Thoracolumbosacral Orthosis Research Articles

Management of Pregnancy-and Lactation-Related Osteoporosis: Case Series.

To share the experience regarding management and follow-up of patients with Pregnancy- and lactation-related osteoporosis (PLRO) who were effectively treated. This case series presented 10 patients diagnosed with PLRO and treated from January 2010 to December 2019. Visual analog scale and laboratory findings were evaluated. Spinal and extremity magnetic resonance imaging was obtained for patients with spinal and extremity pains. Dual energy X-ray absorptiometry was used for the measurement of bone mineral density. Values assessed on dual energy X-ray absorptiometry were L1?L4 T score, L2?L4 T score, and femoral neck T score. In the first-month follow-ups, all patients had meaningful pain relief and symptom resolution. The mean duration of pain control during the treatment period was 2.4 months. Two patients who continued breast-feeding were also the patients whose pain control was achieved at the latest. One patient required vertebroplasty. Patients with PLRO should be promptly treated and followed up. Discontinuation of breast-feeding will provide rapid advantage and should be the first step of the management. Early diagnosis and treatment of calcium and vitamin D with conservative procedures with spinal braces are very important for the treatment of PLRO patients. Additionally, bisphosphonates or teriparatide can improve the bone mineral density in patients with PLRO.

Evaluation of night-time bracing efficacy in the treatment of adolescent idiopathic scoliosis: a systematic review.

Systematic review of the literature. To systematically review the literature to assess the efficacy of night-time bracing in controlling curve progression with respect to traditional full-time thoraco-lumbo-sacral orthoses (TLSOs) in patient with adolescent idiopathic scoliosis. PubMed, Ovid, Cochrane Reviews and Google Scholar were all accessed and a combination of terms and keywords pertaining to the core concept was used in the research. Case reports, technical notes, instructional courses, literature reviews, biomechanical and/or in vitro studies were all excluded, as well as case series (level IV studies). The methodological quality of the selected articles was assessed using the MINORS methodology score. Given the overall level and quality of the available evidence, conclusions were drawn based on a summary of the evidence. Seven studies were included. Five papers reported no differences in curve progression between traditional TLSOs and night-time braces and the remaining two studies reported TLSO to be superior. The current available literature does not permit us to draw conclusions about night-time braces. The low methodological quality of the studies examined makes it impossible to compare the effectiveness of the night-time braces with that of traditional TLSOs. Prospective well-designed clinical trials applying SRS inclusion and evaluation criteria are mandatory to better define the role of night-time orthosis in the treatment of adolescent idiopathic scoliosis.

3D-printed brace in the treatment of adolescent idiopathic scoliosis: a study protocol of a prospective randomised controlled trial

IntroductionAdolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. Brace treatment is effective for eligible patients with AIS and the effectiveness is significantly correlated with the average brace-wear...

Brace Effectiveness Is Related to 3-Dimensional Plane Parameters in Patients with Adolescent Idiopathic Scoliosis

