Jean Claude de Mauroy

2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth

BackgroundThe International Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT), that produced its first Guidelines in 2005, felt the need to revise them and increase their scientific quality. The aim is to offer to all professionals and their patients an evidence-based updated review of the actual evidence on conservative treatment of idiopathic scoliosis (CTIS).MethodsAll types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting.ResultsThe contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D.ConclusionThese Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.

Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools

In recent decades, there has been a call for change among all stakeholders involved in scoliosis management. Parents of children with scoliosis have complained about the so-called “wait and see” approach that far too many doctors use when evaluating children’s scoliosis curves between 10° and 25°. Observation, Physiotherapy Scoliosis Specific Exercises (PSSE) and bracing for idiopathic scoliosis during growth are all therapeutic interventions accepted by the 2011 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). The standard features of these interventions are: 1) 3-dimension self-correction; 2) Training activities of daily living (ADL); and 3) Stabilization of the corrected posture. PSSE is part of a scoliosis care model that includes scoliosis specific education, scoliosis specific physical therapy exercises, observation or surveillance, psychological support and intervention, bracing and surgery. The model is oriented to the patient. Diagnosis and patient evaluation is essential in this model looking at a patient-oriented decision according to clinical experience, scientific evidence and patient’s preference. Thus, specific exercises are not considered as an alternative to bracing or surgery but as a therapeutic intervention, which can be used alone or in combination with bracing or surgery according to individual indication. In the PSSE model it is recommended that the physical therapist work as part of a multidisciplinary team including the orthopeadic doctor, the orthotist, and the mental health care provider - all are according to the SOSORT guidelines and Scoliosis Research Society (SRS) philosophy. From clinical experiences, PSSE can temporarily stabilize progressive scoliosis curves during the secondary period of progression, more than a year after passing the peak of growth. In non-progressive scoliosis, the regular practice of PSSE could produce a temporary and significant reduction of the Cobb angle. PSSE can also produce benefits in subjects with scoliosis other than reducing the Cobb angle, like improving back asymmetry, based on 3D self-correction and stabilization of a stable 3D corrected posture, as well as the secondary muscle imbalance and related pain. In more severe cases of thoracic scoliosis, it can also improve breathing function.This paper will discuss in detail seven major scoliosis schools and their approaches to PSSE, including their bracing techniques and scientific evidence. The aim of this paper is to understand and learn about the different international treatment methods so that physical therapists can incorporate the best from each into their own practices, and in that way attempt to improve the conservative management of patients with idiopathic scoliosis. These schools are presented in the historical order in which they were developed. They include the Lyon approach from France, the Katharina Schroth Asklepios approach from Germany, the Scientific Exercise Approach to Scoliosis (SEAS) from Italy, the Barcelona Scoliosis Physical Therapy School approach (BSPTS) from Spain, the Dobomed approach from Poland, the Side Shift approach from the United Kingdom, and the Functional Individual Therapy of Scoliosis approach (FITS) from Poland.

Terminology - glossary including acronyms and quotations in use for the conservative spinal deformities treatment: 8th SOSORT consensus paper.

BackgroundThis report is the SOSORT Consensus Paper on Terminology for use in the treatment of conservative spinal deformities. Figures are provided and relevant literature is cited where appropriate.MethodsThe Delphi method was used to reach a preliminary consensus before the meeting, where the terms that still needed further clarification were discussed.ResultsA final agreement was found for all the terms, which now constitute the base of this glossary. New terms will be added after being discussed and accepted.DiscussionWhen only one set of terms is used for communication in a place or among a group of people, then everyone can clearly and efficiently communicate. This principle applies for any professional group. Until now, no common set of terms was available in the field of the conservative treatment of scoliosis and spinal deformities. This glossary gives a common base language to draw from to discuss data, findings and treatment.

Research quality in scoliosis conservative treatment: state of the art.

The publication of research in the field of conservative treatment of scoliosis is increasing after a long period of progressive decline. In 2014, three high quality and scientifically sound papers gave new strength to the conservative scoliosis approach. The efficacy of treatment over observation was demonstrated by two RCTs for bracing, and one for scoliosis-specific exercises provided by a physical therapist. It is difficult to design strong studies in this field due to the long time needed for follow up and the challenge of recruiting patients and families willing to be involved in the decision process. Nevertheless, the main methodological errors are not related to the study design but rather on the way it is performed, which very frequently affects the reliability of results. The most common errors are: selection bias, with many studies including functional rather than a true structural scoliosis; inappropriate outcome measures, utilizing parameters not related to scoliosis progression or quality of life; inappropriate follow up, reporting only immediate results and not addressing end of growth results; an incorrect interpretation of findings, with an overestimation of results; and missing the evaluation of skeletal maturity, without which results cannot be considered stable. Being aware of these errors is extremely important both for authors and for readers in order to avoid questionable practices based on inconclusive studies that could harm patients.

The new Lyon ARTbrace versus the historical Lyon brace: a prospective case series of 148 consecutive scoliosis with short time results after 1 year compared with a historical retrospective case series of 100 consecutive scoliosis; SOSORT award 2015 winner

Competing interests JCdM, CL and SP are co-inventor of the ARTbrace. AJ, FG and FB declare that they have no competing interests. Authors’ contributions JCdM planned the study and collected the data. FG contributed to the references. All authors participated in the design of the study and contributed to writing the text, read and approved the final manuscript. Authors’ information JCdM is the clinical manager and medical responsible of ARTbrace project. AJ is orthopedic surgeon successor of JCdM. FG is Italian resident orthopedic surgeon in Lyon for 1 year. CL, FB SP are CPO technical managers of ARTbrace project.

