Correction effects of the ScoliOlogiC "Chêneau light" brace in patients with scoliosis

Abstract

Background: Different bracing concepts are used today for the treatment of scoliosis. The plaster cast method worldwide seems to be the most practiced technique at the moment. CAD (Computer Aided Design) systems are on the market which allow brace adjustments without plaster. The latest development however, is the use of the ScoliOlogiC off the shelf system enabling the orthopaedic technician to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This "Chêneau light" brace, developed according to the Chêneau principle, promises a reduced impediment of quality of life in the brace. However, material reduction should not result in reduced effectiveness. Therefore the primary correction effect in the "Chêneau light" brace has been evaluated and compared with that of other braces used today.

Methods: The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principle of the "Chêneau light" brace were evaluated after an average treatment time of 6 weeks by a full-body X-ray made in the standing position whilst wearing the brace and compared with the last X-ray before bracing. The average curvature angle of the whole group was 35,6 degrees , the average age was 12,9 years (SD 1,9), average Risser sign was 1,3 (SD 1,5), average Tanner rating 2,75 (SD 0,7).

Results: The Cobb angle in the whole group was reduced by an average of 16,4 degrees , which corresponds to a correction effect of 51%. The differences were highly significant in the T-test (T = 17,4; p < 0,001). The best correction effects reported in literature so far are about 40% in two different studies. The correction effect was highest in lumbar and thoracolumbar curve pattern (62 %; n = 18). In thoracic scoliosis the correction effect was 36 % (n = 41) and in double major curve pattern 50 % (n = 22). The correction effect correlated slightly negative with age (r = -0,24; p = 0,014), negatively with the Risser stage (-0,29; p = 0,0096) and correlated negatively with the Cobb angle measured before treatment (r = -0,43; p < 0,0001).

Conclusion: The use of the "Chêneau light" brace leads to correction effects above average when compared to the correction effects of other braces described in literature. The reduction of material seems to affect the desired correction in a positive way.

Figure 1

Comparison Chêneau/Chêneau light. Dorsal and ventral aspect of two patients with comparable curve patterns. The left patient wears a Rigo-System Chêneau (RSC) brace and the patient on the right a Chêneau light brace. The material necessary for the Chêneau light brace is clearly less.

Figure 2

Example of a double major scoliosis treated with a Chêneau light brace. Nearly 13 year old girl with a 29/29° Double major AIS in the ScoliOlogiC „Chêneau light" corrected to 11/9° Cobb.

Figure 3

Example of a patient with an overcorrection in a Chêneau light brace. Overcorrection of a thoracic curve from 38° to -14° in a T2 „Chêneau light" model in an 11-year old premenstrual girl with Tanner II. For the measurement of the corrected curve the neutral vertebra of this X-ray was used. If we would have taken the neutral vertebrae of the previous X-ray the correction effect would have been less important.

Figure 4

Example of a patient with two different high correction braces. 13-year old girl with AIS (39° thoracic). In the previous brace she had 22° high thoracic, 12° low thoracic and 5° lumbar, while in the Chêneau light^® brace she has 22° high thoracic, 8° low thoracic and 11° lumbar. The lumbar correction has not been improved after this x-ray in order to achieve a better balance of curves after treatment and a better cosmetic result. The reduction of material in the Chêneau light^® brace compared to the previous brace is clearly visible.