acceptance and compliance as limiting factors of brace treatment. Those theoretical benefits have not been proved by compliance studies yet. METHODS SpineCor braces of 12 adolescent scoliotic girls were equipped with flexible temperature loggers, which were sandwiched between gel foam and the brace's pelvic base. Patients and parents were blinded for the observation period of 14 days and gave post-hoc consent. The logger yielded 672 time-stamped values at 30-min intervals. Pilot testing revealed values beyond the 30°C threshold as indicative for brace wear. RESULTS The average overall compliance (% wearing hours/prescribed 23 h) was 54% ± 22.3 (range, 11.8-95.8%). The youngest patients (aged 10-12 years) were significantly more compliant than the others (P < 0.05). Most patients had a scattered wearing pattern: one was a day-wearer, one a night-wearer and only the two high adherers showed a consistent daily pattern. There was no significant difference between weekdays, weekdays and weekends, nor between day and night wear. CONCLUSION The current study showed that the compliance of patients in a dynamic SpineCor is as limited as in a conventional brace. This is in line with earlier data on patients' SpineCor and rigid brace acceptance evaluated by a questionnaire and on temperature logging in rigid braces.
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Hasler C, Schmid C, Enggist A, Neuhaus C, Erb T. No effect of osteopathic treatment on trunk morphology and spine flexibility in young women with adolescent idiopathic scoliosis. J Child Orthop 2010; 4:219-26. [PMID: 21629373 PMCID: PMC2866846 DOI: 10.1007/s11832-010-0258-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Accepted: 03/31/2010] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Brace treatment is the gold standard for patients with mild adolescent idiopathic scoliosis (Cobb angle 20°-40°). However, negative psychosocial impacts, physical constraints and incompliance cause many patients and parents to seek for so-called holistic and apparently less harmful approaches within the field of complementary and alternative medicine (CAM). Osteopathy-manual interventions on the viscera and locomotor system-is widely used for scoliosis. There is, however, a complete lack of evidence regarding its efficacy. We, therefore, tested the hypothesis that osteopathy alters trunk morphology, a prerequisite to unload the concave side of the scoliosis, and that it halts curve progression. METHODS This was a prospective, controlled trial of 20 post-pubertal young women (20°-40° idiopathic scoliosis) randomly allocated to an observation (group 0) or osteopathic treatment (group 1). The latter comprised three sessions (5 weeks). Trunk morphology (clinical examination, video rasterstereography) and spine flexibility (MediMouse(®)) were assessed at a pre- and post-intervention with a 3-month interval (blinded examiner). We chose scoliometer measurement (rib hump, lumbar prominence) as the main outcome parameter. RESULTS Two patients in the treatment group refused further treatment and the final examination, as they felt no benefit after two osteopathic treatments. Regression analysis for repeat measurements (independent statistician) revealed no therapeutic effect on rib hump, lumbar prominence, plumb line, sagittal profile and global spinal flexibility. CONCLUSIONS We found no evidence to support osteopathy in the treatment of mild adolescent idiopathic scoliosis. Therefore, we caution against abandoning the conventional standard of care for mild idiopathic scoliosis. As for other CAM therapies, the use of osteopathy as a treatment option for scoliosis still needs to be clearly defined.
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Affiliation(s)
- Carol Hasler
- />Orthopaedic Department, University Children’s Hospital, Roemergasse 8, 4005 Basel, Switzerland
| | - Caius Schmid
- />Corpo Sana, Training and Therapy, Münchensteinerstrasse 220, 4053 Basel, Switzerland
| | - Andreas Enggist
- />Enggist Medical Fitness, Bahnhofstrasse 43, 9470 Buchs, Switzerland
| | - Conny Neuhaus
- />Division of Physiotherapy, University Children’s Hospital, Roemergasse 8, 4005 Basel, Switzerland
| | - Thomas Erb
- />Division of Anaesthesiology, University Children’s Hospital, Roemergasse 8, 4005 Basel, Switzerland
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Negrini S, Minozzi S, Bettany-Saltikov J, Zaina F, Chockalingam N, Grivas TB, Kotwicki T, Maruyama T, Romano M, Vasiliadis ES. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst Rev 2010:CD006850. [PMID: 20091609 DOI: 10.1002/14651858.cd006850.pub2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional deformity of the spine. While AIS can progress during growth and cause a surface deformity, it is usually not symptomatic. However, in adulthood, if the final spinal curvature surpasses a certain critical threshold, the risk of health problems and curve progression is increased. Braces are traditionally recommended to stop curvature progression in some countries and criticized in others. They generally need to be worn full time, with treatment extending over years. OBJECTIVES To evaluate the efficacy of bracing in adolescent patients with AIS. SEARCH STRATEGY The following databases (up to July 2008) were searched with no language limitations: the Cochrane Central Register of Controlled Trials, MEDLINE (from January 1966), EMBASE (from January 1980), CINHAL (from January 1982) and reference lists of articles. An extensive handsearch of the grey literature was also conducted. SELECTION CRITERIA Randomised controlled trials and prospective cohort studies comparing braces with no treatment, other treatment, surgery, and different types of braces. