EFFECTS OF SCHROTH EXERCISE ON COBB’S ANGLE, VITAL CAPACITY AND THE IMPROVEMENT OF DAILY ACTIVITIES ON PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

The aim of this study was to investigate the effects of Schroth exercise on Cobb's angle, vital capacity as well as the improvement of daily activities on patients with idiopathic adolescent scoliosis. Forty patients with idiopathic scoliosis with a Cobb thoracic vertebral angle of 15-30 degrees or higher and the Risser sign stage 3 or higher. The Schroth exercise was applied 3 times a week for 12 weeks. We measured the chest trunk inclination, Cobb angle and vital capacity before and after exercise program. A comprehensive search for all published review articles for spinal deformity was undertaken on PubMed, PEDRO, Google Scholar, Physiopedia up to December 2018. All full-text articles reporting evaluation, validation, surgical, orthotic, and/or physiotherapeutic scoliosis specific exercises (PSSE) treatment outcomes of these spinal deformities were retrieved and analyzed by us and methodology for functional assessment of patients with AIS was developed. Forty patients with idiopathic scoliosis with a Cobb thoracic vertebral angle of 15-30 degrees or higher and the Risser sign stage 3 or higher. The Schroth exercise was applied 3 times a week for 12 weeks. We measured the chest trunk inclination, Cobb angle and vital capacity before and after exercise program. For a period of 12 weeks we accessed adolescents with AIS. All adolescents make Schroth PSSE. The analysis of the results confirms the positive effect of the PSSE to improve muscle endurance, balance and correction of the scoliosis. Within a month from the beginning, patients reported no back pain and within 2 months – a respiratory improvement, an enlargement of the chest, a reduced Cobb angle, an increased vital capacity. PSSE seem to have positive effects by reducing the symptoms and improving functions and body asymmetries. Schroth method is effective of preventing the scoliosis’ progression. The conservative method of treating scoliosis was found to be effective even at a Cobb angle of 35 degrees or higher. In the future, universal methods of approaching exercises and preventive training for the treatment of scoliosis needs to be further developed.

The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study

Objective: To evaluate the effect of Milwaukee brace treatment on adolescents with idiopathic scoliosis (AIS) with large curves (40° to 55°) who refuse to do surgery.Methods: In this retrospective cohort study, we gathered the clinical records of all adolescents with AIS with an initial curve of 40° to 55°. They had been referred to our center from December 1990 to January 2017. Although they had been advised to do surgery, they had all refused to do it. Their clinical data were recorded, such as sex, age, Risser sign, scoliosis, and kyphosis curve magnitude (at the beginning of brace treatment, weaning time, brace discontinuation, and minimum of 2 years after the treatment). Based on treatment success, the patients were divided into 2 groups: progressed and nonprogressed.Results: Sixty patients with an average initial Cobb angle of 44.93° ± 4.86° were included. The curve progressed in 57%, stabilized in 25%, and improved in 18% of the patients. In the progressed group (34 patients), 31 patients had undergone surgery. There was no significant association between the age of beginning the brace treatment and the final Cobb angle of nonprogressed group (p > 0.05). However, in-brace correction and initial Risser sign had a significant correlation with curve magnitude at the final follow-up (p < 0.05).Conclusion: Brace treatment seems to be effective in controlling the further curve progression in AIS with 40° and 55° curves. Our results can help physicians make sound decisions about the patients with larger curves who refuse to do surgery.

The influence of early thoracic fusion on the pulmonary function of patients with idiopathic scoliosis in the early period of the second growth peak with different Risser signs

Background Previous reports confirmed early spinal fusion may compromise pulmonary function and thoracic development in skeletal immature patients with scoliosis. However, the different effects in patients with various Risser signs remain unknown. This study aimed to compare the influence of early thoracic fusion on pulmonary function and thoracic growth in patients with idiopathic scoliosis (IS) with closed triangular cartilage (TRC) and different Risser signs. Methods Thirty-six patients with IS and a closed TRC were retrospectively selected and divided into the low Risser (LR, Risser sign ≤2, 22 patients) and high Risser (HR, 2<Risser sign≤4, 14 patients) groups. Patient age, Risser sign, main Cobb angle, thoracic kyphosis, and fusion levels were recorded. Perioperative and minimum of 2-year follow-up pulmonary function and thoracic diameters were compared between both groups. Results There were no differences in patients’ general characteristics between two groups. The preoperative forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 2.06±0.43 L and 2.50±0.49 L, respectively, in the LR group, and 2.31±0.49 L (p = 0.067) and 2.74±0.56 L (p = 0.122), respectively, in the HR group. While these values significantly increased postoperatively, to 2.62±0.46 L (p < 0.001) and 3.09±0.69 L (p < 0.001), in the LR group, they remained unchanged in the HR group [2.53±0.56 L (p = 0.093) and 2.70±0.98 L (p = 0.386), respectively]. The FEV1/FVC in both groups was >80% before and after surgery. The T1-T12 and anteroposterior thoracic diameter significantly increased after surgery in both groups, while the maximum inner chest diameter only increased in the LR group at the final follow-up. However, there were no significant differences in respiratory function and thoracic data between both groups. Conclusion For patients with IS, early fusion did not deteriorate pulmonary function or thoracic development in TRC-closed patients whose Risser sign was ≤2 compared with those with a Risser sign >2.

Impact of body mass index on the initial in-brace correction in patients with idiopathic scoliosis

Background/Aim: Many factors affect initial in-brace correction and treatment outcome in patients with idiopathic scoliosis. Previous studies have observed contradictory results on the role of BMI in orthotic treatment. The aim of this study was to examine whether BMI impacts in-brace correction, isolated and in relation to other predictive factors (curve magnitude, curve location and Risser sign). Methods: A retrospective study has been conducted on patients with idiopathic scoliosis treated with Cheneau-Sobernheim brace, that had no prior treatment. The collected and analysed data included patient demographics, BMI percentile and radiological parameters (curve magnitude in Cobb angle, curve location, Risser sign). The initial in-brace correction was expressed as a percentage of Cobb angle reduction in the brace as opposed to Cobb angle out of brace. Patients were categorised into groups according to their BMI, expressed in percentiles, ie: low BMI (< 5 percentiles), normal BMI (5-85 percentiles) and high BMI (> 85 percentiles). To determine the significant difference and correlation relationship between the examined variables, variance tests, t-test with unequal variance, and Pearson correlation coefficient have been used. Results: The cohort study comprised 213 patients (170 females and 43 males) with a mean age of 13.5 years at brace prescription. Low BMI has been detected in 10 % patients, normal BMI in 78 % and high BMI in 10 % patients. No significant difference in in-brace correction has been found between BMI groups, nor has there been any significant correlation between BMI and in-brace correction. Regarding other factors, significant difference within BMI groups was found between in-brace correction and curve location, as well as in-brace correction and Risser sign. Lumbar curves had significantly better in-brace correction than thoracic curves. Significant correlations between in-brace correction and curve magnitude, curve location and Risser sign were detected. Conclusion: The results of the present study show that, as an independent factor, BMI does not impact in-brace correction. Other factors, such as curve magnitude, curve location and Risser sign, play a more significant role in the orthotic treatment of patients with idiopathic scoliosis.