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Guy A, Coulombe M, Labelle H, Barchi S, Aubin CÉ. Automated design of nighttime braces for adolescent idiopathic scoliosis with global shape optimization using a patient-specific finite element model. Sci Rep 2024; 14:3300. [PMID: 38332053 PMCID: PMC10853218 DOI: 10.1038/s41598-024-53586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
Adolescent idiopathic scoliosis is a complex three-dimensional deformity of the spine, the moderate forms of which require treatment with an orthopedic brace. Existing brace design approaches rely mainly on empirical manual processes, vary considerably depending on the training and expertise of the orthotist, and do not always guarantee biomechanical effectiveness. To address these issues, we propose a new automated design method for creating bespoke nighttime braces requiring virtually no user input in the process. From standard biplanar radiographs and a surface topography torso scan, a personalized finite element model of the patient is created to simulate bracing and the resulting spine growth over the treatment period. Then, the topography of an automatically generated brace is modified and simulated over hundreds of iterations by a clinically driven optimization algorithm aiming to improve brace immediate and long-term effectiveness while respecting safety thresholds. This method was clinically tested on 17 patients prospectively recruited. The optimized braces showed a highly effective immediate correction of the thoracic and lumbar curves (70% and 90% respectively), with no modifications needed to fit the braces onto the patients. In addition, the simulated lumbar lordosis and thoracic apical rotation were improved by 5° ± 3° and 2° ± 3° respectively. Our approach distinguishes from traditional brace design as it relies solely on biomechanically validated models of the patient's digital twin and a design strategy that is entirely abstracted from empirical knowledge. It provides clinicians with an efficient way to create effective braces without relying on lengthy manual processes and variable orthotist expertise to ensure a proper correction of scoliosis.
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Affiliation(s)
- Aymeric Guy
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Maxence Coulombe
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Hubert Labelle
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Soraya Barchi
- Sainte-Justine University Hospital Center, Montreal, QC, Canada
| | - Carl-Éric Aubin
- Polytechnique Montreal, 2500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.
- Sainte-Justine University Hospital Center, Montreal, QC, Canada.
- Université de Montréal, Montreal, QC, Canada.
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Bidari S, Kamyab M, Ganjavian MS, Komeili A. A new scoliosis brace padding method based on trunk asymmetry for scoliosis treatment. Prosthet Orthot Int 2023; 47:416-423. [PMID: 36723400 DOI: 10.1097/pxr.0000000000000210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 11/21/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pressure pads are used with scoliosis braces to adjust the magnitude and location of corrective forces that mechanically support the torso to correct the spine deformity. In the conventional brace (C.B.) design approaches, the location and shape of pads are determined based on the visual assessment of the clinician. The accuracy of this approach could be improved because it is limited to the clinician's expertise. The present study aimed to develop a new brace (N.B.) padding method based on trunk asymmetry for adolescents with idiopathic scoliosis and compare the efficacy of the developed method with C.B. in improving the Cobb angle and body posture symmetricity. METHODS The trunk surface geometry was scanned using a 3-dimensional scanner. The best plane of symmetry was determined, and the original trunk was reflected in the plane of symmetry, creating the reflected trunk. The difference between the reflected and original trunks was computed and color-coded using deviation contour maps. The boundary of deformed regions, with a minimum of 6-mm deviation contour maps, was identified as the trim lines for brace pads. Eight participants were recruited and divided into conventional and new padding groups. The variation of Cobb angle and torso asymmetry parameters, including the trunk rotation and back surface rotation, as well as the brace satisfaction and trunk appearance perception of the 2 groups, were compared after 3 months of treatment. RESULTS Cobb angle improved equally in the N.B. and C.B. groups. However, back surface rotation improved in the N.B. group (+49.6%) and worsened in the C.B. group (-6.8%). The mean trunk rotation was improved by 30% in the N.B. and further exacerbated by -2.2% in the C.B. group. The brace satisfaction and trunk appearance perception scores were higher in the N.B. than in the C.B. group, however not statistically significant. CONCLUSIONS The present study showed that the proposed brace padding system improved the trunk appearance without negatively affecting the Cobb angle correction.
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Affiliation(s)
- Shahrbanoo Bidari
- Department of Orthotics and Prosthetics, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, California State University Dominguez Hills, Carson, CA, USA
| | - Mohammad Saleh Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amin Komeili
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta, Canada
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Donzelli S, Fregna G, Zaina F, Livetti G, Reitano MC, Negrini S. Predictors of Clinically Meaningful Results of Bracing in a Large Cohort of Adolescents with Idiopathic Scoliosis Reaching the End of Conservative Treatment. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10040719. [PMID: 37189968 DOI: 10.3390/children10040719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND We need good outcome predictors to maximize the treatment efficiency of adolescents with idiopathic scoliosis (AIS). The in-brace correction has shown an important predictive effect on brace failure, while the influence of other variables is still debated. We aimed to identify new outcome predictors from a big prospective database of AIS. METHODS Design: Retrospective analysis of prospectively collected data. INCLUSION CRITERIA AIS between 21 and 45°, Risser 0-2, brace prescription during the observation, treatment conclusion. All of the participants followed a personalized conservative approach according to the SOSORT Guidelines. OUTCOMES End of growth below 30°-40°-50°. The regression model included age, BMI, Cobb angle, ATR, TRACE score, real brace wear (RBW), and in-brace correction (IBC). RESULTS A total of 1050 patients, 84% females, ages 12.1 ± 1.1, 28.2 ± 7.9° Cobb. IBC increased by 30%, 24%, and 23% the odds of ending treatment below 30°, 40°, and 50°, respectively. The OR did not change after the covariate adjustment. Cobb angle and ATR at the start also showed a predictive effect. CONCLUSIONS The systematic evaluation of IBC in clinics is useful for individuating the patient response to brace treatment more accurately, even in relation to the Cobb angle and ATR degrees at the start. Further studies are needed to increase the knowledge on predictors of AIS treatment results.
