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BACKGROUND: In respect to the prescribed regimen and the regular daily pattern, investigate how short-term results are affected by wear time adherence in terms of hours per day. METHODS: This is a case-control study. The setting is outpatient clinic. There were 168 subjects, all of whom met the inclusion criteria: adolescent idiopathic scoliosis and Sforzesco brace prescription of 18 to 23 h/day. The minimum period of follow-up was 4 months, and the maximum was 6 months, which is the average time passing between the Thermobrace (TB) adoption and out-of-brace X-ray before treatment. The brace wear adherence rate, calculated from the ratio of brace wear time with the prescription, was considered in combination with the daily pattern compliance, classified as consistent (104 patients) or inconsistent according to the abnormal distribution of Thermobrace data. The short-term results were finally explored. RESULTS: Consistent brace wear is associated with a higher probability of improvement in curve magnitude (OR 1.96 CI 95% 1.22-3.14 chi-square 7.78 p = 0.0053). Inconsistent brace wear is more likely to progress (OR 0.14 CI 95% 0.30-0.75 chi-square 10.13 p = 0.0015). Results from the logistic regression show that the most influencing factor for improvement is Cobb degrees at the start. CONCLUSIONS: In clinical everyday activity, patients must be encouraged to consistently follow their brace wear prescription, because this attitude is clearly associated with a higher probability of improvement. ispartof: SCOLIOSIS AND SPINAL DISORDERS vol:13 ispartof: location:England status: published

Recently, positive results in bracing patients with idiopathic scoliosis (IS) above 45° who refused surgery have been presented in a retrospective study. Obviously, this can give only an efficacy (EA) analysis, as there is neither a control group, nor it is possible to know failures because of dropouts.To present the prospective results of bracing patients affected by IS above 45° and still growing.Prospective study including all IS patients with 45° or more, Risser stage 0 to 4, who had their first evaluation in our institute, an outpatient clinic specialized in scoliosis evaluation and conservative treatment, from March 1, 2003 to December 21, 2010 and utterly denied any surgical intervention.Of 59 patients, we excluded 2 patients still in treatment and 57 (11 males) patients were included. At the beginning of the study, they were 15 years 3±22 months of age, had 52.5° Cobb (range, 45°-93°), and Risser 2 (0-4). Thirty-nine accepted a full-time brace treatment (BG) to try avoiding surgery, 18 refused any treatment and served as controls (CG).Physiological measures: radiographic and clinical data.Treatment: A year of full-time Sforzesco brace (23 hours/day) or Risser cast (8-12 months) and gradual weaning after Risser 3; all patients performed exercises; and International Society on Scoliosis Orthopaedic and Rehabilitation TREATMENT management criteria were respected. Analyses: EA in patients who completed treatment/observation (34 in BG and 10 in CG) and intent-to-treat (ITT) with worst case analysis in the whole population. Relative risk (RR) and 95% confidence interval (CI) have been computed.Efficacy: failures were 23.5% in BG and 100% in CG. Intent-to-treat: failures were 20.5% in BG and 55.6% in CG. Relative risks of failure in CG were 4.3 (95% CI, 3.6-4.9) in EA and 2.7 (95% CI, 2.0-3.5) in ITT (p.05). Percentage of patients (53.8%) improved: RRs of improvement in BG were 1.6 (95% CI, 1.46-1.9) in EA and 1.9 (95% CI, 1.6-2.2) in ITT (p.05). Patients who joined the treatment achieved a 10.4°±10.7° Cobb improvement, an ATR reduction of 4.2°±4.3°, and an esthetic improvement of 2.8±1.9 of 12 points (TRACE). At the end, in BG, 24 patients were below 45° and 6 patients below 35°.Through this study we can conclude that the conservative brace plus exercises treatment (if correctly performed and managed) is a suitable alternative for those patients who reject any surgical intervention for IS above 45°. But we could also conclude that a good brace treatment should be considered as the first choice to try avoiding fusion because of the high sanitary and social costs of surgery.

