Abstract
The three-dimensional nature of adolescent idiopathic scoliosis (AIS) necessitates a tridimensional assessment and management. Bracing constitutes the mainstay conservative treatment for mild adolescent idiopathic scoliosis. In the literature hitherto, there has been uncertainty regarding the behavior of the spine, pelvis, and vertebral orientations in the context of bracing, especially in the transverse plane. This poses a challenge to healthcare providers, patients, and their families, as brace treatment, although not as invasive as surgery, is laden with medical and psychological complications and could be considered traumatizing. Hence, a thorough understanding of initial three-dimensional spinal behavior in the context of bracing is important. The purpose of this retrospective study was to investigate the immediate 3D impact of Chêneau-type brace. Thirty-eight patients with AIS undergoing Chêneau-type bracing were included. Patients were stratified according to their structural curve topography into thoracic, thoracolumbar, and lumbar groups. 3D reconstruction of the spine using a dedicated biplanar stereoradiography software with and without the brace was performed. The examined anthropometric radiographic measures were pre- to in-brace variations and differences of spinopelvic parameters and vertebral orientations in the coronal, sagittal, and transverse planes. The complex impact of the Chêneau-type brace on different curves in three planes was delineated. In the coronal plane, the Cobb angle was significantly decreased in all types of curves, and the coronal tilt correction was concentrated in specific segments. The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis. In the transverse plane, an axial vertebral rotation change and detorsion above the apex occurred in the thoracolumbar curves. The results from this exploratory study could shed some light on the initial 3D spinal behavior in the context of bracing and may be of beneficial for treating physicians and brace makers.
Highlights
Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) deformity of the spine and trunk
In 32% (12 cases) of our patients, AVR decreased more than 5◦, remained unchanged in 58% (22 cases), and increased more than 5◦ in 10% (4 cases) of the study population
Though the reliability of the 3D measurements is very good, a previous reliability study [20] demonstrated that the measurement errors of the discussed parameters could be as high as 3.5 degrees. This retrospective pre- to in-brace analysis delineated the complex impact of the Chêneau-type brace (C-brace) on different curves in 3D
Summary
Adolescent idiopathic scoliosis (AIS) is a three-dimensional (3D) deformity of the spine and trunk. It affects 1%–3% of children aged 10–16 years [1]. The advent of new 3D imaging and postprocessing techniques triggered novel research to address the etiology, pathomechanism, diagnosis, and treatment of spinal deformities in the coronal, sagittal, and transverse planes. The treatment modalities of AIS are non-operative and surgical. Brace treatment is the cornerstone of non-operative management that aims to halt the progression of deformity before reaching the surgical threshold. In terms of bracing biomechanics, few correction principles have reached final consensus among the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment SOSORT expert committee [7]
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