Orthotic Bracing Research Articles

Cervical Collar Use Following Cervical Spine Surgery: A Systematic Review.

The utility and risks associated with the use of cervical collars in the postoperative period after cervical spine surgery have been of debate. The purpose of this study was to systematically review the currently available evidence on the use of cervical collars after cervical spine surgery to assess their impact on outcomes. A literature search of the PubMed database was performed using keywords "cervical collar," "anterior cervical discectomy and fusion (ACDF)," "posterior cervical decompression and fusion," "laminoplasty," "post-operative orthotic bracing," "cervical decompression," and "cervical orthosis" in all possible combinations. All English studies with the level of evidence of I to IV that were published from May 1, 1986, to December 3, 2023, were considered for inclusion. A total of 25 articles meeting the inclusion criteria were identified and reviewed. Regarding anterior and posterior fusion procedures, cervical collar use demonstrated improved short-term patient-reported outcomes and pain control. While surgeon motivation for collar use was to increase fusion rates, this is not well drawn out in the literature with the majority of studies demonstrated no significant difference in fusion rates between patients who wore a cervical collar and those who did not. Regarding motion-preserving procedures such as cervical laminoplasty, patients with prolonged postoperative cervical collar use demonstrated increased rates of axial neck pain and decreased final range of motion (ROM). Surgeon motivation for postoperative cervical collar immobilization after completion of fusion procedures is to increase fusion rates and improve postoperative pain and disability despite this not being fully drawn out in the literature. After completion of motion-sparing procedures, the benefits of collar immobilization diminish with their prolonged use which could lead to increased rates of axial neck pain and decreased ROM. Cervical collar immobilization in the postoperative period should be considered its own intervention, with its own associated risk-benefit profile. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Design and development of an intelligent wearing system for adolescent spinal orthotics.

Adolescent idiopathic scoliosis is the deformity of the human spine in three-dimensional space. It is a disease with a long course and difficult to recover in a short time. Currently, spinal orthotic braces are an effective non-surgical treatment for this condition. However, existing spinal orthotic braces are still deficient. For example, existing spinal orthotics braces have no way of knowing how correct, effective, and comfortable a patient is wearing the orthotics. Based on distributed pressure monitoring technology, this paper conducts pressure acquisition and compensation research on spinal orthotics used by adolescent patients. After analyzing the principles of orthopedics and selecting monitoring points, this paper selects appropriate sensors and calibrates them. An intelligent wearable system for adolescent spinal orthotics was developed based on these findings. The experimental results show that the system can effectively monitor the process of patients wearing spinal orthotic braces. In addition, the system can compensate and visualize the pressure in real-time, so that doctors and patients can know the process and make judgments and adjustments.

Bracing of Pectus Carinatum in Children: Current Practices.

Although effective, compressive orthotic bracing (COB) in children with pectus carinatum is still not standardized. This study has aimed to analyze current practices amongst members of the Chest Wall International Group (CWIG). A web-based questionnaire was mailed to all CWIG members at 208 departments. It included 30 questions regarding diagnostic work-up, age for COB indication, type of COB used, daily wearing time, treatment duration, complications, and recurrence rate. Members from 44 departments have responded (institutional response rate 21.2%). A total of 93% consider COB as the first-line treatment for PC. A conventional COB (CC) is used in 59%, and the dynamic compression system (FMF) in 41%. The overall compliance rate is >80%. A total of 67% of responders consider COB to be indicated in patients <10 years. The actual wearing time is significantly shorter than the physician-recommended time (p < 0.01). FMF patients experience a significantly faster response than CC patients (p < 0.01). No recurrence of PC has been noted in 34%; recurrence rates of 10-30% have been noted in 61%. COB is the first-line treatment for PC with a high compliance rate. During puberty, the recurrence rate is high. Treatment standardization and follow-up until the end of puberty are recommended to enhance COB effectiveness.

