"Brace Technology" Thematic Series - The Lyon approach to the conservative treatment of scoliosis

<p>Abstract</p> <p/> <p>The Lyon Brace, or adjustable multi-shell brace, has been used for more than 60 years.</p> <p>The use and function of the Lyon Brace includes:</p> <p>- The utilization of one or two corrective plaster casts, which enables a true lengthening of the concave ligaments.</p> <p>- An oriented CAD-CAM moulding in 3D auto correction after the removal of the plaster cast.</p> <p>- A blueprint adapted to Lenke's classification.</p> <p>- A specific physiotherapy program.</p> <p>Background</p> <p>Pierre Stagnara created the Lyon Brace in 1947. The brace has the following characteristics:</p> <p>- It adjusts to allow for a child's growth of up to seven centimetres and for an increase in weight of up to seven kilograms.</p> <p>- It is 'active' in that the rigidity of the PMM (polymetacrylate of methyl) structure stimulates the user to auto-correct. The active axial auto-correction decreases the pressures of the brace on the trunk.</p> <p>- It is decompressive in that the effect of extension between the two pelvic and scapular girdles decreases the pressure on the intervertebral disc allowing for more effective pushes in the other planes.</p> <p>- It is symmetrical making it both more aesthetically pleasing and easier to build.</p> <p>- It is stable at both shoulders and pelvic girdle, facilitating the intermediate 3D corrections.</p> <p>- It is transparent. The pressure of the shells on the skin can be directly controlled so "pads" are usually not necessary.</p> <p>Brace description</p> <p>Two metal bars are fixed vertically, one anterior the other posterior and all shells are attached from the bottom to the top in this order:</p> <p>- Two pelvic shells ensure an optimal stability of the brace.</p> <p>- One lumbar shell T12-L4, which can be either independent or extending, at the abdominal chondrocostal level.</p> <p>- One thoracic shell at the level of the thoracic convexity.</p> <p>- One opposite thoracic shell used as a counter push.</p> <p>- One shoulder balance shell on the side of the thoracic convexity.</p> <p>Long term follow up results</p> <p>This is a retrospective study of 1,338 completed treatments checked a minimum of two years after weaning from the brace.</p> <p>Only 5% of the curves progressed more than 5° from the initial magnitudes. This translates to an effectiveness index of 0.95.</p> <p>A subset of 174 subjects who started treatment at Risser 0 was isolated. The global progressive angular mean curve was superimposed on the statistic general curve and the effectiveness index was calculated at 0.80.</p> <p>The Surgery rate was just 2% of the patients presenting with an initial curve below 45°.</p> <p>Conclusion</p> <p>The Lyon Brace is the historical reference of bracing AIS. To be fully effective, it requires the patient to wear a plaster cast for at least one month and receive specific physiotherapy training. Although this is a retrospective study, the results are very positive, and clearly indicate a need for a prospective study.</p

Prospective study of 158 adult scoliosis treated by a bivalve polyethylene overlapping brace and reviewed at least 5 years after brace fitting

Abstract Background The conservative orthopaedic treatment of adult scoliosis is very disappointing. In a series of 144 patients; only 25 % (33 cases) were monitored at 2 years of treatment. (Papadopoulos 2013). Thereby the literature typically focuses on a small number of patients, which limits the usefulness and relevance of its results. The brace effect on pain has been systematically described, but there is no publication on the effect of treatment on the Cobb angle and main clinical parameters. Methods From a prospective database started in 1998, we selected all 158 consecutive patients effectively treated conservatively with the Lyon management treatment and controlled five years after brace fitting. Lyon management includes a lordosing bivalve polyethylene overlapping brace in association with specific physiotherapy. The brace can either be short with anterior support under the chest or long with sterno-clavicular support when there is a high thoracic kyphosis. Results 1. For the rate of scoliosis controlled after 5 years, the follow-up was 24 % of the 661 patients accepting the treatment. Pain is almost the main reason for the medical consultation, generally correlating with an increase of the scoliotic angulation. 2. The descriptive data can be superimposed on general group with age (m=56 years, SD=13) but initial Cobb angulation is significantly higher (m=40°, SD=17). Ratio Female/Male=0.91. Generally, the scoliosis is stabilized at (m=39.74 °, SD=19.40), 8 years after the beginning of the treatment. 38 improvements of more than 5°= 24 %; 88 stable = 56 %; 32 worsening of more than 5° = 20 % The rib hump is improved of by 3 mm, (modelling effect of the brace). The occipital axis is improved by more than 6 mm. But the T1 plumb line distance is worsening by 7 mm (most braces are short without sterno-clavicular support). Conclusions For the first time, the number of records and follow up after 8 years allows to study the radiological progression of adult scoliosis rigid bracing. Stability or improvement of more than 5° in 80 % of cases justify rigid bracing in adults. The accentuation of the thoracic kyphosis is the only negative element and a modified ARTbrace will soon be used

