European Vertebral  Deviation Center - Clinique du Parc - Lyon (France)    6 months Results

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RESULTS OF 390 JUVENILE AND ADOLESCENT IDIOPATHIC SCOLIOSIS IN ACCORDANCE WITH SRS CRITERIA TREATED BY THE NEW LYON ARTBRACE AND REVIEWED AT 6 MONTHS.


Authors and Institutions: De Mauroy JC, Gagliano F, Barral F, Pourret S.


Introduction: The ARTbrace is a technological evolution of the classic Lyon conservative treatment with replacement of the Elongation Derotation Flexion plaster cast by a digital cast allowing the design of an asymmetrical brace with very high rigidity. The comparison with the old Lyon brace has demonstrated the superiority of the ARTbrace. Four years after the first ARTbrace more than 1000 patients have been treated with this new brace.
With ARTbrace, a previous study shows also that there is a correlation close to 0.9 between the angulation 6 months after fitting the brace and the final result 2 years after weaning the brace. Landauer and Aulisa showed also a predictive correlation at 6 months.
For scoliosis of more than 40°, the results at 6 months were significantly superior to those of the old Lyon brace. The SRS and SOSORT criteria allow comparison of results with other braces.
Objective(s): The aim is to present the results of Cobb angle at the first 3 stages of treatment: 1. initial, 2. immediate in-brace correction and 3. without brace at 6 months.
Method(s): 748 patients were treated with ARTbrace from May 2013 to March 2017. 413 patients responded to the SRS and SOSORT criteria. 23 drop-outs (6%) were excluded and 390 consecutive patients (318 females & 72 males) were selected from our prospective database. The Cobb curve magnitude (CM) of the 507 primitive curves (279 thoracic and 228 lumbar) is registered before bracing (t1), in-brace (tB)and at 6 months without brace (t2). Lenke 5 lumbar curves are excluded as treated by the short GTB brace.
Design: Case series of all consecutive patients. All descriptive parameters are studied with the SPSS v20 package.
Result(s) and Discussions: The average age of patients was 13.5 years (SD = 6.78)
The results of our study showed that for the Thoracic curves CM mean value was 30.06 ± 6.78 SD at t1, 10.82 ± 6.82 SD at tB and 20.03 ± 7.39 SD at t2.
The average results of our study showed that for the Lumbar curves CM mean value was 28.70 ± 7.40 SD at t1, 7.65 ± 7.12 SD at tB and 17.00 ± 7.67 SD at t2.
The results for all 507 primitive curves was: 29.45 ±5.07 SD at t1, 9.40 ± 7.13 SD at tB and 18.65 ± 7.66 SD at t2.


The average percentage of correction was 69.2% at tB and 37.6% at t2, identical to our previous publications. (Figure 1)
At t2 Curve correction was accomplished in 333 patients (85.4%), stabilization was obtained in 54 patients (13.8%), 3 patients have a progression (0.76%).


The drop-out rate is low and probably related to the initial motivation of patients who are aware of avoiding the plaster cast.
The initial average angulation of 30°, the in-brace correction of 70%, and the correction of more than 30% without brace at 6 months are identical to that of the general statistics.


The in-brace correction is superior to other asymmetric braces such as the Chêneau brace (40%) probably related to the very high rigidity of polycarbonate and the design from digital cast. The results at 6 months without brace are also better than those published and seem to confirm the correlation between the immediate in-brace correction and the final result of the treatment.

Conclusion(s) and Significance: Our study confirms the improvement of the results compared to the old Lyon brace with the possibility of avoiding the plaster cast with the digital cast in 3 blocks. They can only encourage the patient to continue the treatment with good compliance.
 

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