H Nordic Spinal Deformities Society (NSDS) είναι μια διεθνώς αναγνωρισμένη επιστημονική κοινότητα, που αποτελείται από τους κορυφαίους Ορθοπεδικούς Χειρουργούς σπονδυλικής στήλης των Σκανδιναβικών χωρών, της Ολλανδίας, Δανίας και Γαλλίας. Ιδρύθηκε το 1975, με σκοπό την έρευνα και την θεραπεία των παθήσεων της σπονδυλικής στήλης. Κάθε χρόνο πραγματοποιεί το ετήσιο συνέδριο της με πανευρωπαϊκή συμμετοχή. Ο Νίκος Καραβίδας θα είναι ομιλητής στο NSDS Meeting 2021, το οποίο θα πραγματοποιηθεί, διαδικτυακά λόγω covid-19, στις 26-27 Αυγούστου 2021. Η παρουσίαση του θα έχει τίτλο:
“Brace and Physiotherapeutic Scoliosis Specific Exercises (PSSE) for Adolescent Idiopathic Scoliosis (AIS) treatment: A prospective study following Scoliosis Research Society (SRS) criteria”
Περίληψη έρευνας:
Background:
A growing scientific evidence for conservative treatment of AIS has recently occurred, using PSSE for mild and bracing for moderate curves. Bracing have proved its superiority to natural history and is recommended by SRS. Few studies have combined PSSE and bracing, showing promising results. Our aim was to investigate the effectiveness of bracing along with PSSE for AIS treatment.
Methods:
Prospective study, enrolling all eligible subjects from a prospective database. SRS research inclusion criteria were used (>10 years, 25ο – 40ο, Risser 0-2, < 1-year post-menarche, no prior treatment). 102 consecutive patients (87 females-15 males, mean age 12.8 years, Risser 0.48, Cobb Thoracic 29.2ο, Lumbar 27.8ο) followed treatment with Cheneau type brace and PSSE. Average follow-up time was 26.4 months. A scale from A to C was used to evaluate compliance with brace and PSSE (A: full-compliant, B: partially compliant, C: non-compliant). A threshold of 5ο defined progression or improvement. 7 subjects dropped-out (6.8%), so finally 95 patients included for statistical analysis, using paired t-test.
Results:
62 patients (65.3%) remained stable, 22 improved Cobb angle >5ο (23.2%) and 11 progressed (11.5%). The mean in-brace correction (IBC) was 49.7% for thoracic curves and 61.7% for lumbar curves, post-treatment thoracic Cobb was 29.9ο and lumbar 27ο. A subsequent analysis for the progressed cases revealed that IBC was lower than average (31.7% for thoracic and 34.4% for lumbar curves), 9 patients (81.8%) were classified as C for brace compliance and 7 patients (63.6%) as C for PSSE compliance. Only 4 subjects (3.9%) progressed above 40ο, reaching the surgical indication range. Another analysis for the full-compliant group, both for brace and PSSE (62 participants – 65,3%), showed significantly greater effectiveness (p=0.005) than overall average, as 44 patients (70.9%) stabilized Cobb angle, 18 (29.1%) improved and none progressed (0%).
Conclusion:
A combination of bracing and PSSE can effectively treat AIS, according to SRS inclusion criteria. 88.5% of patients did not progress more than 5ο and only 6.4% overpassed surgical indication range. IBC and compliance are the most important prognostic factors for successful treatment result. Our multi-professional approach probably enhanced adherence to treatment protocol. Future randomized controlled studies, with brace and PSSE, are recommended to provide stronger scientific evidence.
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