Abstract: ABSTRACT: BACKGROUND: Studies investigating the outcome of conservative scoliosis treatment differ widely with respect to the inclusion criteria used. This study has been performed to investigate the possibility to find useful inclusion criteria for future prospective studies on physiotherapy (PT). Materials and methods A PubMed search for outcome papers on PT was performed in order to detect study designs and inclusion criteria used. RESULTS: Real outcome papers (start of treatment in immature samples/end results after the end of growth; controlled studies in adults with scoliosis with a follow-up of more than 5 years) have not been found. Some papers investigated mid-term effects of exercises, most were retrospective, few prospective and many included patient samples with questionable treatment indications. CONCLUSION: There is no outcome paper on PT in scoliosis with a patient sample at risk for being progressive in adults or in adolescents followed from premenarchial status until skeletal maturity. However, papers on bracing are more frequently found and bracing can be regarded as evidence-based in the conservative management and rehabilitation of idiopathic scoliosis in adolescents.
Abstract: ABSTRACT: 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). METHODS: All types of professionals (specialty physicians, and allied health professionals) engaged in CTIS have been involved together with a methodologist and a patient representative. A review of all the relevant literature and of the existing Guidelines have been performed. Documents, recommendations, and practical approach flow charts have been developed according to a Delphi procedure. A methodological and practical review has been made, and a final Consensus Session was held during the 2011 Barcelona SOSORT Meeting. RESULTS: The contents of the document are: methodology; generalities on idiopathic scoliosis; approach to CTIS in different patients, with practical flow-charts; literature review and recommendations on assessment, bracing, physiotherapy, Physiotherapeutic Specific Exercises (PSE) and other CTIS. Sixty-five recommendations have been given, divided in the following topics: Bracing (20 recommendations), PSE to prevent scoliosis progression during growth (8), PSE during brace treatment and surgical therapy (5), Other conservative treatments (3), Respiratory function and exercises (3), Sports activities (6), Assessment (20). No recommendations reached a Strength of Evidence level I; 2 were level II; 7 level III; and 20 level IV; through the Consensus procedure 26 reached level V and 10 level VI. The Strength of Recommendations was Grade A for 13, B for 49 and C for 3; none had grade D. CONCLUSION: These Guidelines have been a big effort of SOSORT to paint the actual situation of CTIS, starting from the evidence, and filling all the gray areas using a scientific method. According to results, it is possible to understand the lack of research in general on CTIS. SOSORT invites researchers to join, and clinicians to develop good research strategies to allow in the future to support or refute these recommendations according to new and stronger evidence.
Abstract: In-brace correction and compliance are the main predictors of a successful outcome of brace treatment in the management of patients with idiopathic scoliosis. The latest CAD/CAM- or module-based bracing concepts related to a proper classification have led to better in-brace corrections and have made the braces easier to wear for the patient. However, even the latest developments on the market do not ensure successful treatment in every case. Thoracic curves with Cobb angles less than 50° may be treated with the best likelihood of success utilizing the latest Chêneau derivates, enabling a real 3D correction that includes sagittal correction of the spine, when patient compliance can be achieved. The successful application of the braces demands a proper classification of curve patterns. The percentage of in-brace correction of the Cobb angle correlates with the end result and consequently is a good indicator for brace quality. However, other factors, such as 3D correction or the absolute reduction of the Cobb angle (i.e., in rigid curves over 50°), might also be important indicators.
Abstract: ABSTRACT: BACKGROUND: In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. METHODS: Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. RESULTS: A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. DISCUSSION: Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. CONCLUSIONS: Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated surgically early, according to the rate of deformity formation and certainly before the pubertal growth spurt to try to avoid cor pulmonale, even though there is lack of evidence for that in the long-term. Furthermore, in patients with formation failures, further investigation is needed to document where a conservative approach would be necessary.
Abstract: ABSTRACT: Katharina Schroth, born February 22nd 1894 in Dresden Germany, was suffering from a moderate scoliosis herself and underwent treatment with a steel brace at the age of 16 years before she decided to develop a more functional approach of treatment for herself. Inspired by a balloon, she tried to correct by breathing away the deformities of her own trunk by inflating the concavities of her body selectively in front of a mirror. She also tried to 'mirror' the deformity, by overcorrecting with the help of certain pattern specific corrective movements. She recognized that postural control can only be achieved by changing postural perception. From 1921 this new form of treatment with specific postural correction, correction of breathing patterns and correction of postural perception was performed with rehabilitation times of 3 months in her own little institute in Meissen and in the late 30's and early 40's she was supported by her daughter, Christa Schroth. After World War II, Katharina Schroth and her daughter moved to West Germany to open a new little institute in Sobernheim, which constantly grew to a clinic with more than 150 in-patients at a time, treated as a rule for 6 weeks. In the 80's this institute was renamed to 'Katharina Schroth Klinik'. At this time the first studies were carried out and the patient series for the first prospective controlled trial was derived from the patient samples of 1989-1991. Content, rehabilitation times and patients meanwhile have changed, and braces have been developed to offer highest treatment security. Therefore today, bracing in the patient at risk has to be regarded as the primary treatment. We have been able to reduce the training times by adapting the old techniques and introducing new forms of postural education (sagittal correction, ADL correction and experiential learning) whilst the programme is still based on the original approaches of the 3-dimensional treatment according to Katharina Schroth, namely specific postural correction, correction of breathing patterns and correction of postural perception.
Abstract: ABSTRACT: 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.
Abstract: ABSTRACT: BACKGROUND: Bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of polyethylene (PE) and soft braces. A new asymmetric Cheneau style CAD / CAM derivate has been designed to overcome problems the first author experienced with other Cheneau CAD / CAM systems over the recent years. Brace description: This CAD / CAM Cheneau derivate has been called Gensingen brace(TM), a brace available to address all possible curve patterns. Once the patients' trunk is scanned with the help of a whole trunk optical 3D-scan and the patients' data from the clinical measurements are recorded, a model of the brace can be created by (1) modifying the trunk model of the patient 'on screen' to achieve a very individual brace model using the CAD / CAM tools provided or by (2) choosing a brace model from our library and re-size it to the patients' properties 'on screen'. RESULTS: End-result studies have been published on the Cheneau brace as early as 1985. Cohort studies on the Cheneau brace are available as is a prospective controlled study respecting the SRS criteria for bracing studies, demonstrating beneficial outcomes, when compared to the controls using a soft brace. Sufficient in-brace correction effects have been demonstrated to be achievable when the Cheneau principles of correction are used appropriately. As there is a positive correlation between in-brace correction and the final outcome, the Cheneau concept of bracing with sufficient in-brace corrections as published can be regarded as being efficient when applied well. Case reports with high in-brace corrections, as shown within this paper using the Gensingen brace(TM) promise beneficial outcomes when a good compliance can be achieved. CONCLUSIONS: The use of the Gensingen brace(TM) leads to sufficient in-brace corrections, when compared to the correction effects achieved with other braces, as described in literature. According to the patients' reports, the Gensingen brace(TM) is comfortable to wear, when adjusted properly. Further studies are necessary (1) in order to evaluate brace comfort and (2) effectiveness using the SRS inclusion criteria.
Abstract: ABSTRACT: 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. METHODS: The Delphi process was utilised in four steps gradually modified according to the results of a set of recommendations: we involved the SOSORT Board twice, then all SOSORT members twice, with a Pre-Meeting Questionnaire (PMQ), and during a Consensus Session at the SOSORT Lyon Meeting with a Meeting Questionnaire (MQ). RESULTS: There was an unanimous agreement on the general efficacy of bracing and physiotherapy for this condition. Most experts suggested the use of 4-5 point bracing systems, however there was some controversy with regards to physiotherapeutic aims and modalities. CONCLUSION: The SOSORT panel of experts suggest the use of rigid braces and physiotherapy to correct thoracic hyperkyphosis during adolescence. The evaluation of specific braces and physiotherapy techniques has been recommended.
Abstract: ABSTRACT: BACKGROUND: Medical rehabilitation aims at an improvement in function, capacity and participation. For the rehabilitation of spinal deformities, the goal is to maintain function and prevent secondary symptoms in the short- and long-term. In patients with scoliosis, predictable signs and symptoms include pain and reduced pulmonary function. Materials and Methods A Pub Med review was completed in order to reveal substantial evidence for inpatient rehabilitation as performed in Germany. No evidence has been found in general to support claims for actual inpatient rehabilitation programmes as used today. Nevertheless, as there is some evidence that inpatient rehabilitation may be beneficial to patients with spinal deformities complicated by certain additional conditions, the body of evidence there is for conservative treatment of spinal deformities has been reviewed in order to allow suggestions for outpatient conservative treatment and inpatient rehabilitation. DISCUSSION: Today, for both children and adolescents, we are able to offer intensive rehabilitation programmes lasting three to five days, which enable the patients to acquire the skills necessary to prevent postures fostering scoliosis in everyday life without missing too much of school teaching subjects at home. The secondary functional impairments adult scoliosis patients might have, as in the opinion of the author, still today require the time of 3-4 weeks in the clinical in-patient setting. Time to address psychosocial as well as somatic limitations, namely chronic pains and cardiorespiratory malfunction is needed to preserve the patients working capability in the long-term. CONCLUSION: Outpatient treatment / rehabilitation is sufficient for adolescents with spinal deformities. Inpatient rehabilitation is recommended for patients with spinal deformities and pain or severe restrictive ventilation disorder.
Abstract: ABSTRACT: BACKGROUND: Bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of polyethylene (PE) and soft braces. The plaster cast method worldwide seems to be the most practiced technique for the construction of hard braces at the moment. CAD (Computer Aided Design) systems are available which allow brace adjustments without plaster. Another possibility is the use of the ScoliOlogiC(R) off the shelf system enabling the Certified Prosthetist and Orthotist (CPO) to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This Cheneau light(TM) brace, developed according to the Cheneau principles, promises a reduced impediment of quality of life in the brace. The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principles of the Cheneau light(TM) brace have shown a satisfactory in-brace correction exceeding 50% of the initial Cobb angle. Brace description The ScoliOlogiC(R) off the shelf bracing system enables the technician (CPO) to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This brace, when finally adjusted is called Cheneau light(TM) brace. The advantage of this new bracing system is that the brace is available immediately, is easily adjustable and that it can also be easily modified. This avoids construction periods of sometimes more than 6 weeks, where the curve may drastically increase during periods of fast growth. The disadvantage of this bracing system is that there is a wide variability of possibilities to arrange the different shells during adjustment. RESULTS: The Cobb angle in the whole group was reduced by an average of 16,4 degrees, which corresponds to a correction effect of 51%. The differences were highly significant in the T-test (t = 17,4; p < 0,001). The best correction effects achieved with Cheneau braces reported in literature so far are about 40% in two different studies. The correction effect was highest in lumbar and thoracolumbar curve patterns (62%; n = 18). In thoracic scoliosis the correction effect was 36% (n = 41) and in double major curve pattern 50% (n = 22). The correction effect of the brace was affected in a slightly negative way by age (r = -0,24; p = 0,014), it correlated negatively with the Risser stage (-0,29; p = 0,0096) and correlated negatively with the Cobb angle measured before treatment (r = -0,43; p < 0,0001). CONCLUSIONS: The use of the Cheneau light(TM) brace leads to correction effects above average when compared to correction effects of other braces described in literature. The reduction of material seems to increase patient's comfort and reduces the stress patients may suffer from whilst in the brace. 80% of the adolescent population of scoliosis patients can be braced with the Cheneau light(TM) brace. In certain patterns of curvature and in the younger population with an age of less than 11 years, other approaches have to be used, such as plaster based bracing or the application of CAD / CAM based orthoses.
