Abstract
BackgroundThe shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle.MethodsCross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years), Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography.ResultsCobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant). The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main curvature was 8.4° ± 2.7°in braced and 11.4° ± 2.7° in un-braced patients (difference extremely significant, p = 0.0003). The value of the sum of angles of trunk rotation at three levels of the trunk was 12.8° ± 4.6° in braced and 16.5° ± 3.8° in un-braced patients (difference very significant, p = 0.0038). The POTSI did not differ significantly between the groups (p = 0.78), the Hump Sum values were not quite different (p = 0.07).Conclusion(1) Adolescent girls wearing the brace for idiopathic scoliosis of 25 to 40 degrees of Cobb angle, reveal smaller clinical rotational deformity of their back than non-treated girls having similar radiological deformity. (2) Evaluation of the results of treatment for idiopathic scoliosis should consider parameters describing both clinical and radiological deformity.
Highlights
The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak
Brace treatment is a standard management for progressive idiopathic scoliosis of moderate Cobb angle; it is usually recommended for angles of 25 to 40 degrees and, if residual growth of the spine is expected [1]
The main clinical parameters are: the C7 plumb line, axillary plumb line, shoulder and hip asymmetry, which can be objectively measured with surface topography using the Posterior trunk symmetry index (POTSI) index [2], as well as the angle of trunk rotation, which is assessed with the scoliometer [3]
Summary
The shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects the shape of the axial skeleton and the surface of the body. On the radiological exam the Cobb angle, apical vertebra translation, angle of vertebral axial rotation are usually used, the Cobb angle is considered the most universal parameter to evaluate the curve magnitude [4] It seems logical and is generally admitted that there exist some parallelism between the degree of intensity of clinical and of radiological parameters describing the deformity. The more severe the curve in terms of Cobb angle the more the surface deformity is pronounced
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