Introduction: Veldhuizen (2002) developed a new flexible Scoliosis-Brace for effective curve correction in Idiopathic Scoliosis. This new Brace is characterised by a improved cosmetic appearance and wearing comfort compared to conventional ortheses (Cheneau, Boston).

We investigated the effectiveness of the TriaC™-Brace regarding the primary curve correction in Idiopathic Scoliosis (IS).

Materials and Method: Following the guidelines given by Veldhuizen (2002) we have treated 20 patients (15 girls, 5 boys, average age: 12,43) with diagnosis of IS (King I:6, King II:4, King III:8, King IV:1, lumbar:1) with the TriaC™-Brace from 2002–2004.

At the beginning of the therapy with the new orthesis the Risser sign was 2,68 at an average.

The daily wearing time was instructed with 22–23 hours.

Lumbar curves showed an average cobb angle of 26,1 degrees (standard deviation=8,6) and thoracic curves of 24,4 degrees (standard deviation=6,5).

The radiological assessment of primary curve correction (cobb-angle) was performed 6,2 weeks after the beginning of the therapy (anterior posterior radiograph of the spine in standing position with orthesis).

Further radiological controls were performed every six months. We evaluated the wearing time, comfort and leisure activity with a valid scoring system (Quality of Life Profile for Spine Deformities).

The overall mean wearing time of the Triac™-Brace was 14,7 months.

Results: For lumbar curves (n=12) we measured a primary correction of 9,9 degrees (40%; statistically significant, t-test, p=0,01) and for thoracic curves (n=20) of 2,2 degrees (8,4%; not statistically significant, t-test, p=0,42).

A insufficient primary curve correction (defined as < 30% of the initial cobb-angle) was observed in 16 thoracic curves (89%) and in 4 lumbar curves (30%).

An increasing correction during the therapy as reported by Veldhuizen (2002) could not be observed.

There was a curve progression of at least 5 degrees of the cobb-angle in 4 cases.

The evaluation by the scoring system (response in 85%) resulted in a high score for cosmetics (4,2/5) and mobility of the back (4,6/5). The wearing time was reported by 90% of the patients with 22–23h.

Conclusion: We do not recommend the conservative therapy of thoracic or double curves (King III, King I and II) with the TriaC™-Brace.

Larger studies are necessary to investigate the effectiveness of the orthesis in lumbar curves. The improved wearing comfort and cosmetics are a potential advantages of this new orthesis.

Study design: Cross-sectional study of 10 patients to measure the serum levels of cobalt and chromium after TDA.

Summary of Background Data: In total hip endoprosthetics and consequently for TDA (total disc arthroplasty), metal-on-metal combinations are used with the aim of reducing wear debris. In metal-on-metal TDA the release of metal ions has until now been secondary to the main discussion.

Objectives: To investigate the release of cobalt and chromium ions into the serum following implantation of the metal-on-metal MaverickTM type artificial lumbar disc.

Materials and methods: We investigated the serum cobalt and chromium concentration following implantation of 15 Maverick™ TDAs (monosegmental L5/S1 n=5; bisegmental L4/5 and L5/S1 n=5; average age = 36.5 years). 5 healthy subjects (no metal implants) acted as a control group. The measurements of the metals were carried out using the HITACHI Z-8200 AAS polarized Zeeman atomic absorption spectrometer after an average of 14,8months.

Results: The concentrations of cobalt and chromium ions in the serum amounted on average to 4.75μg/l (standard deviation 2,71) for cobalt and 1.10μg/l (standard deviation 1,24) for chromium. Compared to the control group, both the chromium and cobalt levels in the serum showed significant increases (Mann-Whitney Rank Sum Test, p=0.0120). At follow-up the Oswestry Disability Score was on average significantly decreased by 24.4 points (L5/S1) (t-test, p < 0.05) and by 26.8 points (L4-S1)(t-test, p < 0.05). The improved clinical situation is also represented by a significant decrease of the Visual Analog Pain Scale of 42,2points after the follow-up (t-test, p< 0,05).

Conclusion: Significant systemic release of Cr/Co was proven in the serum compared to the control group. The concentrations of Cr/Co measured in the serum are similar in terms of their level to the values measured in THA metal-on-metal combinations or exceed these values given in the literature. Long-term implication of this metal exposuere in unknown and should be studied further.