16 grivas lecture overview on braces used more in europe ... · grivas et al 2003 overall initial...
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Trau
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Dr Theodoros B. GRIVAS, MD PhDOrthopaedic & Spinal Surgeon
Director of the Trauma and Orthopaedic Department
“Tzaneio” General Hospital of Piraeus, Greece
“Scoliosis” Chief Editor
President of International Research Society of Spinal Deformities (IRSSD) &
Past President of Society on Scoliosis Orthopaedic and Rehabilitation Treatment SOSORT
Overview on Braces used more in
Europe
11th International Conference on Conservative Management of Spinal Deformities4th SOSORT Educational Course, 6-7 May
2014, Wiesbaden (Germany)
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Disclosuresno Relationships
11th International Conference on Conservative Management of Spinal Deformities4th SOSORT Educational Course, 6-7 May
2014, Wiesbaden (Germany)Tr
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European Braces
1. Cheneau Brace (France)
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European Braces
During the 60’s Dr Jacques Chêneau built the brace World - wide accepted & used
Dr Jacques Cheneau
http://cheneau.info
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European Braces
rigid brace - 3D correction
Passive mechanisms1) convex to concave tissue transfer, achieved by multiple three‐point systemacting in 3D, with the aim of curve hypercorrection2) elongation and unloading3) Derotation of the thorax4) bending
Active mechanisms1) vertebral growth acting as a corrective factor2) asymmetrically guided respiratory movements of the rib‐cage (RG)3) repositioning of the spatial arrangement of the trunk muscles to provide theirphysiological action4) anti‐gravitational effect
mechanisms of correction of Chêneau Brace
Kotwicki & Cheneau 2008
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elongation & unloadingconvex to concave tissue transfer
Derotation of the thorax
Passive mechanisms
Bending
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asymmetrically guided respiratory movements of R‐Gvertebral growth
Bending & anti‐gravitational effectrepositioning of the trunk muscles
Active mechanisms
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European BracesHuge free spaces
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outcomes
The Cheneau‐Toulouse‐Munster brace decreased the coronal shift forward, the coronal tilt, the axial rotation, and increased the sagittal shift forward and the sagittal vertebral tilt (3‐D correction)
Périé et al: Clin Biomech (Bristol, Avon). 2001 Feb;16(2):129‐37
primary correction 41% (thoracic, lumbar, double) N = 52 patients
Long term correction 14.2% thoracic, 9.2% Lumbardouble curves: 5.5% in thoracic & 5.6% in lumbar
Hopf and Heine Z Orthop Ihre Grenzgeb. 1985, 123(3):312‐22.
average primary correction 43 %
at long term FU curve progression was prevented in 58 %
Bullmann et al Z Orthop Ihre Grenzgeb. 2004, 142(4):403‐9.
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1. Cheneau Brace derivatives
1a Rigo System Cheneau Brace (Spain)
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European Braces
Developed byDr Manuel Rigoduring early 90sBarcelona Spain
Dr Manuel Rigo
http://www.ortholutions.de/start_english.php
Instituto Èlena SalváBarcelonaSpain
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imbalanced thoracic (Three - curve scoliosis pattern)Tr
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European Bracestrue double (or 4 curve pattern)
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balanced thoracic & false double (non 3 non 4)Tr
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Single lumbar/thoracolumbar lumbar
Three‐point systems
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European BracesBiomechanics of the RSC
Regional derotation: The brace derotates the thoracic section (b) against the lumbar section (a), with a counter‐rotation pad at the upper thoracic region
Rigo & Weiss 2008
Three‐point systems
Sagittal Normalization
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Physiological sagittal profile
Biomechanics of the RSC
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European BracesoutcomesInitial reports
31.1% primary Cobb angle correction &
22.2% primary torsion angle correction
FU of 16.8 months 54% of curves were stable
27% improved
19% progressed
Rigo et al 2002
w/ a recently described RSC brace design (three-curve-scoliosis brace w/ pelvis open)
In long thoracic curves treated there was in-brace correction
76.7 % Cobb angle &
55.9% axial rotation Rigo & Gallo 2009
81%Good
results
FU 16.8 months
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1. Cheneau Brace derivatives
1b ScoliOlogiC® “Chêneau light” (Germany)
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European BracesScoliOlogiC® “Chêneau light”
the brace was invented by Dr. Hans-Rudolph Weiss
April 2005 application for the patent
May 2005 the first braces were built
http://www.koob-scolitech.com/scoliologic.php
Gensingen brace - 2010
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2007
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The Cobb angle in the whole group was reduced by an
average of 16,4 degrees 51% correctionlumbar & thoracolumbar curve pattern
…………….. 62 % correction
thoracic scoliosis ……………... 36 % correction
double major curve pattern …. 50 % correction
The correction effect correlatednegatively with age (r = ‐0,24; p = 0,014)negatively with the Risser stage (‐0,29; p = 0,0096)negatively with Cobb angle before treatment (r = ‐0,43; p
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European Braces
2. Lyonnaise Brace (France)
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1947: The Lyon Brace was created by Pierre Stagnara.1958: Allègre and Lecante modify it to the actual using aluminium bars and plexidur (high rigidity material)It is an adjustable rigid brace, without any collar
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two main principles of treatment- Plaster cast to stretch the deep ligaments before the Lyon brace- Adjustable brace of 7 cm in length and 7 kg of weight
Design: 14 types according to Lenke classificationIndication: 11-15 years, not earlier to prevent tubular deformation of the thorax
