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Minerva Ortopedica e Traumatologica 2019 December;70(4):188-92

DOI: 10.23736/S0394-3410.19.03957-2


language: English

Effectiveness and reliability of brace treatment in scoliosis related to Marfan syndrome

Alessandro RAVA 1 , Eugenio DEMA 2, Matteo PALMISANI 2, Rosa PALMISANI 3, Massimo GIRARDO 4, Stefano CERVELLATI 2

1 Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Città della Salute e della Scienza, Turin, Italy; 2 Scoliosis and Spinal Surgery Center, Hesperia Hospital, Modena, Italy; 3 Department of Clinical and Molecular Sciences, School of Medicine, Università Politecnica delle Marche, Ancona, Italy; 4 Unit of Spine Surgery, Department of Orthopedics and Traumatology, Orthopedic and Trauma Center, Città della Salute e della Scienza, Turin, Italy

BACKGROUND: Brace treatment is the most appreciated conservative treatment for spinal deformities and many studies report its results for adolescent idiopathic scoliosis (AIS). On the contrary only few studies regarding brace treatment analyze the treatment of spinal deformities in patients affected by Marfan syndrome (MFS).
METHODS: Patients were selected by reviewing cases of a single specialized spine center. Inclusion criteria were: MFS diagnosis made using modified Ghent criteria, moderate scoliosis with curves range between 15° to 45° Cobb, Risser grade 0-2. All patients were treated with thoracolumbosacral orthoses (TLSO) or cervicothoracolumbosacral orthoses (CTLSO). Patients were requested to wear brace for at least 18 hours daily and were clinically and radiologically controlled during growth. Treatment was continued till skeletal maturity; the success of treatment was defined as a major curve <40° at Risser 5.
RESULTS: A total of 21 patients (13 females and 8 males) aged from 3 to 14 (mean 9.14±2.76) at the start of treatment were included in the study. The upper and lower curves had a mean magnitude of 28.05±5.16°; 53.24±7.92° and 26.85±5.98°; 55.86±8.39° respectively before starting and after brace treatment. Only 9.50% achieved the success of treatment, while in 90.50% of patients we appreciated a slightly progression of the curves over the 45° that needed surgery.
CONCLUSIONS: Despite its low results, brace treatment should be always prescribed to delay the surgical treatment that in MFS patients is burdened by more operative risks compared to AIS.

KEY WORDS: Conservative treatment; Braces; Marfan syndrome; Scoliosis

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