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Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies - SOSORT award 2013 winner.

Aulisa AG, Guzzanti V, Marzetti E, Giordano M, Falciglia F, Aulisa L - Scoliosis (2014)

Bottom Line: The different clinical experiences leave unsolved the question that arises in applying a conservative treatment when the patients are effectively forward a long growing period, in scoliosis characterized by inevitable evolutivity.The results from our study showed that of the 113 patients with a definite outcome CM mean value was 29.6 ± 7.5 SD at t1 and 16.9 ± 11.1 SD at t5.The variations between CM t5-t1 and TA t5-t1 were statistically significantly different.

View Article: PubMed Central - HTML - PubMed

Affiliation: U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio 4, 00165 Rome, Italy.

ABSTRACT

Background: The Juvenile idiopathic scoliosis by age of onset, severity and evolutivity is source of great doubts concerning the purpose and use of conservative treatment. The different clinical experiences leave unsolved the question that arises in applying a conservative treatment when the patients are effectively forward a long growing period, in scoliosis characterized by inevitable evolutivity. The purpose of the present prospective study was to determine the effectiveness of conservative treatment in Juvenile idiopathic scoliosis.

Methods: From 1238 patients treated for idiopathic scoliosis between 1995 and 2012 fulfill the inclusion criteria 163 patients treated with PASB, Lyon brace and Milwaukee. Of these, 113 patients had a definite outcome, 27 have abandoned treatment e 23 are still in treatment. The minimum follow-up was 24 months. Radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning (t1), 6 months after the beginning (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-years minimum follow-up (t5). Three outcomes were distinguished in agreement with SRS criteria: correction, stabilization and progression.

Results: The results from our study showed that of the 113 patients with a definite outcome CM mean value was 29.6 ± 7.5 SD at t1 and 16.9 ± 11.1 SD at t5. TA was 13.5 ± 5.4 SD at t1 and 8.5 ± 5.6 at t5. The variations between CM t5-t1 and TA t5-t1 were statistically significantly different. Curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Of 26 patients who abandoned the treatment, at the time of abandonment (12.5 age) have achieved curve correction in 19 cases (70.0%), stabilization in 5 cases (19%) and progression in 3 cases (11%). Of these patients, reviewed at the end of growing, four have been operated on.

Conclusions: Our study confirmed that conservative treatment with brace is highly effective in treating juvenile idiopathic scoliosis, in particular most patients reaching a complete curve correction and only 4.9% of patients need surgery.

No MeSH data available.


Related in: MedlinePlus

This is a case with a thoracic curve treated with Lyon Brace; Cobb degrees value was 40°at beginning of treatment and 24° at 6 years of follow-up.
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Figure 3: This is a case with a thoracic curve treated with Lyon Brace; Cobb degrees value was 40°at beginning of treatment and 24° at 6 years of follow-up.

Mentions: Overall, 88 patients (77.8%) obtained a curve correction, while stabilization was achieved in 18 cases (15.9%). Curve progression was experienced by 7 patients (6.2%), 4 of whom were subsequently recommended for surgery. In patients with CM < 30° at t1, the average reduction was -12.6° Cobb, while in cases with CM ≥ 30 at t1, the mean correction was 11.8° Cobb. As for the curve type, patients with lumbar curves obtained an average correction of 14.7° Cobb [Figure 3], whereas a 8.0° Cobb decrease was observed in cases with thoraco-lumbar curves and 10.0° Cobb in those with thoracic curves [Figure 4]. Finally, patients with double curves experienced an average 12.5° Cobb reduction.


Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies - SOSORT award 2013 winner.

Aulisa AG, Guzzanti V, Marzetti E, Giordano M, Falciglia F, Aulisa L - Scoliosis (2014)

This is a case with a thoracic curve treated with Lyon Brace; Cobb degrees value was 40°at beginning of treatment and 24° at 6 years of follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4016774&req=5

Figure 3: This is a case with a thoracic curve treated with Lyon Brace; Cobb degrees value was 40°at beginning of treatment and 24° at 6 years of follow-up.
Mentions: Overall, 88 patients (77.8%) obtained a curve correction, while stabilization was achieved in 18 cases (15.9%). Curve progression was experienced by 7 patients (6.2%), 4 of whom were subsequently recommended for surgery. In patients with CM < 30° at t1, the average reduction was -12.6° Cobb, while in cases with CM ≥ 30 at t1, the mean correction was 11.8° Cobb. As for the curve type, patients with lumbar curves obtained an average correction of 14.7° Cobb [Figure 3], whereas a 8.0° Cobb decrease was observed in cases with thoraco-lumbar curves and 10.0° Cobb in those with thoracic curves [Figure 4]. Finally, patients with double curves experienced an average 12.5° Cobb reduction.

Bottom Line: The different clinical experiences leave unsolved the question that arises in applying a conservative treatment when the patients are effectively forward a long growing period, in scoliosis characterized by inevitable evolutivity.The results from our study showed that of the 113 patients with a definite outcome CM mean value was 29.6 ± 7.5 SD at t1 and 16.9 ± 11.1 SD at t5.The variations between CM t5-t1 and TA t5-t1 were statistically significantly different.

View Article: PubMed Central - HTML - PubMed

Affiliation: U.O.C. of Orthopedics and Traumatology, Children's Hospital Bambino Gesù, Institute of Scientific Research, P.zza S. Onofrio 4, 00165 Rome, Italy.

ABSTRACT

Background: The Juvenile idiopathic scoliosis by age of onset, severity and evolutivity is source of great doubts concerning the purpose and use of conservative treatment. The different clinical experiences leave unsolved the question that arises in applying a conservative treatment when the patients are effectively forward a long growing period, in scoliosis characterized by inevitable evolutivity. The purpose of the present prospective study was to determine the effectiveness of conservative treatment in Juvenile idiopathic scoliosis.

Methods: From 1238 patients treated for idiopathic scoliosis between 1995 and 2012 fulfill the inclusion criteria 163 patients treated with PASB, Lyon brace and Milwaukee. Of these, 113 patients had a definite outcome, 27 have abandoned treatment e 23 are still in treatment. The minimum follow-up was 24 months. Radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points: beginning (t1), 6 months after the beginning (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-years minimum follow-up (t5). Three outcomes were distinguished in agreement with SRS criteria: correction, stabilization and progression.

Results: The results from our study showed that of the 113 patients with a definite outcome CM mean value was 29.6 ± 7.5 SD at t1 and 16.9 ± 11.1 SD at t5. TA was 13.5 ± 5.4 SD at t1 and 8.5 ± 5.6 at t5. The variations between CM t5-t1 and TA t5-t1 were statistically significantly different. Curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Of 26 patients who abandoned the treatment, at the time of abandonment (12.5 age) have achieved curve correction in 19 cases (70.0%), stabilization in 5 cases (19%) and progression in 3 cases (11%). Of these patients, reviewed at the end of growing, four have been operated on.

Conclusions: Our study confirmed that conservative treatment with brace is highly effective in treating juvenile idiopathic scoliosis, in particular most patients reaching a complete curve correction and only 4.9% of patients need surgery.

No MeSH data available.


Related in: MedlinePlus