Bracing Adult Scoliosis: From Immobilization to Correction of Adult Scoliosis

Unlike adolescent idiopathic scoliosis, bracing was used in adults less and was used more as a way of reducing pain. There is little publication of adult scoliosis series in the literature. The use of very high-rigidity and high-precision CAD/CAM technologies currently makes it possible to create corrective braces for the adult. The digital CAD/CAM cast in three blocks allows for precise correction at the pelvic, lumbar, and thoracic levels. This chapter presents the results of a series of 62 consecutive adult scoliotic patients treated with a corrective asymmetric detorsion brace of very high rigidity made in 2014–2016. Tolerance and angular correction results will be compared to those of 158 patients treated with the former bivalve polyethylene overlapping immobilization brace mainly used for lumbar scoliosis. The new Lyon adult ARTbrace is a detorsion brace adapted to all the curvatures which controls the sagittal plane. Despite a resistance four times greater than that of polyethylene of the same thickness, the tolerance of the Europlex’O is excellent as it is a “shock absorber,” and the anterior opening facilitates the use for very old people. Consequently, the aim of this chapter is to consider if it is possible to envisage for some patients an alternative to surgery, thanks to the new technologies of bracing

"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

Terminology - glossary including acronyms and quotations in use for the conservative spinal deformities treatment: 8th SOSORT consensus paper

<p>Abstract</p> <p>Background</p> <p>This report is the SOSORT Consensus Paper on Terminology for use in the treatment of conservative spinal deformities. Figures are provided and relevant literature is cited where appropriate.</p> <p>Methods</p> <p>The Delphi method was used to reach a preliminary consensus before the meeting, where the terms that still needed further clarification were discussed.</p> <p>Results</p> <p>A final agreement was found for all the terms, which now constitute the base of this glossary. New terms will be added after being discussed and accepted.</p> <p>Discussion</p> <p>When only one set of terms is used for communication in a place or among a group of people, then everyone can clearly and efficiently communicate. This principle applies for any professional group. Until now, no common set of terms was available in the field of the conservative treatment of scoliosis and spinal deformities. This glossary gives a common base language to draw from to discuss data, findings and treatment.</p