Although scoliosis is a 3-dimensional (3D) deformity, little research has been performed on the use of 3D imaging in brace curve correction. The purpose of the present study was to determine the effect of axial-plane parameters on the outcomes of bracing with a thoracolumbosacral orthosis for adolescent idiopathic scoliosis. This prospective longitudinal cohort study included patients with adolescent idiopathic scoliosis who fulfilled the criteria for bracing according to the Scoliosis Research Society, and was conducted from the time the patient began wearing the brace through a minimum follow-up of 2 years or until a surgical procedure was performed. Radiographs made with use of an EOS Imaging System were used to reconstruct 3D images of the spine at the pre-brace, immediate in-brace, 1-year in-brace, and latest follow-up out-of-brace stages. Univariate and multiple linear regressions were performed to determine the association between axial rotation correction and curve progression at the time of the latest follow-up. Logistic regressions were performed to model the probability of risk of progression. Fifty-three patients were enrolled, and 46 patients were included in the analysis. At the time of the latest follow-up, 30 patients did not experience curve progression and 16 patients had curve progression. There was no difference in baseline demographic characteristics between groups. For the transverse-plane parameters, there was a significant difference between non-progression and progression groups in pre-brace apical vertebral rotation (4.5° ± 11.2° compared with -2.4° ± 9.8°, respectively; p = 0.044) and in 1-year in-brace apical vertebral rotation correction velocity (2.0° ± 5.0°/year compared with -1.7° ± 4.4°/year, respectively; p = 0.016). Logistic regression analysis showed that pre-brace apical vertebral rotation (odds ratio, 1.063; 95% confidence interval, 1.000 to 1.131; p = 0.049) and 1-year in-brace apical vertebral rotation correction velocity (odds ratio, 1.19; 95% confidence interval, 1.021 to 1.38; p = 0.026) were associated with an increased risk of curve progression. There was no difference in Scoliosis Research Society 22-Item scores between patients who experienced curve progression and those who did not. In this prospective study, we demonstrated that axial-plane parameters and the correction of these parameters during bracing are related to the successful use of the brace. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

3D printing orthopedic scoliosis braces: a test comparing FDM with thermoforming

In recent years, 3D printing gained considerable attention in the orthopedic sector. This work evaluates the feasibility of producing orthopedic scoliosis braces by 3D printing, comparing performance and costs with classical thermoforming procedures. Critical parameters, such as manufacture time, mechanical properties, weight, and comfort are carefully considered. Polyethylene terephthalate glycol-modified (PETG) was selected among the several filaments materials present on the market. Printed samples were analyzed with electronic microscope, tensile, and impact tests and compared with thermoformed polyethylene (PE) and polypropylene (PP) samples. Moreover, a cost analysis was carried out for the specific application. The thermoformed brace of a volunteer patient affected by scoliosis was reproduced using reverse-engineering techniques. The model was then printed as a single piece and postprocessed by an expert orthotist. Subsequently, the patient wore the brace in a pilot case to compare comfort and mechanical effectiveness. Results show that the 3D printing fabrication method is able to provide a valid alternative to the current fabrication methods, being also very competitive in terms of costs. The morphological analysis does not show critical defects in 3D printed samples, while the mechanical tests highlighted their anisotropy, with an overall brittleness of PETG samples in the direction orthogonal to the fibers. However, in terms of mechanical stresses, a back brace should never reach the polymer yield stress, otherwise the shape would be modified and the therapeutic effect could be compromised. Finally, the patient reported the perception of improved support and no significant comfort differences compared with the thermoformed brace.

P86. Postoperative bracing does not improve the rate of proximal junctional kyphosis in adult spinal deformity

