Brace Treatment can Lead to a Persistent Correction of Adolescent Idiopathic Scoliosis: A Case Report | Chapter 16 | Highlights on Medicine and Medical Research Vol. 11

 The main treatment for patients with scoliosis is brace treatment during the growth spurt. Scoliosis is a spine and trunk deformity that occurs in three dimensions. The bracing norm varies from country to country. Patients are unable to rely on a uniform standard of practise among practitioners. According to the evidence in the literature, braces effectively avoid curvature progression and in some cases also boost trunk deformity. However, there are still concerns about long-term stability. The aim of this case report is to demonstrate a case with long-term clinical and radiological improvement after weaning.

Beginning in 2005, a girl with AIS was treated with a Chêneau light brace. She was 11 years old at the time of treatment, with a Tanner stage of 2 and a Cobb angle of 38° for the single thoracic curvature. The brace had to be replaced after two years of therapy. Cobb angle measurement was 19° on the x-ray taken before the new brace was adjusted. Weaning started at the age of 15 because no further growth was planned. At weaning, the Cobb angle was 14°. The patient recently presented at the age of nearly 21 years, five and a half years after weaning from the brace. As compared to the intermediate result obtained in 2007, there was no difference in trunk deformity. The final Cobb angle was 19°, which was half of the initial Cobb angle. The patient is fully functional and pleased with the end result.

Conclusion: Scoliosis bracing can be very effective and is backed up by scientific evidence. Bracing based on cutting-edge research will help with both the angle of curvature and the trunk deformity. In the long run, bracing based on cutting-edge technologies will lead to significant and long-lasting changes in Cobb angle and trunk deformity.

Author (s) Details

Hans-Rudolf Weiss
Schroth Best Practice Academy, Neu-Bamberg, Germany.

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Adolescent Idiopathic Scoliosis – Pilot Study on the Application of Extra-corporal Shockwave Therapy (ECSWT) | Chapter 15 | Highlights on Medicine and Medical Research Vol. 11

 Scoliosis is a lateral deviation of the spine that has no known cause. Overgrowth of the vertebral column due to a lordo-scoliotic maladaptation of the spine to the subclinical (functional) tether of a relatively short spinal cord can cause the onset and progression of AIS.With the exception of spinal manipulation described by Tomaschewski and neurosurgical release of the filum terminale described by Royo-Salvador, no treatment implications have yet been obtained from the results as published so far.

External manipulation, according to Tomaschewski's logic, can affect the 'flatback' contracture found in the lower thoracic region in patients with early AIS and have a beneficial effect on the 3D deformity of the spine and trunk. The hypothesis for this pilot study was that by using ECSWT, the ‘flatback' contracture that is normal in patients with AIS in the lower thoracic region could be minimised.

Materials and Procedures: Girls aged 12 to 15 years old with a Cobb angle between 20 and 50 degrees (average 35.3 degrees, SD 9.6) were qualified for the analysis (average 14.1years SD 1.1).

(1) Surface Topography (Formetric Diers) before, (2) after 5 minutes in the treatment position without application of ECSWT, and (3) after application of ECSWT were used in the study.

After the intervention, both lateral deviation (RMS = Root Mean Square) and surface rotation (RMS) were steadily reduced. After the intervention, the sagittal parameters kyphosis angle and lordosis angle both increased consistently. The findings were consistent, but not statistically important.

Conclusions: The findings of this study support the idea of a functional tethering of the spinal cord in patients with AIS. In patients with AIS, ECSWT seems to have a positive effect on 3D deformity and the subjective sensation of a tense back. As Tomaschewski points out, manipulating the 'flatback' contracture, which is typical in the lower thoracic region, can be beneficial.

Author (s) Details

Hans-Rudolf Weiss
Schroth Best Practice Academy, Neu-Bamberg, Germany.

Sarah Seibel
Department of Radiology, Medizinisches Versorgungszentrum Mittelmosel, Zell-Barl, Germany.

Marc Moramarco
Scoliosis 3DC, Baldwin Green Common, Suite 204, Woburn, MA, USA.

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