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Affiliation(s)
| | - Giulia Fregna
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Fabio Zaina
- ISICO (Italian Scientific Spine Institute), 20141 Milan, Italy
| | - Giulia Livetti
- IRCCS Eugenio Medea-Associazione La Nostra Famiglia, 23842 Bosisio Parini, Italy
| | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", 20122 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20157 Milan, Italy
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Negrini S, Di Felice F, Negrini F, Rebagliati G, Zaina F, Donzelli S. Predicting final results of brace treatment of adolescents with idiopathic scoliosis: first out-of-brace radiograph is better than in-brace radiograph-SOSORT 2020 award winner. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3519-3526. [PMID: 35376983 DOI: 10.1007/s00586-022-07165-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/01/2022] [Accepted: 02/28/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE In-brace radiograph of adolescents with idiopathic scoliosis (AIS) has been shown to reflect brace efficacy and the possibility of achieving curve correction. Conversely, the first out-of-brace radiograph could demonstrate the patient's ability to maintain the correction. We aimed to determine which of the two radiographs is the best predictor of the Cobb angle at the end of treatment (final radiograph). DESIGN Retrospective cohort study of a prospective dataset. METHODS The population was selected based on the following inclusion criteria: AIS, age 10-18 years; Risser score 0-2; Cobb angle 25-40°; brace treatment; availability of all radiographs. STATISTICS Pearson correlations provide a first exploration of data. The univariate and multivariate logistic regression model tested the predictors. Finally ROC curve provided a check of model accuracy. RESULTS A total of 131 patients were included (mean age 13.0 ± 1.3, Cobb angle 33.2 ± 5.5°; 78% females). At the end of treatment, 56% had stabilised, 9% had progressed, and 44% had improved. The difference between the in-brace and final radiographs was 8.0 ± 6.0°, while the difference between the first out-of-brace and final radiographs was 1.8 ± 5.2°. The best predictor of final outcome was the first out-of-brace radiograph (0.80), compared to in-brace (0.68) and baseline (0.59) radiographs. The best cut-offs to predict avoidance of progression were 30% and 10% of the correction rates for the in-brace and first out-of-brace radiographs, respectively. CONCLUSION The first out-of-brace radiograph predicts end results better than the in-brace radiograph. It offers an excellent clinical reference for clinicians and patients. The first out-of-brace radiograph should be considered an essential element of future predictive models. LEVEL OF EVIDENCE 1: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
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Affiliation(s)
- Stefano Negrini
- Department of Biomedica, Surgical and Dental Scientes, University "La statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Francesco Negrini
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Giulia Rebagliati
- Istituto Scientifico Italiano Colonna Vertebrale (ISICO), Milan, Italy
| | - Fabio Zaina
- Istituto Scientifico Italiano Colonna Vertebrale (ISICO), Milan, Italy
| | - Sabrina Donzelli
- Istituto Scientifico Italiano Colonna Vertebrale (ISICO), Milan, Italy.
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Nonoperative management of adolescent idiopathic scoliosis (AIS) using braces. Prosthet Orthot Int 2022; 46:383-391. [PMID: 35320151 DOI: 10.1097/pxr.0000000000000117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 01/06/2022] [Indexed: 02/03/2023]
Abstract
This review presents the state of the art according to the current evidence on nonoperative treatment for adolescent idiopathic scoliosis, focusing on bracing. The definition of braces for the treatment of adolescent idiopathic scoliosis and a short history are provided. The analysis includes biomechanics, types, existing classifications, indications for treatment, time of brace wear and weaning, adherence, three-dimensional modeling, use of ultrasound imaging for bracing, management of treatment, issue of immediate in-brace correction, and documentation of the outcomes usually assessed for brace treatment, including the quality-of-life issues. According to the current evidence, there are two randomized control trials in favor of bracing. There are insufficient data on the superiority of one brace over another, although it is possible to classify and grade braces for efficacy from nonrigid to rigid and very rigid. Nevertheless, there is consensus on patients' management on the need for teamwork focusing on adherence to treatment, acceptability, and family and patient involvement.
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Li H, Yang Z, Li D, Qiao F. A Novel Low-Cost 3D Printed Brace Design Method for Early Onset Scoliosis. J Med Device 2022. [DOI: 10.1115/1.4054998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Early onset scoliosis (EOS) is a type of spine deformity that presents before 10 years of age. The biomechanical properties in scoliosis have been found to be di?erent, especially in the case of the concave and convex paraverte-bral muscles. Based on this fact, a novel 3d printed patient-specific asymmetric stiffness brace design method is proposed in this paper, aiming to provide asymmetric stiffness to match "imbalanced" biomechanical properties of the concave and convex paravertebral muscles, respectively, and treat EOS by applying the block-structure brace.A 3d CAD draft model of the brace contour was implemented from 3D scanning. The asymmetric stiffness block-structure brace was designed in Rhinoceros and the Finite Ele-ment (FE) model was imported into ABAQUS. FE simulation was employed to study the mechanical characteristics of the brace, which provided a quan-titative index for the "imbalanced" property of brace stiffness. The results of the FE simulation showed that the stiffnesses of the concave and convex sides were 145.88 N/mm and 35.95 N/mm, respectively. The block-structure brace was fabricated using 3d printing. Asymmetric stiffness was evaluated by corrective force measurements, which were obtained from a thin-film pressure sensor equipped on the brace. The patient-specific asymmetric stiffness brace was applied to clinical practice in a one-year old EOS patient. A novel low-cost 3D printed brace design method for EOS was proposed in this study that could potentially be useful in patient treatment acceptance.