Case report: Nonsimultaneous bilateral triceps tendon rupture and surgical repair in a healthy dog

A 7-year-old female spayed Australian shepherd dog was presented for an acute onset of inability to stand. On physical examination, the dog was unable to support weight on the thoracic limbs. On neurological examination, the thoracic limbs had absent hopping and paw placement and reduced withdrawal reflexes bilaterally. The remainder of the neurological examination was normal. The anatomic lesion localized to the C6-T2 spinal nerve roots, spinal nerves, or the named nerves of the thoracic limb, bilaterally. A lesion affecting the ventral gray column of the C6 through T2 spinal cord segments was considered less likely. In an effort to exclude an orthopedic disorder from consideration, radiographs of the shoulders, elbows, and manus were normal. Magnetic resonance imaging of the cervical and cranial thoracic vertebral column was normal. Analysis of synovial fluid from the carpi, elbows, and shoulders were normal. Ultrasonography of the triceps muscle and tendon of insertion revealed bilateral, acute-subacute tears of the tendon at insertion of the triceps muscles, bilaterally. Magnetic resonance imaging of both elbows revealed complete avulsion of the triceps tendons bilaterally. Surgical repair of both tendons was performed using the Arthrex FiberLoop system combined with autologous conditioned plasma soaked in a collagen sponge. Postoperatively, external coaptation was provided using Spica splints for 6 weeks followed by the use of soft padded orthotic braces for an additional 6 weeks. Concurrently, a front support wheelchair was used for 10 weeks postoperative. By 10 weeks postoperative, the dog was able to ambulate without support. To the authors’ knowledge, this is the first report of bilateral triceps tendon avulsion in a dog. Tendon avulsion occurred without a known history of trauma or predisposing metabolic abnormalities. Magnetic resonance imaging provided excellent anatomical detail that aided in surgical repair.

Numerical modelling of an orthopedic brace with increased functional characteristics for the treatment of idiopathic scoliosis.

Orthotic braces play a key role in the correction of spinal deformities. The effectiveness of these devices depends on the design and distribution of corrective forces transmitted through the corset shell. The present study aimed to reduce the weight of the orthosis and improve its functionality while maintaining its corrective function. The distribution of corrective forces transmitted by the orthosis was evaluated using the finite element method (FEM). Areas of the orthosis, which had minimal impact on the overall stiffness, were identified and material from these areas was removed. The modified orthosis shell was subjected to minor adjustments to maintain its corrective stiffness. With the modifications made, a 39% reduction in the weight of the orthosis was achieved, while maintaining its corrective stiffness. This indicates that the corrective function was largely preserved. The study provides a novel approach to orthosis design demonstrating that optimizing the structure using the distribution of maximum principal stress trajectories can significantly improve the functionality of the brace. The proposed method offers potential advances in the design of various types of orthoses, contributing to developments in the field.

Mechanical Evaluation of PET-G 3D-Printed Wrist-Hand Orthosis: An Integrated Experimental and Numerical Approach.

Limb injuries frequently necessitate orthotic bracing, and the utilization of material extrusion (MEX) additive manufacturing (AM) or 3D printing offers a rapid and cost-effective means of producing orthoses. These characteristics are highly sought after in today's orthotic market. The study focused on the mechanical strength analysis of the wrist-hand orthosis (WHO) made of PET-G filament. Experimental testing and simulation were employed to assess the properties of individualized wrist orthoses fabricated through the MEX AM process. Standard three-point bending samples were manufactured using PET-G filament on a low-cost MEX 3D printer, alongside orthotic fragments and complete orthosis. Experimental testing was performed using a universal testing machine, and results were juxtaposed with those from a finite element simulation model created in the Abaqus environment. This comprehensive research approach facilitates the comparison of the modulus of elasticity of the fabricated components, enabling a comparison between the mechanical properties of the complete wrist-hand orthosis (WHO) product and those of a conventional bending sample.

Longer Brace Duration Is Associated with Lower Stress Levels and Better Quality of Life in Adolescents with Idiopathic Scoliosis.

Physical and psychological health concerns have been raised due to either spine deformity or orthotic treatment in adolescents with idiopathic scoliosis. To determine whether orthotic bracing duration affects psychological stress and health-related quality of life, a sample of 46 patients (8M, 38F, aged 11-17 years, regularly treated with bracing) with moderate or moderate to severe idiopathic scoliosis were separated into two groups based on whether their treatment duration was up to six months or longer. The brace-related levels of stress and quality of life were investigated in both groups by using the Bad Sobernheim Stress Questionnaire and the Italian Spine Youth Quality of Life, respectively. The questionnaire scores were categorized as low, mean, and high. Our statistical analysis considered the proportion of patients falling into the three categories and the difference in crude score rates between the two groups. Values were considered significant at p < 0.05. The proportion of patients with brace-related stress and impaired quality of life was significantly lower in the group treated longer compared to the group that had only received treatment for up to six months (chi-square test, p < 0.0001). Overall, mean ± SD BSSQ scored 8.72 ± 4.91 and 12.89 ± 4.65 in group 1 and group 2, respectively (Mann-Whitney U test, p = 0.008), while ISYQoL scored 19.94 ± 8.21 and 16.07 ± 6.12, respectively. We argue that the differences could depend on both the physical and psychological adaptation patients make to their brace and that more support should be provided to patients when they start to wear their brace.