BACKGROUND CONTEXT The development of proximal junctional kyphosis (PJK) is an ongoing issue in adult spinal deformity (ASD) patients following spine surgery, with an incidence reported to be as high as 61.7%. Approximately 47.4% of patients who develop PJK will require revision surgery within 6 months. Currently, there are no reports in the literature on the effects of postoperative bracing on the incidence of PJK. We sought to determine whether postoperative bracing results in decreased rates of PJK in ASD treated with open posterior instrumented fusion (PSF) greater than six levels. PURPOSE To determine whether postoperative bracing results in decreased rates of PJK in ASD patients treated with PSF greater than six levels. We hypothesized that postoperative bracing would result in lower rates of PJK. STUDY DESIGN/SETTING We performed a retrospective analysis of prospectively collected data comparing patients treated with a thoracic lumbar sacral orthosis (TLSO) postoperatively for 3 months vs no brace following PSF. PATIENT SAMPLE Consecutive cohort of ASD patients (n=112) from a single surgical spine practice who underwent PSF were included. OUTCOME MEASURES Clinical and functional outcomes assessed: Oswestry Disability Index (ODI) and Visual Analog Scale pain (VAS). Radiographic measures: spinopelvic parameters, thoracic kyphosis (T5-T12), junctional kyphosis (T10-L2), lumbar lordosis (T12-S1), sagittal and coronal alignment, and PJK angle with corresponding level. METHODS Clinical and radiographic data of 112 (78 braced and 34 non-braced) consecutive adult patients who underwent PSF (> 6 levels) for deformity correction were analyzed. Radiographic measurements were performed preoperatively and postoperatively at 6 weeks and 6 months. PJK was defined as more than 10 degrees of abnormal kyphotic angulation measured at the superior end plate of one adjacent vertebra above the upper instrumented vertebra (UIV), to the inferior endplate of the UIV. Chi-square test and ANCOVA were used to analyze data. Statistical significance was set at p≤0.05. RESULTS The baseline clinical and radiographic demographics between the two cohorts were similar. The incidence of PJK was not statistically different (p=0.98) between patients who were braced (n=13/34; 38.2%) versus those not braced (n=30/78; 38.5%) postoperatively. Women had five times greater odds of developing PJK than men [OR=5.44;(95%CI =1.51-19.64)]. There were no significant differences at 6 months follow-up between the braced and not braced groups in ODI, VAS, or radiographic features, with the exception of T10-L2 thoracolumbar kyphosis, which was 3.08 versus 7.95 degrees in the braced and non-braced groups, respectively (p=0.03). CONCLUSIONS There was no statistical difference in the incidence of PJK in the braced versus non-braced groups. Interestingly, thoracolumbar kyphosis was significantly decreased in ASD patients who were braced postoperatively. Further investigation is needed to determine if postoperative bracing is protective against excessive postoperative kyphosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Low Back Pain Among Weightlifting Adolescents and Young Adults.

BackgroundWeightlifting is a common type of sports training that develops the strength and size of skeletal muscles. Low back pain (LBP) is one of its most common complaints. This sport has become prevalent among adolescents and young adults as they work to enhance their physique and body image. The aim of our study is to explore the nature and cause of LBP in weightlifting adolescents and young adults in an aim of extrapolating proper preventive measures.MethodsParticipants were patients who engaged in weightlifting sports and had presented to our clinic with nonspecific LBP. They were examined and asked to rate and localize their pain. Back positioning during weightlifting techniques along with other exercise habits was explored. Patients with congenital or systemic diseases and fractures were excluded from our study.ResultsA total of 93 patients presented with LBP (age range: 16-26 years), all of whom partook in weightlifting (N=93). Localized pain was found in 43 patients (46%). Pain radiating to the left side was found in 31 patients (33%), while pain radiating to the right was found in 19 patients (21%). LBP localized at the level of L4-L5 was found in 44 cases (47%), while that localized at L5-S1 was found in 43 cases (46%). Only six cases localized pain at the level of L3-L4 (7%). A total of 23 cases required surgery (25%), while others were managed conservatively. All the participants (100%) reported their pain to be initiated during or after weightlifting maneuvers. Psychological symptoms were found in 13 cases (19%). Factors that helped relieve the pain included surgery, swimming, and wearing a back brace.ConclusionWeightlifting is a sport that utilizes heavy weights to engage the muscles in the body, and consequently, predisposes athletes to LBP. Using excessive weights and performing improper techniques puts the back in a compromising position that may lead to injury. Medical and sports personnel should raise awareness on the biomechanical properties of the lumbar spine and the correct spine-protective posture during training to help prevent these injuries in the future.

