Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure

The effect of brace on apical vertebral derotation in adolescent idiopathic scoliosis

PURPOSE

The current study aims to evaluate the effect of Boston brace treatment on apical vertebral derotation in adolescent idiopathic scoliosis (AIS) patients receiving conservative treatment.

METHODS

The study included 51 AIS patients, consisting of 8 males and 43 females, with Cobb angles between 25° and 45° and Risser's findings ranging from 0 to 4. The mean age of the participants was 12.20 ± 1.34 years. All patients were treated with the Boston brace for a minimum of 2 years and evaluated before the brace, during early brace use, and at the last follow-up. Radiographs were assessed to measure apical vertebral rotation (AVR) and vertebral translation (AVT). The SRS-22 questionnaire was used to evaluate patient outcomes.

RESULTS

The radiographs of patients were evaluated over a mean follow-up period of 32.42 ± 8.65 months. Before the brace, the mean AVR was 2.1 ± 0.6, while it was 1.1 ± 0.5 with the brace. At the last follow-up, the mean AVR was 1.3 ± 0.5 (p < 0.001). Before the brace, the mean AVT was 36.4 ± 9.6 mm, which decreased to 16.7 ± 7.3 mm with the brace (p < 0.001). At the last follow-up, the mean AVT was 19.8 ± 8.1 mm (p < 0.001). The use of the brace had a significant corrective effect on thoracolumbar and lumbar curvatures compared to before the brace (p < 0.001).

CONCLUSION

The findings of the current study suggest that the use of a Boston brace in the conservative treatment of AIS is effective in correcting the coronal and sagittal plane deformities, including thoracic, thoracolumbar, and lumbar curvatures, and in reducing apical vertebral rotation and translation.

Adolescent Idiopathic Scoliosis for Pediatric Providers

Adolescent idiopathic scoliosis occurs in 2% to 3% of the adolescent population, affecting people between ages 10 and 16 years. Scoliosis onset is usually earlier in girls than in boys-generally occurring between ages 10 and 14 years for girls and 12 and 16 years for boys. The cause of idiopathic scoliosis is unknown. It is probably multifactorial. Much of the research on the etiology has focused on connective tissue abnormalities, nutritional deficiency, and genetic factors. [Pediatr Ann. 2022;51(9):e364-e369.].

Evaluation of In-brace Correction in Individuals with Adolescent Idiopathic Scoliosis: A Retrospective and Descriptive Study

Introductions: Achieving maximum correction at the beginning of brace treatment in AIS is the only factor that can be controlled by the bracing provider if we have a better understanding of the prognostics and factors associated with achieving in-brace correction. The aim of this present study was to evaluate in-brace correction in a cohort of AIS patients who were treated by full-time bracing with plastic moulded thoraco-lumbo-sacral spinal orthosis (TLSO). Methods: This study was a retrospective descriptive study. We collected data from medical records of individuals with AIS who receiving full-time braces treatment from Orthotic Clinic, King Chulalongkorn Memorial Hospital. Demographic data included age, gender, weight, height, and body mass index (BMI). Cobb angle, Risser sign, and curve type were determined using pre and post-brace standing posteroanterior (PA) radiographs. Correlation analysis was performed to investigate in-brace correction with associated factors.  Results: We included 91 patients' data and radiographic images with AIS, with seven (7.69%) boys and 84 (92.31%). The overall mean Cobb angle was 32.9 ± 8.5º, and during brace treatment, it was 22.5 ± 11.5º. There was a significant mean difference in the mean Cobb angle before and in-brace (p < 0.001). The overall mean in-brace correction in the study was 34.1 ± 22.7%. Initial Cobb angle and BMI were found to be significantly negatively associated with in-brace correction with a Pearson coefficient of -0.49 and -0.24, respectively. Conclusion: The mean of first in-brace correction TLSO was 34.1% from the initial Cobb angle. No difference in in-brace correction across curve types in our study. There was a significant Cobb angle changed before and in-brace radiograph. We found that in-brace correction was significantly associated with initial Cobb angle and BMI. Keywords: Adolescent Idiopathic Scoliosis, in-brace correction, bracing