Maria Adelaide brace in the management of Scheuermann's Kyphosis

Abstract

Purpose: This prospective observational study aims to assess the MA brace effectiveness in hyperkyphosis correction, focusing also on patients' compliance of bracing and its psychological impact.

Methods: Patients referring to our spine outpatient department with Scheuermann's kyphosis (SK) from January 2011 to January 2017 were prospectively recruited. Patients were divided into two groups, according to their global thoracic kyphosis (TK): Group-A TK_T0 < 60°, Group-B TK_T0 ≥ 60°. The MA brace was prescribed according to SRS criteria. Full spine X-rays were analyzed at conventional times: at the beginning of treatment (T0), at 6-months follow-up (T1, in-brace X-rays), at the end of treatment (T2) and at 2-year minimum follow-up from bracing removal (T3). At T₀, T₂ and T₃ all the patients were assessed using the Italian Version of the SRS-22 Patient Questionnaire (I-SRS22). Variability between and within-groups was assessed; a p value < 0.05 was considered significant.

Results: 192 adolescents (87 girls and 105 boys, mean age 13.1) were recruited. The mean global TK at recruitment was 61.9° ± 11.3°, the mean follow-up time was 57.4 months. A good patients' reported compliance was observed: 84.9% of patients used the brace as scheduled. A mean in-brace correction (in-brace TK_%) of 37.4% was observed and a mean final correction (TK_%T3) of 31.6%. At final follow-up (T3), curve reduction (ΔTK ≤ - 5°) was observed in 60.4% of patients and curve stabilization (- 5° < ΔTK < 5) in 29.7% of patients. At baseline, worse SRS22-mental health (p = 0.023) and self-image mean scores (p = 0.001) were observed in Group-B, compared with Group-A. At the end of treatment (T2), an improvement of all items was observed, wit significantly better improvement of self-image domain in Group-B.

Conclusion: The MA brace has shown to be effective in the management of SK; good patients' reported compliance and a positive effect on the patients' mental status were recorded.

Keywords: Anti-gravity brace; Bracing; Developmental kyphosis; Maria adelaide brace; Scheuermann’s kyphosis.

Fig. 1

CAD/CAM MA brace model. a Anterior view. b Posterior view. c Lateral view

Fig. 2

MA brace

Fig. 3

A 14-years old patient managed with MA brace. a Anterior view. b Posterior view. c Lateral view. d Lateral full spine X-rays at recruitment (T₀). e Lateral full spine in-brace X-rays (T₁). f Lateral full spine X-rays at the end of treatment (T₃)

Fig. 4

SRS-22 mean scores at recruitment (Fig. 1a) and at the end of bracing (Fig. 1b). *p < 0.05, p values indicate differences between groups (unpaired t test); ⁺p < 0.05, p values indicate differences within groups (baseline vs end of bracing; paired t test)

Fig. 5

Answers to question 22 from the SRS-22 questionnaire recorded at the end of follow-up (T₃): “Would you have the same management again if you had the same condition?”