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Affiliation(s)
- Hongwei Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University , Xi'an, Shaanxi 710049, China
| | - Zhangkai Yang
- Department of Neurosurgery, Xi'an Children's Hospital, The Affiliated Children's Hospital of Xi'an Jiaotong University , Xi'an, Shaanxi 710003, China
| | - Dichen Li
- State Key Laboratory for Manufacturing System Engineering, School of Mechanical Engineering, Xi'an Jiaotong University , Xi'an, Shaanxi 710049, China
| | - Feng Qiao
- Honghui Hospital, Xi'an Jiaotong University , No.555, Youyidong Rd, Xi'an, Shaanxi 710054, China
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Biomechanical analysis of the impact of increasing levels of body mass index on the ability of a bracing orthosis to alter the asymmetric compressive growth plate loading in a scoliotic spine. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Putra RAC, Limskul D, Yotnuengnit P, Promsang T, Kuptniratsaikul S. Evaluation of In-brace Correction in Individuals with Adolescent Idiopathic Scoliosis: A Retrospective and Descriptive Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introductions: Achieving maximum correction at the beginning of brace treatment in AIS is the only factor that can be controlled by the bracing provider if we have a better understanding of the prognostics and factors associated with achieving in-brace correction. The aim of this present study was to evaluate in-brace correction in a cohort of AIS patients who were treated by full-time bracing with plastic moulded thoraco-lumbo-sacral spinal orthosis (TLSO).
Methods: This study was a retrospective descriptive study. We collected data from medical records of individuals with AIS who receiving full-time braces treatment from Orthotic Clinic, King Chulalongkorn Memorial Hospital. Demographic data included age, gender, weight, height, and body mass index (BMI). Cobb angle, Risser sign, and curve type were determined using pre and post-brace standing posteroanterior (PA) radiographs. Correlation analysis was performed to investigate in-brace correction with associated factors.
Results: We included 91 patients' data and radiographic images with AIS, with seven (7.69%) boys and 84 (92.31%). The overall mean Cobb angle was 32.9 ± 8.5º, and during brace treatment, it was 22.5 ± 11.5º. There was a significant mean difference in the mean Cobb angle before and in-brace (p < 0.001). The overall mean in-brace correction in the study was 34.1 ± 22.7%. Initial Cobb angle and BMI were found to be significantly negatively associated with in-brace correction with a Pearson coefficient of -0.49 and -0.24, respectively.
Conclusion: The mean of first in-brace correction TLSO was 34.1% from the initial Cobb angle. No difference in in-brace correction across curve types in our study. There was a significant Cobb angle changed before and in-brace radiograph. We found that in-brace correction was significantly associated with initial Cobb angle and BMI.
Keywords: Adolescent Idiopathic Scoliosis, in-brace correction, bracing
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Improvement of Adolescent Idiopathic Scoliosis Primary Correction by Brace Design Optimization. CHILDREN 2022; 9:children9050656. [PMID: 35626833 PMCID: PMC9139214 DOI: 10.3390/children9050656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022]
Abstract
(1) Background: Primary in-brace correction has been shown to be related to conservative adolescent idiopathic scoliosis (AIS) treatment outcome. The purpose of the study was to evaluate TLSO brace design changes over eight years regarding primary Cobb correction and de-rotation of the (major) curve. (2) Methods: This retrospective analysis included AIS patients treated with a full-time TLSO-brace in a single Orthopedic University hospital in 2012–2014 and 2017–2019. Brace design changes resulted from an evolutionary process, from a 3-point bending to a 3D TLSO. The brace parameters (presence of an anterior shoulder pad, posterior high-thoracic pad, thoracic space, and angle of the lumbar and thoracic pressure points) were analyzed regarding the primary (major) Cobb angle and apex rotation correction with a multivariate analysis. (3) Results: A total of 74 (63 female) patients were included in the study. The Cobb angle primary correction was significantly improved over the timeframe. The primary correction was significantly influenced by all design parameters and partially by its interactions with (curve specific) different effects on the Cobb correction and apex de-rotation. (4) Conclusions: Knowledge about the effects of brace design parameters on the curve’s angle and rotation correction enables improvements in individualized brace design and the brace optimization process.
