Evaluation of Brace Treatment Using the Soft Brace Spinaposture: A Four-Years Follow-Up

The braces of today are constructed to correct the frontal plane deformity of idiopathic adolescent scoliosis (AIS). The Spinaposture brace© (Spinaposture Aps, Copenhagen, Denmark) is a soft-fabric brace for AIS and is designed to enhance rotational axial stability by inducing a sagittal plane kyphotic correction. This prospective observational study evaluated the brace in fifteen patients with AIS. The initial average CA was 16.8° (SD: 2.8). They were followed prospectively every 3 to 6 months during their brace usage until skeletal maturity of 25 months and at long-term follow-up of 44 months. In- and out-of-brace radiographs were performed in six subjects at inclusion. This resulted in an immediate in-brace correction of 25.3 percent in CA (14.3°→10.8°) and induced a kyphotic effect of 14.9 percent (40.8°→47.9°). The average in-brace improvement at first follow-up was 4.5° in CA, and the CA at skeletal maturity was 11° (SD: 7.4°) and long-term 12.0° (SD: 6.8°). In conclusion, the Spinaposture brace© had an immediate in-brace deformity correction and a thoracic kyphotic effect. At skeletal maturity, the deformities improved more than expected when compared to that of the natural history/observation and similar to that of other soft braces. No long-term deformity progression was seen. To substantiate these findings, stronger designed studies with additional subjects are needed.

Determination of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis Correction Fusion using Pedicle Screw Versus Hook Plus Screw Pedicle Instrumentation

Introduction: Spinal instrumentation in idiopathic adolescent scoliosis (AIS) aims to correct spinal deformity, and maintain spinal stability. Proximal junctional kyphosis (PJK) is a relatively common postoperative complication. Posterior-only fusion using diverse instruments such as pedicle screw and hybrid hook plus screw is favored to correct spinal deformity. The current study aims to compare PJK incidence between pedicle screw versus hybrid hook plus screw. Methods: This non-randomized clinical trial has been conducted on 71 AIS patients undergone posterior-only spinal deformity fusion using pedicle screw only (n=42) or hook plus pedicle (n=29) implantation in 2015-20. The proximal thoracic (PT), main thoracic (MT), T5-T12 sagittal Cobb angles and proximal junctional angle (PJA) were evaluated through radiographies taken at baseline, immediately postoperative, within 6 and 18 months. PJK was defined as PJA >10 degrees. Results: Using both pedicle screw only and hook plus pedicle have led to significant improvement in MT, PT, PJA and T5-T12 angles (P-value<0.05); however, the two groups were not statistically different (P-value>0.05). Seventeen cases (23.9%) presented PJK among which 11 (26.2%) and 6 (20.7%) ones were in the predicle screw versus hook plus screw implantation groups, respectively (P-value=0.54). The comparison of PJA and T5-T12 Cobb angles revealed significant difference between the PJK versus non-PJK cases (P-value<0.05). Conclusion: AIS instrumentation was accompanied by satisfying outcomes using pedicle screw or hook plus screw. However, none of the applied instruments was superior over the other; PJK occurred in fewer cases undergone posterior-only approach of AIS correctional surgery using hook and screw.

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.

Use of modern spinal braces in the treatment of idiopathic scoliosis

This review presents an analysis of scientific papers on the conservative treatment of idiopathic scoliosis with spinal braces. Insufficient awareness of brace treatment for spinal deformities is often the reason for the negative attitude of orthopedists toward brace therapy and the conservative treatment of scoliosis in general. In world practice, braces have been the primary and scientifically proven technique for conservative treatment of intermediate forms (grades IIIII) of scoliosis in children and adolescents for over 50 years. Modern spinal braces are active orthopedic products that provide three-dimensional correction of the existing deformity and prevent the progression of scoliosis. The main goal of using braces is to eliminate the pathological displacement of the vertebrae, ribs, and pelvis to a physiological state by applying pressure to specific body areas and actively correcting the deformity. Using a brace is the only non-surgical method to treat scoliosis with scientifically proven efficiency. The poor results of using braces to treat scoliosis are primarily due to insufficient correction in the brace, non-compliance with the wearing time, and the lack of adjunctive therapy. The efficiency of brace therapy depends on three main factors that require the personal involvement of the patient: the time of wearing the corset per day, the degree of correction in the corset, and constant (daily) training of the back muscles. The results of recent multicenter studies confirm the efficiency of using braces to treat idiopathic adolescent scoliosis.

Selected components of the lifestyle of adolescent girls with idiopathic scoliosis – an observational study

Background: This research study is focused on factors affecting the level of physical activity in girls with scoliosis, looking for answers as to whether scoliosis itself is a predictive factor of motor passivity, which, as WHO indicates, is dangerous to health. Objective: The aim of the study was to determine selected components of the lifestyle of young women with diagnosed scoliosis in confrontation with a group of women who were not diagnosed with spinal deformities. Methods: The study consisted of a group of 82 young girls aged 16 – 18 years (x=16.9±0.81) with AIS (mean Cobb angle=17.37±4.05) who were who were the main group. The control group included 138 young health girls with the same ages. The girls were not diagnosed with idiopathic adolescent scoliosis and their body posture were not deviate from the norm in the sagittal, frontal and transverse planes. BMI was calculated in percentiles, and the physical activity level by IPAQ have been investigated. Results In the studied groups of girls the level of physical activity at the moderate level dominates (p>0.05). There are no differences between each IPAQ domain except for the domains “Leisure/Free time” (t=2.23; P=.02). Among the assessed factors, only BMI (A; p<0.003 and B; 0.0001), diet (A; 0.0006 and B; 0.0002) and the use of electronic devices (A; 0.00004 and B; 0.03) influence the physical activity in both groups. Place of residence, age, self acceptance, physical activity of parents and sedentary positions are not important (all p values in the range 0.17 – 0.94). Conclusion. The most important aspect of teenage girls' lifestyles is physical activity and the leisure and diet, as well as body weight. Scoliosis is not a determinant of physical activity and its level does not significantly differ between girls who are diagnosed with scoliosis and those with normal body posture, except for leisure time, which is more passive in girls with scoliosis. Overweight and abnormal eating habits affect physical activity regardless of the quality of posture. A reduction in physical activity predisposes to more frequent and increased use of electronic devices during the week.

