Background
Neuromuscular scoliosis is known to be a frequent, progressive, and untreatable condition. Although spinal orthosis is frequently applied and investigated in adolescent idiopathic scoliosis (AIS), spinal orthosis in neuromuscular scoliosis is not much investigated, or even being applied. In fact, current consensus on scoliosis of neuromuscular disorder (NMD) is surgical correction of the curve. The aim of this study is to apply spinal orthosis in the early stage of NMD scoliosis when scoliotic curve is still flexible.
Methods
Subjects with NMD scoliosis in early stage whose flexibility of scoliotic curve exceeds 50% were retrospectively reviewed for enrollment. Spine radiographs and spirometry results of 28 participants were studied before and after applying spinal orthosis. Lateral curve magnitude in Cobb angle and rotation of the apex vertebra by Perdriolle torsionmeter were measured. Forced vital capacity (FVC) and Forced expiratory volume in 1 second (FEV1) were recorded in those aged more than 7 years old. Three point controlling system of fabric type spinal orthosis was applied which is adjusted form of Kallabis harness (Orliman, Valencia, Spain) (Figure 1).
Results
Characteristics of subjects are shown in Table 1. There was significant difference in Cobb angles in both positions (p<0.01, p=0.04, respectively) after application of orthosis (Figure 2). Rotation of apex vertebra was also significantly different (p=0.003). There were no significant difference in FVC and FEV1 pre and post orthosis application (Figure 1). In Pearson correlation analysis, there were negative correlation between Cobb angle in supine position, rotation of apex vertebra and curve flexibility and Cobb angle correction rate after application of spinal braces (r=-0.41,p=0.03, r=-0.41,p=0.04, and r=0.47,p=0.014 respectively). Age and height of the patients were inversely correlated with the correction ratio (r=-0.38,p=0.04, and r=-0.41,p=0.03, respectively). Brace compliance rate showed mean value of 66% and maintained as 64% even after a month after.
Conclusion
In neuromuscular scoliosis, in-brace correction of the curve is shown both in with gravity and without gravity position, when applied in the early stage. Successful compliance was also noted. Reduction of spinal curve depends on Cobb angle of lateral curve and flexibility of the curve along with age and height of patients. This study could be a cornerstone for future studies of applying spinal braces in NMD patients and provides references to which candidates should the braces be applied.
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Values are presented as mean ± standard deviation. *18 participants had spirometry results. Spirometry could only be performed in those aged above 7 years old. †Correction rate was calculated as (In-brace correction (°))/(Initial curve angle(°)) ⅹ100. DMD : Duchenne Muscular dystrophy; SMA : Spinal Muscular Atrophy; CSVL : Central sacral vertical line; SVA : Sagittal vertical axis.
Left shows before application of the orthosis. Note how posture and curve of scoliosis is corrected both grossly and on radiograph after application of the orthosis.
Figure 2. Comparison of in-brace curve angle and initial angle in sitting position
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