Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria - PubMed (original) (raw)
Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria
Angelo G Aulisa et al. Scoliosis. 2009.
Abstract
Background: The effectiveness of conservative treatment of scoliosis is controversial. Some studies suggest that brace is effective in stopping curve progression, whilst others did not report such an effect.The purpose of the present study was to effectiveness of Progressive Action Short Brace (PASB) in the correction of thoraco-lumbar curves, in agreement with the Scoliosis Research Society (SRS) Committee on Bracing and Nonoperative Management Standardisation Criteria.
Methods: Fifty adolescent females (mean age 11.8 +/- 0.5 years) with thoraco-lumbar curve and a pre-treatment Risser score ranging from 0 to 2 have been enrolled. The minimum duration of follow-up was 24 months (mean: 55.4 +/- 44.5 months). Antero-posterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-year minimum follow-up from t4 (t5). Three situations were distinguished: curve correction, curve stabilisation and curve progression.The Kruskal Wallis and Spearman Rank Correlation tests have been used as statistical tests.
Results: CM mean value was 29,30 +/- 5,16 SD at t1 and 14,67 +/- 7,65 SD at t5. TA was 12.70 +/- 6,14 SD at t1 and 8,95 +/- 5,82 at t5. The variation between measures of Cobb and Perdriolle degrees at t1,2,3,4,5 and between CM t5-t1 and TA t5-t1 were significantly different.Curve correction was accomplished in 94% of patients, whereas a curve stabilisation was obtained in 6% of patients.
Conclusion: The PASB, due to its peculiar biomechanical action on vertebral modelling, is highly effective in correcting thoraco-lumbar curves.
Figures
Figure 1
Brace or plaster cast custom made. a. The patient, in light traction, is positioned with hip and knees lightly bent, in order to obtain the correction of the hyperlordosis. b. Lateral deflection is achieved by applying a plaster strap just beneath the apical vertebra (B). A second strap stabilises the pelvis (A). c. After the plaster cast is complited, the operator appliesa twisting moment. d. The direction of the rotation produced by the couple of forces is opposite to the direction of the vertebral torsion of the scoliotic curve. This allows to obtain transverse sections represented by asymmetrical ellipses.
Figure 2
The finishing touches of the plaster cast establish the same geometry of the plastic brace.
Figure 3
Dynamics bound by the geometry of the brace. From the concave side, the brace extends from the throcanteric region (A) upto the superior neutral vertebra (b. Therefore, the flection toward the deformity is opposed. The presence of a free space (c-d) between the iliac crest and the upper vertebral limit favours the spine realignment along the cefalo-caudal axis plane (A). The shape of the concave side without (b) and with the brace (c) shows the remarkable diversity between the dynamics of the free and of bound spine.
Figure 4
Dynamics bound by the geometry of the brace. On the convex side, the superior margin ends under the apex vertebra, allowing the lateral flection movement to induce the deflection of the curve and the realignment of the spine under the apex vertebra. The posterior edge is modelled with a central active prominence which is uncomfortable and compels the patient to perform an anterior translation that allows the hyperlordosis correction (A). Such a profile imposes a particular dynamics, for which the anterior flection movements can be performed only together with a lateral flection and a rotation in the direction of the correction of the curve. The bending X-Ray exam executed on the convexity side without (b) and with the brace (c) confirms the theoretical presuppositions showing the remarkable behaviour diversity between the dynamics of the free and the bound spine.
Figure 5
Dynamics bound by the geometry of the brace. The trasverse section of the brace (A), elliptical and asymmetrical up to the plan of the pelvic Hold, produces twisting moments opposed to the direction of the rotation of the vertebrae included in the curve (b). The bending X-ray (c) shows the efficacy of the twisting action produced by the brace for all movements of the trunk.
Figure 6
Variation of Cobb degrees at t1,2,3,4,5.
Figure 7
Variation of Perdriolle degrees at t1,2,3,4,5.
Figure 8
Typical trend of scoliosis in treattment with PASB.
Figure 9
Example of the effectiveness of the derotation actions with inversion of prossimal vertebrae rotation and curve doubling.
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