Impact of Rotation Correction after Brace Treatment on Prognosis in Adolescent Idiopathic Scoliosis

Abstract

Study DesignLevel 4 retrospective review.PurposeBrace treatment is the standard nonoperative treatment for adolescent idiopathic scoliosis (AIS). Rotation correction is also important, because AIS involves a rotation deformity. The purpose of this study was to evaluate the impact of rotation correction after Osaka Medical College (OMC) brace treatment on clinical outcomes in AIS.Overview of LiteratureBrace treatment has a significant effect on the progression of AIS. However, few reports have examined rotation correction after brace treatment.MethodsA total of 46 patients who wore the OMC brace were retrospectively reviewed. The curve magnitude was determined according to the Cobb method, and the rotation angle of the apical vertebrae was measured by the modified Nash-Moe method. Based on the difference in the rotation angle before and after the initial brace treatment, patients were divided into two groups. Group A (n=33) was defined as no change or improvement of the rotation angle; group B (n=13) was defined as deterioration of the rotation angle. If the patients had curve or rotation progression of 5° or more at skeletal maturity, or had undergone surgery, the treatment was considered a failure.ResultsDifferences of rotation angle between before and after the initial brace treatment were 2°±2° in group A and –3°±2° in group B (p<0.001). The rates of treatment failure were 42% in group A and 77% in group B (p<0.05). This study included 25 patients with Lenke type 1 (54%). Group A (24%) with Lenke type 1 also had a significantly better success rate of brace treatment than group B (75%) (p<0.05).ConclusionsInsufficient rotation correction increased brace treatment failure. Better rotation correction resulted in a higher success rate of brace treatment in patients with Lenke type 1.

<p>Bracing In The Treatment Of Adolescent Idiopathic Scoliosis: Evidence To Date</p>

“…Ovadia et al (2012)62 reported that low Angle Trunk Rotation (ATR), measured by scoliometer during Adam’s test, was associated with increased potential for successful treatment. Yamane et al (2016)84 found that insufficient in-brace correction of rotation increased the likelihood of progression. It seems that vertebra and trunk rotation are factors that can influence the final result, but the quality of evidence is still very low.…”

The Effect of Bracing on Spinopelvic Rotation and Psychosocial Parameters in Adolescents with Idiopathic Scoliosis

“…With respect to non-surgical treatment, frontal plane deformity has been the primary outcome broadly used by clinicians or researchers, and less attention has been paid to rotational components of the deformity [2,3]. Dubousset et al [4] proposed the theory that the pelvis behaves as a vertebra; therefore, it is likely that scoliosis deformity involves the pelvis.…”

“…Pelvic rotation has mostly been mentioned as an independent factor in previous studies and has been measured pre- and postoperatively [5,6]. Moreover, few studies have quantitatively evaluated the effect of bracing on axial vertebral rotation in AIS [3,7,8]. Yamane et al [3] found that in patients with insufficient vertebral rotation control, the rate of bracing failure increased.…”

Brace Treatment for Children and Adolescents with Scoliosis

“…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].…”