(1) Orthopedic Rehabilitation Services ‘Gesundheitsforum Nahetal’, Gensingen, Germany
(2) Scoliosis 3DC, Baldwin Green Common, Suite 204, Woburn, MA, USA
* Corresponding authors Emails: hr.weiss@skoliose-dr-weiss.com, marc@drmoramarco.com
Introduction
In the literature, there are papers on scoliosis reporting improvements of spinal curvatures under brace treatment, but this predominately relates to results revealed on X-ray, not clinically. Therefore, it is worthwhile to review the literature showing improvements after brace treatment and to show what can be done conservatively via bracing in curvatures exceeding 45° Cobb.
Materials and method
• A PubMed review of the literature with a keyword search for ‘scoliosis’, ‘brace treatment’ and ‘improvement’ and alternatively for ‘scoliosis’, ‘orthosis’ and ‘improvement’ was conducted.
• Additionally, a case series of patients is demonstrated, with curvatures exceeding 45° clinically and radiologically.
Results
Ninety-two papers were displayed in the keyword search for ‘scoliosis’, ‘brace treatment’ and ‘improvement’ and 79 papers were displayed in the keyword search for ‘scoliosis’, ‘orthosis’ and ‘improvement’.
A case series of three patients with curvatures exceeding 45° is demonstrated within this paper, revealing radiological and clinical improvements when using the recent Chêneau standard of bracing with a reliable computer-aided design library of braces and an experienced team.
Discussion
The solution for the high variability of bracing outcomes is standardization. Braces can be standardized when applying well-tested, standardized brace models from computer-aided design libraries. In comparison, manually-made braces cannot be standardized, resulting in unpredictable outcomes. In addition, there is future advancement potential of baseline quality in braces produced using computer-aided design/computer-aided manufacturing technology.
Conclusion
Trunk and backshape can be improved conservatively even in patients with curvatures exceeding 45°. Modern concepts of bracing may improve even scoliotic deformities exceeding 45° Cobb, radiologically. Clinical improvements, with modern bracing concepts, are comparable to clinical improvements via surgery. For the majority of scoliosis patients with curvatures exceeding 45°, surgery is not indicated, considering the long-term detrimental effects as shown in the literature.