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Babaee T, Kamyab M, Ganjavian MS, Rouhani N, Khorramrouz A, Jarvis JG. Coronal deformity angular ratio as a predictive factor for in-brace curve correction and long-term outcome of brace treatment in adolescents with idiopathic scoliosis. Spine Deform 2022; 10:543-551. [PMID: 35034344 DOI: 10.1007/s43390-021-00452-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the relationship between coronal deformity angular ratio (C-DAR) and in-brace correction (IBC) and their role in predicting the long-term bracing outcome in adolescents with idiopathic scoliosis (AIS). METHODS In this retrospective multicenter study, the patient's sex, age, primary curve Cobb angle (at initiation of brace treatment, best in-brace, before spinal fusion, and final follow-up), curve pattern, duration of brace treatment, brace type, and C-DAR at initiation of bracing were recorded. The C-DAR values were classified as < 5, 5 ≤ to ≤ 6, and > 6. The IBC values were classified as ≥ 50%, 40% ≤ to ≤ 49%, and < 40%. We classified the patients into two groups of success and failure according to the Cobb angle at the final follow-up. RESULTS A total of 164 patients (25 boys and 119 girls) were included. Bracing was successful in 60.4% of them. There was a significant association between C-DAR and bracing outcome (p < 0.0001). 63.9% of the patients with C-DAR < 5 had an IBC ≥ 50%. However, when C-DAR was 5 ≤ to ≤ 6 and > 6, 29.2% and 16.9% of the patients had an IBC of ≥ 50%, respectively. For patients with IBC ≥ 50%, the success rate of bracing was 89.2%. Results of logistic regression analysis revealed that the strongest predictor for brace treatment outcome was the C-DAR, with an odds ratio of 2.11. CONCLUSION C-DAR may be used as a predictive factor for the long-term outcome of brace treatment in AIS. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, California State University Dominguez Hills, 1000 East Victoria Street, Carson, CA, 90747, USA.
| | - Mohammad Saleh Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naeimeh Rouhani
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Adel Khorramrouz
- Department of Electrical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - James G Jarvis
- Division of Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
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Predictive Factors on Initial in-brace Correction in Idiopathic Scoliosis: A Systematic Review. Spine (Phila Pa 1976) 2022; 47:E353-E361. [PMID: 35500086 DOI: 10.1097/brs.0000000000004305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE The aim of this study was to systematically review the literature and provide an overview of reported predictive factors on initial in-brace correction in patients with idiopathic scoliosis (IS). SUMMARY OF BACKGROUND DATA Brace therapy is the best proven non-surgical treatment for IS. There is strong evidence that lack of initial in-brace correction is associated with brace treatment failure. To improve initial in-brace corrections and subsequently long-term brace treatment success, knowledge about factors influencing initial in-brace correction is a prerequisite. METHODS A systematic literature search was performed in Pubmed, Embase, Web-of-Science, Scopus, Cinahl, and Cochrane in November 2020. Studies which reported factors influencing initial in-brace correction in IS patients treated with brace therapy were considered eligible for inclusion. RESULTS Of the 4562 potentially eligible articles identified, 28 studies fulfilled the inclusion criteria and were included in this systematic review. Nine studies (32%) were classified as high quality studies and the remaining 19 studies (68%) as low quality. Thirty-four different reported factors were collected from the included studies. Strong evidence was found for increased curve flexibility as favorable predictive factor for initial in-brace correction. Moderate evidence was found for thoracolumbar or lumbar curve pattern as favourable predictive factor, and double major curve pattern as unfavourable predictive factor for initial in-brace correction. Also moderate evidence was found that there is no significant difference on initial in-brace correction between computer-aided design and manufacturing systems (CAD/CAM) braces with or without finite element models (FEM) simulation, and braces fabricated using the conventional plaster-cast. CONCLUSION The results of this systematic review indicate that increased curve flexibility is strongly associated with increased initial in-brace correction.Level of Evidence: 1.
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Wang L, Xia N, Wang C, Zheng Q, Ma CZ, Youssef ASA, Zhang C, Deng Y, Zhu G, Huang X. Optimized scheme for paired transverse corrective forces in S-shaped scoliosis via ultrasound and application in Chêneau brace: a pilot study. Prosthet Orthot Int 2022; 46:42-49. [PMID: 34789711 PMCID: PMC8865621 DOI: 10.1097/pxr.0000000000000064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/03/2021] [Accepted: 09/15/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND There is currently no consensus on the optimal positions of the transverse corrective forces (TCFs) for scoliosis braces. OBJECTIVES This study aimed to explore an optimal scheme of placing paired TCF for S-shaped adolescent idiopathic scoliosis and its feasibility in Chêneau brace (CB) treatment. STUDY DESIGN Cross-over feasibility pilot trial. METHODS Ten S-shaped adolescent idiopathic scoliosis participants were invited to receive four tests with different paired TCF positions under ultrasound. The positions of the paired TCF were test 1: thoracic apical vertebra (AV), lumbar AV; test 2: 2 cm inferior to thoracic AV, lumbar AV; test 3: thoracic AV, 2 cm superior to lumbar AV; and test 4: 2 cm inferior to thoracic AV, 2 cm superior to lumbar AV. The test scheme with the highest mean in-force correction rate (IFCR) for the thoracic spinous process angle (SPA) was further applied in the CB fabrication of 4 additional participants. RESULTS A significant higher mean IFCR of the thoracic SPA of 63.6% was found in test 2 (P < 0.001), which also contributed to its higher overall IFCR of the SPA of 64.6% (P = 0.001). Moreover, the mean in-brace correction rates for the thoracic and overall curves in CB were 46.4% and 51.8%, respectively. No adverse events were reported. CONCLUSIONS Placing paired TCF at the lumbar AV and 2 cm inferior to the thoracic AV achieved better treatment efficacy than other schemes. The practical application of this scheme on the CB was feasible.