A novel synergistic device for joint inflammation – efficacy on ankle sprain cases

Joint inflammation results from soft-tissue injuries and cartilage damage. PRICE is the standard treatment approach for acute soft tissue injuries like ankle sprain. Electrical stimulation, application of orthotic braces, etc. is also effective for this. In a synergistic device all these components are combined and applied simultaneously. This device was developed for joint inflammation and tested for grade I & II acute ankle joint sprain. To test a synergistic – semirigid device, combining PRICE & electrical stimulation for acute ankle sprains of grades I & II for pain, range of motion and swelling is a case series was the objective. Device was developed using novel concept of synergistic applications of PRICE with electrical stimulation. The joint contour of ankle and specific biomechanical bony surface landmarks were considered. Ethical approval was taken from NTCC committee, AIPT. Recordings were taken from eight patients of acute ankle sprain with – in two days of injury, after getting ethical approval. Elevation to the ankle was provided by keeping the part over the pillow and data was recorded with the help of: 1.VAS scale for pain; 2. Measuring tape; 3. Goniometry. t-test was used to find out the significant difference pre and post the application of device. There was a significant reduction in pain (p = 0.006), edema (p = 0.011), dorsi-flexion (p = 0.015), and plantar flexion (p =0.008). The synegistic device has been effective for acute ankle inflammation - grade I & II ankle sprains in 5 sessions; sufficient for the return of function.

Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure

BackgroundIn-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not.MethodsAll skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation.ResultsNinety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014).ConclusionsPatients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays.Trial registrationClinicalTrials.gov—NCT02412137, initial registration date April 2015Level of evidenceIII

Orthotic Bracing or Minimally Invasive Surgery? A Summary of 767 Pectus Carinatum Cases for 9 Years.

Orthotic bracing and minimally invasive surgery are currently the treatment methods for pectus carinatum. We present our experience with the advantages, method selection criteria, and precautions for both treatment methods. A total of 767 pediatric patients (596 boys and 171 girls) with pectus carinatum were retrospectively analyzed. All of them received orthotic bracing, and 108 pediatric patients received minimally invasive surgery, achieving good outcomes. Among the 767 pediatric patients, 644 obtained satisfactory chest appearance through orthotic bracing, with a success rate of 84.0%. Younger pediatric patients had better orthotic outcomes. Among the 123 failure cases, 108 pediatric patients underwent minimally invasive surgery as the treatment. Seventy-six pediatric patients with simple chondrogladiolar prominence underwent a minimally invasive sternal depression procedure, whereas 32 pediatric patients with complex chondromanubrial prominence underwent surgery. All 108 pediatric patients successfully completed the surgery. The operation time was 112.8 ± 23.5 min, and the average length of hospital stay after the surgery was 7 days. A follow-up was conducted for at least 3 months and up to 3 years. The orthotic effect was satisfactory. For younger pediatric patients with pectus carinatum, noninvasive orthotic bracing treatment should be considered first. For older pediatric patients, the failure rate of the bracing was higher, and the outcomes were often unsatisfactory. Especially for patients over 15 years old, minimally invasive sternal depression may be the preferred treatment for pectus carinatum.

Spinal Deformities after Childhood Tumors.

