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IX SOSORT Annual MeetingWiesbaden, May 8-10 2014
CONSERVATIVE TREATMENT WITH BRACE AND
EXERCISE FOR HYPERKYPHOSIS: A RETROSPECTIVE OBSERVATIONAL
COHORT STUDY
Minnella SDonzelli SLusini MZaina FRomano MNegrini ANegrini S
BACKGROUND
HYPERKYPHOSISACCORDING TO SRS CRITERIA
THORACIC KYPHOSIS(According to COBB DEGREES in LL Rx GOLD STANDARD)
20° < NORMAL RANGE< 40° Tribus CB.J Am Acad Orthop Surg, 1998
Wenger DR. In the art and practice of Children’s Orthopaedics,1993Lowe TG. J Bone Joint Surgery[Am],1990
BACKGROUND
HYPERKYPHOSISWHEN
THORACIC KYPHOSIS > 45°(According to COBB DEGREES in LL Rx GOLD STANDARD)
UPPER LIMIT IN A STUDY OF 316 HEALTHY SUBJECTS
Fon GT, Pitt MJ, Thies ACJ. AJR Am J Roentgenol,1980
BACKGROUND
EPIDEMIOLOGY
There’s NO CERTAIN DATA about
PREVALENCE and INCIDENCE
during childhood.
Wengerr DR, Frick SL. Spine, 1999
BACKGROUND
EPIDEMIOLOGY
Just two data
Wenger DR, Frick SL. Spine, 1999
PREVALENCE changes duringgrowth being higherin adolescencethan in childhood
PREVALENCE of
HYPERKYPHOSIS in Scheuermanndisease about
1-8%
BACKGROUND
ACCORDING TO
SRS CLASSIFICATION:
1) CONGENITAL FORMrare
2) ACQUIRED FORMmore frequent
BACKGROUND
HYPERKYPHOSIS:Acquired forms
Idiopathic hyperkyphosis
Scheuermann’s kyphosis
BACKGROUND
GOLD STANDARD
LL X- RAY
DIAGNOSIS
BACKGROUND
DIAGNOSIS
CLINICAL TOOLS:
Plumbline distance at C7
Plumbline distance at L3
Sagittal index (C7+L3)
BACKGROUND
DIAGNOSIS
CLINICAL TOOLS:
Plumbline distance at C7 correlation with Kyphosis
Plumbline distance at L3 correlation with Lordosis
Sagittal index (C7+L3) > 95 risk of hyperkyphosis
Zaina F.,Donzelli S.,Lusini M.,Negrini S. Research into Spinal Deformities.2012
BACKGROUND
Zaina F.,Donzelli S.,Lusini M.,Negrini S. Research into Spinal Deformities.2012
DIAGNOSIS
CLINICAL TOOLS:
Plumbline distance at C7: 34±11 mm (F) and 34±10mm (M)
Plumbline distance at L3: 34±15 mm (F) and 48± 10mm (M)
BACKGROUND
DIAGNOSIS
CLINICAL TOOLS:
MEASUREMENTS ERRORS
C7:0.9 intra-rater1.7 inter-rater
L3:1.2 intra-rater2.2 inter-rater
AIM OF THE STUDY
To assess CONSERVATIVE TREATMENT of IDIOPATHIC and SCHEUERMANN’S KYPHOSIS
ByBRACE AND SPECIFIC EXERCISE
METHODS
STUDY DESIGN:
• RETROSPECTIVE OBSERVATIONAL COHORT STUDY
POPULATION:
• A TOTAL OF 57 PATIENTS aged between 9 and 17 years (mean age 14.1± 1.4)
• 25 Females ; 32 Males
METHODS
AGE< 18At first
evaluation
Diagnosis ofidiopathic or
Scheuermann’s Kyphosis
At least 2 clinicalevaluations by ourphysicians at the
time of therapystart (T0) and stop
(T1)
INCLUSION CRITERIAOUT IN
At least 2 spinal X-rays(lateralprojection) in T0 and T1
METHODS57
patients
43with Scheuermann’shyperkyphosis
14 withIdiopathic
hyperkyphosisAll treated inconservative
way
SpecificExercises
For hyperkyphosis
BRACE(MG or LP)
METHODS
