European Vertebral  Deviation Center - Clinique du Parc - Lyon (France)    Spirometry

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Spirometry

Course on the LYON METHOD for Scoliosis - Bangalore India 2017

 


SOSORT 2017

Title : The immediate pulmonary effect of the new Lyon ARTbrace: Spirometry study of a case series of 64 consecutive Adolescent idiopathic scoliosis collected prospectively.

Abstract

Background: All braces, even asymmetric are reducing vital capacity.

The objective is to calculate the average percentage change of the 3 main parameters 1. Forced Vital Capacity (FVC), 2. Forced Expiratory Volume in 1 second (FEV1), 3. Peak Exploratory Flow (PEF) immediately 3 days after fitting the brace.

Method: A series of 64 consecutive patients selected according to the SRS-SOSORT criteria was measured using the Contec SP10 spirometer between May and November 2016. All the curvatures are thoracic because lumbar scoliosis, treated with another detorsion brace (GTB), are excluded. The measurement takes place at the time of the radiological brace control, the child is staying for about an hour without the brace. No specific physiotherapy was performed. The best of 3 measurements was chosen and the order with and without brace was randomised. The statistical analysis was carried out using SPSS 20.

Results and Discussion: A paired-samples t-test was conducted to compare FVC, FEV1, and PEF without and with brace

1. FVC is significantly higher without brace (M=2.47, SD=0.62) than in-brace (M=2.27, SD=0.60).

t(63)=-3.89, p<.000

2. FEV1 (pair 2) is not significantly higher without brace (M=2.06, SD=0.54) than in-brace (M=2.02, SD=0.63), t(63)=0.855, p=0.396

3. PEF (pair 3) is not significantly lower without brace (M=3.36, SD=1.31) than in-brace (M=3.47, SD=1.32), t(63)=-0.930, p=0.356

Despite their importance, spirometric data are often lacking in the evaluation of braces. In abbott plaster cast  the decrease of FVC and FEV1 is -37% (Margonato 2005). In TLSO the decrease of the FVC is -14% (Kennedy 1989). The percentage is slightly less -11% with Boston brace (Katsaris 1999). The immediate decrease of -7% in FCV with ARTbrace is the lowest reported to date.

The fact that FEV1 is less altered is normal since a brace does not cause airway obstruction.

The fact that the PEF is improved, even in a non-significant way is unexpected. We can even consider that the brace improves the ventilatory mechanics.

Conclusion: All braces decrease the FVC, but thanks to its original design, the immediate limitation is only 7%: the lowest reported to date. The other obstructive and mechanical parameters are not significantly modified.


INTRODUCTION
One of the disadvantages of bracing scoliosis is the effect on pulmonary function during pubertal thoracic development. The new Lyon ARTbrace has 4 basic characteristics designed to facilitate breathing.
1. Asymmetry with breathing expansion in the concavity,
2. Adjustable during the growth,
3. Lateral thoracic support at the sub-axillary level (baby-lift) which allows to detach the sterno-clavicular high strap to facilitate inspiration.
4. Lumbar lordosis with an anterior abdominal expansion

The objective is to calculate the average percentage change of the 3 main parameters 1. Forced Vital Capacity (FVC), 2. Forced Expiratory Volume in 1 second (FEV1), 3. Peak Exploratory Flow (PEF) immediately 3 days after fitting the brace.

Between May and November 2016, a cohort of 64 consecutive patients were selected according to the SRS-SOSORT criteria from our prospective database for analytic observational study, started in 1998. [3] FVC, FEV1 and PEF were measured using the Contec SP10 spirometer. [4] All patients have thoracic curves, because lumbar scoliosis are treated with another detorsion brace (GTB) and are excluded. The measurement takes place at the time of the radiological brace control, the child is staying for about an hour without the brace. No specific physiotherapy was performed. The top upper scratch is open. A pair of measurements with and without brace is performed after the x-ray. The best of 3 measurements was chosen and the order with and without brace was randomised.
The statistical analysis was carried out using SPSS v20 package with 95% confidence interval.