Abstract: There is evidence that physiotherapy is an effective treatment module used in the management of patients with scoliosis. There is a RCT from China as well as a prospective controlled study from Germany supporting physiotherapy. The latter study was on scoliosis in-patient rehabilitation with patient samples treated intensively for 6 weeks. Today in-patient rehabilitation programs have changed and the length of the program has been reduced. Therefore, there is doubt that the results of the study are reproducible today. This is why new concepts of scoliosis rehabilitation have been developed on the basis of the latest methodological studies in this field. Material and Methods: In June 2010 the new 5-day scoliosis short-term rehabilitation was introduced based on experiential learning and the methods of treatment described in literature. 10 patients from New Zealand, US, Canada, Belarus, Rumania and Russia took part. Nine had a scoliosis, one was treated for kyphosis. [h1] The concept consisted of two guided 90 min. sessions and one experiential learning session of another 90 min on a daily basis. Finally, 9 patients with the diagnosis of AIS (Adolescent Idiopathic Scoliosis), two males and seven females with an average Cobb angle of 46° (29 – 64°) and with an average age of 14 (11 – 18) years were included.ATR (Angle of Trunk Rotation = Scoliometer) measurements were taken before and after the treatment. Additionally, the ability to correct themselves was measured after four days of treatment. A questionnaire to measure patient satisfaction was also used.Results: The ATR was reduced significantly from 10.3° to 8.2° (p < 0,001) after treatment in the nine patients with scoliosis. The ability to correct themselves as measured with the help of the Scoliometer (ATR 8.2° / ATR auto-corrected (without additional help by the therapist ) 5.7[h2] ) was 1,45 and the difference between ATR 8.2° / ATR auto-corrected 5.7 was significant as well (p = 0,0035). Patient satisfaction was over average and the patient examination at the end clearly showed that all goals set were achieved for all patients.Conclusions: This new concept of rehabilitation is less time consuming and seems as effective as in-patient rehabilitation of 3-4 weeks. Therefore, in-patient rehabilitation lasting several weeks today seems necessary no more for children and adolescents with scoliosis. Studies with increasing patient samples are needed to substantiate these conclusions. [h1]Only the group of patients with scolisois is needed to be included. [h2]More explanation is needed.
Abstract: From the time of its initial, informal meetings starting in 1980 to its formal creation in 1990, the IRSSD has met on a bi-annual basis to discuss all aspects of the spine and associated deformities. It has encouraged open discussion on all topics and, in particular, has tried to be the seed-bed for new ideas. The members are spread around the world and include people from all areas of academia as well as the most important people, the patients themselves. Most notably, application of the ideas and results of the research has always been at the forefront of the discussions. This paper was conceived with the idea of evaluating the impact made by the IRSSD over the last 30 years in the various areas and is intended to create discussion for the upcoming meeting in Montreal regarding future focus: "We are lost over the Atlantic Ocean but we are making good time."
Abstract: ABSTRACT: BACKGROUND: Up to now, chronic low back pain without radicular symptoms is not classified and attributed in international literature as being "unspecific". For specific bracing of this patient group we use simple physical tests to predict the brace type the patient is most likely to benefit from. Based on these physical tests we have developed a simple functional classification of "unspecific" low back pain in patients with spinal deformities. METHODS: Between January 2006 and July 2007 we have tested 130 patients (116 females and 14 males) with spinal deformities (average age 45 years, ranging from 14 years to 69) and chronic unspecific low back pain (pain for > 24 months) along with the indication for brace treatment for chronic unspecific low back pain. Some of the patients had symptoms of spinal claudication (n = 16). The "sagittal realignment test" (SRT) was applied, a lumbar hyperextension test, and the "sagittal delordosation test" (SDT). Additionally 3 female patients with spondylolisthesis were tested, including one female with symptoms of spinal claudication and 2 of these patients were 14 years of age and the other 43yrs old at the time of testing. RESULTS: 117 Patients reported significant pain release in the SRT and 13 in the SDT (>/= 2 steps in the Roland & Morris VRS). 3 Patients had no significant pain release in both of the tests (< 2 steps in the Roland & Morris VRS).Pain intensity was high (3,29) before performing the physical tests (VRS-scale 0-5) and low (1,37) while performing the physical test for the whole sample of patients. The differences where highly significant in the Wilcoxon test (z = -3,79; p < 0,0001).In the 16 patients who did not respond to the SRT in the manual investigation we found hypermobility at L5/S1 or a spondylolisthesis at level L5/S1. In the other patients who responded well to the SRT loss of lumbar lordosis was the main issue, a finding which, according to scientific literature, correlates well with low back pain. The 3 patients who did not respond to either test had a fair pain reduction in a generally delordosing brace with an isolated small foam pad inserted at the level of L 2/3, leading to a lordosation at this region. DISCUSSION: With the exception of 3 patients (2.3%) a clear distribution to one of the two classes has been possible. 117 patients were supplied successfully with a sagittal realignment test-brace (physio-logic(R) brace) and 13 with a sagittal delordosing brace (spondylogic(R) brace). There were patients with scoliosies and hyperkyphosiesbrace). Therefore a clear distribution of the patients from this sample to either chronic postural or chronic instability back pain was possible. In 2.3% a combined chronic low back pain from the findings obtained seems reasonable. CONCLUSION: Chronic unspecific low back pain is possible to clearly be classified physically. This functional classification is necessary to decide on which specific conservative approach (physical therapy, braces) should be used.Other factors than spinal deformities contribute to chronic low back pain.
Abstract: ABSTRACT: BACKGROUND: In contemporary literature few have written in detail on the in-brace correction effects of braces used for the treatment of hyperkyphosis. Bradford et al. found their attempts effective, treating Scheuermann's kyphosis with Milwaukee braces, but their report did not specifically focus on in-brace corrections. White and Panjabi's research attempted to correct a curvature of > 50 degrees with the help of distraction forces, but consequently led to a reduction in patient comfort in the application of the Milwaukee brace. In Germany they avoid this by utitlising braces to treat hyperkyphosis that use transverse correction forces instead of distraction forces. Further efforts to reduce brace material have resulted in a special bracing design called kyphologic brace. The aim of this review is to present appropriate research to collect and evaluate possible in-brace corrections which have been achieved with brace treatment for hyperkyphosis. This paper introduces new methods of bracing and compares the results of these with other successful bracing concepts. MATERIALS AND METHODS: 56 adolescents with the diagnosis of thoracic Scheuermann's hyperkyphosis or a thoracic idiopathic hyperkyphosis (22 girls and 34 boys) with an average age of 14 years (12-17 yrs.) were treated with the kyphologic brace between May 2007 and December 2008. The average Stagnara angle was 55,6 degrees (43-80). In-brace correction was recorded and compared to the initial angle using the t-test. RESULTS: The average Stagnara angle in the brace was 39 degrees . The average in-brace correction was 16.5 degrees (1-40 degrees ). The verage percentage of in-brace correction compared to the initial value was 36%. The differences were significant in the t-test (t = 5.31, p < 0,001). To make these results comparable to other studies, the kyphosis angle of 25 degrees was set to 0 for our sample in order to achieve a norm value adapted (NVA) percentage of in-brace correction. By doing this a correction of 54.1% was achieved. There was no correlation between the percentage of in-brace correction and the age of the patient, but a highly significant correlation between percentage of in-brace correction and the initial Stagnara angle. DISCUSSION: If we assume that outcome of brace treatment positively correlates with in-brace correction, the treatment should be initiated before the curvature angle exceeds 50 - 55 degrees in a growing adolescent. In scoliosis bracing, if the average in-brace correction equals > 15 degrees , then it is predicted that the result will lead to a final correction. Applying this to hyperkyphosis patients, the average in-brace correction with this brace was also > 15 degrees . We therefore estimated to achieve a favourable outcome using this brace type (once compliance was attained) especially when comparing the correction effects achieved with this new approach to the correction effects reported upon using the Milwaukee brace. The latter brace has been shown to lead to beneficial outcomes in long-term studies with comparable in-brace corrections. CONCLUSION: Conservative treatment of Scheuermann's hyperkyphosis in international literature is generally regarded as an effective treatment approach. Physiotherapy and bracing are the first-line treatments for this condition.An average in-brace correction of > 15 degrees as was achieved using the kyphologic brace predicts a favourable outcome.The kyphologic brace leads to in-brace corrections comparable to those of the Milwaukee brace, which has previously been shown to provide beneficial outcome in the long-term.A prospective follow-up study seems desirable before final conclusions can be drawn.Future studies should focus more on thoracolumbar and lumbar curve patterns, because these patterns may predict chronic low back pain in adulthood with reduced quality of life of the patients and high costs with respect to medical care and occupational sickness leave.Surgery according to international literature is rarely necessary in this condition.
Abstract: ABSTRACT: BACKGROUND: For adult scoliosis patients with chronic low back pain bracing is initially indicated before spinal surgery is considered. Until recently there has been a lack of research into the effect upon pain reductions in the mid and long-term. Promising results have been documented in short-term studies for the application of a sagittal re-alignment brace in patients with spinal deformities and along with pain; however mid-term and long-term results are not yet available. The purpose of this study is to investigate the mid-term effects of this brace with respect to pain control. MATERIALS AND METHODS: 67 patients (58 females and 9 males) with chronic low back pain (> 24 months) and the diagnosis of scoliosis or hyperkyphosis were treated with a sagittal re-alignment brace (physio-logic brace) between January 2006 and July 2007. The indication for this kind of brace treatment was derived from a positive sagittal re-alignment test (SRT) and the exclusion of successful conservative treatment during the last 24 months. The aim of this type of conservative intervention was to avoid surgery for chronic low back pain. RESULTS: The average pain intensity was measured on the Roland and Morris VRS (5 steps) before treatment. This was 3.3 (t1), at the time of brace adjustment it was 2.7 (t2) and after at an average observation time of 18 months it was 2.0 (t3). The differences were highly significant in the Wilcoxon test. DISCUSSION: Short-term measurements showed that a significant pain reduction is possible in chronic postural low back pain using a sagittal re-alignment brace inducing lumbar re-lordosation. In a preliminary report at adjustment (t2), highly significant improvements of pain intensity have also been demonstrated. At 6 months of treatment however, no improvement was measured. The improvement of the mid-term effects (18 months) found in this study compared to the preliminary report may be due to the changed approach to compliance: whilst the bracing standard was not changed; the patients in this study were obligated to wear the brace for a minimum of 20 hrs per day for the first 6 months of treatment. CONCLUSION: The effect of the sagittal re-alignment brace leads to promising short-term improvements in patients with chronic low back pain and spinal deformities. Contrary to unspecific orthoses, which after a short period without persistent pain reduction are omitted by the patients, the sagittal re-alignment brace (physio-logic brace) leads to an effective reduction of pain intensity in mid-term even in patients who have stopped brace treatment after the initial 6 months of treatment. In conservative treatment of chronic low back pain specific approaches such as the sagittal re-alignment brace are indicated prior to considering the surgical options.
Abstract: ABSTRACT: : In children with Prader Willi syndrome (PWS), besides growth hormone (GH) therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. METHODS: Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS.Types of participants included: patients with scoliosis and PWS.Type of intervention: surgery.Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles.Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. RESULTS: From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70 degrees and some of which improved. DISCUSSION: If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees) conservatively, this treatment seems to have fewer complications than surgical treatments. The results of our retrospective study of nine patients demonstrate that scoliosis in this entity plays only a minor role and surgery is unnecessary when high quality conservative management exists. CONCLUSION: There is lack of the long follow-up studies in post-surgical cases in patients with PWS and scoliosis. The rate of complications of spinal fusion in patients with PWS and scoliosis is very high and the death rates have been found to be higher than in patients with Adolescent Idiopathic Scoliosis (AIS). The long-term side-effects of the intervention are detrimental, so that the risk-benefit ratio favours the conservative approaches over spinal fusion surgery.
Abstract: Surface topography evaluations are prone to technical errors due to postural sway of the patients measured. The technical error of lateral deviation (rms) and surface rotation (rms) may vary between 15 and 20%, while the kyphosis angle (IP-ITL) has a technical error of only 5% (2,5 degrees), which is comparable to the x-ray measurement. Purpose of this study was to investigate the hypothesis that video rasterstereography can be used for prognostication of a kyphosis patient. MATERIALS AND METHODS: 53 Patients (23 females, 30 males, average age 17 years with a range from 11 to 56 years) undergoing in-patient rehabilitation have been measured with the help of video rasterstereography (VRS) before starting the treatment program and the values for kyphosis angle have been correlated to the kyphosis angle measured on a lateral x-ray (XR) not older than 6 weeks before VRS measurement. 26 had a thoracic Scheuermann, 3 a thoracolumbar, 15 an Idiopathic Kyphosis and 9 a kyphosis of other origin. RESULTS: Average Kyphosis angle XR was 49 degrees (SD 17) and VRS 63 degrees (SD 13). There was a high significant Pearson correlation of 0.78 and a high significant difference of 14 degrees in the t-test (t -9,6, p<0,001). CONCLUSIONS: The kyphosis angle VRS (Vertebra prominens - lower neutral zone of inclination) seems to allow a follow-up of individual kyphosis patients. The XR kyphosis angle according to Stagnara is measured from T4 to the lower end vertebra and therefore is lower than the VRS kyphosis angle measured from T1. The difference found between XR and VRS kyphosis angles may be explained by the angle between T1 (VRS) and T4 (XR) differently used as the upper end vertebra. Therefore the prognostication of an individual patient seems possible within certain limits.
