Abstract
BackgroundDespite the frequency of adult scoliosis, very few publications concern the conservative orthopaedic treatments. The indications have not been defined to date. The experience of a department specialized in rigid bracing allows us to consolidate and clarify diagnosis and indications as well.MethodsIndividual observational prospective cohort study from a database started in 1998, with selection of all 739 adult scoliosis patients for which conservative orthopaedic treatment has been proposed to, even in case of drop-out. Scoliosis treated during adolescence and monitored in adulthood are included if a new brace is prescribed.A first descriptive study of the main parameters was performed: gender, age, Cobb angle.A tentative classification according to aetiology, age and angulation is proposed.Results Descriptive Data:The Ratio Female/Male is 88 %, the mean age: 56.97 ± 15.82, the mean Cobb angle: 35.58 ± 17.35. The rate of non-adherent patients not wearing the brace is 17 % (but the plaster cast before bracing was routinely proposed at the time). All patients can be grouped into five diagnoses, all statistically different, according to the age and the initial Cobb angle:Rotatory dislocation: 361 cases, age: 59.73 ± 13.52 (p = 0.05), (Cobb 39.08 ± 16.59 (p = 0.02)*Instability and disc disease: 150 cases, age: 46.03 ± 15.49 (p = 0.00)*, Cobb: 25.29 ± 12.29 (p = 0.00)*Camptocormia: 68 cases, age: 69.78 ± 12.19 (p = 0.00)*), Cobb: 38.09 ± 14.23 (p = 0.25)Kyphosis TL or T: 62 cases, age: 60.73 ± 15.51 (p = 0.07), Cobb: 43.34 ± (21.48 (p = 0.00)*Disabling pain: 33 cases, age: 48.36 ± 13.73 (p = 0.02)*, Cobb: 36.45 ± 25.21 (p = 0.78) Treatment after surgery and in the context of a lumbar stenosis and spondylolisthesis are independent groups.Despite the wide variety of etiologies, nearly 2/3 of patients have a discal pathology like rotatory dislocation and disc instability. For these patients a short brace can be used. Other patients usually have high kyphotic pathology as Kyphosis or camptocormia. They need a long brace.ConclusionsThe wide variety of adult scoliosis makes any objective classification difficult. This first approach is intended to specify the best indications of bracing in adulthood.The female ratio is slightly higher than that of the adolescent.The dropout rate is high and justify improvements with adaptation of bracing to adults.All proposed etiological groups are statistically significantly different. Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-016-0090-y) contains supplementary material, which is available to authorized users.
Highlights
Despite the frequency of adult scoliosis, very few publications concern the conservative orthopaedic treatments
Scoliosis in adults is 10 % of the population aged 65, conservative non-surgical orthopaedic treatment is the subject of few publications
As growth is the main factor of progression for AIS; in adulthood, the anatomical aetiologies are much more varied: disc, bone with osteoporosis, muscle, and postural system for the camptocormia which is characterized by forward flexion of the spine when standing or walking and disappears when lying down
Summary
Despite the frequency of adult scoliosis, very few publications concern the conservative orthopaedic treatments. Methods: Individual observational prospective cohort study from a database started in 1998, with selection of all 739 adult scoliosis patients for which conservative orthopaedic treatment has been proposed to, even in case of drop-out. A first descriptive study of the main parameters was performed: gender, age, Cobb angle. Scoliosis in adults is 10 % of the population aged 65, conservative non-surgical orthopaedic treatment is the subject of few publications. As growth is the main factor of progression for AIS; in adulthood, the anatomical aetiologies are much more varied: disc, bone with osteoporosis, muscle, and postural system for the camptocormia which is characterized by forward flexion of the spine when standing or walking and disappears when lying down. It is related to atrophy of the deep muscles of extra-pyramidal origin
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