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS We included two studies. There was very low quality evidence from one prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth (success rate 74% (95% CI: 52% to 84%)), better than observation (success rate 34% (95% CI:16% to 49%)) and electrical stimulation (success rate 33% (95% CI:12% to 60%)). There is low quality evidence from one RCT with 43 girls that a rigid brace is more successful than an elastic one (SpineCor) at curbing curve progression when measured in Cobb degrees, but there were no significant differences between the two groups in the subjective perception of daily difficulties associated with wearing the brace. AUTHORS' CONCLUSIONS There is very low quality evidence in favour of using braces, making generalization very difficult. Further research could change the actual results and our confidence in them; in the meantime, patients' choices should be informed by multidisciplinary discussion. Future research should focus on short and long-term patient-centred outcomes, in addition to measures such as Cobb angles. RCTs and prospective cohort studies should follow both the Scoliosis Resarch Society (SRS) and Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) criteria for bracing studies.
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Affiliation(s)
- Stefano Negrini
- ISICO (Italian Scientific Spine Institute), Via Roberto Bellarmino 13/1, Milan, Italy, 20141
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Vestibular asymmetry as the cause of idiopathic scoliosis: a possible answer from Xenopus. J Neurosci 2009; 29:12477-83. [PMID: 19812323 DOI: 10.1523/jneurosci.2583-09.2009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Human idiopathic scoliosis is characterized by severe deformations of the spine and skeleton. The occurrence of vestibular-related deficits in these patients is well established but it is unclear whether a vestibular pathology is the common cause for the scoliotic syndrome and the gaze/posture deficits or if the latter behavioral deficits are a consequence of the scoliotic deformations. A possible vestibular origin was tested in the frog Xenopus laevis by unilateral removal of the labyrinthine endorgans at larval stages. After metamorphosis into young adult frogs, X-ray images and three-dimensional reconstructed micro-computer tomographic scans of the skeleton showed deformations similar to those of scoliotic patients. The skeletal distortions consisted of a curvature of the spine in the frontal and sagittal plane, a transverse rotation along the body axis and substantial deformations of all vertebrae. In terrestrial vertebrates, the initial postural syndrome after unilateral labyrinthectomy recovers over time and requires body weight-supporting limb proprioceptive information. In an aquatic environment, however, this information is absent. Hence, the lesion-induced asymmetric activity in descending spinal pathways and the resulting asymmetric muscular tonus persists. As a consequence the mostly cartilaginous skeleton of the frog tadpoles progressively deforms. Lack of limb proprioceptive signals in an aquatic environment is thus the element, which links the Xenopus model with human scoliosis because a comparable situation occurs during gestation in utero. A permanently imbalanced activity in descending locomotor/posture control pathways might be the common origin for the observed structural and behavioral deficits in humans as in the different animal models of scoliosis.
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Grivas TB, Vasiliadis ES, Polyzois VD, Mouzakis V. Trunk asymmetry and handedness in 8245 school children. ACTA ACUST UNITED AC 2009; 9:259-66. [PMID: 17050403 DOI: 10.1080/10428190500343027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this report is the appraisal of a possible correlation of trunk asymmetry assessed with a scoliometer and lateralization of the brain as expressed by handedness in a school aged population. Many (8245) students (4173 girls and 4072 boys), 6-18 years of age were examined. A checklist was completed for each student including handedness and trunk asymmetry. The standing forward bending test was performed using the Pruijs scoliometer and the examined children were divided into three groups for each of the three examined regions (mid-thoracic, thoracolumbar and lumbar) according to the recorded asymmetry (no asymmetry, 2-7 degrees and > or =7 degrees ). Ninety-one per cent of children were right-handed, while 9% were left-handed. A significant statistical correlation of trunk asymmetry and handedness was found both in boys and girls in the group of asymmetry 2-7 degrees at mid-thoracic (p < 0.038) but not at thoracolumbar and at lumbar region. These findings show that there is significant correlation of mild mid-thoracic asymmetry and the dominant brain hemisphere in terms of handedness, in children who are entitled at risk of developing scoliosis. These findings are implicating the possible aetiopathogenic role of cerebral cortex function in the determination of the thoracic surface morphology of the trunk.
