Abstract
Objective: The development of braces for the non-operative treatment of idiopathic scoliosis has been empirical, based on trial and error. Brace designs have changed periodically over the years, but most modifications have been attempts to improve efficacy and failed to acknowledge the importance, especially to teenagers, of physical appearance. This group resists acting or looking different from their peers, which obviously occurs when a visible brace is worn. Modern materials, lower profiles, and reduced wearing times have been tried, in attempts to reduce resistance and the emotional difficulties encountered with brace wear.
A transverse force system, consisting of an anterior progression force counteracted by a posterior force and torque, acts on the vertebrae of a scoliotic spine. The aim of the newly introduced TriaC brace is to reverse this transverse force pattern by externally applied and constantly present orthotic forces. In the frontal plane the force system is in accordance with the conventional braces. However, in the sagittal plane the force system acts only in the thoracic region. As a result, there is no pelvic tilt, and it provides flexibility without affecting the correction forces during body motion.
Design: In 1996, when we almost completed the design of the new orthosis, we started a prospective trial in our University Hospital, which we expanded in the year 2000 to a prospective multi-center trial.
Subjects: The study included 45 consecutive patients with idiopathic scoliosis treated since 1996 with the newly introduced brace. The group consisted of 40 female and 5 male patients with an average age at the initiation of treatment of 12,6 years. All patients were Risser zero to two and had verified progressive curves (an increase of 5 degrees or more Cobb angle).
Results: Three parameters were measured during treatment: the Cobb angle, lateral deviation and axial rotation of the apex of the scoliotic curve. These measurements were conducted on digital X-rays using the Philips Easy Vision Digital Radiographic technique.[2] Statistical analysis for differences in time for the three measured parameters was performed using the Friedman’s two-way analysis of variance test. Level of significance was reached when the p-value (two-tailed) was less than 0,05.
The new brace prevented further progression of the scoliotic curves, except for seven patients, who required surgery. The initial mean Cobb angle before brace treatment, was 26,5 degrees, the mean lateral displacement at the apex 18,5 millimetres, and the initial axial rotation of the apex was 12,3 degrees. Analysis of differences between each successive visit showed that the difference was not statistically significant for the Cobb angle (p=0,71), nor for the other parameters.
Conclusions: This presentation shows that the preliminary results of the TriaC brace are very promising, but we acknowledge that our patient number is too small to make definite claims. Our failure rate is comparable with the numbers in literature. But being efficacious is not enough; this brace is reasonable comfortable and cosmetically acceptable so that the teenagers who require this treatment will use it.
The abstracts were prepared by Mr Peter Millner. Correspondence should be addressed to Peter Millner, Consultant Spinal Surgeon, Orthopaedic Surgery, Chancellor Wing, Ward 28 Office Suite, St James’ University Hospital, Beckett Street, Leeds LS9 7TF.
References:
1) Veldhuizen AG. Cheung J. Bulthuis GJ. Nijenbanning G. A new orthotic device in the non-operative treatment of idiopathic scoliosis. Medical Engineering & Physics, 2002;24:209–218. Google Scholar
2) Cheung J. Wever DJ. Veldhuizen AG. Van Horn JR. The reliability of quantitative analysis on digital images of the scoliotic spine. Eur Spine J, 2002;11:535–542 Google Scholar
