Evaluation of Brace Treatment Using the Soft Brace Spinaposture: A Four-Years Follow-Up

Abstract

The braces of today are constructed to correct the frontal plane deformity of idiopathic adolescent scoliosis (AIS). The Spinaposture brace© (Spinaposture Aps, Copenhagen, Denmark) is a soft-fabric brace for AIS and is designed to enhance rotational axial stability by inducing a sagittal plane kyphotic correction. This prospective observational study evaluated the brace in fifteen patients with AIS. The initial average CA was 16.8° (SD: 2.8). They were followed prospectively every 3 to 6 months during their brace usage until skeletal maturity of 25 months and at long-term follow-up of 44 months. In- and out-of-brace radiographs were performed in six subjects at inclusion. This resulted in an immediate in-brace correction of 25.3 percent in CA (14.3°→10.8°) and induced a kyphotic effect of 14.9 percent (40.8°→47.9°). The average in-brace improvement at first follow-up was 4.5° in CA, and the CA at skeletal maturity was 11° (SD: 7.4°) and long-term 12.0° (SD: 6.8°). In conclusion, the Spinaposture brace© had an immediate in-brace deformity correction and a thoracic kyphotic effect. At skeletal maturity, the deformities improved more than expected when compared to that of the natural history/observation and similar to that of other soft braces. No long-term deformity progression was seen. To substantiate these findings, stronger designed studies with additional subjects are needed.

Keywords: bracing; follow-up study; idiopathic scoliosis; pathobiomechanics; spinal deformities.

Figure 1

The ‘suit’ of the Spinaposture brace (left), a schematic diagram of the ’shield with fingers’ and placement of the shield (middle) and the Spinaposture brace© worn by a subject (right).

Figure 2

An example of radiographs using the low dose technique.

Figure 3

Timeline of the subject’s participation. *¹ Six patients had initial in and out-of-brace radiographs as part of the inclusion process. *² Seven patients did not fulfil the inclusion and exclusion criteria, thus were excluded. *³ Fifteen subjects were included with an improvement of one-fourth in Cobb’s angle. *⁴ Five subjects dropped out due to change to other brace strategies by their own accord. *⁵ Evaluation at skeletal maturity and when the soft brace was discontinued. *⁶ Two subjects did not participate in the follow-up at four years. *⁷ Evaluation at follow-up at four years.

Figure 4

In-brace (picture two and four from left) and out-of-brace (picture one and three from left) of the frontal and sagittal radiographic examinations of a 10-year-old girl. The brace can be identified by the zipper at chest level in picture two and the ‘fingers’ are seen in picture four.

Figure 5

Average changes in Cobb’s angle (±one standard deviation) over time in the follow-up from the brace initiation to the long-term follow-up. (Upper-A).

Figure 6

An example of a period with daytime and nighttime use of the brace. The heat sensor would register the temperature rise when the brace was worn. A period of brace use is seen on the left-hand side of the figure (compliance) and a period of non-compliance is seen on the right-hand side of the figure. (Upper-A).