Bracing in adult with scoliosis: experience in diagnosis and classification from a 15 year prospective study of 739 patients

Abstract Background Despite the frequency of adult scoliosis, very few publications concern the conservative orthopaedic treatments. The indications have not been defined to date. The experience of a department specialized in rigid bracing allows us to consolidate and clarify diagnosis and indications as well. Methods Individual observational prospective cohort study from a database started in 1998, with selection of all 739 adult scoliosis patients for which conservative orthopaedic treatment has been proposed to, even in case of drop-out. Scoliosis treated during adolescence and monitored in adulthood are included if a new brace is prescribed. A first descriptive study of the main parameters was performed: gender, age, Cobb angle. A tentative classification according to aetiology, age and angulation is proposed. Results 1) Descriptive Data: The Ratio Female/Male is 88 %, the mean age: 56.97 ± 15.82, the mean Cobb angle: 35.58 ± 17.35. The rate of non-adherent patients not wearing the brace is 17 % (but the plaster cast before bracing was routinely proposed at the time). 2) All patients can be grouped into five diagnoses, all statistically different, according to the age and the initial Cobb angle: Rotatory dislocation: 361 cases, age: 59.73 ± 13.52 (p = 0.05), (Cobb 39.08 ± 16.59 (p = 0.02)* Instability and disc disease: 150 cases, age: 46.03 ± 15.49 (p = 0.00)*, Cobb: 25.29 ± 12.29 (p = 0.00)* Camptocormia: 68 cases, age: 69.78 ± 12.19 (p = 0.00)*), Cobb: 38.09 ± 14.23 (p = 0.25) Kyphosis TL or T: 62 cases, age: 60.73 ± 15.51 (p = 0.07), Cobb: 43.34 ± (21.48 (p = 0.00)* Disabling pain: 33 cases, age: 48.36 ± 13.73 (p = 0.02)*, Cobb: 36.45 ± 25.21 (p = 0.78) Treatment after surgery and in the context of a lumbar stenosis and spondylolisthesis are independent groups. Despite the wide variety of etiologies, nearly 2/3 of patients have a discal pathology like rotatory dislocation and disc instability. For these patients a short brace can be used. Other patients usually have high kyphotic pathology as Kyphosis or camptocormia. They need a long brace. Conclusions The wide variety of adult scoliosis makes any objective classification difficult. This first approach is intended to specify the best indications of bracing in adulthood. 1. The female ratio is slightly higher than that of the adolescent. 2. The dropout rate is high and justify improvements with adaptation of bracing to adults. 3. All proposed etiological groups are statistically significantly different

Additional file 1: of Prospective study of 158 adult scoliosis treated by a bivalve polyethylene overlapping brace and reviewed at least 5Â years after brace fitting

Excel spreadsheet with results of 158 patients. Data from the prospective database (age, Cobb, balance, follow up at the Beginning and last follow-up). (XLSX 24 kb

Additional file 1: of Prospective study of 158 adult scoliosis treated by a bivalve polyethylene overlapping brace and reviewed at least 5Â years after brace fitting

Excel spreadsheet with results of 158 patients. Data from the prospective database (age, Cobb, balance, follow up at the Beginning and last follow-up). (XLSX 24 kb

Additional file 1: of Bracing in adult with scoliosis: experience in diagnosis and classification from a 15 year prospective study of 739 patients

Excel spreadsheet: Spreadsheet used for the diagnostic comparison of average according to the age and angulation. (XLSX 80 kb