Université Claude Bernard Lyon 1
Institut Techniques de Réadaptation
Background: This 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. Methods: The Delphi method was used... more
Background: This 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. Methods: The Delphi method was used to reach a preliminary consensus before the meeting, where the terms that still needed further clarification were discussed. Results: A 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. Discussion: When 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.
This 2012 Consensus paper reviews the literature on side effects of x-ray exposure in the pediatric population as it relates to scoliosis evaluation and treatment. Alternative methods of spinal assessment and imaging are reviewed, and... more
This 2012 Consensus paper reviews the literature on side effects of x-ray exposure in the pediatric population as it relates to scoliosis evaluation and treatment. Alternative methods of spinal assessment and imaging are reviewed, and strategies for reducing the number of radiographs are developed. Using the Delphi technique, SOSORT members developed consensus statements that describe how often radiographs should be taken in each of the pediatric and adolescent sub-populations.
- by Manuel Rigo and +5
- •
- Clinical Sciences, Scoliosis
Background: The 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... more
Background: The 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).
- by Jean Claude de Mauroy and +6
- •
- Clinical Sciences, Scoliosis
Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to... more
Idiopathic scoliosis (IS) is a three-dimensional deformity of the spine and trunk. The most common form involve adolescents. The prevalence is 2-3% of the population, with 1 out of 6 patients requiring treatment of which 25% progress to surgery. Physical and rehabilitation medicine (PRM) plays a primary role in the so-called conservative treatment of adolescents with IS, since all the therapeutic tools used (exercises and braces) fall into the PRM domain. According to a Cochrane systematic review there is evidence in favor of bracing, even if it is of low quality. Recently, a controlled prospective trial including a randomised arm gave more strength to this conclusion. Another Cochrane review shows that there is evidence in favor of exercises as an adjunctive treatment, but of low quality. Three meta-analysis have been published on bracing: one shows that bracing does not reduce surgery rates, but studies with bracing plus exercises were not included and had the highest effectivenes...
Bracing is currently the primary method for treating moderate idiopathic scoliosis (IS) during the developmental phase of growth. Following a lengthy debate, during which researchers and authors questioned the role of bracing in the... more
Bracing is currently the primary method for treating moderate idiopathic scoliosis (IS) during the developmental phase of growth. Following a lengthy debate, during which researchers and authors questioned the role of bracing in the treatment of IS due to inconsistent evidence, the Bracing in Adolescent Idiopathic Scoliosis Trial study have provided a high level of evidence to the value of bracing and may have convinced most of those who were skeptic. However, although some guidelines have been published, there remains no standard for constructing scoliosis orthoses and no standard treatment protocol. The Scoliosis Research Society criteria were established to provide a framework by which to research bracing and adolescent idiopathic scoliosis, and the Society on Scoliosis Orthopedic and Rehabilitation Treatment criteria were published to guarantee a minimum level of expertise for MDs and CPOs involved in the brace treatment. However, very few contemporary papers follow both sets of...
Thoracic hyperkyphosis is a frequent problem and can impact greatly on patient's quality of life during adolescence. This condition can be idiopathic or secondary to Scheuermann disease, a disease disturbing vertebral growth. To date,... more
Thoracic hyperkyphosis is a frequent problem and can impact greatly on patient's quality of life during adolescence. This condition can be idiopathic or secondary to Scheuermann disease, a disease disturbing vertebral growth. To date, there is no sound scientific data available on the management of this condition. Some studies discuss the effects of bracing, however no guidelines, protocols or indication's of treatment for this condition were found. The aim of this paper was to develop and verify the consensus on managing thoracic hyperkyphosis patients treated with braces and/ or physiotherapy.
Background The immediate first results of the new Lyon brace: ARTbrace demonstrates an in-brace correction of the Cobb angle of 70% for the first 225 cohort of patients treated since May 2013. This correction is 40% higher than the former... more
Background
The immediate first results of the new Lyon brace: ARTbrace demonstrates an in-brace correction of the Cobb angle of 70% for the first 225 cohort of patients treated since May 2013. This correction is 40% higher than the former Lyon brace or historical Lyon brace. It is also higher than any studies which have been published to date in the literature including retrospective studies. These results can be explained by numerous innovations such as:
- Segmental moulding with correction of the sagittal plane
- Biomechanical helicoidally detorsion
- High rigidity asymmetric polycarbonate…
Despite numerous publications which highlight a correlation between the immediate in-brace correction and the final result of the treatment, there is no consensus on this criterion. So it was crucial to see if the in-brace results are decreasing over time, are being consistent or are continuing to improve during treatment.
Design
Prospective case series of 148 scoliosis with short time results after 1 year compared with a historical retrospective case series of 100 scoliosis. Consecutive cases are recruited in both groups. Randomization was not possible due to the administrative impossibility to perform plaster casts after May 2013.. OCEMB level 2 [1]
Material and Methods
All thoracic, thoracolumbar and double major scoliosis justifying a conservative orthopaedic treatment were included. Patients suffering from lumbar scoliosis Lenke 5 continue to be treated by GTB short brace.
The first group consists of the first 148 patients reviewed one year after the brace fitting and the second group of the last 100 patients treated with plaster cast and the historical Lyon brace also controlled 1 year after brace fitting. All treatment parameters like indications, physiotherapy, full or part-time bracing are identical.