Simple SummaryA significant number of children surviving intra- or juxta-spinal tumors develop secondary spinal deformities and disabilities. This retrospective non-comparative study focuses on deformity analysis, age, and skeletal maturity dependent treatment options and results. Patients who developed severe scoliosis, pathological kyphosis, and/or lordosis were either treated conservatively or surgically by using growth-friendly spinal implants in younger children or definite spinal fusion during puberty. Despite severe spinal deformity, some patients were not surgically corrected in order to preserve mobility through trunk motion or malignant tumor progression. Growth-friendly spinal implants and spinal fusions were able to significantly reduce pathological curves. The first method, with bilateral rib-to-pelvis fixation, still allows spinal magnetic resonance imaging or neurosurgical intervention if needed. Severe ad hoc curve correction enhances the risk of neurological deterioration because of prior spinal cord impairment. The data of this study may help to improve the individual patient care.Childhood tumors of the central nervous system (CNS) and other entities affecting the spine are rare. Treatment options vary from surgical biopsy to partial, subtotal, and total resection, to radiation, to chemotherapy. The aim of this study is to investigate spinal deformity and subsequent surgical interventions in this patient cohort. A retrospective review at our institution identified children with CNS tumors, spinal tumors, and juxta-spinal tumors, as well as spinal deformities. Tumor entity, treatment, mobilization, and radiographic images were analyzed relative to the spinal deformity, using curve angles in two planes. Conservative or surgical interventions such as orthotic braces, growth-friendly spinal implants, and spinal fusions were evaluated and analyzed with respect to treatment results. Tumor entities in the 76 patients of this study included CNS tumors (n = 41), neurofibromatosis with spinal or paraspinal tumors (n = 14), bone tumors (n = 12), embryonal tumors (n = 7), and others (n = 2). The initial treatment consisted of surgical biopsy (n = 5), partial, subtotal, or total surgical resection (n = 59), or none (n = 12), followed by chemotherapy, radiotherapy, or both (n = 40). Out of 65 evaluated patients, 25 revealed a moderate or severe scoliotic deformity of 71° (range 21–116°), pathological thoracic kyphosis of 66° (range 50–130°), and lordosis of 61° (range 41–97°). Surgical treatment was performed on 21 patients with implantation of growth-friendly spinal implants (n = 9) as well as twelve dorsal spinal fusions (two with prior halo distraction). Surgical interventions significantly improved spinal deformities without additional neurological impairment. With the increasing number of children surviving rare tumors, attention should be focused on long-term problems such as spinal deformities and consequent disabilities. A significant number of children with CNS tumors, spinal tumors or juxta-spinal tumors required surgical intervention. Early information about spinal deformities and a close follow-up are mandatory for this patient group.

Usefulness of 3-Dimensional Body Surface Scanning in the Evaluation of Patients with Pectus Carinatum.

BackgroundRadiographic modalities have been commonly used to evaluate pectus carinatum (PC), and compressive orthotic bracing is the most widely accepted treatment method. The aim of this study was to determine the efficacy of 3-dimensional (3D) body surface scanning as an alternative modality for the evaluation of PC.MethodsThe medical records of 63 patients with PC who were treated with compressive orthotic bracing therapy between July 2017 and February 2019 were retrospectively analyzed. Using both 2-view chest radiography (posteroanterior and lateral view) and 3D body scanning, the height of maximal protrusion of the chest wall was measured both before and after 2 weeks of bracing therapy. The difference between the pre- and post-treatment measurements was calculated for both modalities, and these differences were compared and analyzed.ResultsBased on the comparison between the pre- and post-treatment radiographs, bracing therapy produced favorable outcomes in all patients (p<0.001). The measurements obtained via 3D scanning were strongly correlated with those obtained via chest radiography (r=0.60).ConclusionBased on the findings of this study, 3D body surface scanning appears to be an effective, radiation-free, and simple method for the post-treatment follow-up evaluation of PC, and thus can be considered an alternative to radiography.

Usefulness of a simulated experience method for transfer assistance for hemiplegia or limited range of motion in multiple joints.

[Purpose] To further the understanding of dysfunctions to which a simulated experience method could be applied, we clarified whether a simulated experience method can promote caregivers to utilize the abilities of care recipients with pseudo-hemiplegia or pseudo-limited range of motion (ROM) in multiple joints. [Participants and Methods] We studied transfer assistance in 60 nursing assistants from nursing home settings: 30 were assigned to the pseudo-hemiplegia (26 females, 4 males) and limited ROM in multiple joints (27 females, 3 males) groups. One healthy person was fitted with orthotic braces to mimic hemiplegia or limited ROM in multiple joints, each making it difficult to stand-up. Participants were randomized to either a simulated experience group (involving interventional help from a physical therapist between the first and second measurements) or a control group. The load difference on the lower limbs of the care recipient between two rounds of transfer assistance was examined. [Results] The difference between the second and first measurements was −5.9 ± 74.5 N for the control group and 107.9 ± 123.6 N for the simulated experience method in the pseudo-hemiplegia study, and −14.7 ± 64.7 N and 149.1 ± 132.4 N, respectively, for the pseudo-limited ROM-in-multiple-joints study. [Conclusion] The simulated experience method promoted transfer assistance of a care recipient with pseudo-hemiplegia or pseudo-limited ROM in multiple joints. These results suggest that hemiplegia and limited ROM in multiple joints are added as dysfunctions that can be applied to a simulated experience method in transfer assistance.

