Abstract
We report the case of a 13-year-old Caucasian girl suffering from severe axial rotation of the T5 to L4 vertebrae. The patient (initially examined during a school screening study) was at first considered to be suspicious of suffering from scoliosis due to a highly positive Adam's forward bending test. However, her radiographic evaluation revealed the existence of axial rotation in 12 of her vertebrae, without inclination in the sagittal and coronal planes. After an observation period of 12 months and due to the fact that both her physical appearance and the measured vertebral rotation deteriorated, the patient was given a modified thoracolumbar Boston brace that had an immediate positive derotational effect on all but two vertebrae. Twenty four months later, the progress of the vertebral rotation(s) seems to have been halted and most affected vertebrae appear to be stabilized in their new, 'post-brace', reduced position, with better results shown when the Boston brace is worn. The patient remains under constant medical observation. The application of a modified Boston brace seems to have served well (so far) a useful purpose for reducing and stabilizing this case of severe axial vertebral rotation, providing less deformity and (possibly) offering a better final cosmetic result.
Highlights
Adolescent Idiopathic Scoliosis (AIS) is a complex three-dimensional deformity of the spine [1]
Adolescent idiopathic scoliosis is a complex threedimensional deformity of the spine characterized by thoracic lordosis in the sagittal, lateral curve(s) in the coronal and vertebral rotation in the transverse plane [1]
Boston brace has been widely used for the treatment of children suffering from Adolescent Idiopathic Scoliosis [5], with moderate influence on their quality of life [6,7], the use of such a treatment has never been proposed for patients suffering from axial vertebral rotation in the horizontal plane and is certainly not currently recommended by the SRS
Summary
Adolescent Idiopathic Scoliosis (AIS) is a complex three-dimensional deformity of the spine [1]. It is rather uncommon [3] for a patient to be diagnosed with a condition (such as vertebral rotation in the horizontal plane without inclination in the sagittal and coronal planes) that seems to lie somewhere ‘in the middle’ between a normal and a scoliotic spine This clinical entity is usually accompanied by minimal clinical deformity and ( rarely) it can interfere with the results of scoliosis screening studies, often leading to a false diagnosis of scoliosis and unnecessary radiographic examination [3]. Due to the unfortunate fact that the patient shortly after her initial examination lost all her radiographs and in order to better evaluate both the structural deformity underlying the vertebral rotation and the possible co-existence of a thoracic cage deformity which could interfere with the interpretation of the Adam’s forward bending test, a Computed Tomography (CT)-scan was suggested Both the patient and her parents refused to consent to it. The patient is under constant medical observation (Risser stage IV upon her latest follow-up Visit 3); she is quite happy with the result of her therapy (as she reports that the rib-hump has -to some extent- been reduced in size) and remains symptoms-free, apart from a skin irritation caused by the brace which is being treated conservatively (Figure 3)
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