Results
Height (M=161.333, SD 9.0337)
Weight (M=50.953, SD=9.3285)
A paired-samples t-test was conducted to compare:
Pair 1 FVC without and with brace
Pair 2 FEV1 without and with brace
Pair 3 PEF without and with brace
1. FVC (pair 1) is statistically significant higher without brace (M=2.47, SD=0.62) than in-brace (M=2.27, SD=0.60). t(63)=-3.89, p<.000. The decrease rate is 8 %.
2. FEV1 (pair 2) is not s statistically significant higher without brace (M=2.06, SD=0.54) than in-brace (M=2.02, SD=0.63), t(63)=0.855, p=0.396. The decrease rate is 2 %.
3. PEF (pair 3) is not statistically significant lower without brace (M=3.36, SD=1.31) than in-brace (M=3.47, SD=1.32), t(63)=-0.930, p=0.356. The increase rate is 3 %.
 

Despite their importance, spirometric data are often lacking in the evaluation of braces. (Margonato 2005) found a -37% decrease of FVC and FEV1 in abbott plaster cast. (Kennedy 1989) notes a -14% decrease of the FVC with TLSO. The percentage is slightly less -11% with Boston brace (Katsaris 1999). The percentage is -13% with Carbon brace (Bernard 2005). The immediate decrease of -7% in FCV with ARTbrace is the lowest reported to date.

The fact that FEV1 is less altered is normal since a brace does not cause airway obstruction.
The fact that the PEF is improved, even in a non-significant way is unexpected. We can even consider that the brace improves the ventilatory mechanics.

CONCLUSION
All braces decrease the FVC, but thanks to its original design, the immediate limitation of the ARTbrace is only 8%: the lowest reported to date. The other obstructive and mechanical parameters are not significantly modified.

The low impact on pulmonary function allows it to be used in early onset scoliosis without the risk of tubular chest like this patient with Early Onset Scoliosis treated with Stagnara brace during 6 years..


 

References
1. Margonato V, Fronte F, Rainero G, Merati G. Veicsteinas A. Effects of short term cast wearing on respiratory and cardiac responses to submaximal and maximal exercise in adolescents with idiopathic scoliosis. Europa Medicophysica 2005 June;41(2):135-40
2. de Mauroy JC, Lecante C, Barral F, Pourret S. Prospective study and new concepts based on scoliosis detorsion of the first 225 early in-brace radiological results with the new Lyon brace: ARTbrace. Scoliosis. 2014 Nov 19;9:19.
3. Richards BS, Bernstein RM, D'Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 2005 Sep 15;30(18):2068-75; discussion 2076-7.
4. Joshi A, Watts CR. Measurement Reliability of Phonation Quotient Derived from Three Aerodynamic Instruments. J Voice. 2016 Nov;30(6):773.e13-773.e19.
5. Kennedy JD, Robertson CF, Hudson I, Phelan PD. Effect of bracing on respiratory mechanics in mild idiopathic scoliosis. Thorax 1989;44:548-553
6. Katsaris G, Loukos A, Valavanis J, Vassiliou M, Behrakis PK. The immediate effect of a Boston brace on lung volumes and pulmonary compliance in mild adolescent idiopathic scoliosis. Eur Spine J. 1999;8(1):2-
7. Bernard JC, Deceuninck J, Kohn C. Vital capacity evolution in patients treated with the CMCR brace: statistical analysis of 90 scoliotic patients treated with the CMCR brace. Scoliosis. 2011 Aug 31;6(1):19.
8. Frownfelter D, Stevens K, Massery M, Bernardoni G. Do abdominal cutouts in thoracolumbosacral orthoses increase pulmonary function? Clin Orthop Relat Res. 2014 Feb;472(2):720-6.
 

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