Dropped Head Syndrome: An Update on Etiology and Surgical Management.

» Dropped head syndrome is a group of disorders with diverse etiologies involving different anatomical components of the neck, ultimately resulting in a debilitating, flexible, anterior curvature of the cervical spine. » Causes of dropped head syndrome include myasthenia gravis, amyotrophic lateral sclerosis, Parkinson disease, radiation therapy, and cumulative age-related changes. Idiopathic cases have also been reported. » Nonoperative treatment of dropped head syndrome includes orthotic bracing and physical therapy. » Surgical treatment of dropped head syndrome consists of cervical spine fusion to correct the deformity. » The limited data available examining the clinical and radiographic outcomes of surgical intervention indicate a higher rate of complications with the majority having favorable outcomes in the long term.

The effect of a semi-rigid thoracolumbosacral orthosis (TLSO) on foot pressure in elderly subjects presenting with spinal hyperkyphosis

Purpose: The ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis (excessive spinal forward curvature) amongst elderly people. This condition can in turn impair mobility, reduce balance, and increase the risk of falling and mortality in affected individuals. The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly. However, there is little evidence that evaluates the use of corrective braces on foot pressure changes in these subjects.Methods: In this study, we evaluated the use of a thoracolumbosacral orthosis (TLSO) on 19 subjects over 60 years old who presented with hyperkyphosis. We measured foot pressure using the Pedar-X system before (without brace) and after (with brace) immediate using a TLSO in both static (quite standing) and dynamic (walking on a 5 meters freeway) scenarios.Results: The results demonstrated that using a TLSO immediately decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions. Hindfoot pressures were increased, but not significantly.Conclusion: This study showed that using a TLSO can be beneficial for elderly people with hyperkyphosis.Implications for rehabilitationThe ageing process can be accompanied by a degeneration of the spine and increase the risk of thoracic hyperkyphosis.The use of corrective orthotic bracing has been shown to improve spinal posture, and increase stability and balance amongst the elderly.Using a TLSO decreases forefoot pressures in stasis, and around the first metatarsal, as well as pressures relating to the second to fifth metatarsals under dynamic conditions.

Outcomes Following Dynamic Compression Bracing for Pectus Carinatum.

Introduction: Children with pectus carinatum (PC) are particularly vulnerable to psychosocial effects of poor body image, even though they may not experience physical symptoms. Nonoperative treatment with orthotic bracing is effective in PC correction. We describe our experience with dynamic compression bracing (DCB) for PC patients and their satisfaction with bracing. Materials and Methods: Prospective institutional data of patients undergoing DCB from July 2011 to June 2018 were reviewed and analyzed for those who entered the retainer mode after correction, defined by a correction pressure of <1 psi. A telephone survey was conducted regarding their bracing experience and satisfaction with the outcome on a scale of 1-10. Results: Of 460 PC patients, 144 reached the retainer mode. Median time to retainer mode was 5.5 months. There was no statistically significant relationship between initial correction pressure or carinatum height and time to retainer mode (P = .08 and P = .10, respectively). Fifty-seven percent were compliant with brace use, and median time to retainer mode in this subset was significantly shorter than noncompliant patients (3.5 months versus 10 months, P < .001). Fifty-three percent responded to the survey 13 months [interquartile ratios 3, 33] after the last clinic visit. The main barrier to compliance with wearing the brace was discomfort (37%), while the main motivation for compliance was appearance (58%). All endorsed bracing as worthwhile, with 94% reporting a satisfaction rating of 8 or greater for the correction outcome. Conclusion: DCB is effective in achieving correction of PC in compliant patients. Regardless of time to retainer mode, patients reported high satisfaction with bracing.