Results: Effectivity index (SRS - SOSORT criteria)Lumbar curve : 0,97Thoraco-lumbar curve: 0,88Thoracic curve: 0,80
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European Bracesoutcomes
Cosmesis (hump in mm)
De Mauroy et al Disabil Rehabil Assist Technol. 2008
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3. Dynamic Derotating Brace DDB (Greece)
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Dynamic Derotating Brace (DDB) 1986
Antoniou D, Valavanis J, Zachariou C, Smyrnis P (1986): “Dynamic Derotation Brace (DDB). A new aspect for the conservative treatment of
Idiopathic Scoliosis” 21st common meeting of SRS and BSS
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DDB designs are based on the commonly used classification, which distinguishes scoliotic curves into thoracic (a), thoracolumbar (b), lumbar (c),
& double major (d) (Ponseti and Friedman)Trau
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BiomechanicsDDB feature derotating blade/s posteriorlyThis function as a force couple, which is added to theside forces (three point systems) exerted by the brace itself
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European Bracesoutcomes
overallImprovement 35.70%Stable 46,42%Increase 7.83%Grivas et al 2003
overallInitial correction 49.54%2yrs FU 44.10%
Valavanis et al 1995
Cobb angle
Cosmesis (Angle Trunk Inclination – ATI – hump)
DDB improves the cosmetic appearance of the back of IS children with all but right thoracic curvesGrivas & Vasiliadis 2008
QoL – Brace Questionnaire (BrQ)
influenced school activity & social functioning, but not general healthperception, physical functioning, emotional functioning, vitality, bodily pain, self-esteem & aestheticsGrivas et al 2006Tra
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European Braces
4 TriaC brace (Nederland)
Dr Albert Gerrit Veldhuizen"
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European BracesInclusion criteria -indicationsPrimary thoracic apex between the 7th & 11th Th vertebraPrimary lumbar apex between the 2nd& 5th L vertebra and for Flexible curve (at least 40% correction on bending films)Trau
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European BracesoutcomesCobb angle
controls or corrects
76% of IS curves
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5. Sforzesco brace (Italy)
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2004Sforzesco bracedeveloped by
Stefano Negrini MD w/ the Gianfranco Marchini CPOBased on
SPoRT concept
http://isico.it/approach/default.htm
Dr. Stefano Negrini
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European BracesThe SPoRT concept
(Symmetric, Patient- Oriented, Rigid, Three-Dimensional, Active)
Sforzesco brace
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4
Deflection actionPushes lateral distal convex, lateral proximal
concave, posterior convexEscapes superior-anterior & lateral superior
Drivers & stops
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Pushes lateral distal convex, lateral proximal concave, posterior convex
Pushes lateral distal convex, lateral proximal concave, posterior convex
Pushes lateral distal convex, lateral proximal concave, posterior convex
Pushes lateral distal convex, lateral proximal concave, posterior convex
Correction of a thoracic right curve
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outcomes
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6. Progressive Action Short Brace PASB, (Italy)
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European BracesProgressive Action Short Brace PASB
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Deflexion DerotationTraction
Application of external actionsApplication of external actions
Phase I Plaster cast
Progressive Action Short Brace PASB
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thSR
S An
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rse San An
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Constrained dynamic of the spineConstrained dynamic of the spine
Inversion of the stress‐loading distributionInversion of the stress‐loading distribution
phase IICustom‐made polypropylene brace from plaster mould
Cast geometry
Progressive Action Short Brace PASB
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Pre treatment Cobb mean value 29,30 ± 5,16 SD Initial apical rotation 12.70 ± 6,14 SD Immediate Cobb correction to 14,67 ± 7,65 SD Apical correction at FU 8,95 ± 5,82
curve correction in 94% of patientscurve stabilization in 06% of patients
Thoraco-lumbar and lumbar curves
Aulisa et al, Scoliosis, 2009
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European Braces7. TLI (thoracolumbar lordotic intervention) brace
developed in 2002 by dr Piet van Loon, Orthopedic Surgeon & Jan Munneke, OrthotistTr
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European BracesTLI (thoracolumbar lordotic intervention) brace
is completely symmetricTLI is based on concept described by M.Jansen in 1913hypothesis that both thoracolumbar kyphotic & scoliotic spinal deformities are due to a
dislocation of the thoracolumbar joint from its normal/optimal position at the center. This dislocation was described by.Mechanically, The TLI bracing concept is a Ponseti-type interventionrepositioning the joint in its optimal position to reduce shearstress & deformative impulse.Outcomes: initial ‘in brace’ outcome -> reduction of the Cobb angles in kyphosis & scoliosis groups (sagittal p < 0.001, pelvic obliquity p < 0.001).FU one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in all sagittal and coronal measurements.Tra
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European Braces1. Cheneau Brace (France and other European Countries)
1a Rigo System Cheneau Brace (Spain)
1b ScoliOlogiC® “Chêneau light” (Germany)
2. Lyonnaise Brace (France)
3. Dynamic Derotating Brace DDB (Greece)
4. TriaC brace (Nederland)
5. Sforzesco brace / SPoRT concept (Italy)
6. Progressive Action Short Brace PASB (Italy)
7. Thoracolumbar lordotic intervention brace TLI (Nederland)
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Orthopaedics and Traumatology Department
“Tzaneio” General Hospital of Piraeus, 2014
T z a n e i o H o s p i t a l 1 8 6 4
Moutsopoulou Coast
Thank you very much for your attention
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