[Conservative treatment of idiopathic scoliosis : Influence of archetypical Cheneau-Corsets on trunk asymmetry]

Ultrasound supports clinical decision-making in determining the Sanders' skeletal maturity score of the hand

PURPOSE

The Sanders Scoring System has revolutionized the way we assess the remaining growth potential of the skeleton. However, because it involves radiation exposure, it must be used with caution in children. The purpose of the study was to evaluate whether the Sanders skeletal maturity score (SMS) could be accurately determined using ultrasound (U).

METHODS

We took radiographs (R) of the hand and performed U of the thumb and index finger in 115 patients between six and 19 years of age who were undergoing treatment for scoliosis or limb deformities. Paediatric orthopaedic surgeons, a paediatrician, and a paediatric radiologist were evaluated the blinded images. Those classified images are based on the SMS and the Thumb Ossification Composite Index (TOCI).

RESULTS

Intrarater reliability was high for SMS and slightly weaker for TOCI, but still significant. Interrater reliability was clear for R and weaker for U in both staging systems. Ultimately, SMS 3 and 7 achieved the highest percentage of concordance (P) of 71.7% and 66.0%, respectively, when U was performed. Combining the clinically relevant groups of SMS 3&4 and SMS 7&8 also significantly increased peak scores (SMS 3 and 4 P = 76.7%; SMS 7 and 8 P = 79.7%). The probabilities of peak scores were significantly weaker when the TOCI score was examined.

CONCLUSION

Our study shows that U can be used effectively especially to measure stages 3 and 4 and stages 7 and 8 of SMS. The U method is easy to use and therefore may offer advantages in clinical practice without the need for radiation exposure.

[Orthopaedic technology and neuromuscular scoliosis : Orthotics, wheelchair seating shells and positioning aids]

Children and adolescents with neuromuscular scoliosis usually undergo severe challenges with their respiratory and locomotor systems during growth. Early onset scoliotic deformities take a whole team of specialists to ease the problematic side effects associated with poor posture and seating abilities. Wheelchairs and seating shells need to be adjusted as does suitable bracing for the collapsing spine. Key issues are the maintenance of proper lung function and upright sitting in the wheelchair or seating shell. Although spine bracing can be helpful and has its place in seating, the natural history of progression in neuromuscular curvatures is rarely sustainably stopped. While bracing is sometimes not tolerated by patients with severe hypotonic thoracic collapse and breathing issues, it can otherwise buy time for some patients to gain height and weight before surgical intervention inevitably takes place.

[Is it possible to improve treatment safety in the brace treatment of scoliosis patients by using standardized CAD algorithms?]

Hintergrund

Die Versorgung von Skoliosepatienten mit korrigierenden Rumpforthesen führt auch heutzutage noch zu recht unterschiedlichen Ergebnissen. Publizierte Erfolgsquoten zwischen 50 und 90 % führen zwangsläufig zu der Frage, wie sich die Erfolgsquoten der Korsettversorgung steigern und vereinheitlichen lassen. Die Ergebnisse einer mit dieser Zielsetzung weiterentwickelten computerunterstützen (CAD/„Computer Aided Design“) Chêneau-Versorgung werden dargestellt.

Methodik

Am Stichtag (08.12.2019) wurde die prospektiv angelegte Datenbank unserer Abteilung retrospektiv ausgewertet. Es waren ausschließlich unreife Mädchen mit einer Adoleszentenskoliose, Alter 10–14 Jahre, Risser 0–2 in die Datenbank aufgenommen worden.

Ergebnisse

Sowohl die Gesamtgruppe mit einem Beobachtungszeitraum von mindestens 18 Monaten als auch die Patientinnengruppen mit bereits erreichtem Behandlungsabschluss zeigten Erfolgsraten zwischen 86 und 88 %. Die Ergebnisse insgesamt waren signifikant besser als die Erfolgsrate der Boston-Brace-Kontrollgruppe (BRAIST) von 72 %. Auch im Vergleich mit den Ergebnissen anderer Chêneau-Derivate war die Erfolgsrate unserer Serie teils deutlich besser.

Schlussfolgerungen

Die Behandlungssicherheit für die Patienten mit Skoliosen sollte verbessert werden. Ein Ansatz hierzu kann die Verwendung standardisierter CAD-Bibliotheken sein. Weitere Untersuchungen mit Studiendesigns höherer Evidenz sind notwendig, um die in unserer Untersuchung gefundenen Ergebnisse zu untermauern.

First end-result of a prospective cohort with AIS treated with a CAD Chêneau style brace

[Purpose] Specific exercises and brace treatment are the two evidence-based modes of treatment for patients with scoliosis. The purpose of this paper is to present the first end-results from a prospective cohort that commenced treatment in 2011 with a CAD based Chêneau derivate and is then compared to the published results achieved with the Boston Brace. [Participants and Methods] Inclusion criteria for the study, refers to the SRS inclusion criteria on bracing, except the range of Cobb angles which was extended to curvatures of up to 45°. Twenty-eight patients were weaned from their CAD Chêneau style brace. The results of this cohort have been compared with the BRAIST study by Weinstein et al. with the help of the Z-test. [Results] A success rate of 92.9% has been achieved. This was compared to the success rate of 72% in the BRAIST study. The differences were highly significant in the Z-test. [Conclusion] The results achieved with the GBW are significantly and better than the results achieved with the Boston brace. Therefore, the standards for bracing should be reviewed with the results that symmetric compression with Boston bracing is not as successful, when compared to asymmetric high correction bracing results, which allow a standardized classification-based corrective approach.