The Impact of Lateral Pads versus Posterolateral Pads in the Management of Idiopathic Scoliosis

Abstract

The Boston-low profile thoracolumbar sacral orthosis (TLSO) is a common treatment for idiopathic scoliosis (IS). Some have found that the forces applied in the brace are not optimal. For example, hypokyphosis, inherent to IS curves, is sometimes amplified by orthotic treatment. Hypokyphosis is a major concern with IS and it is important to reduce. Proper pad placement is therefore critical in achieving optimal correction in the coronal plane while not accentuating hypokyphosis in the sagittal plane. In correction of the thoracic spine, pads are placed either laterally or posterolaterally, pushing against the ribs, thereby correcting lateral curvature of the spine. The decision to use either lateral (L) pads or posterolateral (PL) pads) has raised some discussion. The current study evaluates the pads in the Boston brace in relation to percentage of thoracic correction and degrees increase in hypokyphosis. Charts and x-rays of 38 first-time bracing patients with adolescent and juvenile IS, between the ages of 7 and 15 years, from two ABC-certified orthotists, were examined. As a cross-sectional, retrospective analysis, it was hypothesized that the PL pads would offer no difference in desired coronal plane thoracic correction compared with L pads and that PL pads would create more unwanted increase in hypokyphosis than L pads. Results indicate that practitioners varied in their preference to pad styles, that there was no difference between pad styles for thoracic scoliosis correction (significant at p < 0.10, but not at p < 0.05), and that the PL pad induced more hypokyphosis than the L pad (p < 0.10 and p < 0.05). In conclusion, the use of L pads should be considered in the majority of IS cases, with the exception of scoliosis curves with excessive kyphosis. Scoliosis curves that are hyperkyphotic should be treated with a PL pad to induce thoracic extension.