Physical Therapy for Adolescents with Idiopathic Scoliosis

Scoliosis is a three-dimensional deformity of the spine. In its most common form, idiopathic scoliosis (70% to 80% of cases), the causes are unknown (Rowe 2003). AIS is discovered at 10 years of age or older, and is defined as a curve of at least 10°, measured on a standing radiograph using the Cobb technique (Parent et al, 2005). While the prevalence of AIS is around 3% in the general population, almost 10% of those diagnosed with AIS will require some form of treatment; usually observation or scoliosis-specific exercises (SSE) for mild curves, braces for moderate curves and spinal surgery for severe curves (Cobb angle >500). Up to 0.1% of the population is at risk of requiring surgery (Lonstein, 2006). A severe form of AIS is more commonly found in females. Typically, AIS does not cause any health problems during growth (except for extreme cases). However, the resulting surface deformity frequently has a negative impact on adolescents` bodyimage and self-esteem that can give rise to quality of life (QoL) issues and in worst cases, psychological disturbances (Maclean et al, 1989). Adolescent patients are generally treated in an attempt to halt the progressive nature of the deformity. No treatments succeed in full correction to a normal spine, and even reduction of the deformity is difficult (Danielson and Nachemson, 2001). If scoliosis surpasses a critical threshold, usually considered to be 30o Cobb, at the end of growth, the risk of health and social problems in adulthood increases significantly (Negrini, 2005). Problems include reduced quality of life, disability, pain, increased cosmetic deformity, functional limitations, sometimes

Historical Lyonaise brace treatment for adolescent hyperkyphosis. Results of 272 cases reviewed 2 years minimum after removal of the brace

The conservative orthopaedic treatment of hyperkyphosis is less classical than the scoliosis one, because Hyperkyphosis does not affect the respiratory function, and it is more difficult to define normality. The consequences of hyperkyphosis are mainly pain and aesthetic. In English literature very few homogeneous series of results are published. Lowe [1] in a review of the current literature using evidence-based medicine, concludes that when recognized early in adolescence with progressive kyphosis, bracing treatment will usually result in modest correction of the deformity. Sachs [2] analyzing the results of 274 patients concludes that the Milwaukee brace is usually an effective method of treatment for patients who have Scheuermann kyphosis; however, four of fourteen patients who had an initial kyphosis of more than 74 degrees required a spinal fusion. Weiss [3] analyzes the use of transverse correction forces instead of distraction forces with a 3 points brace in 56 patients.In Lyon, we use since 60 years, an historical protocol consisting of: plaster cast reduction, plexidur 5 points brace and specific exercises. Currently, this treatment is performed in day hospital.

Developing a tool to measure objectively the rib hump from an instantaneous 3D scanning in a full upright position. Results of 50 scoliosis before and after plaster cas

Comprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. The Adams test implies a forward bending of the trunk and radiological examinations are performed in an upright position. The aim of this study is to explore the possibility to obtain a clinical measure of the rib hump in an upright position like the Cobb angle. Orten scanning system is a full 3D instantaneous measurement device in an upright position, working with structured light projection. Initially developed to avoid the plaster cast moulding, this system gives a full 3D digital representation of scoliosis. [1] The software offers many versatile and flexible solutions needed to study the patient 3D model.

Brace Classification Study Group (BCSG): part one – definitions and atlas

BACKGROUND The current increase in types of scoliosis braces defined by a surname or a town makes scientific classification essential. Currently, it is a challenge to compare braces and specify the indications of each brace. A precise definition of the characteristics of current braces is needed. As such, the International Society for Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) mandated the Brace Classification Study Group (BCSG) to address the pertinent terminology and brace classification. As such, the following study represents the first part of the SOSORT consensus in addressing the definitions and providing a visual atlas of bracing. METHODS After a short introduction on the braces, the aim of the BCSG is described and its policies/general consideration are outlined. The BSCG endeavor embraces the very important SOSORT - Scoliosis Research Society cooperation, the history of which is also briefly narrated. This report contains contributions from a multidisciplinary panel of 17 professionals who are part of the BCSG. The BCSG introduced several pertinent domains to characterize bracing systems. The domains are defined to allow for analysis of each brace system. RESULTS A first approach to brace classification based on some of these proposed domains is presented. The BCSG has reached a consensus on 139 terms related to bracing and has provided over 120 figures to serve as an atlas for educational purposes. CONCLUSIONS This is the first clinical terminology tool for bracing related to scoliosis based on the current scientific evidence and formal multidisciplinary consensus. A visual atlas of various brace types is also provided.

Controversial Issue Session: Brace treatment in infantile scoliosis: benefits

Material and methods In 1965, Cotrel and Morel describing the EDF plaster jacket technique stated that “in young children, it should be feasible not only to prevent further progression but above all to use the child’s growth to regress structural vertebral and thoracic deformities”. Before the child start walking, we use a plaster shell in bending correction. After walking, an underarm plaster cast with a large anterior opening, and the modified Milwaukee brace with polyethylene bars and cervical collar without hyoid support is the only brace that can manage curves in the top part of the spine. It is also the only brace that can avoid a hypoplastic thorax.Material and methods In 1965, Cotrel and Morel describing the EDF plaster jacket technique stated that “in young children, it should be feasible not only to prevent further progression but above all to use the child’s growth to regress structural vertebral and thoracic deformities”. Before the child start walking, we use a plaster shell in bending correction. After walking, an underarm plaster cast with a large anterior opening, and the modified Milwaukee brace with polyethylene bars and cervical collar without hyoid support is the only brace that can manage curves in the top part of the spine. It is also the only brace that can avoid a hypoplastic thorax.