 
Results in the Frontal plane
SOSORT 2019 San francisco
FINAL Results 2 years after Weaning for the first 111 patients with
SRSSOSORT criteria
The dropout rate calculated for the first 125 patients is 14%.
Description of the population
111 (92 women and 19 men) AIS (Adolescent Idiopathic Scoliosis) meeting the
inclusion criteria were treated from 29/04/2013 to 02/09/2015. There were 49
primary thoracic curves, 25 double major curves and 37 thoracolumbar curves.
This is a consecutive series extracted from a prospective database started in
1998. The average age at the start of treatment is 13 years and 5 months (± 1
year). At the time of the study 1125 patients had been treated with the
ARTbrace. As the lumbar curves continue to be treated by a short brace, it is
mainly thoracic, thoracolumbar and double major curves.
Statistical analysis
The patients were divided into 2 groups according to the anatomoradiological
location of the curvature: group A = 74 thoracic curvatures and group B 62
lumbar and thoracolumbar curvatures. The clinical and radiological parameters
were studied throughout the treatment: 1. Initial; 2. inbrace; 3. Six months
after placement of the brace (Rx without brace) 4. Removal of the brace; 5. 6
months after weaning; 6. 2 years after weaning.
Standard statistical methods were used for descriptive statistics. Normally
distributed continuous variables were analysed using a ttest based on an
independent sample. Angular changes in Cobb’s angle were evaluated using
unidirectional analysis of variance for repeated measurements.
Demography
111 patients with 136 curvatures divided into 74 thoracic curvatures and 62
primary thoracolumbar and lumbar curvatures. 25 patients had double major
curves. The mean age at the start of treatment was 13.5 (± 1.35).
The initial mean angulation was: 29.9 ° (± = 8.05) (20 ° to 48 °)
The average inbrace angulation was: 8.83 ° (± = 9.24)
Mean angulation at 6 months without brace was: 17.3 ° (± = 10.7)
Mean angulation at weaning was: 18,5 ° (± 11,8)
Mean angulation 6 months after weaning was: 19.5 ° (± = 11.5)
Mean angulation two years after weaning was: 19.1 ° (± = 11.5)
The average percentage of inbrace correction was 73%, the final average
correction two years after weaning was 36% .
95% of the curves are improved by more than 5 °, 5% are stable, no curve is
worsened Cobb Init Inbrace Weaning
29,9° ± 8.0 8,83° ± 9,24 (73% ± 24.6) 18.5° ± 11,8 (33.0% ± 23.6)
For Group A (n = 74), the mean initial angulation was 29.88 ° (± 9.12). The
inbrace angulation was 11.05 ° (± 9.07) (63% correction). Angulation at 6
months without brace was 19.74 (± 10.49). The angulation at weaning was 20.81 (±
11.58). Angulation 6 months after weaning was: 21.76 (± 11.93). Angulation 2
years after weaning was 22.03 ± 11.45, (final correction 34%).
For Group B (n = 62), the mean initial angulation was 27.26 ° (± 6.92). The
inbrace angulation was 6.03 ° (± 8.42) (78% correction). Angulation at 6 months
without brace was 14.13 (± 9.70). The angulation at weaning was 15.73 (± 10.05).
Angulation 6 months after weaning was: 16.56 (± 9.86). Angulation 2 years after
weaning was 15.85 ° (± 9.75), (final correction 42%)
A Pearson correlation coefficient was calculated to evaluate the relationship
between Cobb angulation at 6 months and Cobb angulation 2 years after weaning.
There was an excellent positive correlation between the two variables: r =
0.907, n = 74 p <0.001, for the thoracic curves and r = 0.900, n = 62 p <0.001
for the lumbar curves.
A Pearson correlation coefficient was calculated to evaluate the relationship
between inbrace correction and Cobb angulation 2 years after weaning. There was
a good positive correlation between the two variables, r = 0.866, n = 74, p
<0.001 for thoracic curves and r = 0.742, n = 62 p <0.001 for lumbar curves.
Cohort Results
Comparison <30 °and ≥30 ° for all curves
34 patients had a curve greater than or equal to 30 ° or 25 thoracic curvatures
and 20 lumbar curves. For the group of 71 patients with angulation between 20
and 30 ° we note 43 thoracic curves and 40 lumbar curves. 6 patients with a
curve greater than 40 ° were not included. The results are shown in Table 1.