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Affiliation(s)
- Theodoros B Grivas
- Scoliosis Clinic, Orthopaedic Department, Thriasio General Hospital, G. Genimato Avenue, Magula, 19600, Greece.
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Watanabe K, Hasegawa K, Hirano T, Uchiyama S, Endo N. Use of the scoliosis research society outcomes instrument to evaluate patient outcome in untreated idiopathic scoliosis patients in Japan: part II: relation between spinal deformity and patient outcomes. Spine (Phila Pa 1976) 2005; 30:1202-5. [PMID: 15897836 DOI: 10.1097/01.brs.0000162285.12045.81] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This study clarifies the relation between the results of the Scoliosis Research Society Outcomes Instrument (SRS-24) and radiographic parameters of back deformity in Japanese idiopathic scoliosis patients. OBJECTIVES To investigate the relation between magnitude of back deformity and results of the SRS-24 in untreated patients. SUMMARY OF BACKGROUND DATA In idiopathic scoliosis, it is necessary to clarify the relation between patient-perceived outcomes of the deformity and magnitude of back deformity before considering treatment. The relation between the magnitude of spinal deformity and outcomes of untreated patients, however, has not been fully investigated. METHODS Patients (n = 166) under 30 years of age with untreated scoliosis were evaluated. Radiologic examination included Cobb angle, rotation angle of apical vertebrae, and translation of C7 vertebra from the central sacral line (C7 translation) on the coronal plane. Patient evaluation using section 1 (15 questions) of the SRS-24 was compared with radiologic findings using Spearman's correlation coefficient by rank (rs). RESULTS The average pain domain score was 27.0 +/- 2.2 points, general self-image 9.9 +/- 1.7 points, general function 12.7 +/- 1.1 points, and overall level of activity 14.9 +/- 0.6 points. In radiologic deformity, the average Cobb angle and rotation angle of the thoracic curve were 35.8 degrees +/- 12.1 degrees (range, 17 degrees-73 degrees) and 13.9 degrees +/- 8.2 degrees (range, 0 degrees-38 degrees), respectively. The average Cobb and rotation angle of the lumbar curve were 31.4 degrees +/- 9.3 degrees (range, 13 degrees-56 degrees) and 15.4 degrees +/- 9.7 degrees (range, 2 degrees-36 degrees), respectively. The mean C7 translation was 12.4 +/- 9.7 mm (range, 0-48 mm). Comparison between individual domains and radiologic measurements revealed that the total pain (rs = -0.33; P < 0.0001) and general self-image (rs = -0.25; P = 0.0024) domain scores had a significant inverse correlation with thoracic curve Cobb angle. Comparison between the scores of individual questions and radiologic measurements revealed that the scores of question 3 (total pain domain) had a significant inverse correlation with thoracic curve Cobb angle (rs = -0.36; P < 0.0001). The scores of question 5 (general self-image domain) had a significant inverse correlation with thoracic curve Cobb angle (rs = -0.41; P < 0.0001) and rotation angle (rs = -0.30; P = 0.0006). CONCLUSION The patients did not have negative self-image regarding back appearance when the thoracic curve Cobb angle was less than 30 degrees but had a negative self-image when the thoracic curve Cobb angle was more than 40 degrees and the rotation angle was more than 20 degrees. On the other hand, the lumbar curve Cobb angle and the rotation angle did not correlate with patient self-image. The results of the present study will help to define the parameters for the initiation of active treatment and physicians should maintain or reduce scoliotic deformity so that the thoracic curve Cobb angle is less than 40 degrees and the rotation angle is less than 20 degrees in idiopathic scoliosis.
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Affiliation(s)
- Kei Watanabe
- Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan.
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Abstract
There are a number of different non-operative interventions which aim to control moderate adolescent idiopathic scoliosis (AIS) from progression. Clinicians may find difficulties in the selection of appropriate interventions for AIS. A comprehensive literature review was carried out to study all contemporary non-operative interventions, it was noted that rigid spinal orthoses apparently give more curve control; however, it would compromise the patient's quality of life via those inevitable factors--physical constraint, poor acceptance and psychological disturbance. There is a trend to develop more effective, acceptable and user-friendly interventions. Under such an aspiration, the theories and clinical evidence of different interventions should be developed along the clinical pathway of early intervention with reliable indicators/predictors, patient's active participation, dynamic control mechanism, holistic psychological and psychosocial considerations, and effective and long-lasting outcome.
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Affiliation(s)
- M S Wong
- Rehabilitation Engineering Centre, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China.
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