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Affiliation(s)
- Li Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nan Xia
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chun Wang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Rehabilitation Medicine, Shantou Central Hospital, Shantou, China
| | - Qian Zheng
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Christina Zonghao Ma
- Department of Biomedical Engineering, the Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ahmed S. A. Youssef
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Basic Science Department, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt
| | - Chao Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guoli Zhu
- School of Mechanical Science and Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolin Huang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Razeghinezhad R, Kamyab M, Babaee T, Ganjavian MS, Bidari S. The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study. Neurospine 2021; 18:437-444. [PMID: 34634198 PMCID: PMC8497257 DOI: 10.14245/ns.2040654.327] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the effect of Milwaukee brace treatment on adolescents with idiopathic scoliosis (AIS) with large curves (40° to 55°) who refuse to do surgery.
Methods In this retrospective cohort study, we gathered the clinical records of all adolescents with AIS with an initial curve of 40° to 55°. They had been referred to our center from December 1990 to January 2017. Although they had been advised to do surgery, they had all refused to do it. Their clinical data were recorded, such as sex, age, Risser sign, scoliosis, and kyphosis curve magnitude (at the beginning of brace treatment, weaning time, brace discontinuation, and minimum of 2 years after the treatment). Based on treatment success, the patients were divided into 2 groups: progressed and nonprogressed.
Results Sixty patients with an average initial Cobb angle of 44.93°±4.86° were included. The curve progressed in 57%, stabilized in 25%, and improved in 18% of the patients. In the progressed group (34 patients), 31 patients had undergone surgery. There was no significant association between the age of beginning the brace treatment and the final Cobb angle of nonprogressed group (p>0.05). However, in-brace correction and initial Risser sign had a significant correlation with curve magnitude at the final follow-up (p<0.05).
Conclusion Brace treatment seems to be effective in controlling the further curve progression in AIS with 40° and 55° curves. Our results can help physicians make sound decisions about the patients with larger curves who refuse to do surgery.
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Affiliation(s)
- Reza Razeghinezhad
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Department of Orthotics and Prosthetics, California State University Dominguez Hills, Carson, CA, USA
| | - Taher Babaee
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saleh Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrbanoo Bidari
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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14
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Alvarez I, Poppino K, Karol L, McIntosh AL. Lack of in-brace x-rays in compliant AIS patients wearing full-time TLSO braces associates with failure. J Orthop Surg Res 2021; 16:540. [PMID: 34465348 PMCID: PMC8406839 DOI: 10.1186/s13018-021-02650-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background In-brace correction and brace compliance with thoraco-lumbo-sacral orthotic (TLSO) braces are associated with successful treatment of adolescent idiopathic scoliosis (AIS). This paper compares patients who had consistent radiographic documentation of in-brace correction to those who did not. Methods All skeletally immature (Risser 0-2) patients were treated for AIS (25-45°) with full-time TLSO braces that had compliance temperature monitors. All patients wore their braces at least 12 h a day. Brace failure was defined as curve progression to a surgical magnitude (≥ 50°). All patients were followed until brace discontinuation. Results Ninety patients (F 82, M 8) with an average age of 12.1 (10.1-15.0) years, Risser grade 0 (0-2), BMI percentile 48.5 (0.0-98.8), and daily brace wear of 16.5 (12.1-21.6) h/day were treated for 24.3 (8.0-66.6) months. Patients went through 1.7 (1-4) braces on average. Forty-two out of 90 (46.7%) patients had some amount of brace time with an unknown in-brace correction, which, on average, was 66.1% of their total treatment course (11.5-100). On univariate analysis, patients that did not have a repeat in-brace x-ray with major brace adjustments or new brace fabrication tended to be more skeletally immature (Risser 0 and tri-radiate open, p = 0.028), wear more braces throughout their treatment (2.0 vs 1.4, p < 0.001), were treated for a longer period of time (27 vs 22 months, p = 0.022), and failed bracing more often (47.6% vs 22.9%, p = 0.014). Conclusions Patients who did not have new in-brace x-rays with major brace adjustments and/or new brace fabrication were 3.1 (95% CI 1.2-7.6) times more likely to fail bracing than patients who were re-checked with new in-brace x-rays. Trial registration ClinicalTrials.gov—NCT02412137, initial registration date April 2015 Level of evidence III
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Affiliation(s)
| | - Kiley Poppino
- Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA
| | - Lori Karol
- Children's Hospital Colorado, Aurora, CO, USA
| | - Amy L McIntosh
- University of Texas-Southwestern, Dallas, TX, USA. .,Texas Scottish Rite Hospital for Children, 2222 Welborn St, Dallas, TX, 75219, USA.
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15
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Pjanić S, Talić G, Bojinović-Rodić D. Impact of body mass index on the initial in-brace correction in patients with idiopathic scoliosis. SCRIPTA MEDICA 2021. [DOI: 10.5937/scriptamed52-29309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background/Aim: Many factors affect initial in-brace correction and treatment outcome in patients with idiopathic scoliosis. Previous studies have observed contradictory results on the role of BMI in orthotic treatment. The aim of this study was to examine whether BMI impacts in-brace correction, isolated and in relation to other predictive factors (curve magnitude, curve location and Risser sign). Methods: A retrospective study has been conducted on patients with idiopathic scoliosis treated with Cheneau-Sobernheim brace, that had no prior treatment. The collected and analysed data included patient demographics, BMI percentile and radiological parameters (curve magnitude in Cobb angle, curve location, Risser sign). The initial in-brace correction was expressed as a percentage of Cobb angle reduction in the brace as opposed to Cobb angle out of brace. Patients were categorised into groups according to their BMI, expressed in percentiles, ie: low BMI (< 5 percentiles), normal BMI (5-85 percentiles) and high BMI (> 85 percentiles). To determine the significant difference and correlation relationship between the examined variables, variance tests, t-test with unequal variance, and Pearson correlation coefficient have been used. Results: The cohort study comprised 213 patients (170 females and 43 males) with a mean age of 13.5 years at brace prescription. Low BMI has been detected in 10 % patients, normal BMI in 78 % and high BMI in 10 % patients. No significant difference in in-brace correction has been found between BMI groups, nor has there been any significant correlation between BMI and in-brace correction. Regarding other factors, significant difference within BMI groups was found between in-brace correction and curve location, as well as in-brace correction and Risser sign. Lumbar curves had significantly better in-brace correction than thoracic curves. Significant correlations between in-brace correction and curve magnitude, curve location and Risser sign were detected. Conclusion: The results of the present study show that, as an independent factor, BMI does not impact in-brace correction. Other factors, such as curve magnitude, curve location and Risser sign, play a more significant role in the orthotic treatment of patients with idiopathic scoliosis.
