Schroth Scoliosis & Spine Clinic

Παρουσίαση έρευνας του Νίκου Καραβίδα στο 13th International SOSORT Meeting, Dubrovnik, με τίτλο: "Adolescent Idiopathic Scoliosis (AIS) treatment with the Dynamic Derotation Brace (DDB): An analysis using patients at high risk of progression"

Ο Νίκος Καραβίδας συμμετείχε όπως κάθε χρόνο στο Ετήσιο Συνέδριο της Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT), το οποίο πραγματοποιήθηκε στο Ντουμπρόβνικ της Κροατίας, από 18 έως 21 Απριλίου του 2018. Στο 13th SOSORT Meeting ο Νίκος Καραβίδας είχε πολύ ενεργή συμμετοχή όντας: 

- Μέλος της Επιστημονικής Επιτροπής του 13th International SOSORT Meeting 2018

- Προσκεκλημένος κεντρικός ομιλητής σε Στρογγυλή Τράπεζα με τίτλο: " Beyond the Cobb angle: Alternative methods for Assessment of Spinal Deformity patients "

- Παρουσιαστής της προσωπικής του έρευνας με τίτλο: " Adolescent Idiopathic Scoliosis (AIS) treatment with the Dynamic Derotation Brace (DDB): An analysis using patients at high risk of progression "

- Συντονιστής σε 2 Στρογγυλές Τράπεζες με τίτλους: " Screening Tools for Spinal Deformity " και " Spinal Deformity and Back Pain"

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Introduction: The Dynamic Derotation Brace (DDB), a modified Boston brace, is the standard of treatment for scoliosis in Greece. Previous studies about DDB showed controversial results, especially regarding thoracic curves. This is the first study to evaluate the effectiveness of DDB in AIS treatment, using SRS criteria.

Objective: The objective of the research is to examine the effectiveness of DDB in a scoliotic population with a high risk of progression.

Methods: A retrospective analysis of patients treated with DDB brace was performed. 41 patients, from our prospective database, were treated with DDB. 10 patients were excluded due to inadequate fulfillment of SRS criteria (Cobb angle<25ο or Risser sign >2) and 8 due to lack of final result. 8 subjects with Cobb angle>40ο, Risser 0-2, were included only for a subsequent analysis. So, 15 patients finally met the SRS criteria (13 girls,2 boys, mean age 11.8, Risser 0.5, Cobb Thoracic (TH) 32ο, Cobb Lumbar/Thoracolumbar (LU/TL) 32.6ο, follow-up 23.7 months). For the interpretation of the results we measured in-brace correction, end-treatment Cobb angle, brace and exercises compliance (self-reported). Brace compliance categorized as A (20-22h), B (16-19h) and C (<16h), while exercises compliance as A (>5d/w), B (3-4d/w), C (1-2d/w) and NO (0d/w).  Most of the patients visited our clinic after brace treatment, so only a few performed Schroth exercises. A cut-off point of 5ο was used to establish improvement or progression.    

Results and Discussion: The mean in-brace correction was 10.2% for TH and 30.9% for LU/TL curves. The average final Cobb angle was 46.8ο for TH and 37.6ο for LU/TL. Only 2 patients remained stable (13.3%), 13 progressed above 5ο (86.7%) and nobody improved. All 4 single TH curves progressed. For double scoliosis, TH 3 stabilized and 8 worsened, LU/TL 6 stabilized and 5 worsened. Brace compliance was rated 8A, 6B, 1C and exercises compliance was rated 0A,2B,1C,12 NO. Surprisingly, the group with Cobb angle >40ο (mean age 12.9, Risser 0.6, initial Cobb TH 46.4ο, LU/TL 40.3ο, mean in-brace correction TH 20.4%, LU/TL 28.2%), achieved better results (4 stable, 4 progressed). An important note is that all successfully treated patients in both groups followed a home-program of Schroth exercises and all but one reported A brace compliance. In total, including also curves above 40ο, DDB halted progression in 6 out of 23 patients, (26.1%) and the remained all progressed (73.9%).

Conclusion and Significance: DDB failed to avoid progression in a significant percentage (73.9%) of AIS patients with high risk of progression, much higher than the published literature. Brace compliance was good, so this can be mostly attributed to the low in-brace correction, mainly for TH curves, and the high-risk population of our study. Schroth exercises, applied in conjunction with DDB, can increase the success rate. Larger studies with SRS criteria are needed for the future to generalize the results.


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