The Lyon Brace, or adjustable multi-shell brace, has been used for more than 60 years.The use and function of the Lyon Brace includes:- The utilization of one or two corrective plaster casts, which enables a true lengthening of the concave ligaments.- An oriented CAD-CAM moulding in 3D auto correction after the removal of the plaster cast.- A blueprint adapted to Lenke's classification.- A specific physiotherapy program.BackgroundPierre Stagnara created the Lyon Brace in 1947. The brace has the following characteristics:- It adjusts to allow for a child's growth of up to seven centimetres and for an increase in weight of up to seven kilograms.- It is 'active' in that the rigidity of the PMM (polymetacrylate of methyl) structure stimulates the user to auto-correct. The active axial auto-correction decreases the pressures of the brace on the trunk.- It is decompressive in that the effect of extension between the two pelvic and scapular girdles decreases the pressure on the intervertebral disc allowing for more effective pushes in the other planes.- It is symmetrical making it both more aesthetically pleasing and easier to build.- It is stable at both shoulders and pelvic girdle, facilitating the intermediate 3D corrections.- It is transparent. The pressure of the shells on the skin can be directly controlled so "pads" are usually not necessary.Brace descriptionTwo metal bars are fixed vertically, one anterior the other posterior and all shells are attached from the bottom to the top in this order:- Two pelvic shells ensure an optimal stability of the brace.- One lumbar shell T12-L4, which can be either independent or extending, at the abdominal chondrocostal level.- One thoracic shell at the level of the thoracic convexity.- One opposite thoracic shell used as a counter push.- One shoulder balance shell on the side of the thoracic convexity.Long term follow up resultsThis is a retrospective study of 1,338 completed treatments checked a minimum of two years after weaning from the brace.Only 5% of the curves progressed more than 5° from the initial magnitudes. This translates to an effectiveness index of 0.95.A subset of 174 subjects who started treatment at Risser 0 was isolated. The global progressive angular mean curve was superimposed on the statistic general curve and the effectiveness index was calculated at 0.80.The Surgery rate was just 2% of the patients presenting with an initial curve below 45°.ConclusionThe Lyon Brace is the historical reference of bracing AIS. To be fully effective, it requires the patient to wear a plaster cast for at least one month and receive specific physiotherapy training. Although this is a retrospective study, the results are very positive, and clearly indicate a need for a prospective study.

Based on our results, we believe that the computer-aided design procedure is equally efficient to traditional method for mild scoliotic curves.

BackgroundThe conservative orthopaedic treatment of adult scoliosis is very disappointing. In a series of 144 patients; only 25 % (33 cases) were monitored at 2 years of treatment. (Papadopoulos 2013). Thereby the literature typically focuses on a small number of patients, which limits the usefulness and relevance of its results. The brace effect on pain has been systematically described, but there is no publication on the effect of treatment on the Cobb angle and main clinical parameters.MethodsFrom a prospective database started in 1998, we selected all 158 consecutive patients effectively treated conservatively with the Lyon management treatment and controlled five years after brace fitting. Lyon management includes a lordosing bivalve polyethylene overlapping brace in association with specific physiotherapy. The brace can either be short with anterior support under the chest or long with sterno-clavicular support when there is a high thoracic kyphosis.Results1. For the rate of scoliosis controlled after 5 years, the follow-up was 24 % of the 661 patients accepting the treatment. Pain is almost the main reason for the medical consultation, generally correlating with an increase of the scoliotic angulation.2. The descriptive data can be superimposed on general group with age (m=56 years, SD=13) but initial Cobb angulation is significantly higher (m=40°, SD=17). Ratio Female/Male=0.91.Generally, the scoliosis is stabilized at (m=39.74 °, SD=19.40), 8 years after the beginning of the treatment.38 improvements of more than 5°= 24 %; 88 stable = 56 %; 32 worsening of more than 5° = 20 %The rib hump is improved of by 3 mm, (modelling effect of the brace).The occipital axis is improved by more than 6 mm.But the T1 plumb line distance is worsening by 7 mm (most braces are short without sterno-clavicular support).ConclusionsFor the first time, the number of records and follow up after 8 years allows to study the radiological progression of adult scoliosis rigid bracing. Stability or improvement of more than 5° in 80 % of cases justify rigid bracing in adults. The accentuation of the thoracic kyphosis is the only negative element and a modified ARTbrace will soon be used.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-016-0091-x) contains supplementary material, which is available to authorized users.

The Lyon Brace or adjustable multi-shells brace has been used for more than 60 years. Three types of braces have been developed: Lyon thoracic brace, Lyon thoraco lumbar brace and Lyon lumbar brace. Considering the conservative orthopaedic treatment of scoliosis we outline the results of this orthosis. The management of the Lyon Brace includes: (i) The use of one or two reductive plastered brace which enable a flow of the concavity ligaments; (ii) a moulding either hand-oriented or electronic after the resection of the plastered brace; (iii) a blueprint adapted to Lenke's classification; and (iv) a specific physiotherapy. The protocol of the wearing of the orthosis depends on the initial angulation of the scoliosis. The effectivity index of 1338 scoliosis checked at least two years after the weaning of the brace, is 0.95. The effectivity index is 0.80 when the Lyon brace is put in place at Risser 0. If the angulation is globally stabilized, the rib hump is, on average, half reduced. We get the best results for lumbar scoliosis and double major. The technological progresses allow a precise use. The adjustment becomes easy during puberty growth.

BackgroundThe symmetrical Lyon brace is a brace, usually used to maintain correction after a plaster cast reduction in the Cotrel’s EDF (Elongation-Derotation-Flexion) frame. The new Lyon brace or ARTbrace is an immediate corrective brace based on some of the principles of the plaster cast which are improved due to advances in CAD/CAM technology. The aim of this paper is to describe concepts of this new brace to be not only a replacement of the plaster cast, but also a definitive brace.MethodsInstead of a plaster cast, three segmental CAD/CAM moulds are made with the instantaneous full 3D raster stereography digitizer (Orten):In self axial elongationIn shift and lumbar lordosisIn shift and thoracic kyphosisA specific software (OrtenShape) makes up the overlay of the three moulds. Mould 1 is used for the pelvis and the shoulders mould 2 for the lumbar segment and mould 3 for the thoracic segment.The mathematical basis of the ARTbrace is the torso column which is a circled helicoid with horizontal circle generator. A torso column is reproduced in the opposite direction of the scoliosis.Like the plaster cast, the ARTbrace is worn for a “total time” of 24 hours 7 days a week without modifying the standard protocol of the Lyon brace reduction.The prospective controlled cohort observational study of the 225 first patients treated since May 2013 is reported below.ResultsThe in-brace immediate reduction is: 0.7, i.e. 40% better with the ARTbrace than with a plaster cast. The correction of flat back is 9° (from 18°.4 to 28°.5 kyphosis Cobb angle). The improved aesthetic appearance is equal for rib hump and ATR.ConclusionThis first paper is an introduction with very short results and does not prejudge the final outcome. The ARTbrace can be used not only to replace the plaster cast, but also as a definitive brace. The new segmental moulding with final detorsion is even more efficient and to this day the ARTbrace is the most effective to reduce the Cobb angle of scoliosis.Electronic supplementary materialThe online version of this article (doi:10.1186/1748-7161-9-19) contains supplementary material, which is available to authorized users.