Prospective study of 136 adolescent scoliosis of more than 40° treated with the Lyon brace

Abstract

Background: Due to a lack of prospective studies, which are difficult to perform, bracing adolescent scoliosis is discussed from 30degree, and sometimes surgery is proposed at this angulation. It seems interesting to study the results of scoliosis over 40degree with the Lyon brace, and to present the criteria for successful treatment. Aim: To prove the effectiveness of the Lyon conservative treatment in the most difficult conditions. If treatment is effective for scoliosis over 40degree, it is even more so for lower angulations. Methods: We selected in our prospective database a cohort of 176 adolescent scoliosis patients with curves over 40degree seen between 1998 and 2007. At this angulation, the Lyon management involves 2 plaster casts, each worn for two months, and a full time Lyon brace up to 18 months after the end of the growth, and a specific program of physiotherapy (Lyon method). Results: 24 patients (13.6%) did not accept the protocol and chose surgery. 11 patients (6.25%) discontinued during the treatment. 136 patients (136 females and 18 males) can be studied statistically. Mean initial angulation is 45.4degree (+-6.33); reducibility in plaster cast and brace is 50%. At follow up 2 years after weaning, angulation is 40.5degree (+-13.1). 61 patients (45%) improved by more than 5degree, 27 patients (20%) are stable, 48 (35%) are worsening by more than 5degree. The results are worse in boys (57% failure). 21 patients were evaluated 10 years after weaning of the brace. Mean progression during this period is 5degree (0.5degree/year) identical to that of the general adult scoliotic population. The best results are obtained when the lower vertebra is L3 (89%); the worst when the lower vertebra is T12 (53%). The two significant predictors of failure of conservative treatment are: - A prior treatment (p>0,05). - Early onset scoliosis (EOS) and non-idiopathic scoliosis (p>0,01). Conclusions: Conservative treatment with Lyon brace and physiotherapy was effective in halting scoliosis progression in 65% of patients including prior treatments. The results of this study confirm that bracing is effective even after 40degree. For EOS and non idiopathic, it allows waiting until end of growth for surgery.