Abstract: In-brace correction and compliance are the main predictors of a successful outcome of brace treatment in the management of patients with Idiopathic scoliosis. The latest CAD/CAM or module based bracing concepts, related to a proper classification have lead to a better in-brace correction and have made the braces easier to wear for the patient. Nevertheless, the latest developments on the market do not allow successful treatment in every case. The latest biomechanical models of brace correction therefore may lead to a differential indication for certain concepts described in this paper. Thoracic curves with Cobb angles < 50 degrees may be treated with the best possible success with the latest Chêneau derivates enabling a real 3D-correction including also the sagittal correction of the spine. The application of those braces demands a proper classification of curve patterns. Thoracic curves with Cobb angles > 50 degrees demand to increase the force vector from dorsal with the ventral counteraction of subclavicular pads both sides, although this may be at the cost of sagittal correction. The percentage of in-brace correction is a good indicator for brace action, however in the individual case this is not always the most important factor.
Abstract: In view of the very limited data about conservative treatment of patients with congenital scoliosis (CS) available, early surgery is suggested already in mild cases with formation failures in the first three years of life. It is common sense that patients with failures of segmentation will not benefit from conservative treatment at all and the same applies to failures of formation with curves of >50 degrees in infancy. MATERIALS AND METHODS: Two patients with rib synostosis denied surgery before entering the pubertal growth spurt. These patients have been treated conservatively with braces and Scoliosis In-Patient Rehabilitation (SIR) and now are beyond the pubertal growth spurt. One patient with a formation failure and a curve of >50 degrees lumbar has been treated with the help of braces and physiotherapy from 1.6 years on and is still under treatment now at the age of 15 years. RESULTS: Severe decompensation was prevented in the two patients with failure of segmentation, however a severe thoracic deformity is evident with underdeveloped lung function and severe restrictive ventilation disorder. The patient with failure of formation is well developed, now without cosmetic or physical complaints although his curve progressed at the end of the growth spurt due to final mal-compliance.CONCLUSIONS: Failures of segmentation should be advised to have surgery before entering the pubertal growth spurt. In case they deny, conservative treatment can at least in part be beneficial. For patients with failures of formation conservative treatment should be suggested in the first place because long-term outcomes of early surgery beyond pubertal growth spurt are not yet revealed.
Abstract: Claims have been made that surface topography is an objective tool, however there are significant postural influences (relatively large technical error due to postural sway) those measurements are prone to. Purpose of this study was to help estimate these influences by measuring patients with scoliosis in three standardized postural positions. MATERIAL AND METHODS: We studied the surface-topography measurement in 100 in-patients with idiopathic scoliosis divided into different age-groups. First group: 7 to 12 years (n=12), second group: 13 to 16 years (n=51), the third 17 to 20 years (n=15) and the fourth >21 years (n=22) (7 males and 93 females). The thoracic Cobb angle was 26.4 degrees, lumbar Cobb angle 25.7 degrees. We investigated the average lateral deviation (rms) and average surface rotation (rms). Measurements were taken one day before the patients left the clinic, after a 3 or 4 week in-patient intensive rehabilitation program (SIR), in three different postures:Normal posture: no specific instructions: standing with feet in an standardized way. Conscious posture: The patients acquired this posture during intensive daily exercising. Corrected posture: The most corrected posture the patients are able to achieve by using specific muscle tension and specific breathing techniques. We compared the results between the different postures. Then we calculated the results for the different age groups. RESULTS: There are significant differences in both parameters tested, some of them more than 40% to 67% greater than the measurement error calculated. The best results were achieved in the second and the third group with the conscious posture, the adult group had the best valued in most corrected posture. For the youngest patients there were no significant changes with the different postures. CONCLUSIONS: Surface measurements can be influenced by artificial postures and therefore cannot be attributed as objective. This is why the surface measurements should be made by someone independent from the treatment process in order to exclude any bias as far as possible. Surface topography may be used for postural monitoring in the rehabilitation process of patients with scoliosis.
Abstract: Patients with Prader-Willi syndrome often suffer from scoliosis of major degrees. Due to current literature surgical intervention seems the gold standard of treatment although the rate of complications in this condition are reported to be significantly higher than in patients with Adolescent Idiopathic Scoliosis. Purpose of this study was to reveal the effects of conservative treatment in this rare patient population. MATERIALS AND METHODS: A case series of patients with this condition has been investigated to estimate as to whether Prader-Willi patients with scoliosis may benefit from conservative scoliosis management. 9 Patients with this condition have been found in our out-patient database. 5 of these retarded patients (3 girls, two boys) today are 19 years and older and therefore are without any significant residual growth. Average Cobb angle was 47 degrees (34 - 66 degrees) at 12 years, average observation time was 6.4 years. RESULTS: Two of the five patients progressed. Average Cobb angle after follow-up was 52 degrees. No progression beyond 70 degrees has been found after cessation of growth. In one patient the curve deteriorated clearly after reducing brace wearing time and therefore was due to non-compliance. CONCLUSIONS: Stabilisation of scoliosis due to Prader-Willi syndrome is possible by means of conservative management. To expose this patient population to the risks of surgical management seems not to be justified.
Abstract: ABSTRACT: Adolescent idiopathic scoliosis (AIS) represents a rare condition with a potentially detrimental impact on young patients. Despite vast clinical research and published treatment guidelines and algorithms, the optimal therapeutic choice for these patients remains highly controversial. While advocates of early surgery emphasize the benefits of surgical deformity correction with regard to physical and psychological outcome, the opponents base their arguments on the high risk of complications and a lack of documented subjective long-term outcome. In the present paper, the authors were invited to debate the opposite positions of "pro" versus "contra" surgical treatment of AIS, based on the currently available evidence and published guidelines.
Abstract: ABSTRACT: BACKGROUND: The exact etiology of congenital scoliosis remains unknown as yet. It seems that its development may be influenced by both genetic predisposition and environmental factors, at varying degrees. International bibliography features few cases of monozygotic twins with congenital scoliosis. The aim of this study is to report a case in monozygotic twins and review the literature relating to the description of similar cases as well as the pathophysiological mechanism involved in its development. METHODS: Clinical examination and simple X-rays revealed scoliosis of differing degrees and types in male monozygotic twins with moderate mental retardation and dyslalia. RESULTS: Congenital scoliosis identified in both twins. In the first, this was manifested as left thoracic scoliosis, with Cobb angle of 34 degrees while in the second as left thoracolumbar scoliosis with Cobb angle of 10 degrees. Both were found to suffer from incarcerated hemivertebrae. CONCLUSION: According to both its clinical identification and severity and to its course, not only the genetic but the environmental factors seem to play a leading role in the appearance of the condition.
Abstract: In the recent peer reviewed literature the SpineCor is described as an effective method of treatment for patients with scoliosis. However until recently no prospective controlled end-result study is presented comparing the results obtained with this soft brace to natural history. The objective was to determine whether the results obtained by the use of the SpineCor are better than natural history during pubertal growth spurt. The method employed prospective comparison of the survival rates of SpineCor treatment vs. natural history with respect to curve progression during pubertal growth spurt. 12 Patients with Cobb angles between 16 and 32 degrees (at average 21 degrees) during pubertal growth spurt are presented as a case series treated with the SpineCor. Survival rate of this sample is described and compared to natural history (SRS brace study 1995). All girls treated in both studies were at risk for being progressive with the first clinical signs of maturation (Tanner 2-3). During the pubertal growth spurt most of the patients (11/12) with SpineCor progressed clinically and radiologically as well (at least 5 degrees). Progression could be stopped changing SpineCor to the Chêneau brace in most of the sample described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees, after an average observation time of 21.5 months 31 degrees. At 24 months of treatment time 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 72 months follow-up time 8 % of the patients with the SpineCor survived with respect to curvature progression. Survival proportion in the SpineCor sample, though was 0.08, while in the natural history cohort it was 0.34. The SpineCor treatment during pubertal growth spurt seems to lead to a worse outcome than observation only. The use of a simple biomechanical model explains that in the brace the compression forces exceed the lateral forces used for the corrective movement. Therefore SpineCor does not seem to be indicated as a treatment during pubertal growth spurt.
Abstract: ABSTRACT: BACKGROUND: Spinal fusion surgery is currently recommended when curve magnitude exceeds 40-45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature.In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see - observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery. MATERIALS AND METHODS: Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'. RESULTS: The electronic search carried out on the 1st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon. CONCLUSION: Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.
Abstract: Different methods of physiotherapy are applied in scoliosis management and different opinions exist about the efficacy of conservative scoliosis treatment. Because this divergence of opinions corresponds to a great variety of standards applied, it is not surprising that also the results of conservative treatment greatly differ. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated. Moreover it is clear that functional and physiological impairments of scoliosis patients-including pain, torso deformity, psychological disturbance and pulmonary dysfunction-require therapeutic intervention. The triad of out-patient physiotherapy, intensive in-patient rehabilitation (SIR) and bracing has proven effective in conservative scoliosis treatment in central Europe. Indication, content and results of physiotherapy are described and discussed in this paper. The differential indication of methods of physiotherapy assigned to current "Best Practice" is documented here as well. The positive outcome of current "Best Practice" conservative management validates a policy of offering conservative treatment as an alternative to scoliosis patients, including those for whom surgery is discussed.
Abstract: This guideline has been discussed by the SOSORT guideline committee prior to the SOSORT consensus meeting in Milan, January 2005 and published in its first version on the SOSORT homepage: http://www.sosort.org/meetings.php. After the meeting it again has been discussed by the members of the SOSORT guideline committee to establish the final 2005 version submitted to Scoliosis, the official Journal of the society, in December 2005. This chapter is a republication from the original paper published in "Scoliosis" BioMed journal and it is included in this book due to its high importance.
Abstract: Current concept of bracing must take in consideration both the three-dimensional (3D) nature of Adolescent Idiopathic Scoliosis (AIS) and its pathomechanism of progression. A modern brace should be able to correct in 3D in order to break the so called 'vicious cycle' model. Generally speaking, it is necessary to create detorsional forces to derotate in the transversal plane, to correct the lateral deviation in the frontal plane and to normalize the sagittal profile of the spine. Breathing mechanics can be used to fight against the thoracic structural flat back. The original Chêneau brace was introduced at the end of the 70's and its principles were based more in anatomical observations rather than in biomechanics. A further evolution , enunciating new principles, has allowed a higher standard, improving in brace corrections and trunk modelling. This biomechanical principles have been developed under the name of Rigo-Chêneau-System (RSC) and used later in latest brace models like the Chêneau light with reduced material, and similar in brace corrections. Experience is also important to improve the end results. The blueprints to built the brace according to the anatomorradiological pattern are very helpful.
Abstract: Traditionally, the treatment options for adolescent idiopathic scoliosis (AIS), the most common form of scoliosis, are exercises; in-patient rehabilitation; braces and surgery. The outcomes of treatments are usually compared with the natural history or observation (non-intervention). The aim of this paper was to provide a synopsis of all treatment options in the light of evidence based practice (EBP). A systematic review was carried out using the most encompassing databases available. Literature has been searched for the outcome parameter ''rate of progression'' and only prospective controlled studies that have considered the treatment versus the natural history have been included. The search strategy included the following terms: ''adolescent idiopathic scoliosis''; ''idiopathic scoliosis''; ''natural history''; ''observation''; ''physiotherapy''; ''physical therapy''; ''rehabilitation''; ''bracing''; ''orthotics'' and ''surgery''. Prospective short-term studies have been found to support outpatient physiotherapy. One prospective controlled study was found to support scoliosis in-patient rehabilitation (SIR). One prospective multi-centre study, a long-term prospective controlled study and a meta-analysis have been found to support bracing. No controlled study, neither short, mid nor long-term, was found to reveal any substantial evidence to support surgery as a treatment for this condition. There is some evidence supporting the conservative treatment for AIS. No substantial evidence has been found in terms of prospective controlled studies to support surgical intervention. In light of the unknown long-term effects of surgery, a randomised controlled trial (RCT) seems necessary. Due to the presence of evidence to support conservative treatments, a plan to compose a RCT for conservative treatment options seems unethical. But it is also important to conclude that the evidence for conservative treatments is weak in number and length.
