Abstract
BackgroundScoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; however, the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified.MethodsA total number of 45 right thoracic AIS patients who had received a thoraco-lumbo-scaral brace for the first time were included retrospectively. For each patient, radiographic images at three visits, pre-brace, in-brace, and at least 1 year after the first brace fit were included. Age, sex, Risser sign, and curve type at pre-brace, and thoracic and lumbar frontal and sagittal Cobb angles, thoracic and lumbar apical rotations, sagittal and frontal balances at pre-brace and in-brace were determined. Two sagittal curve types (hypothoracolumbar and normal/hyperthoracolumbar kyphosis), two rib cage types based on the costovertebral joints (drooping and horizontal), and two axial shapes of the spine (S shaped and V shaped) were used to stratify the patients. Feature selection and linear regression with regularization determined the parameters and the interaction terms that predicted the brace effectiveness significantly.ResultsSmaller in-brace thoracic Cobb and larger in-brace lordosis predicted brace effectiveness, p < 0.05. Impact of the out of brace lordosis on the brace success increased as the in brace kyphosis angle decreased, p = 0.046. A larger out of brace lordosis in hypothoracolumbar sagittal profile type patients improved the outcomes, p = 0.031. A smaller out of brace thoracic rotation improved the bracing outcomes in patients with horizontal ribs, p = 0.040.ConclusionBoth 3D patient specific parameters (lordosis, thoracic rotation, shape of the rib cage, and sagittal profile) and brace design (which allows larger in brace lordosis, better in brace Cobb correction) are important predictors of the brace effectiveness in AIS.
Highlights
Scoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients
Scoliosis bracing is a common approach in conservative management of adolescent idiopathic scoliosis (AIS)
The objective of this study is to identify the pre-brace and in-brace spinal curve and rib cage characteristics in the frontal, sagittal, and axial planes that predict the outcome of bracing in a cohort of right main thoracic AIS patients
Summary
Scoliotic braces are the standard of curve for management of moderate spinal deformities in pediatric patients. The effectiveness of this treatment method has been shown; the spinal and rib cage parameters, in the three anatomical planes, that are associated with bracing outcome in adolescent idiopathic scoliosis (AIS) are not fully identified. Scoliosis bracing is a common approach in conservative management of adolescent idiopathic scoliosis (AIS). While the etiology of AIS remains unknown, the effectiveness of bracing in controlling the curve progression has been shown [1]. Spinal curve severity changes at a varying rate as treating the patients with the brace, and in some cases progresses significantly requiring a spinal fusion surgery. Many studies have determined the factors predicting the brace effectiveness in the AIS population. While the pre-operative shape of the spine and surgical factors have predicted the surgical correction of
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