ABSTRACT
BACKGROUND: Physiotherapy, brace applications or surgery are the treatment options utilised to manage patients with scoliosis. Many different brace applications are used, and the success rates of orthoses vary. OBJECTIVES: Brace applications can have detrimental impacts on the patient leading to physical discomfort, psychological discomfort, and in some instance the use of braces may even be painful. Therefore, future developments in this field should be aimed at improving the success rate and reducing physical distress experienced by the patient while using brace applications. The purpose of this article is to provide recommendations with respect to the most appropriate bracing approach in general. METHOD: A narrative review of the scientific literature was carried out to substantiate the statements made in this article. RESULTS: The most important braces provided for the treatment of patients with scoliosis and the treatment results that can be achieved are presented and discussed, taking into account the most recent systematic reviews. A wide range of success rates have been found for the different brace applications. CONCLUSION: Given that brace application may impact the patient leading to physical discomfort and psychological distress, good quality management in brace application for patients with scoliosis is needed to ensure the best possible outcome and the least stressful management. CLINICAL IMPLICATIONS: Safety in brace application for patients with scoliosis needs improvement. The use of standardised and reliable computer aided design (CAD) libraries and appropriate patient information based on published guidelines is suggested.
ABSTRACT
INTRODUCTION: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD). PATIENT PRESENTATION MANAGEMENT AND OUTCOME: Initially, the premenarchial female was 9 years old and had a Tanner stage 2-3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2. CONCLUSION: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood. CLINICAL IMPLICATIONS: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.
ABSTRACT
BACKGROUND: The treatment of scoliosis patients with corrective braces today still leads to quite different results. The published success rates between 50 and 90% inevitably lead to the question of how the success rates of brace treatment can be increased and standardized. The results of a computer aided design (CAD) Chêneau application, developed with this objective, are presented. MATERIALS AND METHODS: On the reporting date (December 8, 2019), the prospectively created database of our department was evaluated retrospectively. Only immature girls with adolescent idiopathic scoliosis (AIS), aged 10-14 years, Risser signs 0-2, were included in the database. RESULTS: Both the entire group with an observation period of at least 18 months and the patient groups with completed treatment had success rates between 86 and 88%. Overall, the results were significantly better than the 72% success rate of the Boston Brace Control Group (BRAIST). In comparison with the results of other Chêneau derivatives, the success rate of our series was distinctly better. CONCLUSIONS: Treatment safety in brace treatment for patients with scoliosis should be improved. One approach may be the use of standardized CAD libraries. Further investigations with study designs of higher evidence are necessary to support the results found in our investigation.