Tennis is widely practiced by adolescents in many countries. Many spinal deformity experts consider this activity, together with other asymmetrical sports, as risk factors for scoliosis development even though scientific data are missing. The aim of the present study was to verify the prevalence of spinal deformities and LBP in adolescent competitive tennis players compared to healthy controls. We designed a cross-sectional study. A convenience sample of 102 adolescent tennis players (52 girls) was compared to 203 scholars (102 girls) of the same age (12 years). We used a questionnaire to collect data on LBP and we measured the ATR to screen for spinal deformities and the plumb line distances for kyphosis (C7 and C7 + L3) and lordosis (L3). We found similar spinal deformities in both groups: ATR female: 3.2° ± 1° (tennis) versus 2.8° ± 1° (school), NS; ATR males: 2.8° ± 1° (tennis) versus 2.6° ± 1° (school), p

Objective To compare the prevalence of spinal deformities and low back pain (LBP) in adolescent competitive swimmers and normal controls. Study design This was a cross-sectional study with convenience sample of 112 adolescent competitive swimmers (62 females) compared with 217 students (106 females) of the same age (12.5 years). We designed a questionnaire to collect data on LBP and measured the angle of trunk rotation with a Bunnell scoliometer to screen for scoliosis, along with the plumbline distances for kyphosis and lordosis. Clinical cutoffs defined in the literature for detection of spinal deformities were applied. Analyses were performed using the t test and χ2 test, and ORs and 95% CIs were calculated. Results Swimming was found to increase the risk of trunk asymmetries (OR, 1.86; 95% CI, 1.08-3.20). Swimming also increased the risk of hyperkyphosis (OR, 2.26; 95% CI, 1.35-3.77) and hyperlordosis (OR, 2.24; 95% CI, 1.06-4.73), and increased LBP in females by 2.1-fold (95% CI, 1.08-4.06). Conclusion Swimming is associated with an increased risk of trunk asymmetries and hyperkyphosis. Although swimming has been considered a complete sport and a treatment option for scoliosis, our data contradict that approach, and also show a higher prevalence of LBP in females.

Methods Setting: outpatient tertiary referral clinic specialized in conservative treatment of spinal deformities. Participants: Inclusion criteria: idiopathic scoliosis; European Risser 0-2; 25° to 45° Cobb; age 10 years or more at start of treatment. Exclusion criteria were for both groups: secondary scoliosis and pathologies known to be possible causes of scoliosis, neurological, previous treatment for scoliosis (brace or surgery).

Background Recently an RCT confirmed brace efficacy in adolescent idiopathic scoliosis (AIS) patients. Previously, a Cochrane review suggested also producing studies according to the Scoliosis Research Society (SRS) criteria on the effectiveness of bracing for AIS. Even if the SRS criteria propose a prospective design, until now only one out of 6 published studies was prospective. Our purpose was to evaluate the effects of bracing plus exercises following the SRS and the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT) criteria for AIS conservative treatment. Methods Study design/setting: prospective cohort study nested in a clinical database of all outpatients of a clinic specialized in scoliosis conservative treatment. Patient sample: seventy-three patients (60 females), age 12 years 10 months ±17 months, 34.4±4.4 Cobb degrees, who satisfied SRS criteria were included out of 3,883 patients at first evaluation. Outcome measures: Cobb angle at the end of treatment according to SRS criteria : (unchanged; worsened 6° or more, over 45° and surgically treated, and rate of improvement of 6° or more). Braces were prescribed for 18–23 hours/day according to curves magnitude and actual international guidelines. Weaning was gradual after Risser 3. All patients performed exercises and were managed according to SOSORT criteria. Results in all patients were analyzed according to intent-to-treat at the end of the treatment. Funding and Conflict of Interest: no. Results Overall 34 patients (52.3%) improved. Seven patients (9.6%) worsened, of which 1 patient progressed beyond 45° and was fused. Referred compliance was assessed during a mean period of 3 years 4 months ±20 months; the median adherence was 99.1% (range 22.2-109.2%). Employing intent-to-treat analysis, there were failures in 11 patients (15.1%). At start, these patients had statistically significant low BMI and kyphosis, high thoracic rotation and higher Cobb angles. Drop-outs showed reduced compliance and years of treatment; their average scoliosis at discontinuation was low: 22.7° (range 16-35°) at Risser 1.3 ± 1. Conclusions Bracing in patients with AIS who satisfy SRS criteria is effective. Combining bracing with exercise according to SOSORT criteria shows better results than the current literature.