Evaluation of Office Ergonomic Risk Using Rapid Office Strain Assessment (ROSA)

Musculoskeletal Disorders (MSDs) caused by computer use have become the most common ergonomic risks. The risk experienced can be in the form of financial losses or even lives. Therefore, efforts are needed to prevent the occurrence of ergonomic risks so as not to cause large losses. The Rapid Office Strain Assessment (ROSA) has been designed to identify ergonomic risk factors and is reliable for the assessment of office workers' MSDs. This study evaluates the potential risk of ergonomics in female office workers because a previous study found that MSDs were more common in women. From the two workers observed, it was found that workers 1 and 2 received different scores on several assessment components. The different things are the length of the seat holder, armrests, spine brace, and keyboard. This difference is caused by body posture and different types of chairs. The length of the chair and the spinal brace is influenced by the different postures of the two workers. Worker 1 has a shorter upper leg length than worker 2, so she cannot use the backbone section of the chair. Although there are differences in scores on some components of the assessment, both workers have the same final ROSA score, which is 5. This indicates that further posture assessment needs to be done using tools other than ROSA to detect the specific cause of MSDs levels.

Application of Fabric-Type Spinal Orthosis for Flexible Neuromuscular Scoliosis: A Preliminary Study.

This study used a 3-point pressure spinal orthosis made of fabric material in neuromuscular scoliosis patients with flexible spinal curve to evaluate the in-brace correction of the spinal curve and to estimate changes in pulmonary function associated with brace wearing. Twenty-eight children with neuromuscular scoliosis with spinal curve flexibility of more than 50% were enrolled. A custom-made 3-point pressure spinal orthosis was fitted for each patient. The Cobb angles in sitting and supine positions, forced vital capacity, forced expiratory volume in the first second, and peak cough flow were measured before and after applying spinal orthoses. Each participant recorded the brace wearing duration, and questionnaires on brace tolerance were collected. Cobb angles after application of orthosis decreased from 31.0 degrees (interquartile range = 21.9-45.0 degrees) to 16.6 degrees (interquartile range = 10.0-34.0 degrees) in the sitting position and from 13.3 degrees (interquartile range = 4.0-21.0 degrees) to 1.4 degrees (interquartile range = 0.0-19.0 degrees) while supine (P < 0.01, P = 0.04, respectively). Preorthosis and postorthosis application forced vital capacity, forced expiratory volume in the first second, and peak cough flow were unaffected. Caregivers reported improved sitting postures and manual activities. In children with flaccid-type neuromuscular scoliosis, curve correction can be achieved using a simple fabric-type spinal orthosis when applied to patients with flexible scoliosis, without compromising lung function. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe the factors associated with the effects of spinal braces in neuromuscular scoliosis; (2) Discuss the characteristics of flaccid-type neuromuscular scoliosis; and (3) Discuss the benefits of fabric-type orthosis regarding pulmonary function and patient compliance. Advanced. The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Bracing to treat dropped head syndrome in cancer patients: A retrospective review.

ABSTRACT Introduction The objective of this study is to describe the use of postural bracing to treat dropped head syndrome (DHS) in cancer patients. The study design is a retrospective review over a 3-year period of cancer patients who presented to a cancer physiatry outpatient practice for treatment of DHS. Patients were individuals with a history of head and neck cancer, Hodgkin lymphoma, or other cancer with a diagnosis of DHS. Materials and Methods The treatment intervention was postural bracing with either a figure-of-eight orthosis with or without a lumbosacral orthosis or a thoracolumbosacral orthosis. Results Subjective, patient-reported improvements in pain, posture, and neck or back strength in addition to objective improvements in physical examination were made. Out of 41 patients initially evaluated for DHS who followed up in brace clinic, 61% reported a positive response to bracing with 17.1% reporting improvement in neck or back strength, 17.1% reporting improvement in pain, and 39% reporting improvement in posture. Discussion In this study, we present a successful alternative to treat DHS through the use of active bracing. The technique of active bracing in this population theoretically strengthens the weak muscles in head drop and improves head position. Maintenance of these achievements, although not directly studied in this project, must be performed through a regular home exercise and bracing program as patients likely have a tendency to weaken again given prior oncologic treatments. Conclusions Active postural bracing using a combination of a figure-of-eight brace with or without a lumbosacral orthosis or a thoracolumbosacral orthosis in conjunction with physical therapy can help improve the posture, pain, and neck and back strength of cancer patients with DHS.