<30° 
Mean 
SD 
≥30° Mean 
SD 
T init 
24,05 
2,87 
34,88 
5,83 
T in brace 
6,28 
5,26 
15,2 
7,97 
T 6 months 
14,19 
6,32 
23,84 
7,45 
T Weaning 
14,19 
6,89 
26,60 
8,17 
T W + 6m 
14,81 
6,38 
27,56 
8,12 
T W + 2y 
15,49 
6,65 
27,72 
8,11 
L init 
23,15 
2,89 
33,85 
5,04 
L in brace 
3,15 
6,98 
10,15 
7,84 
L 6 months 
10,40 
7,61 
19,45 
8,72 
L Weaning 
12,28 
7,53 
20,15 
9,82 
L W + 6m 
13,03 
6,91 
21,10 
9,86 
L W + 2y 
12,25 
7,50 
20,75 
2,00 
Table 1: Evolution of the results according
to the initial angulation for a cut off of 30 ° 
DISCUSSION
The ARTbrace is currently the most effective brace (70% average inbrace
correction) in respect of the frontal plane. This work confirms that there is a
strong correlation between the inbrace reduction and the final result of nearly
90% for thoracic and lumbar curvatures. The remaining 10% are probably related
to compliance. The average inbrace correction could be compared [10]: Rigo
System Chêneau 48% [11]; Scoliologic Lightweight 51% [12]; old Lyon brace 38.7%
[8]; TriaC 22% [13]; Osaka Medical College (OMC) 46.8% [14]; and the Boston 50%
[15]
The improvement of almost 40% of the inbrace correction compared to the most
recent braces is explained by the new biomechanical concepts of the ARTbrace: 1.
It is no longer a flat geometry, but of a geometry of solids. The brace performs
a kind of Bobsleigh track in the opposite direction of the scoliosis torso
column. There is no more press hold, but a soft contact that will vary with the
different positions during the day. This is a dynamic brace; 2. Specific digital
correction with superposition of 3 blocks. The asymmetry is not the consequence
of a complex classification, but the result of 3 successive scanners, the first
in translation along the vertical axis, the second in lumbar shift and
physiological lordosis, the third in bending and thoracic kyphosis. The very
precise protocol ensures the reproducibility of the measurements; 3. Untwisting
is achieved by coupled motions in the frontal plane and in the sagittal plane.
Detorsion is geometric and mechanical; 4. The correcting moment combines an
action in the transversal plane by tightening at the level of the chondrocostal
awnings using a rack closure and a translation along the vertical axis that can
be compared to that of the a lever corkscrew with lowering of initially raised
shoulders as the detorsion of the spine is progressing; 5. The very high
rigidity of the polycarbonate, however, requires a high 1mm precision of CAD /
CAM digitizer technology and professional software. [16].
The importance of immediate inbrace reduction also explains the prognosis of
the final result only 6 months after fitting the brace, which may encourage the
child’s compliance. The other parameters with improved curves in the sagittal
plane and in the horizontal plane have already been presented [5,9].
The goals of nonsurgical orthopaedic treatment can be expanded. It is no longer
only a question of avoiding surgery with a lower than 50 ° angulation, nor even
of stabilizing the scoliosis during the period of growth, but of getting a final
gain of approximately 30% at the end of treatment.
This treatment has the advantage of promoting teamwork with the doctor who
performs the digital cast and the orthopaedic technician who will make the final
brace.
Correlations
There is a negative correlation between initial angulation and end treatment
percent correction, r=0.414, n=43, p=0.001 for thoracic curves and less
r=0.292, n=53, p=0.034 for lumbar curves.
There is a strong positive correlation between inbrace correction rate and end
treatment correction rate, r=0.684, n=43, p=0.000 for thoracic curves and
r=0.596, n=53, p=0.000 for lumbar curves.
In our experience, the weaning results are very close to those 2 years after
weaning and can be considered as significant. Patients are a little older (14.4
vs 13.4) and with lower initial angulation than in the general statistics (26.84
vs 29.61). The inbrace reduction is greater (79.4% vs 69.4%) which explains the
outstanding weaning correction rate (50% vs 25% for the old Lyon brace)
CONCLUSION
For the same indications and with the same management principles, we can confirm
that:
1. The early treatment with low angle,
2. The quality of immediate inbrace correction
is fundamental to a successful outcome.
