A 3D German-designed brace used to treat adolescent idiopathic scoliosis

Introduction Adolescent Idiopathic Scoliosis (AIS) is a condition that affects an otherwise healthy child 10 years of age or older and is the high risk of severe deformity and surgery. Different brace applications include the Milwaukee Brace, Boston Scoliosis Brace, TLSO and others, and the success rates of orthoses vary. With little experience in the use of the Chêneau-type corset, the brace provides an effective means for the active correction of scoliotic spinal deformity.

The objective was to demonstrate an outcome with a 3D functional corrective German-designed corset used to treat a patient with AIS in the period from the onset of the curve to the onset of skeletal maturity.

Material and methods The medical history of patient S. including anamnestic, clinical and radiological findings recorded 2018 and 2023 when she used a 3D German-designed (3D GD) corset. The corset design was defined as 3CL/B2 according to the Lehnert – Schroth scoliotic classification as modified by Rigo.

Results The left-sided thoracolumbar curve of a 9-year-old patient with a Risser sign of 0 and a Cobb angle of 25° at baseline decreased to 12° at the age of 16 years (Risser sign — 5) due to bracing.

Discussion The AIS was diagnosed in the patient at the age of 5 years and bracing was initiated at the age of 9. The curve correction using 3D GD brace was based on the principles offered by Chêneau. The patient used the corset for 20 hours per day. The initial brace correction was 90 %. The curve decreased from Cobb angle 25° to 12° over a six-year period of brace treatment with no need for surgery. Three cases with identical outcomes were reported with the use of the Boston and Chêneau braces in AIS.

Conclusion The clinical case showed effective use of the 3D GD corset as a new exponent of corsets developed on the principles offered by Chêneau to prevent surgical treatment by the time of skeletal maturity.

1. Negrini S, Donzelli S, Aulisa AG, et al. 2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis Spinal Disord. 2018;13:3. doi: 10.1186/s13013-017-0145-8

2. Skaggs D, Guillaume T, El-Hawary R, et al. Early onset scoliosis consensus statement, SRS Growing Spine Committee 2015. Spine Deform. 2015;3(2):107. doi: 10.1016/j.jspd.2015.01.002

3. Masso PD, Meeropol E, Lennon E. Juvenile-onset scoliosis followed up to adulthood: orthopaedic and functional outcomes. J Pediatr Orthop. 2002;22(3):279-284.

4. Dobbs MB, Weinstein SL. Infantile and juvenile scoliosis. Orthop Clin North Am. 1999;30(3):331-341. doi: 10.1016/s0030-5898(05)70090-0

5. Lenke LG, Dobbs MB. Management of juvenile idiopathic scoliosis. J Bone Joint Surg Am. 2007;89(Suppl_1):55 63. doi: 10.2106/JBJS.F.00644

6. Aulisa AG, Guzzanti V, Marzetti E, et al. Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies - SOSORT award 2013 winner. Scoliosis. 2014;9:3. doi: 10.1186/1748-7161-9-3

7. Khoshbin A, Caspi L, Law PW, et al. Outcomes of bracing in juvenile idiopathic scoliosis until skeletal maturity or surgery. Spine (Phila Pa 1976). 2015;40(1):50-55. doi: 10.1097/BRS.0000000000000669

8. Babaee T, Kamyab M, Ganjavian MS, et al. Success Rate of Brace Treatment for Juvenile-Onset Idiopathic Scoliosis up to Skeletal Maturity. Int J Spine Surg. 2020;14(5):824-831. doi: 10.14444/7117

9. Robinson CM, McMaster MJ. Juvenile idiopathic scoliosis. Curve patterns and prognosis in one hundred and nine patients. J Bone Joint Surg Am. 1996;78(8):1140-1148. doi: 10.2106/00004623-199608000-00003

10. Tolo VT, Gillespie R. The characteristics of juvenile idiopathic scoliosis and results of its treatment. J Bone Joint Surg Br. 1978;60-B(2):181-188. doi: 10.1302/0301-620X.60B2.659460

11. Kahanovitz N, Levine DB, Lardone J. The part-time Milwaukee brace treatment of juvenile idiopathic scoliosis. Long-term follow-up. Clin Orthop Relat Res. 1982;(167):145-151.

12. Weiss H.R: “Brace technology” thematic series - the Gensingen brace™ in the treatment of scoliosis. Scoliosis 2010 5:22. doi: 10.1186/1748-7161-5-22.

13. Rigo M, Jelačić M. Brace technology thematic series: the 3D Rigo Chêneau-type brace. Scoliosis Spinal Disord. 2017;12:10. doi: 10.1186/s13013-017-0114-2

14. Weiss HR, Turnbull D, Seibel S, Kleban A. First end-result of a prospective cohort with AIS treated with a CAD Chêneau style brace. J Phys Ther Sci. 2019;31(12):983-991. doi: 10.1589/jpts.31.983

15. Rigo MD, Villagrasa M, Gallo D. A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis. 2010;5(1):1. doi: 10.1186/1748-7161-5-1

16. Weinstein SL, Dolan LA, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369(16):1512-1521. doi: 10.1056/NEJMoa1307337

17. Taghi Karimi M, Rabczuk T, Kavyani M. Evaluation of the efficiency of the Chêneau brace on scoliosis deformity : A systematic review of the literature. Orthopade. 2018;47(3):198-204. doi: 10.1007/s00132- 018-3529-4

18. Nikolaev VF, Baranovskaya IA, Andrievskaya AO. Results of using a functional corrective Cheneau type brace in complex rehabilitation of children and teenagers with idiopathic scoliosis. Genij Ortopedii. 2019;25(3):368-377. doi: 10.18019/1028-4427-2019-25-3-368-377

19. Tesakov D.K. Brace treatment of children and adolescents with grade IV spinal deformities. Russian Journal of Spine Surgery. 2010;(2):25-34. (In Russ.) doi: 10.14531/ss2010.2.25-34

20. Richards BS, Bernstein RM, D'Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine (Phila Pa 1976). 2005;30(18):2068-2075; discussion 2076-2077. doi: 10.1097/01.brs.0000178819.90239.d0

21. Wang SF, Qiu Y, Zhu ZZ, et al. Assessment of the residual spine growth potential in idiopathic scoliosis by risser sign and histological grading. Zhonghua Yi Xue Za Zhi. 2008;88(7):461-464. (In Chin.)

22. Gupta P, Lenke LG, Bridwell KH. Incidence of neural axis abnormalities in infantile and juvenile patients with spinal deformity. Is a magnetic resonance image screening necessary? Spine (Phila Pa 1976). 1998;23(2):206-210. doi: 10.1097/00007632-199801150-00011

23. Weiss HR. Spinal deformities rehabilitation - state of the art review. Scoliosis. 2010;5:28. doi: 10.1186/1748- 7161-5-28

24. Weiss HR, Rigo M. Expert-driven Chêneau applications: Description and in-brace corrections. Physiother Theory Pract. 2011;27(1):61-67. doi: 10.3109/09593985.2010.503991

25. Sauvagnac R, Rigo M. Evolution of Early Onset Scoliosis under Treatment with a 3D-Brace Concept. J Clin Med. 2022;11(5):1186. doi: 10.3390/jcm11051186