A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results

Abstract

Introduction:There is a growing resistance from patients and their families to spinal fusion surgery for scoliosis. Due to inconclusive evidence that surgery has a long-term effect on scoliosis and/or improves the quality of life for patients with scoliosis, there is a need to extend the conservative perspective of treatment to patients with curvatures greater than 40 degrees. For that reason, a prospective cohort study was initiated to determine the effectiveness of the Gensingen brace (a Cheneau-style TLSO) in preventing progression in skeletally immature patients.Materials and Methods:Since 2011, fifty-five patients have been enrolled in this prospective cohort study. This report includes the mid-term results of twenty-five of these patients, who have a minimum follow-up of 18 months and an average follow-up of 30.4 months (SD 9.2). The twenty-five patients had the following characteristics at the start of treatment: Cobb angle: 49° (SD 8.4; 40º-71º); 12.4 years old (SD 0.82); Risser: 0.84 (SD 0.94; 0-2). A z-test was used to compare the success rate in this cohort to the success rate in the prospective braced cohort from BrAIST.Results:After follow-up, the average Cobb angle was 44.2° (SD 12.9). Two patients progressed, 12 patients were able to achieve halted progression, and eleven patients improved. Angle of trunk rotation (ATR) decreased from 12.2 to 10.1 degrees in the thoracic spine (p = 0.11) while the ATR decreased from 4.7 to 3.6 degrees in the lumbar spine (p = 0.0074). When comparing the success rate of the BrAIST cohort with the success rate of patients in this cohort, the difference was statistically significant (z = -3.041; p = 0.01).Conclusion:Conservative brace treatment using the Gensingen brace was successful in 92% of cases of patients with AIS of 40 degrees and higher. This is a significant improvement compared to the results attained in the BrAIST study (72%). Reduction of the ATR shows that postural improvement is also possible.

Brace Treatment for Children and Adolescents with Scoliosis

“…Night-time braces when compared to full-time braces seem to have poor results (57.1%) [55]. Standardised asymmetrical braces may have success rates exceeding 80% [8,41,46] even in curves of 40° and above [47,74].…”

“…The results of the search; (1) 31 items have been found of which 14 were found to be relevant reporting a rate of success [7,9,47,52,55,[62][63][64][65][66][67][68][69][70]; (2) 14 items were found of which 3 reported upon cosmetic outcomes [71][72][73]. In the hand search additional papers were revealed for search (1) [32- 46, 48-51, 53-55, 74].…”

“…Symmetrical braces (Boston style with dorsal or ventral closures) provide success rates of 70% or little over [7,9,[32][33][34][35] (Figure 2). Asymmetrical threedimensional braces (mainly Chêneau style) may have success rates between less than 50 and more than 90% [8,[36][37][38][39][40][41][42][43][44][45][46][47][48][49]. There is a wide variety of outcomes used in research, which may be related to the differing qualities of asymmetrical brace adjustments and designs (Figures 3-5).…”

“…In studies with more high quality brace designs, the more immature patients seem easier to correct and preserve better outcomes than the more mature patients [45,47,74,75,79,82].…”

“…Brace treatment is supported by high-quality evidence as well [7][8][9]; however, the approach to bracing differs significantly in design (Figure 1). There are many types such as symmetrical braces [7,9,[32][33][34][35], asymmetrical braces [8,[36][37][38][39][40][41][42][43][44][45][46][47][48][49], night-time braces [50][51][52][53][54][55] and soft braces [56,57]. It has been shown that soft braces have no advantage over hard braces [8,[58][59][60].…”