Abstract: PURPOSE: Historically, the treatment options for AIS, the most common form of scoliosis are: Exercises, in-patient rehabilitation, braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no review on prospective controlled trials for surgical treatment. The aim of this review was to perform a systematic search of the Pub Med literature to reveal the evidence on scoliosis surgery. METHODS: A systematic review has been performed using the Pub Med database. Literature has been searched for the outcome parameter; 'rate of progression' and only prospective controlled studies that have considered the treatment versus the natural history have been included. RESULTS: No controlled study, not in the short, mid or long term, searched within the review, has been found to reveal evidence to support the hypothesis that the effects of surgery as a treatment option for AIS is superior to natural history. CONCLUSIONS: No evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view. In the light of the unknown long-term effects of surgery and in concluding on the lack of evidence already found that surgery might change the signs and symptoms of scoliosis, a randomized controlled trial (RCT) is long overdue. Until such a time that such evidence exists, there can be no medical indication for surgery. The indications for surgery are limited for cosmetic reasons in severe cases and only if the patient and the family agree with this.
Abstract: ABSTRACT: BACKGROUND: Today, acupuncture therapy is commonly used for pain control throughout the world, although the putative mechanisms are still unclear. A Pub Med search for the key words "Acupuncture" and "Scoliosis" reveals 3 papers only, not containing any results of studies designed for the treatment of scoliosis with the help of acupuncture. Because of this lack of trials especially designed for the treatment of scoliosis this pilot study has been performed. METHODS: 24 girls undergoing in-patient rehabilitation, 14 - 16 years of age (at average 15,1 years, SD 0,74) with the diagnosis of an Adolescent Idiopathic Scoliosis (AIS) have agreed to take part in this controlled single blind crossover study. Average Cobb angle was 33 degrees (SD 9,2) ranging from 16 to 49 degrees. 10 of the girls had a thoracic, one a lumbar, 7 a double major and 6 a thoracolumbar curve pattern. The patients have been scanned with the Formetric(R) surface topography measurement system before and after lying on the left side [L], before and after sham acupuncture [S] and before and after real acupuncture [R]. RESULTS: For the whole group of patients no significant changes have been found during lying, sham acupuncture or real acupuncture. There were no differences between the patient groups with different curve pattern. In the explorative subgroup analysis of Patients with curvatures from 16 to 35 degrees, however significant changes in surface rotation have been found after R intervention as well as a strong differences in lateral deviation while in the L or S intervention no real changes have been achieved. CONCLUSION: One session with real (verum) acupuncture seems to have an influence on the deformity of scoliosis patients with no more than 35 degrees. The findings during verum acupuncture clearly are different to sham acupuncture or just lying, while in the whole group of patients also including patients with curvatures of more than 35 degrees no obvious changes have been found. The results of this study justify further investigation of the effect of acupuncture in the treatment of patients with scoliosis.
Abstract: ABSTRACT: BACKGROUND: Although there is no evidence that the long-term effects of scoliosis surgery are superior to the long-term effects of Adolescent Idiopathic Scoliosis (AIS) itself, patients can fear the consequences of not under going this surgery due to incorrect or insufficient information. The main indication for surgical treatment in patients with AIS, is cosmetic. However spinal surgery may, along with other negative side effects, actually cause postoperative clinical deterioration. This complication of surgery has not yet been described in international literature. CASE PRESENTATION: A 15-year old female patient originally presenting with a well-compensated double curve pattern scoliosis. The patient was advised to undergo surgery due to the long-term negative impact of signs and symptoms of scoliosis upon her health. The patient agreed to surgery, which was performed in one of Germanys leading centres for spinal surgery. The thoracolumbar curve was corrected and fused, while the thoracic curve, clearly showing wedged vertebrae, defined as structural scoliosis, remained untreated.This operation left the patient with an unbalanced appearance, with radiological and clinical imbalance to the right. The clinical appearance of the patient though clearly deteriorated post-surgery. Furthermore, the wedged disc space below the fusion area indicates future problems with possible destabilisation accompanied probably by low back pain. CONCLUSION: Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. Therefore the treatment leading to the best possible clinical appearance and balance has to be chosen. Patients should be informed that surgery will not necessarily improve their health status. Clinical deterioration after surgery may occur, and such information is crucial for an adequate informed consent.
Abstract: ABSTRACT: Historically, the treatment options for AIS, the most common form of scoliosis are; exercises; in-patient rehabilitation; braces and surgery. While there is evidence in the form of prospective controlled studies that Scoliosis Intensive Rehabilitation (SIR) and braces can alter the natural history of the condition, there is no prospective controlled study comparing the natural history with surgical treatment.One aim of the Scoliosis Society (SOSORT) should be; to help develop a body of research regarding the outcomes of conservative and operative treatment as well, and to highlight the problems of treatment indications in patients with AIS and other spinal deformities. Another aim is to help to improve the safety of patients who have surgery. By producing evidence-based information that can be used to develop guidelines that could aid both professionals and patients in making decisions about surgical and conservative options.Although 'Scoliosis' is the official journal of the SOSORT and is the main forum for experts in the field of conservative management of patients with spinal deformities, there needs to be more wide spread attempt to develop a fuller body of evidence focussing on spine surgery as well.
Abstract: ABSTRACT: This report is the SOSORT Consensus Paper on School Screening for Scoliosis discussed at the 4th International Conference on Conservative Management of Spinal Deformities, presented by SOSORT, on May 2007. The objectives were numerous, 1) the inclusion of the existing information on the issue, 2) the analysis and discussion of the responses by the meeting attendees to the twenty six questions of the questionnaire, 3) the impact of screening on frequency of surgical treatment and of its discontinuation, 4) the reasons why these programs must be continued, 5) the evolving aim of School Screening for Scoliosis and 6) recommendations for improvement of the procedure.
Abstract: ABSTRACT: BACKGROUND: The BSSQbrace questionnaire has been shown to be reliable with good internal consistency and reproducibility estimating the stress scoliosis patients have whilst wearing their brace. Eight questions are provided focussing on this topic. A max. score of 24 can be achieved (from 0 for most stress to 24 for no stress). The subdivision of the score values is: 0-8 (strong stress), 9-16 (medium stress) and 17-24 (little stress). STUDY DESIGN: Two BSSQbrace questionnaires have been posted to 65 patients under brace treatment from our Cheneau light data base. All patients had another kind of brace prior to the Cheneau light. The patients have been asked to rate their stress level using one questionnaire for the current brace and the other for the previous one. RESULTS: 63 Patients (59 girls and 4 boys) returned their fully completed questionnaires (average age 13,6 years, average Cobb angle 43,7 degrees). Stress level in the previous brace was 11,04 and in the Cheneau light(r) 13,87. The differences were highly significant in the t-test; t = -4,67; p < 0,001. CONCLUSION: The use of the Cheneau light(R) brace leads to reduced stress and/or impairment for the patients under treatment compared to heavier brace models used so far.
Abstract: PURPOSE: The role of genetic factors in the development of Adolescent Idiopathic Scoliosis (AIS) has been well documented; however, reports of the specific mode of genetic inheritance are inconclusive. These facts, combined with the phenotypic variability of this disorder, suggest that the genetic expression of idiopathic scoliosis may be dependent on multiple factors and genetic interactions. However, it seems questionable whether there is evidence for a genetic aetiology for adolescent idiopathic scoliosis, when in monozygotic twins there is no 100% concordance of the symptoms and prognosis. METHODS: Five pairs of monozygotic tested twins with the diagnosis of AIS were presented in the outpatient practice of the author. There was no history of scoliosis in any other member of the family. RESULTS: Pair 1: Growth is still left in both girls, however prognosis is totally different. The progression factor of the first girl was 1.75 and so she has a risk of >65% for curve progression, Cobb angle 40. Progression factor of the second girl was 0.56 and so she has a risk of <5% for curve progression, Cobb angle 18. Pair 2: Both girls presented with Risser 4. Cobb angle was 55 degrees in one of the twins (progression factor: 3.1; risk for progression >95%) and 220 in the other (progression factor: 0.7; risk for progression <5%). Curve pattern was thoracic in the first, double major in the second girl. Pair 3: Two monozygotic tested boys with similar bad prognoses and similar curve pattern and similar degrees of curvature (90 and 100 degrees). Pair 4: Two not tested girls with similar benign prognoses and similar curve patterns (18 and 22 degrees). Pair 5: Two monozygotic tested girls with different prognoses and similar curve patterns (26 and 49 degrees). CONCLUSIONS: Different curve patterns in two of the five pairs of twins as well as different prognoses can be discussed as phenotypic variability of AIS, however the findings from the other three pairs may be interpreted in the way that genetic factors play a role in the aetiology of AIS.
Abstract: BACKGROUND: Different bracing concepts are used today for the treatment of scoliosis. The plaster cast method worldwide seems to be the most practiced technique at the moment. CAD (Computer Aided Design) systems are on the market which allow brace adjustments without plaster. The latest development however, is the use of the ScoliOlogiC off the shelf system enabling the orthopaedic technician to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This "Chêneau light" brace, developed according to the Chêneau principle, promises a reduced impediment of quality of life in the brace. However, material reduction should not result in reduced effectiveness. Therefore the primary correction effect in the "Chêneau light" brace has been evaluated and compared with that of other braces used today. METHODS: The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principle of the "Chêneau light" brace were evaluated after an average treatment time of 6 weeks by a full-body X-ray made in the standing position whilst wearing the brace and compared with the last X-ray before bracing. The average curvature angle of the whole group was 35,6 degrees , the average age was 12,9 years (SD 1,9), average Risser sign was 1,3 (SD 1,5), average Tanner rating 2,75 (SD 0,7). RESULTS: The Cobb angle in the whole group was reduced by an average of 16,4 degrees , which corresponds to a correction effect of 51%. The differences were highly significant in the T-test (T = 17,4; p < 0,001). The best correction effects reported in literature so far are about 40% in two different studies. The correction effect was highest in lumbar and thoracolumbar curve pattern (62 %; n = 18). In thoracic scoliosis the correction effect was 36 % (n = 41) and in double major curve pattern 50 % (n = 22). The correction effect correlated slightly negative with age (r = -0,24; p = 0,014), negatively with the Risser stage (-0,29; p = 0,0096) and correlated negatively with the Cobb angle measured before treatment (r = -0,43; p < 0,0001). CONCLUSION: The use of the "Chêneau light" brace leads to correction effects above average when compared to the correction effects of other braces described in literature. The reduction of material seems to affect the desired correction in a positive way.
Abstract: A new questionnaire (The Bad Sobernheim Stress Questionnaire BSSQ) has been developed to assess the psychological stress scoliosis patients develop as a consequence of their deformity. The aim of this study was to determine this stress level in a sample of adolescents with scoliosis. MATERIALS AND METHODS: 206 Patients were recruited to the study and completed a questionnaire (8 items). The average age was 15.7 years with an average Cobb angle of 35.8 degrees. All subjects returned a fully completed questionnaire. Plausibility of the results was assessed by examining for consistent responses to two plausibility questions. RESULTS: The average stress value was 19.97 / 24, which can be regarded as "low stress". The average stress value in the group meeting the plausibility threshold (n = 155) was 21 / 24 while the average stress value in the group not meeting the threshold (n = 51) was 15.9 / 24, regarded as "medium stress". This correlated negatively with the Cobb angle (r = -.54; p < 0,001). The Cobb angle / test value correlation was highest in thoracic curves (n = 87; r = -.49; p < 0,001) and lowest in double major curves (n = 46; r = -.27; p = 0,03). CONCLUSIONS: Adolescents with scoliosis have on average only "low stress" associated with their deformity. Not fulfilling a plausibility threshold seems to be a predictor for more stress associated with the scoliotic deformity.
Abstract: Although spinal claudication may arise from spondylolisthesis, little information exists about successful conservative treatment of this condition. However there are studies describing pain reduction due to physiotherapy and bracing. Significant improvement of walking distance and pain intensity in an adolescent with scoliosis, spondylolisthesis and spinal claudication while wearing a delordosing spondylogic brace is presented here. MATERIAL AND METHOD: A 14 year old girl with a 25 degrees thoracic scoliosis (2 years postmenarchial), grade IV spondylolisthesis and spinal claudication underwent treatment with a delordosing spondylogic brace. Walking distance without brace was at around 300 steps before intolerable pain appeared. Self reported walking distance was recorded in the brace 14 days after adjustment. RESULTS: Walking distance increased to an unlimited number of steps after 14 days while pain intensity decreased three points in the VRS. However, no correction effect of the orthosis on the degree of slippage was found. CONCLUSIONS: Although there is evidence that pain in patients with spondylolithesis can be reduced using exercises and bracing in mild to moderate symptomatic cases, this case demonstrates that bracing can also improve signs and symptoms of spinal claudication in patients with spondylolisthesis of higher degrees. A prospective case series study seems desirable.