Spinal Infections: An Update.

Spinal infection poses a demanding diagnostic and treatment problem for which a multidisciplinary approach with spine surgeons, radiologists, and infectious disease specialists is required. Infections are usually caused by bacterial microorganisms, although fungal infections can also occur. The most common route for spinal infection is through hematogenous spread of the microorganism from a distant infected area. Most patients with spinal infections diagnosed in early stages can be successfully managed conservatively with antibiotics, bed rest, and spinal braces. In cases of gross or pending instability, progressive neurological deficits, failure of conservative treatment, spinal abscess formation, severe symptoms indicating sepsis, and failure of previous conservative treatment, surgical treatment is required. In either case, close monitoring of the patients with spinal infection with serial neurological examinations and imaging studies is necessary.

Effectiveness of orthoses for treatment in patients with spinal pain.

Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients’ lifestyle.

Study of Textile Fabric Materials used in Spinal Braces for Scoliosis

Scoliosis patients are normally treated either by surgery or by wearing spinal braces for correction. A spinal brace may be made of rigid materials or soft materials. The use of soft materials for braces, such as fabric materials, is one alternative being used to develop soft braces because textile materials could be comfortable and provide high compliance with users. However, there are no studies about how to provide treatment/prevention of scoliosis using various textile fabric materials to fabricate a soft brace. Thus, this study aims to study the effect of the physical and mechanical properties of textile fabric materials used in a soft brace for the treatment/prevention of scoliosis using finite element model (FEM) simulation. This study covers the following stages: a) development of a geometric model of scoliosis through finite element modelling using 2D X-ray clinical data; b) selection of appropriate textile materials to be used in a soft brace by measuring physical and mechanical properties; and c) determination of the performance of the soft brace fabricated with various textile fabric materials in terms of the Cobb angle through FEM simulation. The results of this study found that the textile fabric materials made of polyester with sandwich mesh and elastic band in parallel layer provides good softness and air permeability and it has a high capability to provide the treatment of scoliosis in terms of Cobb angle changed by 14.4% using FEM simulation. Such design of soft brace with textile fabric materials provides more comfortable for patients in wearing for long time. It is worthwhile for rehabilitation professionals to design appropriate textile-based soft braces for scoliosis.

Experimental Evaluation of Back Braces for the Treatment of Spinal Deformity Produced With 3D Printing Technology

Experimental Evaluation of Back Braces for the Treatment of Spinal Deformity Produced With 3D Printing Technology

Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions.

Low back pain (LBP) is prevalent and may transition into chronic LBP (cLBP) with associated reduced quality of life, pain, and disability. Because cLBP affects a heterogenous population, rehabilitation efforts must be individualized to meet the needs of various patient populations as well as individuals. This narrative review evaluated the many approaches to LBP rehabilitation including treatment-based classifications and specific types of rehabilitation efforts from exercise and physical therapy to spinal manipulation and bracing. Clinicians caring for patients with LBP or cLBP must be aware of the various options to find the right treatment course for each patient. In many cases, with proper patient expectations and care, nonpharmacological options may suffice to manage cLBP. While there is a rightful role for analgesics in the management of LBP, nonpharmacological options should be seriously considered, as they can play an important and health-sustaining role in patient management.

Gender differences in treatments and interventions received by children and adolescents with cerebral palsy

