Abstract
PurposeThis prospective observational study aims to assess the MA brace effectiveness in hyperkyphosis correction, focusing also on patients’ compliance of bracing and its psychological impact.MethodsPatients referring to our spine outpatient department with Scheuermann’s kyphosis (SK) from January 2011 to January 2017 were prospectively recruited. Patients were divided into two groups, according to their global thoracic kyphosis (TK): Group-A TKT0 < 60°, Group-B TKT0 ≥ 60°.The MA brace was prescribed according to SRS criteria. Full spine X-rays were analyzed at conventional times: at the beginning of treatment (T0), at 6-months follow-up (T1, in-brace X-rays), at the end of treatment (T2) and at 2-year minimum follow-up from bracing removal (T3). At T0, T2 and T3 all the patients were assessed using the Italian Version of the SRS-22 Patient Questionnaire (I-SRS22). Variability between and within-groups was assessed; a p value < 0.05 was considered significant.Results192 adolescents (87 girls and 105 boys, mean age 13.1) were recruited. The mean global TK at recruitment was 61.9° ± 11.3°, the mean follow-up time was 57.4 months. A good patients’ reported compliance was observed: 84.9% of patients used the brace as scheduled. A mean in-brace correction (in-brace TK%) of 37.4% was observed and a mean final correction (TK%T3) of 31.6%. At final follow-up (T3), curve reduction (ΔTK ≤ − 5°) was observed in 60.4% of patients and curve stabilization (− 5° < ΔTK < 5) in 29.7% of patients. At baseline, worse SRS22-mental health (p = 0.023) and self-image mean scores (p = 0.001) were observed in Group-B, compared with Group-A. At the end of treatment (T2), an improvement of all items was observed, wit significantly better improvement of self-image domain in Group-B.ConclusionThe MA brace has shown to be effective in the management of SK; good patients’ reported compliance and a positive effect on the patients’ mental status were recorded.
Highlights
Scheuermann’s Kyphosis (SK) is a juvenile osteochondrosis of the spine characterized by defective growth of the vertebral cartilage endplate [1, 2]
We describe an antigravity brace design, the Maria Adelaide (MA) brace, which is currently used at our institution as a gold standard for the orthotic treatment of SK
This study aims to assess the MA brace effectiveness in hyperkyphosis correction, focusing on patients’ reported compliance of bracing and its psychological impact
Summary
Scheuermann’s Kyphosis (SK) is a juvenile osteochondrosis of the spine characterized by defective growth of the vertebral cartilage endplate [1, 2]. It mainly involves thoracic (traditional pattern) or thoracolumbar spine. The onset of SK usually appears just before puberty, after ossification of the ring apophysis [3]. Adolescents affected by SK generally complain an excessive rigid thoracic or thoracolumbar hyperkyphosis, associated with concomitant vertebral structural changes and, sometimes, subacute thoracic pain [1, 2]. With a reported prevalence of 1–8% in the USA, SK currently represents the leading cause of sagittal spinal deformity in developmental age [2]. In the past SK was thought to be more frequent in male than female,
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