Abstract
Background
Progressive idiopathic scoliosis can negatively influence the development and functioning of 2-3% of adolescents, with health consequences and economic costs, placing the disease in the centre of interest of the developmental medicine. The aim of this study was to evaluate the effectiveness of Chêneau brace in the management of idiopathic scoliosis.
Methods
A prospective observational study according to SOSORT and SRS recommendations comprised 79 patients (58 girls and 21 boys) with progressive idiopathic scoliosis, treated with Chêneau brace and physiotherapy, with initial Cobb angle between 20 and 45 degrees, no previous brace treatment, Risser 4 or more at the final evaluation and minimum one year follow-up after weaning the brace. Achieving 50° of Cobb angle was considered surgical recommendation.
Results
At follow-up 20 patients (25.3%) improved, 18 patients (22.8%) were stable, 31 patients (39.2%) progressed below 50 degrees and 10 patients (12.7%) progressed beyond 50 degrees (2 of these 10 patients progressed beyond 60 degrees). Progression concerned the younger and less skeletally mature patients.
Conclusion
Conservative treatment with Chêneau orthosis and physiotherapy was effective in halting scoliosis progression in 48.1% of patients. The results of this study suggest that bracing is effective in reducing the incidence of surgery in comparison with natural history.
Dr. Morningstar’s Comments:
This study merely demonstrates a 50/50 chance of the brace preventing the scoliosis from getting worse. It is interesting to wonder what the results in these patients would have been if they had been only performing a comprehensive exercise-based therapy, like ARC3D, without the bracing. Under this protocol, 40% of patients still progressed while still below 40 degrees. This is significant because if we use the oft-cited American surgical threshold of 40 degrees, then a full 51.9% of patients progressed to a surgical level.
Source: http://www.scoliosisjournal.com/content/6/1/2
