Brace modifications that can result in improved curve correction in idiopathic scoliosis

Abstract

Background and aimThe purpose of this paper is to share with scoliosis professionals the X-rays of different pad placement levels associated with improved curve correction in a case of idiopathic scoliosis (IS). Scoliosis braces of all types and brands utilize common principles of construction that ensure good fit and function. Equally important to the end result is good patient follow-up care and brace quality control by the orthotist.Design and methodsThis report reviewed the case of an 11-year-old girl diagnosed with IS, focusing on the in and out-of-brace x-rays, as well as the fit and function of the braces. The first brace was a TLSO-type, the second a Cheneau-type brace using a B1 model following the Rigo classification of scoliosis.ResultsThe first TLSO-type brace presented an in-brace X-ray that showed a curve increase. The Cheneau-type scoliosis brace reduced the Cobb angles over 50%.ConclusionsThe biomechanical changes consequent to modifications in brace design and pad placements appeared to have improved the scoliosis and reduced the Cobb angles in this case. An orthotist must provide optimal fit and function of the brace which was prescribed by the referring physician. Adherence to certain basic design principles, and close follow up by the orthotist-especially during growth spurts - are critical to its effectiveness. Specifically, a skilled orthotist must be experienced with the particular brace-type, apply these principles, maintain a good working relationship with both physician and patient to ensure timely brace adjustments essential to continued brace comfort and efficacy.

It's not just the big kids: Both high and low BMI impact bracing success for adolescent idiopathic scoliosis

“…Multiple factors associated with the type and quality of spinal orthosis used have also been shown to contribute to the amount of correction achieved. These include, but are not limited to, optimal pad placement, maximization of pad pressure and strap tension, creation of appropriate threepoint pressure, including axillary extension as indicated, and force maximization at the curve apex [16][17][18].…”

Optimized scheme for paired transverse corrective forces in S-shaped scoliosis via ultrasound and application in Chêneau brace: a pilot study

“…Considering that the application of TCF at 2 cm superior to the thoracic AV and 2 cm inferior to the lumbar AV will cause obvious discomfort to the armpits and iliac crest, we discarded those two points. Because excessively lower position of the TCF of the thoracic curve may hinder the correction of the lumbar curve, 12 we chose the position of 2 cm inferior to the AV instead of more inferior position. Thus, there were four possible combinations for the entire study: test 1 (thoracic AV, lumbar AV), test 2 (2 cm inferior to thoracic AV, lumbar AV), test 3 (thoracic AV, 2 cm superior to lumbar AV), and test 4 (2 cm inferior to thoracic AV, 2 cm superior to lumbar AV).…”

“…10 However, Karam et al 11 provided a different opinion from his observation of better reduction for thoracic deformity when applying a lateral force at the level of the AV instead of apical rib. In addition, the corrective effect of two opposing TCFs acting on adjacent spine segments of curvatures will affect each other 12 ; thus, the position selection of the paired TCFs for the thoracic and lumbar curves in S-shaped scoliosis is more complicated. Locating the TCFs in the fabrication process of braces for S-shaped scoliosis becomes an issue that needs to be addressed.…”

A mechanical analog thoracolumbar spine model for the evaluation of scoliosis bracing technology

“…Current experimental research of scoliosis bracing mechanics has largely been limited to two-dimensional (2D) and 3D imaging techniques 8–15 and computational models. 16–36 In vivo imaging methods provide a measure of the angular deformity but no information of the brace mechanics or structural properties.…”