Vertical Transmission of the Hip Rolls Due to Wearing of TLSO for Scoliosis

Abstract

Cosmesis is important in the treatment of adolescent patients with idiopathic scoliosis. It has been shown that although bracing reduces the rib hump, it induces several complications. The aim of this study was to describe a new disturbing complication due to wearing a thoracolumbosacral orthosis (TLSO) for adolescent idiopathic scoliosis: the vertical transmission of the hip rolls (trochanteric lipomatosis) in girls and its pathogenetic mechanisms. Trochanteric lipomatosis is common in the female population, particularly after adolescence, and is responsible for the characteristic appearance of the hip rolls. No data have been reported concerning vertical transmission of normal trochanteric lipomatosis with subsequent disturbance of aesthetic appearance while wearing the TLSO. In this prospective study, 300 consecutive adolescent girls who were treated with the TLSO for progressive idiopathic scoliosis were followed and evaluated for development of any vertical transmission of the hip rolls after application of the brace for an average of 2.5 years after termination of the treatment. Almost simultaneously, 290 age-matched, randomly selected adolescent girls served as controls and were examined by two unbiased observers during the school screening program to estimate the prevalence of trochanteric lipomatosis in female adolescents of the same geographic area. In this series, bracing reduced the thoracic scoliosis from 34.4 +/- 5 degrees to 18.5 +/- 6 degrees and the lumbar scoliosis from 29.4 +/- 4 degrees to 16.7 +/- 4 degrees 6 months after initiation of brace wearing. The average prevalence of normal trochanteric lipomatosis in girls in the control group was 26% (range, 12.2-68.4%) for the ages 9-14 years and was increasing with the age and weight. No correlation was found between amount of reduction of scoliosis and prevalence of the complication. Vertical transmission of the hip rolls was observed in 69 (23%) of the girls with scoliosis 6 months after initiation of brace wearing and was positively correlated with the rigidity of the scoliotic curvature (p < 0.05) and the amount of reduction of the curvature (p < 0.05). Seven (8.8%) girls discontinued brace wearing because of psychological distress related to the deformity around the hip rolls, whereas 51 (73%) additional girls underwent suction lipoplasty during or after the termination of the brace wearing, because of persistent and disturbing lipomatosis. Recurrence of significant lipomatosis was observed in 3 (5.8%) of the girls who underwent lipoplasty. Physicians who are involved with treatment of scoliosis with bracing should be aware of this aesthetic complication. Brace wearing should not attempt maximum correction of scoliosis, thus avoiding excessive force on the body, and should be ordered only in patients with immature spines, curves of > 25 degrees, and radiologically justified progression. Suction lipoplasty seems to be a safe method of treatment and should be advised in cases with unaesthetic vertical transmission of the hip rolls.