Abstract: For adult scoliosis patients with chronic pain bracing is indicated before spinal surgery is considered. The treatment with the "sagittal realignment brace" (physio-logic brace) has clearly improved chronic low back pain in a short test period. Thus we started a prospective study to estimate also medium term effects. MATERIAL AND METHODS: 29 Patients (Cobb angle 37 degrees ; age 41 years) have been treated with the physio-logic brace for an average of 7,5 Months (SD 5,6). Before brace prescription the brace action was simulated using the sagittal realignment test. Pain intensity was recorded before brace treatment, within the 1(st) week after brace adjustment and at follow-up using the Roland and Morris VRS. Period of daily wearing time as well as total wearing time / day was left up to the patients. RESULTS: Pain intensity was high (3,38) before treatment (scale 0-5) and low (1,28) in the brace after adjustment. The differences where highly significant in the Wilcoxon test (z=-4,29; p < 0,0001). After follow-up the pain intensity was moderate to severe (2,69; ns). There was a clear reduction of pain severity, however in most of the cases the compliance has been lost during the follow-up period. Only 7 Patients continued to wear the brace for a considerable time (> 4 hrs.). CONCLUSIONS: The brace action of the sagittal realignment brace leads to promising short-term effects. A better compliance might be achieved by prescribing the total wearing time / day and though a better efficiency of pain reduction in the long-term.
Abstract: BACKGROUND: Chêneau-Brace treatment of a certain standard reduces the rate of surgery, prevents progression and in a certain patient population leads to marked improvement of Cobb angle and cosmetic appearance. During the last two years a patient refusing surgery with a double major curvature of initially 60 degrees showed a clear cosmetic improvement and a clear radiological progression at the same time. The findings of this patient have been reviewed in order to find out how cosmetic appearance and Cobb angle can develop differently. METHODS: The patient entered conservative treatment at the age of 13 years, premenarchial with Tanner II and a Cobb angle of 60 degrees thoracic and 59 degrees lumbar. The angle of trunk rotation (ATR; Scoliometer) was 13 degrees thoracic and 13 degrees lumbar. We have documented the findings of this patient (Surface topography, ATR, Cobb angles and angles of vertebral rotation (according to Raimondi) during the treatment period (27 Month) until 2 years after the onset of menarche. RESULTS: After a treatment time of 27 Month the Cobb angle increased to 74 degrees thoracic and 65 degrees lumbar. The angles of vertebral rotation according to Raimondi increased slightly from 26 degrees thoracic and 28 degrees lumbar to 30 degrees thoracic and 28 degrees lumbar. The ATR improved to 12 degrees thoracic and 5 degrees lumbar while Lateral deviation improved from 22.4 mm to 4.6 mm and average surface rotation improved from 10.6 degrees to 6 degrees. In the X-rays a reduction of decompensation was visible. The patient felt comfortable with the cosmetic result. CONCLUSION: Conservative treatment may improve cosmetic appearance while the curve progresses radiologically. This could be explained by assuming that (1) the Rigo Chêneau brace is able to improve cosmetic appearance by changing the shape of the thorax when the curve itself is too stiff to be corrected by a brace, that (2) reduction of decompensation leads to significant cosmetical improvements or (3) that the patient gained weight and therefore the deformation is masked. However, the weight the patient gained cannot explain the cosmetical improvement in this case. Conservative treatment with a certain standard of quality seems a viable alternative for patients with Cobb angles of > 60 degrees when surgical treatment is refused. Specialists in scoliosis management should be aware of the fact that curve progression can occur even if the clinical measurements show an improvement.
Abstract: A new ADL (Activities of Daily Living) approach in scoliosis rehabilitation has been designed. The ADL approach uses Side-Shift, physiologic(R), 3D-ADL exercises and Schroth exercises according to current standard. It was compared to an exercise based scoliosis rehabilitation that mainly uses Schroth exercises and as an add-on the training of ADL. The ADL approach in practice seems to be easier to teach and the treatment needs fewer theoretical modules leading to a better time-efficiency. Aim of this study was to test whether the gain in time-efficiency is at the loss of outcome. MATERIALS AND METHODS: We studied 13 patients having had a 2 weeks ADL based rehabilitation (ABR) and compared their clinical outcome parameters (surface topograhy & Scoliometer angle) to a group of 13 diagnosis-, age-, sex-, Cobb-angle and curve pattern-matched controls having a 4 weeks programme of exercise based rehabilitation (EBR) only. Average age in the study group was 15 years and average Cobb-angle 39 degrees. RESULTS: Lateral deviation in the study group already after 2 weeks of ABR decreased 2mm (Formetric). Lateral deviation in the control group (EBR) decreased 1,9 mm. The changes were not significant. Thoracic as well as lumbar Scoliometer angle decreased highly significantly in both groups (ABR: 1,8 degrees thoracic, 2,3 degrees lumbar; EBR: 2,1 degrees thoracic, 2,6 degrees lumbar). The differences of outcome between the two groups were not significant. CONCLUSIONS: ABR (2-week programme) seems to provide similar results as EBR (4-week programme). ABR seems to provide a better time efficiency, however a prospective controlled study with a larger sample of patients is desirable before final conclusions can be drawn.
Abstract: The "Chêneau light" brace, developed according to the Chêneau principles, promises a lesser impairment of quality of life in the brace. However material reduction should not result in reduced effectiveness. Therefore the primary correction effect in the "Chêneau light" brace has been evaluated and compared with that of other traditional braces. MATERIAL AND METHOD: The correction effects of the first 99 patients (main diagnosis AIS or EOS; 7 boys, 92 girls), treated according to the principles of the "Chêneau light" brace were evaluated after an average treatment time of 6 weeks by a full-body X-ray made in the standing position while wearing the brace and compared with the last X-ray before bracing. The average curvature angle of the whole group was 41 degrees , the average age was 13 years. RESULTS: The Cobb angle in the whole sample has been reduced by an average of 14,7 degrees, which corresponds to a correction effect of 42%. In patients from this sample who had their first brace (n=53; Cobb angle 36,6 degrees) the in-brace correction was at 49,8%. The correction effect correlated slightly negative with age (r = -0,18; p = 0,034) and correlated negatively with the Cobb angle measured before treatment (r = -0,49; p = 0,0001). CONCLUSIONS: The use of the "Chêneau light" brace leads to correction effects above average when compared to correction effects of other braces described in literature. The reduction of material seems to affect the desired correction in a positive way.
Abstract: OBJECTIVES: Physiotherapy programmes so far mainly address the lateral deformity of scoliosis, a few aim at the correction of rotation and only very few address the sagittal profile. Meanwhile, there is evidence that correction forces applied in the sagittal plane are also able to correct the scoliotic deformity in the coronal and frontal planes. So it should be possible to improve excellence in scoliosis rehabilitation by the implementation of exercises to correct the sagittal deformity in scoliosis patients. An exercise programme (physio-logic exercises) aiming at a physiologic sagittal profile was developed to add to the programme applied at the centre or to replace certain exercises or exercising positions. MATERIAL AND METHODS: To test the hypothesis that physio-logic exercises improve the outcome of Scoliosis Intensive Rehabilitation (SIR), the following study design was chosen: Prospective controlled trial of pairs of patients with idiopathic scoliosis matched by sex, age, Cobb angle and curve pattern. There were 18 patients in the treatment group (SIR + physio-logic exercises) and 18 patients in the control group (SIR only), all in matched pairs. Average Cobb angle in the treatment group was 34.5 degrees (SD 7.8) Cobb angle in the control group was 31.6 degrees (SD 5.8). Age in the treatment group was at average 15.3 years (SD 1.1) and in the control group 14.7 years (SD 1.3). Thirteen of the 18 patients in either group had a brace. Outcome parameter: average lateral deviation (mm), average surface rotation ( degrees ) and maximum Kyphosis angle ( degrees ) as evaluated with the help of surface topography (Formetric-system). RESULTS: Lateral deviation (mm) decreased significantly after the performance of the physio-logic programme and highly significantly in the physio-logic ADL posture; however, it was not significant after completion of the whole rehabilitation programme (2.3 vs 0.3 mm in the controls). Surface rotation improved at average 1.2 degrees in the treatment group and 0.8 degrees in the controls while Kyphosis angle did not improve in both groups. DISCUSSION: The physio-logic programme has to be regarded as a useful 'add on' to Scoliosis Rehabilitation with regards to the lateral deviation of the scoliotic trunk. A longitudinal controlled study is necessary to evaluate the long-term effect of the the physio-logic programme also with the help of X-rays.
Abstract: BACKGROUND : Medicine is a scientific art: once science is not clear, choices are made according to individual and collective beliefs that should be better understood. This is particularly true in a field like adolescent idiopathic scoliosis, where currently does not exist definitive scientific evidence on the efficacy either of conservative or of surgical treatments. AIM OF THE STUDY : To verify the philosophical choices on the final outcome of a group of people believing and engaged in a conservative treatment of idiopathic scoliosis. METHODS : We performed a multifaceted study that included a bibliometric analysis, a questionnaire, and a careful Consensus reaching procedure between experts in the conservative treatment of scoliosis (SOSORT members). RESULTS : The Consensus reaching procedure has shown to be useful: answers changed in a statistically significant way, and 9 new outcome criteria were included. The most important final outcomes were considered Aesthetics (100%), Quality of life and Disability (more than 90%), while more than 80% of preferences went to Back Pain, Psychological well-being, Progression in adulthood, Breathing function, Scoliosis Cobb degrees (radiographic lateral flexion), Needs of further treatments in adulthood. DISCUSSION : In the literature prevail outcome criteria driven by the contingent treatment needs or the possibility to have measurement systems (even if it seems that usual clinical and radiographic methods are given much more importance than more complex Disability or Quality of Life instruments). SOSORT members give importance to a wide range of outcome criteria, in which clinical and radiographic issues have the lowest importance. CONCLUSION : We treat our patients for what they need for their future (Breathing function, Needs of further treatments in adulthood, Progression in adulthood), and their present too (Aesthetics, Disability, Quality of life). Technical matters, such as rib hump or radiographic lateral alignment and rotation, but not lateral flexion, are secondary outcomes and only instrumental to previously reported primary outcomes. We advocate a multidimensional, comprehensive evaluation of scoliosis patients, to gather all necessary data for a complete therapeutic approach, that goes beyond x-rays to reach the person and the family.
Abstract: BACKGROUND: In patients with idiopathic scoliosis (IS), reduced thoracic kyphosis and reduced lumbar lordosis frequently occur in correlation with the lateral spinal curvature. Normalization of the sagittal profile and hyper-correction of the deviation in frontal and coronal plane are the main issues of the latest concept of bracing. The purpose of this study was to investigate the influence of of sagittal counter forces (SCF) on the scoliotic deformity. STUDY DESIGN: A case series of four patients with IS treated with two braces designed to improve the sagittal profile (Rigo-System-Chêneau-brace and with a sagittal counter force brace, SCF-brace). METHODS: The short-term effect (30 min) of both braces was evaluated using surface topography (Formetric surface topography system, Diers International, Wiesbaden). RESULTS: One patient (Cobb angle 92 degrees ) showed no short-term correction in the frontal and coronal planes; others (Cobb angles between 39 and 48 degrees ) exhibited valuable correction in frontal and coronal planes. There was no short-term correction in the sagittal plane for either brace. CONCLUSION: The application of sagittal counter forces (SCF) seems to have similar short-term effects as 3D correction and should be addressed more in future concepts of scoliosis bracing.