BackgroundIn the Swedish population-based follow-up program and national quality registry for individuals with cerebral palsy (CPUP), physiotherapy (PT) and occupational therapy (OT) treatments are regularly recorded along with functional status. By Swedish law, all citizens irrespective of personal characteristics or socioeconomic status, have the right to receive healthcare and medical treatments as applicable. Previous research has shown gender differences in treatments and interventions received by children with cerebral palsy (CP). The purpose of this study was to examine differences in treatments and interventions by gender and place of birth in children and adolescents participating in CPUP.MethodsThis was a cross-sectional registry study. Data from the latest PT (n = 2635) and OT assessment forms (n = 3480) in CPUP were extracted for individuals aged 0–17 years. Logistic regressions were used to assess the relationships between the outcome variables and gender and place of birth (including an interaction term gender X place of birth), adjusted for age, Gross Motor Function Classification System (GMFCS) levels and spasticity scores for PT interventions and Manual Ability Classification System (MACS) for OT interventions.ResultsResults are presented as odds ratios [95% confidence intervals] and p-values. Girls were significantly more likely to have spinal braces than boys; 1.54 [1.07, 2.22] p < 0.05, a significant interaction with place of birth indicated fewer spinal braces prescribed to children born outside of the Nordic countries; 0.20 [0.079, 0.53] p < 0.001. Girls were less likely to have undergone selective dorsal rhizotomy (SDR); 0.49 [0.25, 0.94] p < 0.05. Individuals born outside of the Nordic countries, were significantly less likely to have received intrathecal baclofen (ITB) 0.27 [0.074, 0.98] p < 0.05.ConclusionsOf the treatments prescribed, gender differences were observed for spinal braces and having undergone SDR. A statistically significant difference based on place of birth was noted for spinal bracing and having received ITB treatment. Other PT and OT treatments were associated with age, level of spasticity, and functional severity as classified using the GMFCS and the MACS. Increased awareness of differences based on gender, and where a child is born, could be obtained by inter- and intraprofessional discussions.

Thoracic Spine Fracture in the Panscan Era

In the current era of frequent chest computed tomography (CT) for adult blunt trauma evaluation, many minor injuries are diagnosed, potentially rendering traditional teachings obsolete. We seek to update teachings in regard to thoracic spine fracture by determining how often such fractures are observed on CT only (ie, not visualized on preceding trauma chest radiograph), the admission rate, mortality, and hospital length of stay of thoracic spine fracture patients, and how often thoracic spine fractures are clinically significant. This was a preplanned analysis of prospectively collected data from the NEXUS Chest CT study conducted from 2011 to 2014 at 9 Level I trauma centers. The inclusion criteria were older than 14 years, blunt trauma occurring within 6 hours of emergency department (ED) presentation, and chest imaging (radiography, CT, or both) during ED evaluation. Of 11,477 enrolled subjects, 217 (1.9%) had a thoracic spine fracture; 181 of the 198 thoracic spine fracture patients (91.4%) who had both chest radiograph and CT had their thoracic spine fracture observed on CT only. Half of patients (49.8%) had more than 1 level of thoracic spine fracture, with a mean of 2.1 levels (SD 1.6 levels) of thoracic spine involved. Most patients (62%) had associated thoracic injuries. Compared with patients without thoracic spine fracture, those with it had higher admission rates (88.5% versus 47.2%; difference 41.3%; 95% confidence interval 36.3% to 45%), higher mortality (6.3% versus 4.0%; difference 2.3%; 95% confidence interval 0 to 6.7%), and longer length of stay (median 9 versus 6 days; difference 3 days; P<.001). However, thoracic spine fracture patients without other thoracic injury had mortality similar to that of patients without thoracic spine fracture (4.6% versus 4%; difference 0.6%; 95% confidence interval -2.5% to 8.6%). Less than half of thoracic spine fractures (47.4%) were clinically significant: 40.8% of patients received thoracolumbosacral orthosis bracing, 10.9% had surgery, and 3.8% had an associated neurologic deficit. Thoracic spine fracture is uncommon. Most thoracic spine fractures are associated with other thoracic injuries, andmortality is more closely related to these other injuries than to the thoracic spine fracture itself. More than half of thoracic spine fractures are clinically insignificant; surgical intervention is uncommon and neurologic injury is rare.