Data were transcribed immediately with Excel 2013 and processed by the statistical package SPSS v20.
Results
An independent-samples t-test was conducted to compare Cobb angles before brace, in-brace at 6 months and at 1 year.
There was not a significant difference in the scores of thoracic Cobb angles before brace for the control group with an old Lyon brace (M=31.14, SD=9.62) and the ARTbrace group (M=29.76, SD=8.75); t(183)=1.015, p = 0.311
There was not a significant difference in the scores of Lumbar Cobb angles before brace for the control group with the old Lyon brace (M=26.69, SD=7.72) and the ARTbrace group (M=27.86, SD=7.54); t(143)=0.905, p = 0.367
There was a significant difference in the scores for thoracic and lumbar curves: in brace, at 6 months and at 1 year.
Thoracic in-brace: t(182)=4.254, p=0.00
Lumbar in-brace: t(144)=3.993, p=0.00
Thoracic at 6 months: t(182)=2.284, p=0.023
Lumbar at 6 months: t(144)=2.131, p=0.035
Thoracic at 1 year: t(182)=3.205, p=0.02
Lumbar at 1 year: t(134)=2.463, p=0.015
The radiological percentage improvement without a brace after 6 months is: 40%, which is equivalent to the best statistics of immediate in-brace results. At 1 year the percentage is even 35.5%.
But especially when compared with the former Lyon treatment, the immediate in-brace differential is 43% (ART vs Old Lyon brace). This differential keeps on improving: 55% at 6 months and 79% at 1 year.
Conclusion
The brace correction effect is confirmed and further improved at 6 months and this improvement continues after one year.
It seems that the in-brace reduction can be considered as a criterion of the final result of the conservative treatment.
The immediate first results of the new Lyon brace: ARTbrace demonstrates an in-brace correction of the Cobb angle of 70% for the first 225 cohort of patients treated since May 2013. This correction is 40% higher than the former Lyon brace or historical Lyon brace. It is also higher than any studies which have been published to date in the literature including retrospective studies. These results can be explained by numerous innovations such as:
- Segmental moulding with correction of the sagittal plane
- Biomechanical helicoidally detorsion
- High rigidity asymmetric polycarbonate…
Despite numerous publications which highlight a correlation between the immediate in-brace correction and the final result of the treatment, there is no consensus on this criterion. So it was crucial to see if the in-brace results are decreasing over time, are being consistent or are continuing to improve during treatment.
Design
Prospective case series of 148 scoliosis with short time results after 1 year compared with a historical retrospective case series of 100 scoliosis. Consecutive cases are recruited in both groups. Randomization was not possible due to the administrative impossibility to perform plaster casts after May 2013.. OCEMB level 2 [1]
Material and Methods
All thoracic, thoracolumbar and double major scoliosis justifying a conservative orthopaedic treatment were included. Patients suffering from lumbar scoliosis Lenke 5 continue to be treated by GTB short brace.
The first group consists of the first 148 patients reviewed one year after the brace fitting and the second group of the last 100 patients treated with plaster cast and the historical Lyon brace also controlled 1 year after brace fitting. All treatment parameters like indications, physiotherapy, full or part-time bracing are identical.
Data were transcribed immediately with Excel 2013 and processed by the statistical package SPSS v20.
Results
An independent-samples t-test was conducted to compare Cobb angles before brace, in-brace at 6 months and at 1 year.
There was not a significant difference in the scores of thoracic Cobb angles before brace for the control group with an old Lyon brace (M=31.14, SD=9.62) and the ARTbrace group (M=29.76, SD=8.75); t(183)=1.015, p = 0.311
There was not a significant difference in the scores of Lumbar Cobb angles before brace for the control group with the old Lyon brace (M=26.69, SD=7.72) and the ARTbrace group (M=27.86, SD=7.54); t(143)=0.905, p = 0.367
There was a significant difference in the scores for thoracic and lumbar curves: in brace, at 6 months and at 1 year.
Thoracic in-brace: t(182)=4.254, p=0.00
Lumbar in-brace: t(144)=3.993, p=0.00
Thoracic at 6 months: t(182)=2.284, p=0.023
Lumbar at 6 months: t(144)=2.131, p=0.035
Thoracic at 1 year: t(182)=3.205, p=0.02
Lumbar at 1 year: t(134)=2.463, p=0.015
The radiological percentage improvement without a brace after 6 months is: 40%, which is equivalent to the best statistics of immediate in-brace results. At 1 year the percentage is even 35.5%.
But especially when compared with the former Lyon treatment, the immediate in-brace differential is 43% (ART vs Old Lyon brace). This differential keeps on improving: 55% at 6 months and 79% at 1 year.
Conclusion
The brace correction effect is confirmed and further improved at 6 months and this improvement continues after one year.
It seems that the in-brace reduction can be considered as a criterion of the final result of the conservative treatment.
Since 1965, 116 trans-thoracic spinal fusions have been performed. This study concerns the first 58 procedures on 54 patients followed up for between 21/2 and 111/2 years. Surgical management differs according to the following... more
Since 1965, 116 trans-thoracic spinal fusions have been performed. This study concerns the first 58 procedures on 54 patients followed up for between 21/2 and 111/2 years. Surgical management differs according to the following circumstances: 1. Round or angular deformities. 2. Kyphosis or kyphoscoliosis. 3. Degree of correction of the deformity. 4. Spinal cord involvement.