Assessment and identification of some factors affecting the results of treatment by orthotic bracing for pectus carinatum

Objective: Assessment and identification of some factors affecting the outcome of treatment of children withPectus carinatum by orthotic bracing (Non - Invasive Intervention).Subjectives: 86 children with Pectus carinatum end of treatment and re-examination at the RehabilitationDepartment of Viet Nam National Children’s Hospital from January 2015 to January 2017.Methods: The intervention study no control group.Result: 100% of children improved on deformity. The Haller Index increased from 1.81 before interventionto 2.23 after 36 months of intervention (p &lt;0.001). Some factors related to progression: The Haller Index beforetreatment (B = 0.383, p &lt;0.001). Time of day Wearing the brace (B = 0.017; p &lt;0.001).

Repair of pectus carinatum by a modified Ravitch technique combined with postoperative bracing

Abstract A 13-year-old boy with pectus carinatum was successfully treated by modified Ravitch's techniques combined with short-term orthotic bracing. No sternal osteotomy and less extensive resection of costal cartilage were performed. This minimally invasive surgery is safely and effectively in pubertal patients with pectus carinatum.

Measured dynamic compression for pectus carinatum: A systematic review

BackgroundPatients with pectus carinatum have been treated with orthotic braces since the 1970s. By applying external pressure to the anterior chest wall, a normal chest shape can be restored. However, high patient treatment dropout rates were reported because of the subjectively high pressures applied to the patient´s skin. Measured dynamic compression allows measurement and adjustments of the brace's pressure on the thoracic wall, leading to a controlled correction. MethodsWe performed an electronic database search (Pubmed and Cochrane) of the medical literature on measured dynamic compression. A total of 14 studies were found and eight studies between 2008 and 2018 were included. Study designs ranged from retrospective chart reviews to cross-sectional cohort studies. ResultsFrom the 8 studies, 1185 patients were included. The median age was 14 years (range 2–28) and 87% were male. The mean study follow up period was 16 months; 44% of patients were still under treatment, 29% of patients successfully completed treatment. 6% dropped out and 21% were lost to follow-up. Dropout was mainly caused social discomfort (7.2%) and failure of treatment (5.8%). Complications were infrequent. Mild chest discomfort or tightness was reported in 12% and skin lesions occurred in 5.1%. The overall recurrence rate was 2.6%. ConclusionsSeveral studies are available on measured dynamic compression. Dynamic compression appears to be a safe, non-invasive and efficient treatment to correct pectus carinatum in patients with a non-rigid thorax. Patients experience less discomfort, which in turn results in better compliance. However, accurate selection of patients based on age, pressure of initial correction and motivation is important and an objective scoring system to assess the esthetic and long-term physical and psychological results of the treatment is needed.

Efficacy of Thoracolumbar Bracing in Spinal Immobilization: Precise Assessment of Gross, Intersegmental, and Segmental Spinal Motion Restriction by a 3D Kinematic System

Various diseases of the spine are treated by immobilization via orthoses, although detailed evidence on the efficiency of orthotic bracing remains elusive. The present study sought to investigate the impact of 3 different orthoses on spinal immobilization using 3-dimensional (3D) kinematic measurements. Twelve healthy volunteers performed different motion tasks, including trunk flexion/extension and bilateral trunk bending. Movements were performed under 4 different conditions: 1) without orthosis, 2) while wearing a 3-point hyperextension brace (HB), 3) while wearing a custom-made semirigid orthosis (SO), and 4) while wearing a custom-made rigid orthosis (RO). Spinal motion was analyzed using a 3D optical motion capture system assessing regional, intersegmental, and segmental range of motion (ROM). Assessment of spinal motion was successfully accomplished in all subjects. Overall, orthoses significantly reduced spinal motion compared with no bracing. RO caused the greatest restriction of regional, intersegmental, and segmental spinal motion among all orthoses. For flexion/extension, the mean percentage decreases between T3 and L5 in full active ROM with HB, SO, and RO compared with no orthosis were 38%/30%, 48%/47%, and 51%/55%, respectively (P ≤ 0.05). Lateral bending was impaired by 28%, 44%, and 70%, respectively (P ≤ 0.05). Assessment of lateral bending revealed greater immobilization by SO and RO compared with HB (P ≤ 0.05). The present 3D kinematic system allows for precise assessment of spinal motion. Custom-made orthoses cause superior restriction on gross spinal motion compared "off-the-shelf" orthoses. If orthotic bracing is indicated, design, comfort, and patient compliance need to be carefully considered to guarantee successful therapy.