Background The most important factor discriminating juvenile (JIS) from adolescent idiopathic scoliosis (AIS) is the risk of deformity progression. Brace treatment can change natural history, even when risk of progression is high. The aim of this study was to compare the end of growth results of JIS subjects, treated after 10 years of age, with final results of AIS. Methods Design: prospective observational controlled cohort study nested in a prospective database. Setting: outpatient tertiary referral clinic specialized in conservative treatment of spinal deformities. Inclusion criteria: idiopathic scoliosis; European Risser 0–2; 25 degrees to 45 degrees Cobb; start treatment age: 10 years or more, never treated before. Exclusion criteria: secondary scoliosis, neurological etiology, prior treatment for scoliosis (brace or surgery). Groups: 27 patients met the inclusion criteria for the AJIS, (Juvenile Idiopathic Scoliosis treated in adolescence), demonstrated by an x-ray before 10 year of age, and treatment start after 10 years of age. AIS group included 45 adolescents with a diagnostic x-ray made after the threshold of age 10 years. Results at the end of growth were analysed; the threshold of 5 Cobb degree to define worsened, improved and stabilized curves was considered. Statistics: Mean and SD were used for descriptive statistics of clinical and radiographic changes. Relative Risk of failure (RR), Chi-square and T-test of all data was calculated to find differences among the two groups. 95% Confidence Interval (CI) , and of radiographic changes have been calculated. Results We did not find any Cobb angle significant differences among groups at baseline and at the end of treatment. The only difference was in the number of patients progressed above 45 degrees, found in the JIS group. The RR of progression of AJIS was, 1.35 (IC95% 0.57-3.17) versus AIS, and it wasn't statistically significant in the AJIS group, in respect to AIS group (p = 0.5338). Conclusion There are no significant differences in the final results of AIS and JIS, treated with total respect of the SRS and SOSORT criteria, in adolescence. Brace efficacy can neutralize the risk of progression.

Background context: The main distinctive aspect of Juvenile Idiopathic Scoliosis (JIS) with respect to Adolescent Idiopathic Scoliosis (AIS) is the high risk of severe deformity and surgery. Approximately 70% of curves in patients with JIS progress and ultimately require surgery. There are presently very few studies with long-term follow-up of JIS and even fewer looking specifically at bracing Purpose To verify the effectiveness of a complete conservative treatment, including bracing and exercises, for JIS. Study design/setting: Retrospective cohort observational study nested in a clinical prospective database of consecutive outpatients. Patient Sample Inclusion criteria: JIS, no previous treatment, all consecutive radiographies available from treatment start to end of growth (Risser sign 3). We found 30 patients, 27 females, 10 JIS type 1; mean age at first diagnosis was 7.8 +/�1.5 and mean treatment lasted 5.8 years. Cobb degrees 24.4+/�10 degrees, with 7 cases >30 degrees, and 2 > 45degrees. Outcome Measures Physiological measures. Radiographic and clinical data. Methods: Treatment (exercises alone, or elastic-rigid-highly rigid braces plus exercises) was tailored and continuously changed according to Cobb degrees, individual preferences, anthropometric characteristics, pubertal spurt, remaining growth, rotation, hump, lumbar curve take-off, and imbalance. The SOSORT Guidelines for patients’ management have been followed. Funding and Conflict of Interest: no. Results: 33.3% (95% Confidence Interval 16.4-50.2%) of patients worsened over the years. At the end of growth, 6.6% (0–15.5%) had surgical deformities (>45degrees). We observed a good correction in the first years of treatment until pubertal growth spurt, when progression was usually noted and treatment changed increasing corrective forces (hours or rigidity of bracing). 23 ca ses were followed up until they had two consecutive radiographies showing Risser sign 5 and showed stability. Conclusions: Conservative treatment initiated already in childhood may favorably change the natural history of JIS with the aim of reaching a curve as far as possible from surgical thresholds. Observation, physical exercises, braces can be useful tools in the hand of physicians, but they must be carefully utilized by a deep knowledge of JIS.