Abstract: Although spinal claudication may arise from narrowing of the spinal canal, not all patients with narrowing develop symptoms. The reason why some patients develop symptomatic stenosis and others do not is still unknown. Therefore, the term lumbar spinal stenosis refers to a clinical syndrome of lower extremity pain caused by mechanical compression on the neural elements or their blood supply. Some studies have shown effectiveness of brace treatment with a common supportive LSO. At our Centre the sagittal realignment brace is used for the treatment of chronic low back pain. This is a lumbar lordosing brace theoretically leading to a reduction of the volume in the spinal canal. However a patient with a significant increase in walking distance due to the application of this brace will be presented here. MATERIAL AND METHOD: A 47 year old woman with a 55 degrees lumbar scoliosis, 30 degrees upper lumbar kyphosis and with highest pain levels under medication (Durogesic 25 mg, Ibuprofen 800, Mirtazapin 15 mg) has been treated with a sagittal realignment brace. Self reported walking distance was at around 800 steps before the pain appeared unbearable (since 5 years). Self reported walking distance was recorded (Patients counts) in the brace 2 days and 10 days after adjustment. RESULTS: Walking distance increased to 8000 steps after 2 days and to 12000 after 10 days while pain intensity decreased only one point in the VRS, however without any further medication. CONCLUSIONS: In contrary to current hypotheses about the aetiology of spinal claudication augmentation of lordosis may lead to a significant improvement of symptoms associated with spinal stenosis and lumbar scoliosis.
Abstract: This guideline has been discussed by the SOSORT guideline committee prior to the SOSORT consensus meeting in Milan, January 2005 and published in its first version on the SOSORT homepage: http://www.sosort.org/meetings.php. After the meeting it again has been discussed by the members of the SOSORT guideline committee to establish the final 2005 version submitted to Scoliosis, the official Journal of the society, in December 2005.
Abstract: BACKGROUND : Based on a recognized need for research to examine the premise that nonsurgical approaches can be used effectively to treat signs and symptoms of scoliosis, a scientific society on scoliosis orthopaedic and rehabilitation treatment (SOSORT) was established in Barcelona in 2004. SOSORT has a primary goal of implementing multidisciplinary research to develop quantitative, objective data to address the role of conservative therapies in the treatment of scoliosis. This international working group of clinicians and scientists specializing in treatment of scoliosis met in Milan, Italy in January 2005. METHODS : As a baseline for developing a consensus for language and goals for proposed multicenter clinical studies, we developed questionnaires to examine current beliefs, before and after the meeting, regarding (1) the aims of physical exercises; (2) standards of treatment; and (3) the impact of such treatment performed by specialists in the field. RESULTS : The responses to the questionnaires show that, in principle, specialists in scoliosis physiotherapy do not disagree and that several features can be regarded, currently, as standard features in the rehabilitation of scoliosis patients. These features include autocorrection in 3D, training in ADL, stabilizing the corrected posture, and patient education.
Abstract: BACKGROUND: The effectiveness of orthotic treatment continues to be controversial in international medical literature due to differences in the reported results and conclusions of various studies. Heterogeneity of the samples has been suggested as a reason for conflicting results. Besides the obvious theoretical differences between the brace concepts, the variability in the technical factors can also explain the contradictory results between same brace types. This paper will investigate the degree of variability among responses of scoliosis specialists from the Brace Study Ground of the International Society on Scoliosis Orthopedic and Rehabilitation Treatment SOSORT. Ultimately, this information could be a foundation for establishing a consensus and framework for future prospective controlled studies. METHODS: A preliminary questionnaire on the topic of 'brace action' relative to the theory of three-dimensional scoliosis correction and brace treatment was developed and circulated to specialists interested in the conservative treatment of adolescent idiopathic scoliosis. A particular case was presented (main thoracic curve with minor lumbar). Several key points emerged and were used to develop a second questionnaire which was discussed and full filed after the SOSORT consensus meeting (Milano, Italy, January 2005). RESULTS: Twenty-one questionnaires were completed. The Chêneau brace was the most frequently recommended. The importance of the three point system mechanism was stressed. Options about proper pad placement on the thoracic convexity were divided 50% for the pad reaching or involving the apical vertebra and 50% for the pad acting caudal to the apical vertebra. There was agreement about the direction of the vector force, 85% selecting a 'dorso lateral to ventro medial' direction but about the shape of the pad to produce such a force. Principles related to three-dimensional correction achieved high consensus (80%-85%), but suggested methods of correction were quite diverse. CONCLUSION: This study reveals that among participating SOSORT specialists there continues to be a strongly held and conflicting if not a contentious opinion regarding brace design and treatment. If the goal of a 'treatment consensus' is realistic and achievable, significantly more effort will be required to reconcile these differences.
Abstract: STUDY DESIGN: Prospective comparison of the survival rates of two different bracing concepts with respect to curve progression and duration of treatment during pubertal growth spurt in two cohorts of patients followed up prospectively. OBJECTIVES: To determine whether the results obtained by the use of a soft brace (SpineCor) is comparable to the results of the Chêneau derived TLSO during pubertal growth spurt. BACKGROUND DATA: In recent peer reviewed literature, the SpineCor is described as an effective method of treatment for patients with scoliosis. However, until now, no controlled study has been presented comparing the results obtained with this soft brace to a sample treated with other bracing concepts proven effective. METHODS: Twelve patients with Cobb angles between 16-32 degrees during pubertal growth spurt are presented as a case series treated with the SpineCor. The survival rate of this sample is described and compared to a matched group of patients treated with the Chêneau brace of the same age group. All girls treated in both studies were pre-menarchial with the first clinical signs of maturation (Tanner 1-3). RESULTS: During the pubertal growth spurt, most of the patients (11/12) with SpineCor progressed clinicly and radiologicly as well (at least 5 degrees ). Progression could be stopped changing SpineCor to the Chêneau brace in most of the samples described (7/10). The avarage Cobb angle at the start of treatment with the SpineCor was 21.3 degrees , after an avarage observation time of 21.5 months, 31 degrees. The control sample, primarily treated with the Chêneau brace (n=15), showed at average no progression. Cobb angle at the start of treatment was 33.7 degrees and after the observation time of 37 months, 33.9 degrees . Radiological improvements can be reported for some of the cases (3/15) as well as progressions (3/15). At 24 months of treatment time, 73% of the patients with a Chêneau brace and 33% of the patients with the SpineCor where still under treatment with their original bracing concept, at 42 month follow-up time 80% of the patients with Chêneau braces and 8% of the patients with the SpineCor survived with respect to curvature progression. The differences of the proportions statisticly where highly significant. CONCLUSIONS: The SpineCor does not change natural history of idiopathic scoliosis during the pubertal growth spurt. The use of the Chêneau brace seems to do so. Oncoming studies with the aim to test the efficiency of braces should be based on samples at immediate risk for progression (only girls with first signs of maturation but pre-menarchial).
Abstract: STUDY DESIGN: Retrospective analysis of outcome in terms of prevalence of surgery for adolescent idiopathic scoliosis in patients receiving conservative management. OBJECTIVES: To determine whether a centre with an active policy of conservative management has fewer patients who eventually undergo surgery for adolescent idiopathic scoliosis than a centre where the practice is non-intervention. BACKGROUND DATA: The efficacy of orthoses for the treatment of idiopathic scoliosis was called into question in a recent publication. Because the prevalence of surgery in an untreated group of patients (28.1%) was not significantly different from that in a braced group (22.4%), the authors concluded that bracing appears to make no difference. Based on prior experience, this conclusion is questioned. METHODS: Since 1991, bracing and physical therapy have been recommended for children with adolescent idiopathic scoliosis at a centre in Barcelona, Spain. The scoliosis database was searched for patients with adolescent idiopathic scoliosis who were at least 15 years of age at last review and who had adequate documentation of the Cobb angle. The prevalence of surgery was compared with that of published data from a centre where the practice is non-intervention. RESULTS: From a total of 106 braced cases out of which 97 were followed up, six cases (5.6%) ultimately underwent spinal fusion. A worst case analysis, which assumes that all nine cases that were lost to follow-up had operations, brings the uppermost number of cases that could have undergone spinal fusion to 15 (14.1%). Either percentage is significant statistically when compared to the 28.1% reported surgeries from the centre with the policy of non-intervention. CONCLUSIONS: If conservative management does reduce the proportion of children with adolescent idiopathic scoliosis that require surgery, it can be said to provide a real and meaningful advantage to both the patients and the community. It is contended that conservative methods of treatment should never be ruled out from scoliosis management, because they can and do offer a viable alternative to those patients who cannot or will not opt for surgical treatment.
Abstract: The effectiveness of bracing and the effectiveness of conservative treatment of scoliosis as a whole is widely denied and rejected. We therefore carried out the present study in order to establish whether the work involved in the conservative treatment of scoliosis is reasonable and worthwhile, including as it does the education of patients, techniques of brace moulding, time-consuming follow-ups and the strain put on patients by the treatment itself. STUDY DESIGN: A retrospective analysis of the incidence of surgery in patients with scoliosis presenting every kind of aetiology. To improve comparison with data already published by other centres, this group of patients was matched with the study design of the control group. MATERIALS AND METHODS: Since 1992, in addition to the intensive inpatient rehabilitation programme developed at our centre, we have also been practising moulding techniques according to Chêneau in order to construct scoliosis orthoses of high correction. For the purposes of this study we chose a number of scoliosis patients from our data bank who had had conservative treatment at our centre between 1993 and 1996. All the patients, like those of the untreated control group, were at least 15 years of age at the time they were last investigated or questioned. The incidence of surgery in our group was compared statistically with data published by other centres. RESULTS: Three hundred and forty-three patients (females only) with a curvature of 33.4 degrees (SD = 18.9) were included in our study and could be followed up under the described pre-conditions. Forty-one patients (11.95%) had had surgery. In patients with adolescent idiopathic scoliosis, we found an incidence of surgery of only 7.3% compared with 28% in the control group with the same diagnosis. Statistically, therefore, the incidence of surgery in our group was highly significantly lower than the incidence of surgery in the control group from Ireland and other centres described in literature. CONCLUSIONS: The conservative treatment of scoliosis (which includes outpatient physiotherapy, inpatient intensive scoliosis rehabilitation (SIR) and high-correction-effect bracing based on plastercasting) shows an obvious reduction in the rate of surgery in patients with idiopathic scoliosis compared with untreated scoliosis patients. Thus it can be seen that the conservative treatment of scoliosis may reduce the incidence of surgery, which not only causes considerable medical expenses but also carries with it the risk of repeated operations and further complications. In our study, we also found highly significant differences by comparison with the work of a bracing centre in the USA. Therefore, the quality of the bracing itself and the effects of primary correction must receive greater consideration in future scientific studies on the subject of "conservative" treatment of scoliosis.
Abstract: The goal of this study is to test the hypothesis that physiotherapy-based intervention can reduce incidence of progression in children with IS. Two independent patient groups matched by age and sex at diagnosis were analysed using the outcome parameter, incidence of progression (> or =5 degrees ). One group was untreated and the other received scoliosis in-patient rehabilitation (SIR). Incidence of progression in groups of untreated patients ranged from 1.5-fold (71.2% vs 46.7%) to 2.9-fold (55.8% vs 19.2%) higher than in groups of patients treated with SIR, even when SIR-treated groups included patients with more severe curvatures. Statistically, the differences were highly significant. Efforts to test the hypothesis that physical therapies addressing postural imbalance can be used effectively in the treatment of IS have been limited. The results of this study are consistent with the possibility that a supervized programme of exercise-based therapies can reduce incidence of progression in children with IS.
Abstract: Opinions differ in the international literature about the efficacy of conservative approaches to scoliosis treatment. Because this divergence of opinion corresponds to a great discrepancy in the standards applied to conservative treatment methods, it is not astonishing that the results of conservative treatment as described in the literature also differ. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated.Moreover, it is clear from the published literature that it is the functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance, and pulmonary dysfunction--which require therapeutic intervention. In Germany the triad of outpatient physiotherapy, intensive inpatient rehabilitation, and bracing has proven effective in conservative scoliosis treatment.Indication, content, and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative scoliosis treatment as an alternative to patients, including those for whom surgery is indicated.
