Effects of Bracing in Adult With Scoliosis: A Retrospective Study.

OBJECTIVE: To assess the effectiveness of bracing in adult with scoliosis. DESIGN: Retrospective cohort study. SETTING: Outpatients followed in 2 tertiary care hospitals. PARTICIPANTS: Adults (N=38) with nonoperated progressive idiopathic or degenerative scoliosis treated by custom-molded lumbar-sacral orthoses, with a minimum follow-up time of 10 years before bracing and 5 years after bracing. Progression was defined as a variation in Cobb angle ≥10° between the first and the last radiograph before bracing. The brace was prescribed to be worn for a minimum of 6h/d. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Rate of progression of the Cobb angle before and after bracing measured on upright 3-ft full-spine radiographs. RESULTS: At the moment of bracing, the mean age was 61.3±8.2 years, and the mean Cobb angle was 49.6°±17.7°. The mean follow-up time was 22.0±11.1 years before bracing and 8.7±3.3 years after bracing. For both types of scoliosis, the rate of progression decreased from 1.28°±.79°/y before to .21°±.43°/y after bracing (P<.0001). For degenerative and idiopathic scoliosis, it dropped from 1.47°±.83°/y before to .24°±.43°/y after bracing (P<.0001) and .70°±.06°/y before to .24°±.43°/y after bracing (P=.03), respectively. CONCLUSIONS: For the first time, to our knowledge, this study suggests that underarm bracing may be effective in slowing down the rate of progression in adult scoliosis. Further prospective studies are needed to confirm these results.

Does hormone replacement therapy prevent lateral rotatory spondylolisthesis in postmenopausal women?

PURPOSE: Degenerative scoliosis usually begins at menopause and lateral rotatory olisthesis (LRO) might be a triggering factor in the onset of degenerative scoliosis in postmenopausal women. We set out to evaluate the influence of hormone replacement therapy (HRT) on degenerative scoliosis and on LRO. METHODS: A cross-sectional study was conducted in 146 postmenopausal women: 75 women had received HRT for more than 1 year (HRT > 1) and 71 women had never received HRT or less than 1 year (HRT < 1). Scoliotic curve, LRO, sacral slope, lordosis, kyphosis were measured. The excess risk of LRO associated with age, BMI, isometric strength of brachial biceps, bone mineral density, lean mass and HRT was evaluated using a multiple logistic regression model. RESULTS: No difference was found in sacral slope, lumbar lordosis or thoracic kyphosis between both groups or in the presence of scoliosis. The prevalence of LRO was significantly lower in HRT >1 than HRT <1 (8 vs. 30%) while the risk was dependent on age, HRT and their interaction. LRO increased with age only in HRT <1 (11% when aged ≤66 years vs. 39% when aged >66 years, p = 0.013), whereas the prevalence of LRO remained stable in HRT >1. CONCLUSIONS: LRO was significantly lower in women who received HRT. The excess risk of LRO was dependent on both age and HRT status. These findings suggest that HRT might prevent the onset of LRO, and therefore might contribute to the prevention of low back pain.

[Non-surgical orthopaedic therapies of the spine in the elderly]. / Thérapeutiques orthopédiques non chirurgicales du rachis chez le sujet âgé.

"Non-surgical orthopaedic therapies of the spine in the elderly. Non-surgical orthopaedic therapies of the spine in the elderly Aging is responsible for several spine pathologies characterized by static disorders. These are degenerative scoliosis (SD), degenerative lumbar kyphosis (CDL), narrow lumbar canal, fracturing osteoporosis with vertebral settlements, complications of spine surgery, degenerative spondylolisthesis, Camptocormia and drooping head. SD is an onset (de novo) or late worsening scoliosis, the critical period being most often menopause. CLD is a non-reducible lumbar kyphosis caused by degenerative disc and posterior joint lesions. Camptocormia is a very disabling thoracolombary kyphosis of at least 30° degrees worthening with walking which is largely reductible. There are different causes: neuromuscular disease or central neurologic disease (extrapyramidal), metabolic, medicamentous but also at a late age the possible evolution of an SD and CLD. The consequences of these pathologies are pain, walking difficulties, aesthetic damage and sometimes in case of camptocormia of digestive and respiratory disorders. Treatments are physiotherapy with postural, muscular and proprioceptive work, radio- guided infiltrations by radiologists experienced in deviations of the spine after an accurate analysis of the cause of pain allowing targeted infiltration and plastic or fabric corsets custom-made in close collaboration between doctor and orthoprosthetist. The purpose of corsets is to improve pain, the static of the spine and to slow down the evolution."