Background A previous study reported that being overweight is predictive of decreased effectiveness of bracing for patients diagnosed with Adolescent Idiopathic Scoliosis (AIS), with the risk of worsening three times higher in overweight patients than in normal-weight scoliosis patients. Purpose The goal of this study was to verify if body mass index (BMI) and, specifically, obesity, are predictive for the effectiveness of bracing in a cohort of AIS patients. Methods Design: retrospective cohort study. Population: 351 AIS patients (306 females), age 10-15 years at first assessment (average 12.9±1.4), worst curve 35.6±11.4° Cobb, ATR 11±4.3°, median Risser 2, BMI 19.7±3. All subjects included were prescribed a brace treatment at first visit (initially 18-23 hours per day) accompanied by Scoliosis Physiotherapic Exercise according to the Scientific Exercises Approach to Scoliosis (SEAS) protocol. After the treatment, all patients were evaluated again and changes were analysed. Outcome: n° of patients improved/worsened (defined as patients with a change of more than 5° Cobb) or stable, average change of Cobb angle. Statistical analysis: a stepwise linear regression was used to look for the effect of BMI as a predictor of result. A chi-square test and a logistic were used for the category of overweight patients (BMI³85° percentile). During the statistical analysis, we controlled for possible confounders. Results The chi-square test showed similar results in overweight and normal weight 44% vs. 52% improved, 52% vs. 41% stable and 3% vs. 7% worsened, respectively. We found BMI to be poorly correlated with final results. Adjusting for confounders did not change this poor correlation, and the predictive model explained about 10% of the result.

Conclusions and discussion At this stage, the following explanatory hypotheses can be drawn: Technical radiological differences (exposure, machine) Variation of pelvis positioning Postural changes influencing the pelvis Brace compression on the pelvis According to our study results, all of the hypotheses include data both in favor and against the reliability of the Risser sign. Since the Risser sign is a 2D evaluation of a 3D phenomenon, pelvis repositioning could perhaps be the most plausible explanation. This case series is open to the possibility that the Risser sign is even less reliable than originally considered. Unfortunately, this result cannot be checked experimentally due to ethical reasons. Nevertheless, observational designs could be considered in the future.

A recent study suggests a correlation between idiopathic scoliosis in adolescence and eating disorders. However, this does not correspond with our clinical experience in the same population. The aim of this study was to verify the correlation between scoliosis and eating disorders in adolescence. A cross-sectional study was designed including 187 consecutive adolescent girls with a diagnosis of idiopathic scoliosis (mean Cobb angle 26°, range 11-73°, age 15.2±2.5; 24% juveniles, 76% adolescent type) and 93 schoolgirls as controls (age 14.9±1.0). All of the participants answered the Italian validated questionnaire EAT-26 about eating habits in order to identify any eating disorders. Body mass index (BMI) was calculated for all participants and compared to reference data.chi-square test, Student's t-test, Pearson's correlation coefficient. Only 3 (1.6%; 95% CI -0.2-3.4%) participants in the scoliosis group showed EAT-26 scores suggestive for eating disorders versus 7 (7.5%; 95% CI 2.2-12.9%) in the school population (p0.05). The BMI was slightly lower (p0.05) for scoliosis patients (19±0.2) than for school girls (21±0.3). EAT-26 is recognized among the most valid questionnaires for eating disorders and has been widely applied in various countries. By applying this questionnaire, a lower incidence of eating disorders in female scoliosis patients was found than in the general population (using both our own controls and Italian reference values). This contrasts with some expert opinions and a recent study performed in Italy. The low BMI already reported in the literature as being typical of scoliosis participants is confirmed by our data.

