The outcome of a modified version of the Cheneau brace in adolescent idiopathic scoliosis (AIS) based on SRS and SOSORT criteria: a retrospective study.

BACKGROUND: Bracing therapy for patients with adolescent idiopathic scoliosis (AIS) continues to be a controversial issue. As a consequence, to achieve an adequate level of evidence, there is a strong need for specific studies conducted according to standard outcome and management criteria. AIM: To assess the outcomes of a modified version of the Cheneau brace, ("Cheneau-P") in patients with AIS, based on SRS and SOSORT criteria. DESIGN: Retrospective study. SETTING: Scoliosis Unit of a Clinical Center. POPULATION: Sixty-seven patients, 56 females and 11 males. METHODS: Inclusion criteria were: diagnosis of AIS, age ≥10 years, Risser Score 0-2, Cobb degrees 20-40, no previous treatment, beginning of brace treatment within 1 year after menarche and minimum 2-year follow-up. According to SRS criteria, bracing outcomes were classified, as follows: "improved" (reduction of the curve ≥6°), "unchanged" (5° curve progression or reduction), "worsened" (≥6° curve progression), and "over 45°" (curve exceeding 45° or undergone surgery during the follow-up). The outcomes "improved" and "unchanged" were considered as successful outcomes. Groups and related subgroups were created according to curve type (thoracic, thoraco-lumbar, lumbar and double major) and magnitude (20°-30°; 30°-40°) and to skeletal age (Risser score 0, 1, 2). A separate analysis was also performed on the 37 patients, 30 females and 7 males, who completely fulfilled the SRS eligibility criteria, showing spinal curves between 25 and 40 Cobb degrees. RESULTS: In the whole group SRS outcome after bracing treatment was successful in 93% and in 81% of patients, at per protocol (PP) and intention to treat (ITT) analysis, respectively, the latter also including drop-outs as worst outcomes. Cobb angles significantly decreased in all subgroups except in patients showing double major curves, lower curve magnitude (20-30°) and Risser score 2. Rib humps and balance rate also significantly improved in the whole sample (12.78±4.54 at T0 vs. 6.83±4.33 at T1 P<0.001; 60% at T0 vs. 94% at T1 P<0.001, respectively). In the subgroup that completely fulfilled the SRS eligibility criteria, the outcome was successful in 92% and 83% of patients, at PP and ITT analysis, respectively, the latter also including, even in this case, drop-outs as worst outcomes. CONCLUSIONS: This study shows that in patients with AIS the treatment with the "Cheneau-P" brace is associated with a remarkably high rate of successful outcomes, both in the whole sample and in the subgroup of patients completely fulfilling the SRS criteria. CLINICAL REHABILITATION IMPACT: The "Cheneau-P" brace proved effective as a conservative treatment for AIS by stabilizing curve progression and limiting the need for surgical treatment.

Prosthesis intolerance in patients with transfemoral amputation: a videocapillaroscopic study.

Videocapillaroscopy is a new technique allowing a noninvasive examination of the capillary framework of the skin by using a contact probe with magnifying lenses and a cold-light epiluminescence system. The aim of this article was to investigate, by videocapillaroscopy, the microcirculation of the skin of the stump in 70 consecutive patients with unilateral transfemoral amputation. Patients were divided into two subgroups according to their tolerance (A) or intolerance (B) to a prosthesis with an Icelandic-Swedish-New York socket. Subgroup A included 48 patients, 17 diabetic and 31 nondiabetic, and subgroup B included 22 patients, 16 diabetic and 6 nondiabetic. In subgroup B, the caliber of capillary loops was significantly larger (mean +/-standard deviation, 23.6 +/-2.04 vs. 16.2 +/-1.96 microm; P < 0.001), neoangiogenesis was significantly more frequent (82%vs. 25%, P < 0.001), and the presence of microaneurysms (64%vs. 15%, P < 0.001) and microhemorrhages (36%vs. 4%, P < 0.001) was also more frequent. Surprisingly, some such diabetes-like microvascular changes were also found in the six nondiabetic patients of subgroup B. By using multiple logistic regression analysis, intolerance to the prosthesis was significantly related to microvascular changes (P = 0.001) but not to diabetes (P = 0.601), although diabetes was unequally distributed in the two subgroups.