Andrzej Szulc

Discrepancy in clinical versus radiological parameters describing deformity due to brace treatment for moderate idiopathic scoliosis

BackgroundThe shape of the torso in patients with idiopathic scoliosis is considered to reflect the shape of the vertebral column, however the direct correlation between parameters describing clinical deformity and those characterizing radiological curvature was reported to be weak. It is not clear if the management proposed for scoliosis (physiotherapy, brace, surgery) affects equally the shape of the axial skeleton and the surface of the body. The aim of the study was to compare clinical deformity of (1) idiopathic scoliosis girls being under brace treatment for radiological curves of 25 to 40 degrees and (2) non treated scoliotic girls matched for age and Cobb angle.MethodsCross-sectional study of 24 girls wearing the brace versus 26 girls without brace treatment, matched for age and Cobb angle. Hypothesis: Patients wearing the brace for more than 6 months, when comparing to patients without brace, may present different external morphology of the trunk, in spite of having similar Cobb angle. Material. Inclusion criteria: girls, idiopathic scoliosis, growing age (10–16 years), Cobb angle minimum 25°, maximum 40°. The braced group consisted of girls wearing a TLSO brace (Cheneau) for more than 6 months with minimum of 16 hours per day. The non-braced group consisted of girls first seen for their spinal deformity, previously not treated. The groups presented similar curve pattern. Methods. Scoliometer exam: angle of trunk rotation at three levels of the spine: upper thoracic, main thoracic, lumbar or thoracolumbar. The maximal angle was noted at each level and the sum of three levels was calculated. Posterior trunk symmetry index (POTSI) and Hump Sum were measured using surface topography.ResultsCobb angle was 34.9° ± 4.8° in braced and 32.7° ± 4.9° in un-braced patients (difference not significant). The age was 14.1 ± 1.6 years in braced patients and 13.1 ± 1.9 years in un-braced group (p = 0.046). The value of angle of trunk rotation in the main curvature was 8.4° ± 2.7°in braced and 11.4° ± 2.7° in un-braced patients (difference extremely significant, p = 0.0003). The value of the sum of angles of trunk rotation at three levels of the trunk was 12.8° ± 4.6° in braced and 16.5° ± 3.8° in un-braced patients (difference very significant, p = 0.0038). The POTSI did not differ significantly between the groups (p = 0.78), the Hump Sum values were not quite different (p = 0.07).Conclusion(1) Adolescent girls wearing the brace for idiopathic scoliosis of 25 to 40 degrees of Cobb angle, reveal smaller clinical rotational deformity of their back than non-treated girls having similar radiological deformity. (2) Evaluation of the results of treatment for idiopathic scoliosis should consider parameters describing both clinical and radiological deformity.

Adolescent girls with idiopathic scoliosis <40 degrees, treated with TLSO brace, reveal less clinical deformity than non-treated girls having similar scoliosis angle

Study design Group 1 consisted of twenty-four girls wearing the brace and Group 2 consisted of twenty-six girls without the brace, matched for Cobb angle. We examined the hypothesis that girls wearing the brace for more than six months, when compared to scoliotics without brace, may present distinct morphology of the trunk, in spite of having similar Cobb angle. Inclusion criteria: Female gender, a diagnosis of AIS, age 10–16 years, out of brace Cobb angle minimum 25 degrees, maximum 40 degrees. The braced group consisted of girls wearing a TLSO brace (Cheneau) a minimum of sixteen hours per day for more than six months. The unbraced group consisted of girls first seen for their spinal deformity, previously not treated.

Sitting forward bending position versus standing position for studying the back shape in scoliotic children

Study design Cross sectional study of 113 girls with idiopathic scoliosis, aged 14.0 ± 2.1 years (range 10 to 18), mean height 160.0 ± 9.4 cm (range 121 to 184), mean weight 48.6 ± 9.2 kg (range 22 to 75) who underwent raster stereography exam of the back in standing position and in sitting forward bending position. The Cobb angle of the main curve was 41.2 ± 16.7 degrees (range 10 to 95), Risser sign value from 0 to 5, median = 2.

Corrective bracing for severe idiopathic scoliosis in adolescence: influence of brace on trunk morphology.

Aim. The aim of the work was to study whether wearing a corrective brace by adolescent girls with severe idiopathic scoliosis can influence external shape of the trunk. Methods. Comparison of clinical deformity of two groups of girls matched for age and Cobb angle: group (1) of 23 girls, aged 14.9 ± 1.3 years, Cobb angle 55.0° ± 6.8°, who refused surgical treatment and have been wearing Chêneau brace for more than 6 months, compared with group (2) of 22 girls, aged 14.1 ± 1.8 years, Cobb angle 59.7° ± 14.6° never treated with corrective bracing. Clinical deformity was assessed with the Bunnell scoliometer (angle of trunk rotation ATR) and surface topography (posterior trunk symmetry index POTSI and Hump Sum HS). Results. The ATR in the primary curvature was 11.9° ± 3.4° (5°–18°) in group 1 versus 15.1° ± 5.6° (6°–25°) in group 2 (P = 0.027). The HS was 16.8° ± 3.8 versus 19.2° ± 4.6, respectively, P = 0.07. The POTSI value did not differ between groups. Conclusion. Girls with Cobb angle above 45 degrees, who have been subjected to brace treatment, revealed smaller clinical deformity of their back comparing to nontreated girls having similar radiological curvatures.

Evaluation of the thorax shape in the transverse plane with simple clinical technique

Cobb angle measures the shadows of the two limit vertebrae while scoliotic deformity is a complex 3D phenomenon. There is a deficiency of simple clinical methods of thorax shape evaluation. The objective of the study was to investigate the technique measuring thorax transverse plane deformity in patients with idiopathic scoliosis.

Measurement of the hip joint range of motion in adolescent girls with idiopathic scoliosis

Results Compared to the controls, the patients with scoliosis revealed less frequent symmetry of the hip joint range of rotation (p = 0.0047), a significantly higher difference between the left and the right hip range of internal rotation (p = 0.0013), and a significantly greater static rotational offset of the pelvis, calculated from the mid-points of rotation, (p = 0.0092). No limitation of the hip joint range of motion was detected, but a transposition of the sector of motion, usually towards the internal rotation in one hip and the external rotation in the opposite hip. No relation between the asymmetry of the hip joint range of motion and the curve type, the Cobb angle, the angle of trunk rotation or the curve progression was demonstrated.