Recently it has been shown that idiopathic scoliosis (IS) curves can be reduced with bracing, and it has been proposed that this could be useful in non-surgically treated high degree curves even after Risser 3. Moreover, bracing has been shown to be able to improve aesthetics, and this could be another reason to treat some patients with cosmetic needs. Our aim is to preliminary check if results can be obtained in IS patients after Risser 3.Design. Retrospective uncontrolled cohort study. Inclusion criteria. All IS patients treated on a voluntary basis for aesthetic reasons and/or for curve reduction; Risser 4-5 at start; end of treatment reached. Population. 34 females and 2 males, age 16.2±1.6 years, Cobb angle 27.6°±8.9°. Treatment. Lyon or SPoRT braces 18 to 24 hours/day, specific SEAS exercises, rapid weaning (2-3 hours every 6 months). Outcome criteria: SRS (unchanged; worsened over 6°; over 45° at the end of treatment; surgically treated), radiographic and clinical. Statistics. ANOVA and chi-test.The reported compliance during the 2.8 ± 1.1 treatment years was 95.1%, while residual growth was 0.9 ± 1.1 cm. Improvements were found in 39% of this cohort, (46% in curves over 30°). Only 1 patient progressed 6°. We found highly statistically significant reductions of maximal (-4.4°), thoracic (-6.0°) and thoracolumbar (-6.6°) curves. Statistically significant improvements were found for Aesthetic Index.Before 20 years of age, even in skeletally mature patients, it is possible to reach radiographic and aesthetic improvements, although not as good as during growth. Correction is based on bone growth, but ligaments and neuromuscular control of posture can also be involved.

The sagittal plane measures have a relevant role both in Idiopathic Scoliosis (AIS) and in Hyperkyphosis (HK) management. Nevertheless, clinical tools for everyday use are scarce and not adequately studied.To assess the repeatability of different methods for the collection of the sagittal profile of patients with spinal deformities during everyday clinics.We performed 4 different studies in 4 different populations of AIS and HK patients. In the first study we reported the normative data and measurement error of the plumbline measures in a general population of 180 adolescents. In the second study we compared the sagittal distances from the plumbline of C7, T12, L3, and Sagittal Index (SI = C7+L3) with the measures of the Video Rasterstereography at the same levels and the angles of kyphosis and lordosis in 100 AIS patients. In the third study we evaluated the intra and inter-rater repeatability and the measurement error of kyphosis and lordosis angles measured with the Inclimed in 100 AIS patients. In the last study we evaluated the repeatability of the sagittal distances from the plumbline, by using a 1 mm change instead of 5 mm in a population of 40 patients.repeatability has been evaluated according to Bland and Altman, to identify the limits of variation that are clinically significant. Results. Study 1: the normative data were: females: 34 ± 11 mm for C7; 34 ± 15 mm for L3, males: 34 ± 10 mm for C7; 48 ± 10 mm for L3;. Study 2: a coefficient of correlation was calculated in order to compare measures. Study 3: the k value for Inclimed varied from fair to good. Study 4: the repeatability was fair for this measure.Some clinical instruments are now available for sagittal plane assessment in AIS and hyperkyphosis. The results of the present study report the limits during measurements in a clinical setting of parameters that are routinely collected by some clinicians.

In-brace radiographic correction is considered a reliable check of brace efficacy. The aim of this study was to correlate the in-brace correction with the short term results of treatment (6 months).pre-post study41 consecutive adolescent girls with idiopathic scoliosis who were prescribed a brace treatment (39 thoracic curves, 37±12°; 16 thoracolumbar, 38±13°; 12 lumbar, 31±8°. Risser 0-3). In-brace radiographic correction and 6 months treatment out of brace X-ray results were correlated, according to curve localization. The in-brace/out-of-brace ratio was calculated, curves were grouped according to the Risser sign, the results (10°, ≥10° out-of-brace), in-brace correction (10°, ≥10°), the magnitude (30°, 30°-45°,45°).Correlation Coefficient.The in-brace/out-of-brace ratio varied according to localization of curve and Risser, achieving the best results for thoracic curves (38-45%). The groups of thoracolumbar and lumbar had higher variability (17-65% and 17-40%). The correlation coefficient between in-brace correction and out-of-brace results was statistically significant: 0.85 for thoracic curves, 0.64 thoracolumbar, 0.72 lumbar. Risser groups: 0.65-0.98 thoracic, 0,78-0.90 thoracolumbar, 0.94-0.98 lumbar. For Results groups, the correlation was better for the group with high degree of correction (High results) in lumbar and the group with low degree of correction (Low results) for thoracolumbar, no differences for thoracic. Low in-brace correction had a low correlation coefficient for thoracic and lumbar curves. No differences for Magnitude.The in-brace correction ranges from 17 to 47% of the curve magnitude. The correlation between in-brace correction and short time results of brace is significant, range 0.64-0.98. The in-brace correction seems able to predict the short time results of treatment.