"Thérapeutiques orthopédiques non chirurgicales du rachis chez le sujet âgé. Le vieillissement est responsable de sieurs pathologies du rachis caractérisées par des troubles de la statique. Ce sont la scoliose dégénérative, la cyphose lombaire dégénérative, le canal lombaire étroit, l'ostéoporose fracturaire avec tassements vertébraux, les complications de la chirurgie du rachis, le spondylolisthésis dégénératif, la camptocormie et tête tombante. La scoliose dégénérative est une scoliose d'apparition (de novo) ou d'aggravation tardive, la période critique étant le plus souvent la ménopause. La cyphose lombaire dégénérative est une cyphose non réductible due à des lésions dégénératives discales et articulaires postérieures étagées. La camptocormie est une cyphose thoracolombaire très invalidante d'au moins 30 °, s'aggravant au cours de la marche, en grande partie réductible. Elle peut être d'origine neurologique neuromusculaire ou centrale (extrapyramidale), métabolique, médicamenteuse ou à, un âge tardif, l'évolution d'une scoliose dégénérative et d'une cyphose lombaire dégénérative. Les conséquences de ces pathologies sont les douleurs, les difficultés à la marche, le préjudice esthétique et parfois des troubles digestifs et respiratoires. Les traitements sont la kinésithérapie, avec un travail postural, musculaire et proprioceptif, les infiltrations radioguidées par des radiologues expérimentés dans les déviations du rachis après une analyse précise de la cause des douleurs permettant une infiltration ciblée et les corsets plastique et/ou tissu faits sur mesure en collaboration étroite médecin et orthoprothésiste. Le but des corsets est d'améliorer les douleurs, la statique du rachis et de freiner l'évolution."

Natural history of progressive adult scoliosis.

STUDY DESIGN: A retrospective analysis of the progression of adult scoliosis. OBJECTIVE: To establish an individual prognosis. SUMMARY OF BACKGROUND DATA: Most studies have investigated the adolescent scoliosis after skeletal maturity, but the results are discordant. METHODS: Two senior physicians measured all the radiographs of 51 adults who had a progressive scoliosis. The mean delay between the first and last radiograph was 27 years. For each patient, a diagram was established with the Cobb angle on the y-axis and the corresponding age on the x-axis. We noted the age and Cobb angle of the first radiograph showing a rotatory subluxation and the age of menopause. We used linear regression and the analysis of variance test. RESULTS: The mean number of radiographs per patient was 6. The linear test was significant in 46 patients. Two main types exist. Type A is an adolescent scoliosis that continues to progress after skeletal maturity, whereas type B appears or progresses late. There were 13 type A and 20 type B of which 11 progressed around menopause. Significant differences were noted between groups A and B regarding loss of body height (group A, 5 cm and group B, 9.5 cm; P < 0.001), rate of progression in lumbar single and thoracolumbar single curves (group A, 0.82 degrees/y and group B, 1.64 degrees/y; P < 0.004), Cobb first radiograph (group A, 37 degrees and group B, 20 degrees; P < 0.0001), age rotatory subluxation (group A, 42 years and group B, 56 years; P < 0.0001), and Cobb rotatory subluxation (group A, 52 degrees and group B, 29 degrees; P < 0.0001). CONCLUSIONS: The originality of our study is the diagram. We demonstrated that the rate of progression was linear, and it can be used to establish an individual prognosis. The diagrams visualized 2 main distinct types. There was a significantly faster rate of progression in type B. In type A, rotary subluxation occurs during progression of the curvature. In type B, it seems to be the initial event. Menopause is a period of deterioration in type B.