Evolution of Early Onset Scoliosis under Treatment with a 3D-Brace Concept

Abstract

The objective of this study is to examine the evolution of all the braced patients diagnosed with early onset scoliosis in a private scoliosis center. All patients diagnosed with EOS and braced before the age of ten were retrospectively reviewed. The results have been defined in accordance with the Scoliosis Research Society (SRS) for bracing criteria, and with a minimum follow-up of one year. Improvement and stabilization were considered successful treatments, while failure was considered to be an unsuccessful treatment. Successful results were observed in 80% of patients (63% worst case). In the success group, the Cobb angle was reduced from 36.3° (21-68) to 25° (10-43), with 36% of patients being initially treated only with night-time bracing. Twenty percent of the patients failed, seven had more than 45° at the last control and five had undergone surgery. This study suggests that bracing, using a modern 3D-brace concept, could be an effective treatment option for early onset scoliosis and advocates exploring its effectiveness as an alternative to casting throughout studies of higher levels of evidence.

Keywords: bracing; early onset scoliosis; non-operative treatment.

Figure 1

The brace design when treating a double structural scoliosis (Rigo B Type). Two mechanisms for regional derotation are applied, one at the main thoracic region and another at the lumbar/thoracolumbar region (red arrows). These two mechanisms for regional derotation work in combination with two counter-rotation forces (yellow arrows). Contact areas are provided, laterally, ventrally and dorsally, to guide the frontal as well as the sagittal plane alignment and balance. (The figures describe the brace design showing an adolescent. The brace design in EOS follows the same principles).

Figure 2

The brace design in a single thoracic scoliosis (Left convex in this EOS patient). One single mechanism of regional derotation (red arrows) works in combination with two counter-rotation forces (yellow arrows). Lateral, dorsal and ventral contacts are provided to guide frontal and sagittal plane alignment and balance.

Figure 3

Flow chart. Worst case analysis = 63.2% success (36 success/57 finally included, presuming that cases lost to follow had failed).

Figure 4

Distribution of clinical types according to Rigo Classification (A: Rigo type A; B: Rigo type B; C: Rigo Type C; E: Rigo Type E; NC: Not Classifiable).

Figure 5

Example of success. Result of treatment in a girl braced at 5 years of age with a left lumbar scoliosis of 27°, completing treatment under night-time regimen until 15 years of age at Risser 4, stopping treatment with a left lumbar curvature of 20°.

Figure 6

Girl treated with full-time brace, initiating the treatment at 7 years of age with a 68° thoracic scoliosis. With a 48% in-brace correction in her first brace she showed a good response until 10 years with a scoliosis of 30°. She was followed until 12 years of age still with a scoliosis of 30°. Next control at 13 years, she was still stable with 30°, but had developed a more relevant proximal curvature (after closing this present study). Between 2020 and 2021 (not registered in this present study), she showed a deterioration, with the development of a proximal curve of 43°, forcing us to stop bracing and recommending her to undergo surgery.