Since the beginning of history of Medicine, it has been possible to learn from the worst and best results of treatments. Our aim was to verify which patients can reach the best and worst results during conservative treatment.All AIS patients with more than 2 visits included in a prospective clinical database started in September 2003 were reviewed on August 31st 2010. A cut-off of 20 degrees (improvement or worsening) from the first observation was used to select patients. Patients were analysed for diagnosis, morphology, Cobb degrees at start, curve improved/worsened, treatment, gender, Body Mass Index, clinical parameters.Out of 1886 consecutive patients, 62 (3.3%) changed 20° or more: 26 (1.4%) improved (range 20-34°), 36 (1.9%) progressed (20-60°). Relative Risk of progression of 20° or more was increased more than 10 times in cases of thoracic curve or secondary scoliosis, 5 times for Moe scoliosis and BMI15 kg/mq, 3 times for age12 years, and congenital or juvenile scoliosis. Relative Risk of improvement of 20° statistically was increased more than 3 times in cases of previous exercises, female gender, thoracolumbar curve or scoliosis, ISICO treatment, and age12 years.Not all our results correspond to the usually reported prognostic factors in ample case series, but it must be taken into account that only wide variations (20° or more) have been considered here. In this population we had 1.9% of patients who improved at least 20° with conservative treatment, and this is notable as well. Finally, since these results are not similar to what would be expected according to the known natural history, conservative treatment appears able to change it.

Methods Setting. Outpatient tertiary referral clinic. Population. Out of 778 patients, 246 fulfilled the inclusion criteria: Idiopathic Scoliosis; first brace prescription; regular use of Thermobrace heat sensor; two evaluations after bracing; age 36; European Risser 0-3. Evaluations. T0 (start of bracing), T1 (4 months), T2 (10 months). Measurements. Brace wearing compliance (BWC) T0 to T1 (T0-T1) and T1 to T2 (T1-T2). Treatment. CBA adjunctive sessions dispensed during PSSE (CBA-PSSE), after the standard CBA provided to all patients including: at prescription, 20’ by Medical Doctor (MD) and 30-45’ by Physiotherapist; at brace check, 10-15’ by MD and Orthopaedic Technician; at T1, 10-15’ by MD. Groups. According to CBA-PSSE in T0-T1 period: CBA1 (143 patients) 32 sessions; Poor-Adherence (PA1, 52) 1 session; Control (CON1, 51) 0 sessions . Similarly, according to CBA-PSSE in T1-T2 period: CBA2 (97), PA2 (78), CON2 (71). Combinations among the 6 groups in the two periods were checked. Statistics. ANOVA for group comparisons.

Method Design: observational prospective study on consecutive patients. Participants: the first 12 female (age 13.07±2.05) patients, with idiopathic scoliosis (41.58°±14.52° Cobb), in Sforzesco brace treatment, who had orthogonal synchronous AP and LL low dose EOS x-rays examination, before treatment start (PRE), with brace (IN) and after four months of treatment at immediate brace take-off (OUT).