Abstract: PURPOSE: The purpose of this study was to answer the question of whether a course of in-patient rehabilitation of 4-6 weeks results in a significant postural improvement in patients with a structural kyphosis. Since all clinical measuring parameters are liable to high margins of error and measuring the surface with the formetric system has shown high reliability in previous studies, this system has been used to evaluate the results of rehabilitation in patients with Scheuermann's disease. MATERIALS AND METHOD: A pre-/post-interventional study was undertaken including only patients (n = 136) with Scheuermann's kyphosis and a thoracic curve pattern. 62 female patients with an average age of 19 years and 74 male patients of average age 20 years were diagnosed with the Formetric system before an in-patient rehabilitation programme of 4-6 weeks. For this study, the maximal kyphotic angle was evaluated. RESULTS: The average kyphotic angle as measured by the surface topography system before inpatient rehabilitation was 60.7 degrees (SD 11.2) and after 54.9 degrees (SD 12.1) for the whole sample of 136 patients. The improvements where highly significant in the t-test. In the cases of the female patients, the maximal kyphotic angle decreased from 62 degrees to nearly 54 degrees; in the cases of the male patients it had decreased from 60 degrees to nearly 55 degrees by the end of the programme. DISCUSSION: After the in-patient treatment, the kyphotic angle decreased very significantly. The range of change was far greater than the margin of error and, thus, the following conclusion may be reached: In-patient rehabilitation with an intensive programme of treatment may result in a correction of structural kyphoses in which there are clear signs of Scheuermann's disease. Consequently in-patient rehabilitation is recommended for adolescents in cases of Scheuermann's kyphoses.
Abstract: Different opinions exist about the efficacy of conservative scoliosis treatment. Because this divergence of opinion corresponds to a great variety of standards applied, it is also not surprising that the results of conservative treatment differ a lot. Scoliosis normally does not have such dramatic effects that immediate surgery would be indicated. Moreover, it is clear that functional and physiological impairments of scoliosis patients--including pain, torso deformity, psychological disturbance and pulmonary dysfunction--require therapeutic intervention. The triad of out-patient physiotherapy, intensive in-patient rehabilitation and bracing has proven effective in conservative scoliosis treatment in central Europe. Indication, content and results of the individual treatment procedures are described and discussed. The positive outcomes of this practice validate a policy of offering conservative treatment as an alternative to scoliosis patients, including those for whom surgery is discussed.
Abstract: In our rehabilitation centre, the treatment of Scheuermann's disease consists of a daily postural education, lasting several hours. As for pain therapy, we mainly apply physiotherapeutic methods with osteopathy, manual therapy, Mc Kenzie and Brügger. In addition, we offer psychological help for pain relief. In case of severe chronic pain, we additionally treat it with acupuncture. Pain therapy with medication is only performed in rare cases. The aim of the present study was to find out if such an intensive rehabilitation programme had any effect on pain level in patients with Scheuermann's disease. An Intervention study (pre-/post-design) was undertaken including the following material: 351 patients suffering from Scheuermann's disease reported their pain level before and after an inpatient treatment. For this aim, we used a visual analog scale (VAS), a numerical scale (NS), a standardised adjective scale (VRS) and a pain frequency scale. In our group, there were 61 female patients with a thoracolumbar Scheuermann's disease, 121 female patients with a thoracic Scheuermann's disease, 92 male patients with a thoracolumbar Scheuermann's disease and 77 male patients with a thoracic Scheuermann's disease. The average age was 17 to 21 years old with an average kyphotic angle varying in the individual groups between 53 and 64 degrees. In the case of the numerical pain severity scale, pain severity was for example 2,9 in female patients with thoracolumbar Scheuermann's disease. In female patients with thoracic Scheuermann's disease, pain severity was also at 2.9. In male patients with thoracolumbar Scheuermann's disease, it was at 2.0 and in male patients with thoracic Scheuermann's disease, it was at 1.9. This numerical pain scale showed highly significant changes in pain severity: 2.1 in female patients with thoracolumbar Scheuermann's disease, 1.9 in female patients with thoracic Scheuermann's disease, 1.4 in male patients with thoracolumbar Scheuermann's disease and 1.8 in male patients with thoracic Scheuermann's disease. There was also a significant decrease in pain frequency. Seen as a whole, each scale showed a pain reduction between 16 and 32%, which is significant in all the cases and even highly significant in some cases. The in patient rehabilitation seems to have a positive effect on pain level in patients with Scheuermann's disease. In case of Scheuermann's disease in adult age, treatment is only indicated when patients suffer from pain. For those reasons, an in-patient intensive program of rehabilitation in a clinic with adequate quality structure should be considered.
Abstract: For the follow-up of patients with sagittal spinal deformities and postural disorders, we do not have well validated measuring systems at our disposal. All clinical measuring parameters are liable to a high margin of error. With a growing number of patients suffering from postural disorders and kyphoses, we have to look for other possibilities to monitor changes of the back, as well as in the short term, without the support of X-rays. As the measuring of the surface with the Formetric system showed a high measurement reliability in previous studies, we used this system to demonstrate the rehabilitation results of our patients with Scheuermann's disease. An intervention study (pre-/post-design) was undertaken including the following material.: 62 female patients with Scheuermann's disease and an average age of 19 years old and 74 male patients with Scheuermann's disease and an average age of 20 years old were measured with the Formetric system before an in-patient rehabilitation of four to six weeks. For this study, we evaluated the maximal kyphotic angle as shown by the system. In the case of female patients, the maximal kyphotic angle decreased highly significantly from sixty two to nearly fifty four degrees. In the case of the male patients, it decreased from sixty to nearly fifty five degrees at the end. It showed that the surface measuring system with the Formetric System is a reliable instrument for the follow-up of sagittal postural disorders and kyphoses for the present study, especially in the case of Scheuermann's disease. In praxis, the use of this measurement is very easy, we obtain the measurement results very quickly, so that the evaluation of data is not very time consuming. After the in patient treatment, the kyphotic angle decreased highly significantly. The changes range far above the margin of error, thus the following conclusions are justified. Firstly, the Formetric System is the appropriated instrument for the follow-up of postural disorder and kyphoses. Secondly, the in-patient rehabilitation with an intensive treatment program may result in a correction of also structural kyphoses with sure signs of Scheuermann's disease. Thus we recommend an in-patient rehabilitation in adolescent age in case of Scheuermann kyphoses with large curvatures and in case of Scheuermann kyphoses in adults suffering from pain.
Abstract: In our centre, physiotherapy and braces are the main approaches in the management of scoliosis and kyphosis as well. If a surgical intervention is necessary patients are guided to the appropriate centre for spine surgery. In order to avoid surgery, we are looking for possibilities to improve the conservative facilities of spinal deformities management. The aim of our study was to find out whether the use of passive transverse forces (PTF) applied on the deformed body is useful in the rehabilitation process of patients with spinal deformities. A randomized controlled study was undertaken including 126 patients with scoliosis treated with our intensive rehabilitation programme and 4 to 6 PTF treatments lasting 20 minutes per treatment. This group had a curvature angle of 38,7 degrees (SD 16,8) thoracic and 32 degrees (SD15,1) lumbar. Average age was 14,8 years (SD2,7). The control group of 126 patients had a curvature angle of 33,1 degrees (SD 16,1) thoracic and 26,9 degrees (SD12,7) lumbar. Average age was 15,2 years (SD2,3). The patients were randomized by the third author in order to have inpatient rehabilitation and PTF or intensive inpatient rehabilitation alone. For the result evaluation we carried out an investigation before and after the intensive inpatient rehabilitation phase of 4-6 weeks long with the surface measuring system (Formetric system). We evaluated the average lateral deviation value, measured in mm, as given out by the system. The value of average lateral deviation in the treatment group decreased highly significantly (p=.00157) with an average improvement of 1.27 mm. The controls also improved comparing the value for the average lateral deviation before and after rehabilitation with an average difference of 0.94 mm, which was not significant in the T-test (p=0.10032). When comparing the treatment group (PTF) without additional braces (n=52) the difference was even bigger with 1.50 mm (p=.0307). The control group without brace showed similar results as the entire control group. Only uncorrected posture can be measured with the Formetric system. When trying to show the possible postural corrections with the help of the Formetric system, more than 50% of the scans show artefacts resulting from the fact that the points necessary for calculating the spinal deviation can no longer be automatically recognized. For this reason also the changes after an intensive inpatient rehabilitation are very moderate, even if they show a significant tendency to postural correction in larger groups. In smaller groups however, we generally only find the nonsignificant tendency to postural correction. Significant values were obtained with additional application of the PTF treatment. This proves the efficacy of passive forces combined with intensive physiotherapy aiming at an active stabilization of the passively mobilized spine. The uncorrected posture is improved significantly by inpatient rehabilitation and PTF, thus the treatment of scoliotic patients with the described methods is superior to inpatient rehabilitation alone.
Abstract: The aim of this study is to test the hypothesis that physiotherapy-based intervention can reduce incidence of progression in children with IS because progression of spinal curvature in patients with idiopathic scoliosis (IS) is of paramount concern in treatment strategies. Follow-up of the outcome of two prospective studies using the outcome parameter, incidence of progression (> or = 5 degrees), in treated and untreated patient groups matched by age, sex, and degree of curvature at diagnosis. A six-week scoliosis in-patient rehabilitation (SIR) program offering patient-specific physiotherapy including intensive therapist-assisted exercise in diagnosis-matched groups. A followup home therapy regime is designed for each patient. Incidence of progression in groups of untreated patients ranged from 1.5-fold (71.2% vs 46.7%) to 2.9-fold (55.8% vs 19.2%) higher than in groups of patients treated with SIR, even when SIR-treated groups included patients with more severe curvatures. Statistically, the differences were highly significant. Postural imbalance is a component of spinal curvature and can be a causative mechanism. However, efforts to test the hypothesis that physical therapies addressing postural imbalance can be used effectively in the treatment of IS have been limited. The results of this study indicate that a supervised program of exercise-based therapies can reduce incidence of progression in children with IS.
Abstract: Scoliosis may lead to multiple impairments depending on its seriousness. Here we have to make the distinction between direct impairments in the physical field and indirect impairments in the psychosocial field. The findings of different studies indicate that the psychosocial situation in juvenile and adult scoliotic patients is characterized by increased strain. The present study is meant to answer the question in which fields of quality of life female scoliotic patients are impaired and if these impairments are dependent of age or seriousness of illness (Cobb angle). Between May 1998 and February 1999, 226 female patients with idiopathic scoliosis were surveyed in a special clinic for spinal deformities with the help of different quality of life measuring instruments (SF-36, BFW, STAIK) and were compared with norm values. Women with idiopathic scoliosis were questioned with the help of an age adapted set of questionnaires containing questions referring to the health related quality of life (SF-36, BFW, STAIK). The results were compared to the norm values and examined in uni- and multivariat procedures (MANOVA) in order to find out if age and seriousness of illness (Cobb angle) have any impact on the quality of life. In comparison to the norm random sample, the juvenile female scoliosis patients showed a less positive point of view towards life (p = .001) and were easier subject to depressive moods (p = .021). The increased strain of adult patients was shown both in the psychic field (p < .001) and in the physical field (p < .001) (SF-36). These results are largely independent of the seriousness of illness (Cobb angle) and of the patients' age. The results indicate that idiopathic scoliosis in children, adolescents and adults can be regarded as a risk factor for the impairment of health related quality of life and thus stress the importance of psychosocial offers during a patient-orientated scoliosis treatment in order to improve the management of scoliosis.
Abstract: In our centre, the postoperative scoliosis rehabilitation consists in stabilizing postural and respiratory exercises lasting several hours a day (5 1/2 to 7 hours). Additionally to pain treatment, we apply pain physiotherapy, physical therapy, acupuncture and besides manual medicine, also a psychological intervention and pain treatment by medication. 46 patients suffered from heavier pain 10 or more years after scoliosis surgery. The patients reported their pain at the beginning and at the end of 3-6 week in-patient rehabilitation programme. We applied a visual analogous scale (VAS), a numerical scale (NS), a standardized adjective scale (VRS), and a pain frequency scale. All the patients with an average age of 36 years old (SD=16) and an average curve angle of 35 degrees thoracic (SD=36) and 26 degrees lumbar (SD=22) showed a decrease of the values on the pain intensity scale. Pain reduction was highly significant, as well as pain frequency. Chronic pain as a late result following scoliosis surgery can be reduced by an intensive in-patient rehabilitation, at least in the short term. There are further necessary studies in order to follow-up the long-term effect of postoperative rehabilitation.