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16
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Babaee T, Kamyab M, Ganjavian MS, Rouhani N, Jarvis J. Success Rate of Brace Treatment for Juvenile-Onset Idiopathic Scoliosis up to Skeletal Maturity. Int J Spine Surg 2020; 14:824-831. [PMID: 33097584 DOI: 10.14444/7117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Natural history studies have reported that the progression rate of juvenile idiopathic scoliosis (JIS) curves larger than 20° is high and tends to progress. The aim of this study was to investigate the outcome of bracing on JIS and to determine the prognostic factors on the success rate of brace treatment. METHODS From March 1985 to February 2015, the clinical data of all JIS patients with referral age from 4 to 10 years who received brace treatment were reviewed. Those patients with a prebrace Cobb angle >20° and a Risser sign of 0 to 2 were included and followed up a minimum of 2 years after discontinuation of the brace or time of spinal fusion. The Cobb angle was recorded at the time of diagnosis, before initiation of bracing, weaning time, brace discontinuation, and final follow-up. RESULTS From 297 patients with JIS, a total of 75 cases (18 boys, 57 girls) with an average curve magnitude of 31.9° at the time of diagnosis met the inclusion criteria of the study. For successfully treated patients, the average best in-brace correction was 55% for Lenke I curves, 59% for Lenke II curves, 41% for Lenke III curves, and 62% for Lenke V curves. For a total of 27 patients (36%), the brace treatment failed. Of these, 21 patients (78%) reached spinal fusion, and curves of 6 patients (22%) increased to ≥50°. The progression rate was highest in patients with Lenke type III curves (67%), and also in those with a curve magnitude of ≥46° (94%). CONCLUSIONS Brace treatment is an effective strategy for controlling the curve progression and avoiding spinal fusion in JIS. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Taher Babaee
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Kamyab
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Saleh Ganjavian
- Department of Orthopaedic Surgery, Shafa Yahyaiian Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naeimeh Rouhani
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - James Jarvis
- Division of Orthopaedic Surgery, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Canada
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17
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Li K, Miao J, Zhang J. Pelvic rotation parameters related to in-brace correction in patients with idiopathic scoliosis. Eur J Med Res 2020; 25:41. [PMID: 32943112 PMCID: PMC7495828 DOI: 10.1186/s40001-020-00437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/18/2020] [Indexed: 11/21/2022] Open
Abstract
Background To identify the pelvic parameters affecting in-brace correction (IBC) in patients with idiopathic scoliosis (IS). Methods Patients with IS receiving Chêneau brace treatment in our scoliosis center from January 2019 to November 2019 were retrospectively analyzed. Pelvic rotation parameters, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), L/R ratio, were collected. Other radiographic data, such as Risser sign, coronal and sagittal balance, curve location, kyphosis, lordosis of each patient were also recorded to analyze their correlations with IBC. Correlation analyses were performed to identify the classified variables influencing IBC. The principal component analysis was used to extract common factors of radiographic parameters to eliminate interaction effects. The linear regression equation was established using principal components, the variables influencing IBC were identified. Results A cohort of 44 patients with IS (36 girls and 8 boys) were included in the present study. The mean IBC was 49.87% (range, 3%–100%). IBC of lumbar IS was negatively correlated with apical rotate factor (ARF, B = –0.385), mainly consisted of pelvic coronal plane rotation (PCPR, 0.449), Cobb angle (CA, 0.575), apical vertebral rotation (AVR, 0.918), and pelvic rotate factor (PRF, B = –0.387), mainly consisted of PT (0.861), PI (0.728), PCPR (–0.570). The regression equation of lumbar IS had statistical significance (F = 6.500, P = 0.005, R2 = 0.317), whereas statistically significance was not found in the regression equation of thoracic IS (F = 2.913, P = 0.106). The remaining parameters were not related to IBC. Conclusions For lumbar IS, ARF and PRF have negative effects on IBC, coronal and sagittal rotation of the pelvis is related to IBC.