Methods Study design: retrospective controlled study. Population: Rigid Brace Groups (RBGs) 20 patients (16 female), age 13±1, Cobb 24±5°, ATR 8±3°, TRACE score 7, Risser 0-3. Spinecor Group (SG): 41 patients (33 females) age 13±1, Cobb angle 24±5°, ATR 8±3°, TRACE score 6, Risser 0-3. Both groups were treated with a full-time brace (18 to 23 hours per day upon initial prescription). Clinical and radiological evaluations were performed at the beginning and end of treatment. Main outcome measures: Cobb angle (changes > ±5), ATR, TRACE (changes ≥3). Statistics: Chi square, t-test.

Methods Study design: retrospective controlled study. Population: Exercise Group (EG): 28 consecutive scoliosis patients (26 females), age 13±2, TRACE 4.5, Cobb angle 18±3°, ATR 7±3°, Risset 0-3. SpineCor Group (SG): 41 patients (33 females), age 13±1, TRACE score 6, Cobb angle 24±5°; ATR 8±3°, Risser 0-3. EG patients performed specific exercises twice per week according to the SEAS protocol. SG patients wore the SpineCor brace 20 hours per day. Patients were evaluated both clinically and radiographically before and after the treatment. Main outcome measured TRACE (changes ≥3), Cobb angle (changes > ±5) and ATR.

Methods Prospective controlled cohort study nested into a clinical database started in 2003. On December 31, 2012, out of 11,800 patients in the database, we selected 168 who met the following inclusion criteria: Adolescent Idiopathic Scoliosis, Sforzesco brace prescription 18 to 23 hours/day, at least four months of observation, Thermobrace (TB) adoption and out-of-brace x-ray before treatment. CBW (104 patients) was compared to ficklebrace wearing (FBW: 64): due to the abnormal distribution of TB values, one hour in the inter-quartile range distinguished the two groups. A 6-degree Cobb cut-off was defined to classify results as improved, worsened or stabilized. Patients were also classified for compliance: High (HC: >95% of prescription), Middle (MC: 70-94%) and Low (LC

Methods 64 consecutive PD patients were included: 53 males, 11 females; 69.5±8.1 years; 5.6±4.1 years of disease (YOD); Hoehn Yahr (H&Y) 2.4±1.1, UPDRS-M 16.1±12.5. The clinical assessment included HY and UPDRS-M score, Pain NRS 0-10 and trunk rotation in bending (ATR). Lumbar lordosis (LL), thoracic kyphosis (TK), scoliosis curves (SC), spinosacral angle (SSA), spinopelvic angle (SPA), pelvic incidence (PI), sacral slope (SS) and pelvic tilt (PT) were radiographically assessed. Patients have been compared according to the presence of SC >10° (PDts) Cobb or the absence of SC (PDns).

Background Bracing treatment proved to be a useful conservative care treatment for adolescent idiopathic scoliosis (AIS) patients according to a Cochrane review. Prospective observational trials following the Scoliosis Research Society (SRS) criteria for bracing studies and the SOSORT management criteria, can give other evidence on the effectiveness of bracing in AIS. The Sforzesco brace has been used in worse curves, and its efficacy compared to casting

Methods We consecutively developed four studies from our clinical prospective database, including 5,142 Females with Idiopathic Scoliosis Patients below the age of 20 years. Results At 2YPM: Risser stage is below 3 in 15.7%, and is still 0 in 2.4%. Growth is not ended and is still decreasing (2.5 cm/y): 5% of patients have 4 cm of residual growth, 12% 3 cm and 25% 2 cm. End of growth is reached around 48 months post-menarche. Scoliosis has not yet finished progressing, particularly in the third year, but also in the subsequent six months. There is no change in the positive results of bracing before and after 2YPM, either for clinical-radiographic results and for percentage of patients improved/ worsened.

Methods Design is a prospective study including all IS patients with 45° or more, Risser 0-4, who had their first evaluation in our Institute from March 1st, 2003 to December 21st, 2010, and utterly deny any surgical intervention. Population: out of 59 patients, we excluded 2 still in treatment. 57 (11 males) were included, who at start of treatment had a mean of: 15.03±1.10 years of age, 52.5° Cobb (range 45-93°), and Risser 2 (0-4). Thirty-nine accepted a full-time brace treatment (BG) to try avoiding surgery, 18 served as controls (CG). Outcomes: radiographic and clinical data. Statistics: efficacy analysis in patients who completed treatment (38 in BG; 10 in CG; failures: surgery, progression 6° or more); intent-totreat (failures also drop-outs). In CG, we had 8 patients not retrievable: they were considered as positive results (no progression or surgery) in the intent-to-treat analysis.

