Influence of Chêneau-Brace Therapy on Lumbar and Thoracic Spine and Its Interdependency with Cervical Spine Alignment in Patients with Adolescent Idiopathic Scoliosis (AIS).

Wojciech Pepke,Thomas Bruckner,Haidara Almansour,Stefan Hemmer,Aly El Zeneiny,Michael Akbar

doi:10.3390/jcm10091849

Wojciech Pepke, Thomas Bruckner + Show 4 more

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https://doi.org/10.3390/jcm10091849

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Abstract

Chêneau-brace is an effective therapy tool for treatment in adolescent idiopathic scoliosis (AIS). Data on potential interdependent changes of the sagittal profile including the cervical spine are still sparse. The purpose of this study was to evaluate in-brace changes of the thoracic and lumbar spine and their influence on the pelvis and the cervical spine and apical vertebral rotation was reported. Ninety-three patients with AIS undergoing Chêneau-bracing were included. Patients were stratified by lumbar, thoracic and global spine alignment into normolordotic vs. hyperlordotic or normokyphotic vs. hypokyphotic or anteriorly aligned vs. posteriorly aligned groups. The coronal Cobb angle was significantly decreased in all groups indicating good correction while in-brace therapy. Sagittally, in-brace treatment led to significant flattening of lumbar lordosis (LL) in all stratified groups. Thoracic kyphosis (TK) was significantly flattened in the normokyphotic group, but no TK changes were noticed in the hypokyphotic group. Pelvic tilt (PT) stayed unchanged during the in-brace therapy. Chêneau-brace showed marginal changes in the lower cervical spine but had no influence on the upper cervical spine. The apical vertebral axis in primary and secondary curves was unchanged during the first radiological follow-up. Results from this study contribute to better understanding of initial spine behavior in sagittal and axial plane in the context of bracing.

Highlights

Adolescent idiopathic scoliosis (AIS) is a deformity of the spine including deviation of a coronal curve, axial vertebral rotation, and flattening of the sagittal profile [1,2].Treatment modalities of AIS range from conservative therapy with physiotherapy and sports, brace therapy, to surgery [3]
We focused on the immediate brace impact on spine alignment
Cobb angle of primary and secondary curves was significantly decreased during brace therapy, indicating a good in-brace coronal correction

Summary

Introduction

Adolescent idiopathic scoliosis (AIS) is a deformity of the spine including deviation of a coronal curve, axial vertebral rotation, and flattening of the sagittal profile [1,2].Treatment modalities of AIS range from conservative therapy with physiotherapy and sports, brace therapy, to surgery [3]. Adolescent idiopathic scoliosis (AIS) is a deformity of the spine including deviation of a coronal curve, axial vertebral rotation, and flattening of the sagittal profile [1,2]. Brace treatment is an important player in nonoperative treatment in adolescents who are still growing (Risser grade 0–2) with structural Cobb curves >20◦, but before surgical threshold is reached [4,5]. The aim of the brace therapy is to guide the spine or at least to stop the curve progression during the pubertal growth spurt [6]. The changes of the thoracic and lumbar spine as well as the pelvis during brace therapy were the focus of many previous investigations [1,2]. Marginal efforts have been put forth to understand the interdependency of cervical spine alignment with regional parameters

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