Prospective study and new concepts based on scoliosis detorsion of the first 225 early in-brace radiological results with the new Lyon brace: ARTbrace

Abstract

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.

SOSORT Award Winner 2015: a multicentre study comparing the SPoRT and ART braces effectiveness according to the SOSORT-SRS recommendations

“…Despite relying on similar biomechanical principles [ 3 ], today braces are quite different in design, and possibly in terms of efficacy [ 4 ]. Not all braces recognize in their design the same biomechanical actions as demonstrated by many papers [ 22 , 25 – 27 ]. From a biomechanical point of view, the stiffness coefficient of the material is one of the characteristics of the brace, but it’s not enough to achieve good results.…”

“…The new super-rigid braces, which have been created to treat high-degree curves, showed interesting results, with the Sforzesco already tested even in surgical curves [ 20 ], while the ART, being born more recently, has been tested in a wider range of curves [ 22 ]. For this reason, we chose for the comparison only curves larger than 40°, for which the risk of progression to the surgical threshold according to the natural history is extremely high.…”

“…The ART brace (acronym for Asymmetrical, Rigid, Torsion brace), which has been described elsewhere [ 22 ], is also constructed with two rigid asymmetrical lateral pieces of polycarbonate, connected posteriorly at the midline by a duraluminum bar like the historical Lyon brace. All metal parts are similar to those of the Lyon brace (Fig.…”

“…The brace is not in complete contact with the body: there is an expansion room in the concavity which is there to allow room for the body’s expansion during inhalation. It’s been applied in clinical practice since 2013, so the results published so far are related to the in-brace correction, which was quite good in all planes [ 22 ].

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“…The Sforzesco brace also showed itself to be capable of improving surgical scoliosis in more than 50 % of cases [ 20 ]. More recently, in 2013, the ART brace was created in Lyon, with the aim of replacing the EDF cast and the Lyon brace [ 21 ], and in this regard the first short-term results were positive [ 22 ].…”