INTERCONNECTION BETWEEN IDIOPATHIC ADOLESCENT SCOLIOSIS OF THE SPINE AND DENTOGNATIC ANOMALIES.

According to state statistics, diseases of the musculoskeletal system in adolescents rank third among the major classes of diseases. The dental system, as a part of the musculoskeletal system, undergoes the same metabolic transformations as the entire bone tissue of the body. The aim of the study was to determine the characteristic disorders of the dental system in adolescents with idiopathic spinal scoliosis, taking into account the anatomical type of lesion. Materials and methods. 225 children aged 12 to 15 years were examined, including 190 (84.4 % ± 3.3 %) girls and 35 (15.6 % ± 2.1 %) boys. All adolescents were registered at a dispensary with an orthopedist-traumatologist. Results and discussion. According to the anatomical type, patients with scoliosis are divided into three groups: Group I - with thoracic spinal deformity; Group II - with thoracolumbar; III group - with lumbar; Group IV - control, almost healthy children without spinal deformities. It was found that the most common type of scoliosis was thoracolumbar scoliosis, observed in 114 patients. In patients of group I, the most common type of tooth closure in the sagittal plane was class II according to Engle. In group II, it was found that distal occlusion is characteristic of 68 people, in 10 revealed mesial occlusion, sagittal gap – in 59 patients. In group III, 13 patients had a neutral bite, and 32 had a distal bite. Sagittal gap was noted in 15 patients, deep bite – in 9. The most characteristic disorders for patients of group IV were distal occlusion 24 %, sagittal gap 16 %, deep occlusion 12 %, shortening of the lower dentition 16 %, oral position of the teeth 12 %. Conclusions. Analysis of the prevalence of dental anomalies in each group leads to the conclusion that regardless of the location of the deformity in the spine in scoliosis for all groups are characterized by the following signs: distal occlusion, sagittal fissure, shortening of the upper dentition, crowding of teeth on the lower jaw, mainly in the front. In the group of almost healthy children without scoliosis, the prevalence of dental anomalies is 2.6 times lower compared with patients with idiopathic adolescent scoliosis.

WHAT IS THE BEST DISTAL LEVEL OF ARTHRODESIS IN LUMBAR FUSION IN PATIENTS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS: L3 OR L4?

ABSTRACT Objective To evaluate coronal alignment in patients with idiopathic adolescent scoliosis with structured lumbar curves submitted to surgical treatment by comparing coronal alignment in the group fusion up to L3 and the group fusion up to L4. Methods Retrospective cohort study. We evaluated patients submitted to surgical treatment with arthrodesis of the lumbar curve with high density of screws with at least 6 months of follow-up. Radiographically, coronal alignment, shoulder height and functional outcome were analyzed through SRS30 questionnaire. Results A total of 25 patients were analyzed, of which 23 were female and 2 were male, with a mean age of 15.2 years (12 to 29 years) at the time of surgery. The patients were divided into two groups. Group A, n = 15: Distal level of fusion in L3 and Group B, n = 10: distal level of fusion in L4. There was no statistically significant difference between Groups A and B when compared to coronal alignment (balanced vs. unbalanced). However, when compared with the coronal alignment (CA) values, lower values of CA were observed in Group A, with statistical significance. No difference was observed between Groups A and B with respect to the SRS30 questionnaire. Conclusions Patients with idiopathic adolescent scoliosis submitted to arthrodesis of the lumbar curve have a better coronal alignment when the distal fusion level is L3. Level of evidence III; Comparative Retrospective Study (based on prospectively collected data).

Association between physical activity and scoliosis: a prospective cohort study

Background Little is understood about the causes of adolescent onset idiopathic scoliosis (AIS). No prospective studies assessing the association between physical activity and idiopathic adolescent scoliosis have been carried out. We aimed to carry out the first prospective population-based study of this association. Methods The Avon Longitudinal Study of Parents and Children (ALSPAC) collected self-reported measures of physical ability/activity at ages 18 months and 10 years. Objective measures of physical activity were collected by accelerometry at age 11 years. scoliosis was identified using the dxa scoliosis Method at age 15 years. Participants with scoliosis at age 10 years were excluded. Results Of 4640 participants at age 15 years who had DXA scans, 267 (5.8%) had scoliosis. At age 18 months, those infants who were able to stand up without being supported were 66% less likely to have developed scoliosis by age 15 (P = 0.030) compared with infants who could not. Those children whose mothers reported they did most vigorous physical activity at age 10 years were 53% less likely to develop scoliosis (P = 0.027). Those children who did more objectively measured moderate/vigorous physical activity at age 11 were 30% less likely to have developed scoliosis (P &lt; 0.001). Results were not affected by adjustment for age, gender, lean mass, fat mass or back pain. Conclusions We report reduced physical ability and activity as early as age 18 months in those who go on to develop scoliosis by age 15 years. Further research is justified to examine the mechanisms underlying this association.