Effect of preoperative brace treatment on the surgical correction results in female adolescent idiopathic scoliosis

English Keywords:Idiopathic scoliosis  Main thoracic curve  Corrective surgery  Brace  Female  Effect

English Abstract:

  【Abstract】 Objectives: To analyze the effect of preoperative brace treatment on the surgical correction results in female adolescent idiopathic scoliosis(AIS). Methods: From July 2001 to December 2009, 70 female patients with major thoracic(MT) curves and under going posterior corrective surgery in our hospital were studied retrospectively. The patients were classified into two groups: group A: with preoperative Boston brace treatment(n=26), and group B: with no preoperative brace treatment(n=44). There were no significant differences with respect to the malformation found age, age at operation, preoperative coronal Cobb angle of the MT curve, Cobb angle on convex bending film, the flexibility of the MT curve and the vertebra included in the fusion range between the 2 groups(P>0.05). Twenty-three patients in group A and 34 patients in group B were followed up for at least 1 year, and the average follow-up time of the 2 groups was 37.7 months(range, 12 to 101 months) and 28.7 months(range, 12 to 87 months), respectively(P>0.05). The differences of the radiographic correction results of the MT curve between the 2 groups were evaluated. Results: The mean pre-operative coronal Cobb angles of the MT curve of the 2 groups were 52.8°±8.3° and 54.0°±10.7°. After surgery, they were corrected to 12.3°±7.3° and 11.5°±8.1°, with an average correction rate of (77.0±12.6)% and (79.3±11.9)%, respectively(P>0.05). At final follow-up, they were 16.7°±8.4° and 15.4°±7.2°, with similar correction rate[(68.8±14.5)% vs. (70.5±13.0)%, P>0.05]. The preoperative apical vertebral translation of the MT curve in 2 groups was 41.4±14.3mm and 36.8±13.7mm, respectively, without significant difference(P>0.05). After operation, they were corrected to 10.4±5.4mm and 7.2±5.6mm, and group B had a better correction(P<0.05) than group A. At final follow-up, they were 14.4±11.3mm and 12.1±8.5mm, without significant difference(P>0.05). The decompensation occurrences of coronal trunk balance in group A and B were 15.4%(4/26) and 9.1%(4/44) preoperatively, 15.4%(4/26) and 15.9%(7/44) postoperatively, and 4.3%(1/23) and 8.8%(3/34) at final follow-up, respectively, which showed no differences(P>0.05). The mean preoperative sagittal Cobb angles of the MT curve of the 2 groups were 12.9°±11.1° and 18.7°±11.3°, and group A had a less thoracic kyphosis(P<0.05) than group B. After surgery, the Cobb angles of thoracic kyphosis were corrected to 18.0°±6.3° and 22.3°±7.8°, with no significant difference(5.0°±9.8° and 3.6°±12.6°, P>0.05). At final follow-up, the sagittal Cobb angle of the MT curve was 20.0°±6.7° and 22.4°±7.7°, respectively(P>0.05). Conclusions: Preoperative brace treatment has no obvious impact on the correction results of the MT curve in female AIS patients.