The classification of scoliosis braces developed by SOSORT with SRS, ISPO, and POSNA and approved by ESPRM.

PURPOSE: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.

Influence of facet and posterior muscle degeneration on clinical results of lumbar total disc replacement: two-year follow-up.

OBJECTIVE: There has been little analysis assessing the correlation between the clinical functional result of total disc replacement and the arthrosis of the posterior facets or the fatty degeneration of the spinal muscles. However, such knowledge is essential for understanding the long-term outcome of devices in functional terms. This prospective study reports the outcome of 64 Maverick (Medtronic) devices implanted between January 2002 and November 2003. RESULTS: Oswestry score preoperatively and at 2-year follow-up was 43.8 and 23.1, respectively (P < 0.05). Low back pain improved from a mean Visual Analog Scale (VAS) score of 7.6 +/- 1.7 preoperatively to 3.2 +/- 1.8 at 2 years. Mean VAS leg pain score decreased from 3.9 to 2.1 at 2 years (P < 0.05). Facet osteoarthritis grade 1 or 2 did not influence outcome (P = 0.82). On the other hand, muscle degeneration of grades 1 and 2 led to a better outcome than grades 3 and 4 (P = 0.006). CONCLUSIONS: This is the first study showing that a semiconstrained implant with a fixed posterior center of rotation can be implanted with grade 1 and 2 facet arthrosis with a good clinical outcome. This seems to confirm previous work showing that a posterior center of rotation lightens the load on the facets. This is also the first study to show a relationship between muscle fatty degeneration and clinical results since the greater the amount of fat, the less satisfactory the result. These promising midterm results must be confirmed by further studies.