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Online ISSN 1827-1707
ADVANCED SPINE TECHNIQUES
De Mauroy J. C., Vallèse P., Lalain J. J.
Spine Orthopedic Department, Clinique du Parc Lyon, France
The aim of this paper was to evaluate evidence for the efficacy and effectiveness of proposed conservative treatment options in adult deformity. Adult deformity is a major demographic health issue in the geriatric population. Surgeons are often very conservative in the treatment of adult scoliosis because of the complication rates associated with the surgeries and the marginal bone quality endemic to this population. There is currently a lack of consensus on the most efficacious conservative treatments for adult deformity. The Lyon Conservative treatment requires: 1) a plaster cast made in a specific standing frame for 3 weeks; 2) a rigid polyethylene bivalve overlapped brace worn for at least 4 hours per day; 3) a specific physiotherapy to prevent muscle atrophy. The plaster cast is an indispensable prerequisite for this treatment. Besides the therapeutic role of muscular-ligamentous adjustment of paravertebral tension, it can also be used as a test. The patient must be pain-free while pursuing normal activities. Medical complications are a major concern in adult spinal deformity surgery. The incidence ranges between 40% to 86%, but there is indeterminate level III/IV evidence on the effectiveness of any usual conservative care option. Thirty-three adult scoliosis patients (30 women and 3 men), were controlled for at least 5 years after the beginning of the Lyon Conservative treatment. The average age at the beginning of treatment is 60 years. In every case the pain and the posture improved. In 31 cases out of 33, the Cobb’s angle was stabilized. 5 years after initiating treatment, half of the patients are continuing to wear the brace for more than 4 hours a day. Conservative care in general may be a helpful option in the care of adult deformity, but evidence for this decision is lacking. Lyon Conservative orthopedic treatment is effective. The decision regarding the treatment is taken thanks to the first stage of the plaster cast. Basic clinical research at any level would be helpful to further clarify the options.