Prospective study of 158 adult scoliosis treated by a bivalve polyethylene overlapping brace and reviewed at least 5 years after brace fitting

Abstract

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.

A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data

“…An analysis of the proceedings from the SOSORT scientific meetings highlighted seven abstracts/oral presentations discussing the effects of bracing in adult populations. Four of these abstracts could be linked to studies that had been written up and already included in the review [20,21]. The remaining three abstracts focused on the effects of the SpineCor brace in adults [22][23][24].…”

Conservative Treatment of Degenerative Lumbar Scoliosis

“…It stabilizes the spine, improves the sagittal imbalance, and reduces the load in the lumbar spine. de Mauroy et al [77] have shown that a spinal brace is able to stabilize progressive curves in 80% of the adults with scoliosis [76].…”

“…Spinal bracing has been advocated in the management of adult scoliosis, to halt progression of curves, restore sagittal balance, and treat pain and disability. The effectiveness of braces, however, has been controversial [77,80]. A number of studies opined that spinal braces do not halt curve progression.…”

“…Recent studies, however, have shown that spinal bracing is effective in reducing pain and halting curve progression (Figure 12) [77,80]. A study which used a lordosing bivalve polyethylene overlapping brace to treat 158 adults with spinal deformities for over 5 years showed that 24% of the curves improved by ≥5°, 56% of the curves stabilized, and 20% worsened by ≥5° [77].…”

“…The yearly progression for curves in patients with DLS reduced from 1.47° to 0.24° per year [80]. de Mauroy [77] suggested that the brace treatment not only is palliative but also helps to stabilize the lumbar spine in lordosis [77].…”