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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
Guido PASQUINI, Francesca CECCHI, Christian BINI, Raffaele MOLINO-LOVA, Federica VANNETTI, Chiara CASTAGNOLI, Anita PAPERINI, Roberta BONI, Claudio MACCHI, Biase CRUSCO, Simone CEPPATELLI, Alvaro CORIGLIANO
Don Gnocchi Foundation, Florence, Italy
BACKGROUND: Bracing therapy for patients with Adolescent Idiopathic Scoliosis (AIS) continues to be a controversial issue. As a consequence, to achieve an adequate level of evidence, there is a strong need for specific studies conducted according to standard outcome and management criteria.
AIM: To assess the outcomes of a modified version of the Cheneau brace, (“Cheneau-P”) in patients with AIS, based on SRS and SOSORT criteria.
DESIGN: Retrospective study.
METHODS: Sixty-seven patients, 56 females and 11 males, participated in the study. Inclusion criteria were: diagnosis of AIS, age ≥ 10 years, Risser score 0-2, Cobb degrees 20-40, no previous treatment, beginning of brace treatment within 1 year after menarche and minimum 2-year follow-up. According to SRS criteria, bracing outcomes were classified, as follows: “improved” (reduction of the curve ≥6°), “unchanged” (5° curve progression or reduction), “worsened” (≥6° curve progression), and “over 45°” (curve exceeding 45° or undergone surgery during the follow-up). The outcomes “improved” and “unchanged” were considered as successful outcomes. Groups and related subgroups were created according to curve type (thoracic , thoraco-lumbar, lumbar and double major) and magnitude (20°-30°; 30°-40°) and to skeletal age (Risser score 0, 1, 2). A separate analysis was also performed on the 37 patients, 30 females and 7 males, who completely fulfilled the SRS eligibility criteria, showing spinal curves between 25 and 40 Cobb degrees.
RESULTS: In the whole group SRS outcome after bracing treatment was successful in 93% and in 81% of patients, at per protocol (PP) and intention to treat (ITT) analysis, respectively, the latter also including drop-outs as worst outcomes. Cobb angles significantly decreased in all subgroups except in patients showing double major curves, lower curve magnitude (20°-30°) and Risser score 2. Rib humps and balance rate also significantly improved in the whole sample (12.78 ± 4.54 at T0 vs 6.83 ± 4.33 at T1 p< 0.001; 60% at T0 vs. 94% at T1 p<0.001, respectively). In the subgroup that completely fulfilled the SRS eligibility criteria, the outcome was successful in 92% and 83% of patients, at PP and ITT analysis, respectively, the latter also including, even in this case, drop-outs as worst outcomes.
CONCLUSIONS: This study shows that in patients with AIS the treatment with the “Cheneau-P” brace is associated with a remarkably high rate of successful outcomes, both in the whole sample and in the subgroup of patients completely fulfilling the SRS criteria.
CLINICAL REHABILITATION IMPACT: The “Cheneau-P” brace proved effective as a conservative treatment for AIS by stabilizing curve progression and limiting the need for surgical treatment.