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Affiliation(s)
- Kepeng Li
- Clinical Department of Orthopaedics, Tianjin Medical University, 406 Jiefang South Road, Hexi District, Tianjin, China
| | - Jun Miao
- Spine Surgery, Tianjin Hospital, 406 Jiefang South Road, Hexi District, Tianjin, China.
| | - Jingan Zhang
- Tianjin Hospital, 406 Jiefang South Road, Hexi District, Tianjin, China
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18
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Hanko M, Soršák J, Snopko P, Opšenák R, Zeleňák K, Kolarovszki B. Incidence and risk factors of early postoperative complications in patients after decompressive craniectomy: a 5-year experience. Eur J Trauma Emerg Surg 2020; 47:1635-1647. [PMID: 32307561 DOI: 10.1007/s00068-020-01367-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Decompressive craniectomy is an effective measure to reduce a pathologically elevated intracranial pressure. Patients' survival and life quality following this surgery have been a subject of several studies and significantly differ according to the primary diagnosis. Since this operation is often associated with a wide spectrum of possibly serious complications, we aimed to describe their incidence and possible associated risk factors. METHODS We evaluated 118 patients who underwent decompressive craniectomy at our clinic during years 2013-2017. The indications included traumatic brain injuries, ischaemic or haemorrhagic strokes and postoperative complications of planned neurosurgical procedures. Subsequently, we assessed the incidence of early postoperative complications (occurring during the first 3 postoperative weeks). The results were statistically analysed with relation to a wide selection of possible risk factors. RESULTS At least one early surgical postoperative complication occurred in 87 (73.73%) patients, the most frequent being a development of an extraaxial fluid collection in 41 (34.75%) patients. We were able to identify risk factors linked with extraaxial fluid collections, subcutaneous and extradural haematomas, postoperative seizures and meningitis. An overall need for reoperation was 13.56%. Neither the duration of the surgery nor the qualification of the operating surgeon had any effect on the complications' occurrence. CONCLUSIONS Decompressive craniectomy is associated with numerous early postoperative complications with a various degree of severity. Most cases of complications can, however, be managed in a conservative way. The risk factors linked with postoperative complications should be taken into account during the indication process in each individual patient.
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Affiliation(s)
- Martin Hanko
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - Jakub Soršák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - Pavol Snopko
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - René Opšenák
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - Kamil Zeleňák
- Clinic of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 2, Martin, 036 59, Slovak Republic
| | - Branislav Kolarovszki
- Clinic of Neurosurgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 2, Martin, 036 59, Slovak Republic.
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19
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Ao S, Liu Y, Wang Y, Zhang H, Leng H. Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life. J Orthop Surg Res 2019; 14:322. [PMID: 31615561 PMCID: PMC6794725 DOI: 10.1186/s13018-019-1351-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background Cervical kyphosis has been pointed out in asymptomatic populations. The purposes of this study were (1) to investigate the incidence of cervical kyphosis in asymptomatic populations, (2) to identify risk factors related to cervical kyphosis, and (3) to assess the relationship between cervical kyphosis and health-related quality of life (HRQOL). Methods A cohort of 235 asymptomatic volunteers’ records was retrospectively analyzed. Radiographic parameters of the coronal and sagittal planes were measured in the full-length spine x-ray. All patients were classified into two groups based on the cervical lordosis angle: cervical lordosis (CL) and cervical kyphosis (CK). HRQOL was evaluated by EQ-5D and SF-36 (PCS and MCS) questionnaires. Results CK was observed in 90 of 235 (38.3%) participants. There was a significant difference with regard to age between volunteers with CK and CL (32.23 ± 8.12 vs. 42.12 ± 6.14, p < 0.05). Several parameters had a significant relationship with CK, including TK, T1 slope, TIA, SVA, and CT. Logistic regression analysis identified age, TK, T1 slope, and SVA as independent risk factors of CK. In addition, there was a negative correlation between CK and the parameters of HRQOL (EQ-5D, − 0.63; PCS, − 0.68; MCS, − 0.59). Conclusions The incidence of CK in normal populations is 38.3%. Some spinal parameters are related to CK. CK is associated with the HRQOL.
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Affiliation(s)
- Shuang Ao
- Department of Spinal Surgery, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Yu Liu
- Department of Spinal Surgery, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Yu Wang
- Department of Spinal Surgery, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Hao Zhang
- Department of Spinal Surgery, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China
| | - Hui Leng
- Department of Spinal Surgery, Chifeng Municipal Hospital, Chifeng, Inner Mongolia, China.
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Andrusiewicz M, Harasymczuk P, Janusz P, Biecek P, Żbikowska A, Kotwicka M, Kotwicki T. TIMP2 Polymorphisms Association With Curve Initiation and Progression of Thoracic Idiopathic Scoliosis in the Caucasian Females. J Orthop Res 2019; 37:2217-2225. [PMID: 31119800 DOI: 10.1002/jor.24380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/17/2019] [Indexed: 02/04/2023]
Abstract
Idiopathic scoliosis (IS) etiology remains unclear, but strong genetic background is suggested. Previously reported TIMP2 study indicates an association of genic rs8179090 with IS progression in a Han Chinese population. However, there has been a lack of investigation into intragenic TIMP2 polymorphisms in IS patients. We recruited 100 Caucasian females with IS and 100 controls. Patients were subdivided accordingly to: progression rate, curve severity, joint mobility, and curve pattern. Allele-specific-polymerase chain reaction based on fluorescence resonance energy transfer was applied to evaluate nine TIMP2 polymorphisms. Distribution of genotype and allele frequency in only one polymorphism (rs11658743) differed in case-control study. Four of the polymorphisms (rs2277700, rs11077401, rs2376999, and rs4789934) showed non-equal distributions either in genotype or/and allele distributions in the patients of different progression rates. The rs11077401 was related to curve severity patients distinction and the rs8179090 distinguished patients with different joint mobility level. Two polymorphisms either differed statistically in case of curve patterns subgrouping (rs8068674 and rs8179090) or showed a slight tendency toward significance in the recessive model of allele distributions (rs9916809 and rs8179090). The remaining two polymorphisms (rs2377005, rs11658743) showed no association with either clinical or radiographic IS characteristics. The influence of the G allele of the rs8179090 on the clinical course of IS has not yet been confirmed. We identified four TIMP2 polymorphisms (rs11077401, rs2376999, rs2277700, and rs4789934) that were associated with a higher risk of the progressive IS form. Further genetic association studies based on suggested clinical criteria would be necessary to validate TIMP2 polymorphisms associated with the curve progression. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2217-2225, 2019.