Background Scoliosis is a three dimensional deformity, and brace correction should be 3D too. There is a lack of knowledge of the effect of braces, particularly in the sagittal and transverse plane. The aim of this study is to analyse the Sforzesco Brace correction, through all the parameters provided by Eos 3D imaging system. Method Design: This is a cross sectional study from a prospective database started in March 2003. Participants: 16 AIS girls (mean age 14.01) in Sforzesco brace treatment, with EOS x-rays, at start, in brace after 1 month and out of brace after the first 4 months of treatment. Outcome measures: All the parameters and the Torsio-Index obtained from 3D Eos System, in and out of brace, in the three planes. Statistical analysis: the variability of the parameters and the mean differences were analyzed and compared using paired T test. ANOVA was used for multiple comparisons. Critical P value was set at 0.05. Results In the comparison of in-brace vs start of treatment, the mean Cobb angle changed significantly from 36.44 +/− 4 to 28.99 + −3.9° (p = 0.01). Significant changes in all the sagittal parameters were found (p = 0.02). In the axial plane, the Torsio Index changed significantly in-brace for thoracolumbar and lumbar curves (P

Outcome measure The threshold of 5° Cobb to define worsened, improved and stabilized curves was considered, average Cobb angle, ATR, TRACE (for aesthetic evaluation) Statistical analyses: Mean and SD were used for descriptive statistics of clinical and radiographic changes. Relative Risk of failure (RR), 95% Confidence Interval (CI), Student’s t, Kruskall Wallis, and chi square test were applied. Results 268 patients were included (226 females), age 13.3 (±1). BRACE Group: 108 (96 females), age 13.2 (±1), Cobb Angle 34±12°, ATR 9.6±0.4, TRACE 5.7. UNTREATED Group: 160 (130 females), age 13.2 (±1), Cobb Angle 33±11° ATR 10.3±0.2°, TRACE 5. No differences among groups at first visit but for TRACE (p

Methods Study Design: Retrospective observational study. Population: A total of 23 patients (15 males; 8 females), aged 11 to 17 years were included. Each patient had at least two clinical evaluations and spinal X rays (lateral projection) at the time of therapy start (T0) and stop (T1). Methods: 20 patients presented thoracic hyperkyphosis and three presented thoracolumbar kyphosis. All of the patients were treated conservatively; specifically, 17 were treated with brace plus specific exercises and 6 were treated with only specific exercises. For all of the patients we measured the sagittal parameters of thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and spinosacral angle (SSA). Statistical analysis: paired Wilcoxon test and correlation (Pearson). Results Mean and standard deviation for each parameter were measured in T0: TK, LL, PI 43.83± 7.95, PT 4.83± 6.96, SS 38.91± 7.67, SSA; and in T1: TK, LL, PI 41.87± 9.62, PT 5.48± 7.04, SS 36.39± 7.80, SSA. Highly significant improvements were found for the main spinal parameters from T0 to T1: TK reduced from 54.22± 13.58 to 44.48± 12.80 (p= 0.0006), LL from 57.43± 11.16 to 51.13± 10.28 (p= 0.0077) and SSA from 132.87± 9.80 to 127.09± 9.24 (p= 0.0036); no significant differences were found for the other parameters. Looking at sagittal parameter correlations,very few were found at the start of treatment: SS correlated with LL (R=0.651; p=0,007), SSA (R=0.600; p=0.0025) and PI (R=0.596; p=0.0027) which also correlated with PT (R=0.515; p=0.0119). Contrarily, at the end of treatment, most parameters were correlated: LL with PI ( R=0.514; p=0.0122), SS (R=0.499; p=0.0152), and SSA (R=0.743; p