Traditional COBB measurements on digital whole spine standing radiographs were done by trained orthopedic surgeons. Patient relevant outcome was assessed by clinical examination and standardized X-ray of the entire spine 2 years after deposition of the brace. Brace weaning was started once the patient had reached Risser stage 4 and did not show any further growth according to length measurements. Patients who reported a daily wearing time of less than 23 hours were excluded from the study. Wearing traces were checked during the follow-up visits. Patients were seen at 6-month intervals, at which times we collected radiographic, clinical, orthotic, and self-reported data. Patients who were prescribed the brace were instructed to wear it for 23 hours/day. All patients also received prescriptions for once or twice weekly guided physiotherapy. All other patients received a Chêneau brace for daytime and a Charleston type nighttime bending brace.
Patients for whom cost coverage of double-brace therapy was denied by the health insurance company received a single full-day and nighttime Chêneau type brace treatment.
Flowchart of the study (CONSORT document). To achieve a synergistic effect we combined the Chêneau (to be worn duing daytime) and the Charleston approach (to be worn at night) as a double-brace treatment ( Fig 2).įig 3. From the aforementioned data it becomes clear that there cannot be an ideal brace type to achieve superior treatment results. Although some results seemed to be promising, especially in terms of patient’s acceptance, nighttime bracing alone could not be advised over full-time bracing as only mild curve types achieved sufficient results. The Charleston bending brace was designed to be worn at night and exerts its compressive forces on the curve convexity through a bending moment, achieved by the elevation of the contralateral shoulder. In order to overcome those limitations, efforts were undertaken to maximize correction, especially in the main thoracic curve while preserving patient compliance. Additionally, trunk shape is subject to elongation when changing patient position to the horizontal, which results in brace malfitting and subsequent loss of correction ( Fig 1). Despite overall good results in most studies, the Chêneau design is challenged in certain cases: impaired quality of life, inferior correction of thoracic curves compared with thoracolumbar and lumbar curves and inferior results in double major curve types. rib hump) and contralateral void spaces to allow for effective derotation. It works through multipoint pressure zones (e.g. The Chêneau brace has proven to be effective over decades since its development in 1978.
The in-brace correction is a good predictor for final results. Rigid bracing has proven to achieve superior results over elastic designs. Although full-time bracing has been shown to have detrimental effects on the quality of life, it has been acknowledged by current standards to be the most effective therapeutic approach in the aforementioned Cobb angle range. As the amount of primary correction and brace acceptance had been identified as key factors for treatment success, efforts were undertaken to maximize patient comfort while maintaining overall good correction. Those include patient parameters (skeletal immaturity, Cobb angle) and study design patterns (follow-up at 2 years, curve progression defined as >5°deterioration and number of failures (curve > 45° +/- surgery). The Scoliosis Research Society has established widely accepted criteria to define whether a child is eligible for bracing and how treatment results should be evaluated. They should be applied in growing children and adolescents only. Braces aim at preventing spinal curve deterioration beyond the point of 45° or surgery in order to preserve long-term life quality. Bracing is acknowledged as standard therapy for idiopathic scoliosis at Cobb angle ranges between 25° and 40°.
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