IT’s a 3 POINTS BRACE• Acromial• Thoracic• Sacral
I
44 patients
MAGUELONE Brace
METHODSLAPADULA –SIBILLA Brace
IT’S a TLSO BRACEwith
Acromial pressures
9 patients
METHODS
SPECIFIC EXERCISES forHYPERKYPHOSIS
• Mobilization• Elongation• Extension
of Thoracic spinewith gradually increasing
complexity(SEAS Approach)
METHODS
For all the PATIENTSWe measured in T0 (therapy start) and T1 (therapy stop)
Radiographic and clinical PARAMETERS
Thoracic kyphosis (TK)Lumbar Lordosis (LL)
Plumbline distance in C7Plumbline distance in L3
Sagittal Index (C7+L3)
All the measurementsMade by our PHYSICIANS
with the same method
STATISTICAL ANALYSIS:Student t- test for matched pairs
RESULTST0 T1
Thoracic Kyphosis 61.0°±7.0° 49.0°±8.0°
Lumbar Lordosis 58.5°± 5.14° 52°± 9°
Plumbline distance in C7 63.0mm± 13.0 48.0mm± 11.0
Plumbline distance in L3 64.0mm± 12.0 52.0mm± 9.0
Sagittal Index (C7+L3) 120.0 mm±18.0 95.0mm± 31.0
All the mean values decreased in a significative way !
RESULTSTHERE WAS AN HIGH STATISTICAL SIGNIFICANT
DIFFERENCE FOR:
Thoracic Kyphosis T0/ T1P<0.0001
(Paired Student t -test)
C7 plumbline distance T0/T1P<0.0001
(Paired Student t- test)
010203040506070
1
Kyphosis T0Kkyphosis T1
0
10
20
30
40
50
60
70
1
C7 plumbline T0C7 plumbline T1
RESULTSTHERE WAS ALSO AN HIGH SIGNIFICANT STATISTICAL
DIFFERENCE FOR :
Sagittal index T0/ T1P<0.0001
(Paired Student t-test)
FINALLY THERE WAS HIGH SIGNIFICANT STATISTICAL
DIFFERENCE FOR THE OTHER 2 PARAMETERS FROM T0 to T1
•Lordosis•L3 plumbline distance
0
20
40
60
80
100
120
2
sagittal index T0sagittal index T1
RESULTS
Im p r o v e d
S ta b le
W o r s e n e dLevel Count Prob
Improved 46 0,80702
Stable 7 0,12281
Worsened 4 0,07018
Total 57 1,00000
Results Distribution at T1
Mean value of brace prescription at T0= 19.7 hours
DISCUSSION1. De Mauroy et al. Scoliosis, 2010:272 patients (119 Scheuermann and 153 idiopathic); average age 13years and 6 months.Very SATISFACTORY results with mean Cobb angle from 59.45°±8to 40.84°±8 (2 years after end of treatment)Protocol with plaster cast reduction before bracing.2. Weiss et al. Scoliosis,2009:56 patients (Scheuermann and idiopathic); average age 14 years.Assessment of in Brace Correction: from 55.6° to 39°.A 3 point pressure Brace.
CONCLUSION
ACCORDING TO OUR RESULTS:CONSERVATIVE TREATMENT WITH
RIGID BRACE AND SPECIFIC EXERCISEIS
AN EFFECTIVE THERAPYOF
HYPERKYPHOSIS
CONCLUSION
CONSERVATIVE TREATMENT CAN SIGNIFICANTLY CHANGE
BOTH RADIOLOGICALAND CLINICAL PARAMETERS
RESTORING MORE PHYSIOLOGICAL VALUES
Thank youSalvatore Minnella
www.isico.it
salvatore.minnella@isico.it
“The most beatiful thing we can experience is the mysterious . It is the fundamental emotionthat stands at the cradle of true art and truescience” A.Einstein
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