RESUMO
BACKGROUND: Scoliosis is a 3D deformity that can be reconstructed through 2D antero-posterior and lateral radiographs, which provide an upper view of the deformed spine as well as regional planes matching all vertebrae of elective plane for each curve. The objective of this study is to explore whether all idiopathic scoliosis classified Lenke 1A have the same 3D representation made with regional planes. METHODS: All patients treated for idiopathic thoracic scoliosis during the growth period and classified Lenke 1A were included in this study conducted in the pediatric spinal orthopedic department of Centre des Massues. A photogrammetric technique was used to obtain a 3D reconstruction, from regional planes identified on radiographs made with the EOS system. Three regional planes are usually identified in asymptomatic spines: lumbar, dorsal, and cervical-none of them presenting rotation. In the studied group, the number of planes, the rotation, and the limit vertebrae of each plane were looked for. RESULTS: Sixty-three patients were included (47 girls and 16 boys, mean age 11.3 years). The Cobb angle was meanly 36.5°. The scoliosis was reconstructed with three regional planes (57%) or four ones (43%, with the thoracic plane divided into two planes). Maximal rotation was found in the thoracic plane, especially when scoliosis was represented with four regional planes. The transition between planes 2 and 3 was mainly located between the fourth and sixth dorsal vertebrae. CONCLUSION: The use of an arbitrary regional plane representation of a 3D shape leads to conclude that there are two types of Lenke 1A scoliosis, which should be taken into account for designing the brace.
RESUMO
OBJECTIVES: The purpose of this retrospective study was to investigate whether treatment with a carbon brace (CMCR) stops the progression of idiopathic scoliosis in children and adolescents affected by combined or thoraco-lumbar scoliosis. METHOD: We compared clinical features (hump and vital capacity) and radiolographic data (Cobb angle, sacral slope, lumbar lordosis and thoracic kyphosis) at brace set-up and removal in 115 children and adolescents with combined or thoraco-lumbar scoliosis. The impact of the brace was evaluated in 2 subgroups: patients who started the treatment at Risser stages 0, 1 or 2 and those who started the treatment at Risser stages 3 or 4. With 95 patients, a questionnaire was used to evaluate the physical and psychological tolerance of the brace and technical difficulties during treatment with the orthosis. RESULTS: At brace set-up, the immediate angular correction was about 50% compared to the pre-brace angle; the reduction of the vital capacity was weak. After brace removal, radiographic data showed significant improvement in thoraco-lumbar scoliosis and in the lumbar curve of patients with combined scoliosis, although the thoracic curvature of the combined scoliosis was unchanged. No significant efficiency on the hump was observed. CONCLUSION: The CMCR brace can stop the progression of moderate combined or thoraco-lumbar scoliosis in growing children and adolescents, with little consequence to vital capacity, but seems to have no efficacy on the hump. This type of orthosis provides a better outcome in terms of thoracic mobility and vital capacity. The CMCR brace is indicated for children and growing teenagers with flexible, progressive scoliosis. This "mobile" brace definitely has its place in the current therapeutic arsenal.