Abstract: PURPOSE: A new, non-invasive method of 3D-measurement is presented which allows the spatial recording of the entire body surface in scoliotic deformities. The application of the system is examined to raise automatically anthropometric data of patients with scoliosis. METHOD: 32 patients with idiopathic scoliosis were examined (average age 15.3 years, 25 girls and 7 boys, Cobb angles between 11 and 72 degrees). The whole body recording is carried out with a 3D laser scanner. During the measuring process the patient is standing in a frame. Within the measuring time of 15 seconds the body surface is registered by lasers and four cameras. The measured values are converted to a digital 3D model. The resolution is up to 1 mm. On the digital 3D model an automatic calculation of defined anthropometric parameters were carried out. Each patient was measured twice. RESULTS: In all patients a virtual 3D model with a high surface accuracy was obtained. Was the model the typical body asymmetries in scoliotic deformities were visible. The automatic calculation shows a mean deviation of the second measurements between 0.23 and 0.71 cm. The reproducibility depended on the type of the measured parameters. CONCLUSIONS: The laser scanning system allows a rapid, touchless and accurate 3D measurement of the whole body in scoliotic deformities. To determine anthropometric parameters the reproducibility of the automatic calculation is sufficient in most parameters.
Abstract: The effectiveness of conservative scoliosis treatment, including bracing, is widely denied. Like any therapeutic intervention, conservative scoliosis treatment including patient education, techniques of brace moulding, and time-consuming follow-ups is reasonable only if the benefits outweigh the strain placed upon the patient by the treatment. The most important benefit of early intervention in scoliosis is prevention of the need for spinal fusion surgery. Retrospective analysis of the incidence of surgery for patients with scoliosis, by comparison with incidence in an untreated control group. Since 1992 the bracing technique according to Chêneau has been applied in parallel with the scoliosis inpatient intensive rehabilitation programme (SIR). For this study we chose from our data base the scoliosis patients who had conservative treatment at our center between 1993 and 1996. All patients, like those of the control group, were at least 15 years of age at the time they were evaluated for the last time. The incidence of surgery of our group was compared with that reported by a center in Ireland. Of 343 female scoliosis patients with a curve angle of 33.4 AE (SD=18.9), 41 (11.95%) had surgery. The incidence of surgery of our collective was significantly lower than the incidence of surgery of the control group which reported an incidence of 28,1%. The AIS matched group of patients (n = 179) had an incidence of surgery of slightly more than 7%. When compared with a matched control group of untreated patients, incidence of surgery was significantly reduced by SIR combined with bracing. So conservative management is indicated in patients with scoliosis.
Abstract: STUDY DESIGN: The health-related quality of life of 226 female patients with idiopathic scoliosis was compared with that in age-matched general population norms. OBJECTIVES: To describe and characterize health-related quality of life in women with idiopathic scoliosis, taking into account age, Cobb angle, and brace use. SUMMARY OF BACKGROUND DATA: Scoliosis may lead to multiple physical and psychosocial impairments depending on its severity. Previous studies have assessed generic health measures, functional status, body image, and self-image. Health-related quality of life data from patients with idiopathic scoliosis are still lacking. METHODS: Women with idiopathic scoliosis completed an age-appropriate health-related quality of life questionnaire (either the 36-Item Short-Form Health Status Survey, SF-36, or the Berner Questionnaire for Well-Being). The results from this sample were compared with general population norms. In univariate and multivariate analyses it was determined whether age, Cobb angle, and brace use had an impact on health-related quality of life. RESULTS: Compared with the age-matched general population norm, juvenile patients with idiopathic scoliosis were unhappier with their lives (P = 0.001). They reported more physical complaints (P < 0.001) and had lower self-esteem (P = 0.01) and higher depression scores (P = 0.021). Adult patients reported more psychologic (P < 0.001) and physical impairment than in the population norm (P < 0.001). These results were largely independent of age and Cobb angle. CONCLUSION: The results show that health-related quality of life can be impaired in patients with idiopathic scoliosis. Therefore, the psychosocial situation should be taken into account in the treatment of these patients.
Abstract: The purpose of this study was to assess the effectiveness of a scoliosis-specific rehabilitation programme as it is carried out in the Katharina Schroth Spinal Deformities Rehabilitation Center. Physiotherapy in the treatment of scoliosis patients is still regarded as ineffective since the study by the American Orthopedic Association in 1941, which showed that general exercises could not influence the natural history of scoliosis. However, specific exercise programmes were not known in the USA at that time. This preliminary study started in 1989 with the following inclusion criteria: (1) diagnosis of idiopathic scoliosis; (2) risser sign < 4; (3) no treatment other than physiotherapy; (4) first control after 1-3 years during repeated in patient treatment; (5) standing AP radiograph taken not more than 6 months before the first in patient treatment. A total of 181 scoliosis patients, with an average age of 12.7 years and an average angle of curvature of 27% according to Cobb, were included in this study. The average risser sign was 1.4, the average follow-up 33 months. The Cobb angle of the major curve was measured in a standardized way. The results of our preliminary study were compared to natural history as known from literature. For the worst-case analysis additionally a questionnaire was sent to the non-repeaters treated at our centre at the same time (1989 and 1990) as the patient sample described above, taking into account the same inclusion criteria for this patient sample except point 4. Results showed that progression as usually defined (increase in curvature of 5 degrees or more per year) has not been found in the preliminary study. The patient sample of this study was divided into different age groups and different groups of curve magnitude, for comparison with other studies. Additional to the patient sample of the preliminary study, 116 of the patients from the years 1989 and 1990 fulfilled the inclusion criteria of the preliminary study with the exception of point 4. These patients formed the questionnaire sample for the worst-case analysis showing that the progression rate of the 181 patients from the preliminary study and the 116 patients of the questionnaire sample together was still better than natural history even if all drop-outs were considered to be failures. The fact that there was no relative progression in our patients sample treated solely by physiotherapy (preliminary study), seems to show the effectiveness of the inpatient rehabilitation programme even in cases with a bad prognosis, severe angles of curvature and unfavourable curvature patterns. A worst-case analysis does not prevent this conclusion, even if all dropouts from the non-repeaters group were considered as failures.
Abstract: The measurement of vertebral rotation according to Perdriolle is widely used in the French-speaking and Anglo-American countries. Even in this measurement technique there may be a relatively high estimation error because of the not very accurate grading in steps of 5 degrees. The measurement according to Raimondi seems to be easier to use and is more accurate, with 2 degrees steps. The purpose of our study was to determine the technical error of both measuring methods. The apex vertebra of 40 curves on 20 anteroposterior (AP) radiographs were measured by using the Perdriolle torsion meter and the Regolo Raimondi. Interrater and intrarater reliability were computed. The thoracic Cobb angle was 43 degrees, the lumbar Cobb angle 36 degrees. The average rotation according to Perdriolle was 19.1 degrees thoracic (SD 11.14), 12.7 degrees lumbar (11.21). Measurement of vertebral rotation according to Raimondi showed an average rotation of 20.25 degrees in the thoracic region (11.40) and 13.4 degrees lumbar (10.92). The intrarater reliability was r = 0.991 (Perdriolle) and r = 0.997 (Raimondi). The average intrarater error was 1.025 degrees in the Perdriolle measurement and 0.4 degrees in the Raimondi measurement. Interrater error was on average 3.112 degrees for the Perdriolle measurement and 3.630 degrees for the Raimondi measurement. This shows that both methods are useful tools for the follow-up of vertebral rotation as projected on standard X-rays for the experienced clinical. The Raimondi ruler is easier to use and is slightly more reliable.
Abstract: The prospective study reported here was instituted in 1987 to obtain more detailed data on the efficacy of scoliosis-specific spinal rehabilitation after Schroth. Inclusion criteria were 1) idiopathic scoliosis, 2) Risser stage < 4, 3) no treatment with corset or electrical stimulation, 4) first examination between 1 and 3 years postoperatively, 5) usable total X-rays taken with the patient standing not more than 6 months prior to admission. A total of 181 scoliosis patients with an average age of 12.76 years and an average Cobb angle of 27 degrees were included in the study. The average Risser's sign was 1.4 and the average follow-up period was 33 months. No cases of relative progression (annual increase in curvature of 5 degrees or more) were observed. For the purpose of comparison with the spontaneous course, the patients were grouped by age and severity of scoliosis. Both the absence of any relative progression as well as direct comparison of the development of scoliosis under therapy with the spontaneous course confirmed the efficacy of the stationary rehabilitation programme notably in cases with poor prognosis, i.e. with large scoliosis angles and unfavourable curvatures.
Abstract: A total of 37 scoliotic patients (33 female, 4 male), aged 20-57 years, participated in a pre-/post-interview study on the basis of the Frankfurt self-concept scales FSKN (Frankfurter Selbstkonzeptskalen; Deusinger 1986). The patients stayed at the Katharina Schroth Clinic for 4 to 6 weeks, with questionnaires to be filled in 1-2 days after admission (pre-interviewing) and 2 days before discharge (post-interviewing). The study findings indicated a positive impact of the in-patient treatment relative to a variety of patient self-concepts. This is clearly suggested by the self-ratings concerning: general coping ability; own sensitivity and mood; own self-assertion towards groups and significant others; perceived appreciation by others; feelings towards and relationship with others; general self-worth; and own ability to make contact and interact. The statistically significant changes in a positive direction found for 7 of 10 self-concept scales, are interpreted to the effect that the in-patient treatment on the whole has ushered in a process of emotional stabilization in the patients, which certainly would be considered an essential precondition for their continued capacity for work.
Abstract: In order to monitor changes in postural performance capacity in patients with idiopathic scoliosis after an intensive in-patient Schroth rehabilitation programme lasting several weeks, we undertook electromyographic investigations in 316 patients with a mean age of 20 years (range 8-76 years) and a mean Cobb curvature angle of 38.2 degrees (range 10 degrees-147 degrees). Electromyographic activity was recorded by means of surface electrodes in the thoracic and lumbar region at the level of the apical vertebra, paravertebrally on both sides of the erector spinae muscle during trunk lifting from the prone position. Two hundred and fifty-nine recordings without artefacts were evaluated. Significant reductions in muscle activity of 6.85% in the thoracic convex region (P < 0.05) and of 14.2% (P < 0.001) on the lumbar convex side were found. The activity quotient (convesx/concave) was reduced by 11.99% (P<0.001) in the thoracic region and by 7.91% (P<0.01) in the lumbar region. These findings confirm the improvement of postural performance capacity after an intensive in-patient Schroth rehabilitation programme. As the imbalance of electromyographic activity may be influenced by scoliosis-specific exercises leading to a highly significant reduction of the Cobb angle, it is assumed to be secondary to the development of the scoliotic curve and may not be a primary factor in the aetiology of idiopathic scoliosis.
Abstract: In 107 patients with idiopathic scoliosis radiographs were performed under standard conditions immediately before and immediately after a 4-6 week in-patient exercise program at the Katharina-Schroth Hospital. The average angle of curvature as measured by the Cobb technique was 43.06 degrees (standard deviation = 22.87) before treatment and 38.96 degrees (SD = 23.00) after treatment. An improvement in the curve of 5 degrees or more was found in 43.93% of the patients, 53.27% were unchanged and in 2.8% the curve increased by 5 degrees or more. Altogether the improvements in curvature were highly significant. These results show that even in severe scoliosis the magnitude of the curve can be reduced by a specific rehabilitation program of physiotherapy.
Abstract: Rehabilitation treatment of adult patients with scoliosis essentially is of a secondary prevention orientation. Along with countering curve progression, the main focus is on improving secondary functional impairments of the cardiopulmonary system as well as on the management of scoliosis-induced pain. In-patient physiotherapy rehabilitation provides major impacts in these respects, especially since they have proven their worth in obtaining increases in vital capacity, rib mobility, cardiopulmonary functioning, and in reducing scoliosis-induced pain complaints.
Abstract: All 813 patients with idiopathic scoliosis who completed their first Schroth physiotherapeutic rehabilitation program at the Katharina Schroth Hospital between 1984 and 1987 were reviewed. The patients were divided into four age groups. In Group I (10-13 years, N = 278), vital capacity in patients treated for the first time improved by 18.94% (445 ml). In Group II (14-17 years, N = 264), the average increase in vital capacity after initial treatment was 16.33% (497 ml). In Groups III (18-24 years, N = 123) and IV (greater than 24 years, N = 148), the corresponding increases were 15.11% (501) and 13.77% (394 ml), respectively. In the 256 patients receiving repeat treatment, the increases in vital capacity in the respective age groups amounted to just more than half those in the patients treated for the first time. The average increase in chest expansion was more than 20% in all groups at all measuring points. These findings show that a course of inpatient treatment by the Schroth method can lead to an increase in vital capacity and chest expansion so that, even in adult scoliosis patients, effective treatment of the associated restrictive ventilatory disorder is possible.