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Affiliation(s)
- Mirosław Andrusiewicz
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806, Poznań, Poland
| | - Piotr Harasymczuk
- Department of Pediatric Orthopedics and Traumatology, Poznan University of Medical Sciences, Poznań, Poland
| | - Piotr Janusz
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznań, Poland
| | - Przemysław Biecek
- Department of Medical Statistics, University of Warsaw, Warsaw, Poland
| | - Aleksandra Żbikowska
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806, Poznań, Poland
| | - Małgorzata Kotwicka
- Department of Cell Biology, Poznan University of Medical Sciences, Rokietnicka 5D, 60-806, Poznań, Poland
| | - Tomasz Kotwicki
- Department of Spine Disorders and Pediatric Orthopedics, Poznan University of Medical Sciences, Poznań, Poland
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21
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Tang Y, Xu X, Zhu F, Chen C, Wang F, Lu M, Huang X. Incidence and Risk Factors of Cervical Kyphosis in Patients with Adolescent Idiopathic Scoliosis. World Neurosurg 2019; 127:e788-e792. [PMID: 30951919 DOI: 10.1016/j.wneu.2019.03.264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cervical kyphosis (CK) has been reported in patients with adolescent idiopathic scoliosis (AIS). The report about the incidence of CK between patients with AIS and normal populations was little. Patients included in previous studies often required scoliosis surgery (Cobb angle ≥40°), which does not represent all patients with AIS. The aims of this study were to compare incidence of CK between patients with AIS (Cobb angle >10°) and an age-matched normal population and to identify risk factors related to CK, especially coronal parameters that have rarely been studied in current literature. METHODS Patients with AIS (n = 112) and asymptomatic subjects from the general population (control group; n = 40) were retrospectively analyzed. Radiographic parameters of coronal and sagittal plane were measured on full-length spine x-rays. Patients with AIS were divided into 2 groups based on cervical lordosis angle: cervical lordosis and CK. RESULTS CK was observed in 14 of 40 (35%) subjects in the control group and 68 of 112 (60.7%) patients with AIS. Several parameters were related to CK, including major curve, proximal thoracic, and main thoracic Cobb angle; proximal thoracic kyphosis angle; main thoracic kyphosis angle; T1 slope; sagittal vertical axis; vertical distance between C7 plumb line and center sacral vertical line; apical vertebral translation; T1 coronal tilt; and lumbar pelvic relationship. Logistic regression identified main thoracic Cobb angle, main thoracic kyphosis angle, sagittal vertical axis, lumbar pelvic relationship, and apical vertebral translation as independent risk factors of CK. CONCLUSIONS Incidence of CK increases in patients with AIS relative to normal subjects. Coronal parameters of the spine could influence cervical sagittal alignment.
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Affiliation(s)
- Yong Tang
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China.
| | - Xingping Xu
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Feng Zhu
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Changwei Chen
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Fusheng Wang
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Min Lu
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
| | - Xing Huang
- Department of Orthopedics, Yinzhou People's Hospital of Ningbo City, Ningbo, Zhejiang, China
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22
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Tsaknakis K, Braunschweig L, Lorenz HM, Hell AK. [Claims and realities of brace treatment : Primary correction of scoliosis in children and adolescents]. DER ORTHOPADE 2019; 49:59-65. [PMID: 30899990 DOI: 10.1007/s00132-019-03709-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND It is understood that an effective brace therapy requires a primary curve angle reduction of 50% after administering the first orthotic brace. OBJECTIVES The aim of the study was to determine the efficacy of conservative brace therapy for scoliosis with a curve angle above 20° and to determine possible influencing factors. MATERIALS AND METHODS The current study included a cohort of 110 scoliosis patients with conservative brace therapy. The development of the scoliotic curve during brace therapy was documented for an average of 40 months. Influencing factors such as the initial Risser sign, age at the start of treatment, gender, curve patterns and body mass index were analyzed. RESULTS The collective consisted of 88 patients with idiopathic and 22 with neuromuscular spinal deformities. At the beginning of the brace therapy, the average age was 12.2 ± 2.8 years with a mean scoliosis curve angle of 30.4° ± 12.5°. The primary brace reduced the scoliotic curve by 31% to 20.9°. In children and adolescents with lower maturity status, the success of the brace therapy was greater than in patients with a higher Risser sign. In addition, children with obesity had less success during brace therapy than normal- or underweight children. CONCLUSIONS The initial curvature correction of 50% required for effective brace therapy could only be achieved in one third of the patients. On average, the correction was 31%.
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Affiliation(s)
- Konstantinos Tsaknakis
- Kinderorthopädie, Operatives Kinderzentrum, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Lena Braunschweig
- Kinderorthopädie, Operatives Kinderzentrum, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Heiko M Lorenz
- Kinderorthopädie, Operatives Kinderzentrum, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Anna K Hell
- Kinderorthopädie, Operatives Kinderzentrum, Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland.
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