The effect of spinal bracing on stability in patients with adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) may change the physical orientation of body segments and affect balance in individuals. Spinal/trunk brace is commonly used for the management of idiopathic scoliosis. The aim of this study was to compare the standing stability of AIS patients with and without a brace, and to compare them with healthy subjects. Twenty subjects (10 healthy subjects and 10 AIS with thoracolumbar/lumbar curve) were recruited for the study. Stability of the scoliotic subjects was evaluated while standing with and without orthosis. A Kistler force plate was employed to estimate the mediolateral and anteroposterior displacements of center of pressure. The results of this study indicated that there was no significant difference between center of pressure variables in healthy subjects and scoliotic patients. Moreover, trunk bracing only influenced the center of pressure (CoP) excursion in mediolateral direction (p< 0.05). Although further research studies are needed, results showed that there was no difference between stability of scoliotic and normal subjects. Moreover, the use of orthosis did not improve their standing stability.

Radiographic Outcomes of Immobilization using Boston Brace for Pediatric Spondylolysis.

Spondylolysis is a common cause of lower back pain during youth. The aim of this study is to report the bony union rate and risk factors for non-union of the lumbar spondylolysis of pediatric patients treated with a rigid thoracolumbosacral orthosis (Boston brace). A retrospective review of 68 children (mean age = 13.9 years) treated for spondylolysis with a thoracolumbosacral orthosis. Patient charts and imaging studies were evaluated to identify the bony union rate of the spondylolysis after a minimum of 3 months of immobilization (mean = 4.2 months). Laterality, grade, level, and presence of high signal intensity in the magnetic resonance imaging were evaluated as prognostic factors. Sixty-eight patients presented with 110 defects. Of them, 46 (42%) were incomplete fractures, 38 (35%) complete fractures, and 26 (24%) pseudoarthrosis. Of these defects, 38 (82.6%), 11 (28.9%), and 0 (0.0%) had bony union at the end of the treatment (p < 0.001). Unilateral defects healed significantly better than bilateral ones (relative risk = 1.71, 95% confidence interval = 1.16-2.54, 17/26 (65%) vs 32/84 (38%), p = 0.014). High signal intensity in the magnetic resonance images before the treatment predicted healing (relative risk = 13.24, 95% confidence interval = 1.93-91.01, 48/87 (55%) vs 1/24 (4.3%), p < 0.001). The level of the spondylolysis (L5 vs above L5) did not affect the healing rate. The union rates of spondylolysis with a thoracolumbosacral orthosis were similar as compared to earlier studies done with a low thoracolumbosacral orthosis. The grade of the defect, laterality, and presence of high signal intensity increased the probability of bony union. A high thoracolumbosacral orthosis (underarm) does not seem to improve the healing rate of pediatric spondylolysis defects.

Conservative treatment of degenerative spondylolisthesis using a rigid brace: A case study

Surgery is not always required in patients with spondylolisthesis. Meanwhile, surgical adverse events contribute significantly to postoperative morbidity. Restriction of the patient's activities, muscle rehabilitation, and other nonoperative measures, including the intermittent use of a rigid back brace, often are sufficient if the symptoms are minimal, and the slippage is mild. The study aimed to figure out the efficacy of conservative treatment using rigid brace in patients with degenerative spondylolisthesis. A total of patients (12 men and 18 women) who were hospitalized as a degenerative spondylolisthesis without neurological deficit at L4–L5 or L5–S1 from June 2015 to April 2017 underwent the rigid bracing. This study investigated pain, satisfaction, rate of reduction obtained according to the initial slip degrees, and degree of slip after the removal of immobilization at follow-up with radiographs of the patients with L4–L5 or L5–S1 spondylolisthesis. Twenty-eight patients (93.3%) complained no back pain and were satisfied with the rigid bracing. The complete reduction rate after reduction maneuver was 76.7% and after removal of the brace, in 15 patients, the slip disappeared at follow-up. Degenerative lumbar spondylolisthesis without neurological deficit can be treated successfully with rigid bracing with good outcomes.