The Influence of Lumbar Modifiers on Functional and Radiological Outcomes in the Brace Treatment of Lenke Type 1 Adolescent Idiopathic Scoliosis

Abstract

Background Brace treatment prevents the progression of scoliosis and reduces surgical treatment rates. However, the efficacy of brace treatment varies depending on the patientʼs age, gender, curve magnitude and type, structure of the curve, and patient compliance at the beginning of treatment.

Methods Between January 2009 and April 2015, 106 Lenke type 1 AIS consecutive patients (69 females, 37 males) who were treated with a brace were examined in three groups according to Lenke classification lumbar modifiers. The patients were evaluated at pre-bracing and 1 and 2 years after bracing. The Scoliosis Research Society 22 (SRS-22) and Oswestry Disability Index (ODI) were used for functional evaluation. Radiological evaluation revealed the Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, trunk shift, shoulder asymmetry, and body height difference.

Results Functional and radiological evaluation showed a statistically significant improvement in Lenke 1A, 1B, and 1C at 1 and 2 years after bracing compared to the pre-bracing (p = 0.000, p = 0.000, and p = 0.000, respectively). Lenke 1C had the best ODI score and followed by decreasing values of 1B and 1A respectively (p = 0.009). Lenke 1B had the best SRS-22 score and the mean scores of 1A and 1C were equal (p = 0.017). There was no significant difference between the groups in the parameters other than the trunk shift in radiological evaluation (p = 0.043).

Conclusions Significant improvement was observed in all types of lumbar modifiers at the end of the 2nd year compared to pre-bracing. The best improvement in the ODI score was in the 1C modifier, whereas the best improvement in the SRS-22 score was in the 1B modifier. The type of lumbar modifier should be directly taken into consideration before starting brace treatment in Lenke type 1 AIS.

Level of evidence Level III, retrospective study

Zusammenfassung

Einleitung Das Ziel der Korsetttherapie ist, die Progression der Wirbelsäulenkrümmung zu verhindern oder zu reduzieren die chirurgischen Behandlungsraten. Die Wirksamkeit der Korsetttherapie hängt jedoch vom Alter, Geschlecht, der Größe und dem Typ der Kurve, der Struktur der Kurve und der Compliance des Patienten zu Beginn der Behandlung ab.

Methoden Im Rahmen einer retrospektiven Studie wurden 106 aufeinanderfolgende Lenke-Typ-1-AIS-Patienten (69 weiblich, 37 männlich) der Skoliose-Sprechstunde von 2009 bis 2015 bzgl. der Korsetttherapie analysiert. Darüber hinaus werden die Lenke-Typ 1 in Abhängigkeit von der lumbalen Krümmungsform weiter in 3 Typen subklassifiziert (sogenannte lumbale Abweichung Typ A, B und C). Die Patienten wurden bevor die Korsetttherapie und nach der Korsetttherapei im ersten und zweiten Jahr untersucht. Die Effektivität der Therapie wurde anhand der Progression der Functionsbewertung (Scoliosis Research Society 22 (SRS-22) und Oswestry Disability Index (ODI)) und der radiologische Untersuchung (Cobb-Winkel, Brustkyphosewinkel, Lendenlordosenwinkel, Rumpfverschiebung, Schulterasymmetrie und Körpergröße) bewertet.

Ergebnisse Die funktionelle und radiologische Bewertung zeigte eine statistisch signifikante Verbesserung von Lenke 1A, 1B und 1C im 1. und 2. Jahr nach der Kosetttherapie. (p = 0,000, p = 0,000 bzw. p = 0,000). Lenke 1C hatte den besten ODI-Score (p = 0,009). Lenke 1B hatte den besten SRS-22-Score und die Mittelwerte von 1A und 1C waren gleich (p = 0,017). Es gab keinen signifikanten Unterschied zwischen den Gruppen bei den Parametern außer der Rumpfverschiebung bei der radiologischen Bewertung (p = 0,043).

Zusammenfassung Am Ende des 2. Jahres wurde bei allen Arten von Lumbalmodifikatoren eine signifikante Verbesserung im Vergleich bevor die Korsetttherapie beobachtet. Die beste Verbesserung des ODI-Scores war im 1C-Modifikator zu verzeichnen, während die beste Verbesserung des SRS-22-Scores im 1B-Modifikator zu verzeichnen war. Die Art des Lendenwirbelsäulenmodifikators sollte direkt berücksichtigt werden, bevor mit der Korsetttherapie in Lenke Typ 1 AIS begonnen wird.

Evidenzgrad Level III, retrospektive Studie

Key words

adolescent idiopathic scoliosis - Lenke type 1 curve - Cobb angle - brace treatment - functional and radiological outcomes

Schlüsselwörter

adoleszente idiopathische Skoliose - Lenke-Typ-1-Kurve - Cobb-Winkel - funktionelle und radiologische Ergebnisse - Korsetttherapie

Publication History

Article published online:
24 November 2020

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