What Are the Different Types of Scoliosis Braces?

There are four physiological curvatures in the sagittal plane of the spine. The frontal plane should not have any radians. Once the radians appear to both sides, it is called scoliosis. Scoliosis is a clinical symptom caused by a variety of causes and can be summarized into two major categories, namely functional scoliosis and structural scoliosis.

Idiopathic Scoliosis in Youth

Right!

There are four physiological curves in the sagittal plane of the spine, and the frontal plane should not have any

Idiopathic scoliosis accounts for the vast majority of scoliosis. If you can understand its cause, it will be of great significance for prevention and treatment. Therefore, for many years, people have been working on the cause of idiopathic scoliosis, but the exact cause has not been found so far.

In 1979, Herman proved that patients with idiopathic scoliosis had labyrinth function impairment. In 1984, Yamada also performed a balance function test on patients with idiopathic scoliosis. The results showed that 79% showed significant balance dysfunction, compared with only 5% in the control group. Wyatt also found that patients with scoliosis had a significant vibration imbalance, suggesting that there was a central disorder in the posterior column pathway in patients with scoliosis. However, these studies did not clarify the relationship between idiopathic scoliosis and balance disorders, let alone the etiology of idiopathic scoliosis.

Observation found that patients with idiopathic scoliosis were taller than their normal peers. The same was true of the 1984 census. Therefore, it is urged to understand the relationship between growth hormone and idiopathic scoliosis. Different authors have different conclusions, and growth hormone content is still a matter of debate. More literature discusses the relationship between paravertebral muscles and idiopathic scoliosis. The detection of paravertebral muscles includes muscle spindles, muscle fiber morphology, muscle biochemistry, electromyography, calcium, copper, and zinc contents. Although there were abnormal findings, none of them elucidated the cause directly. People have also investigated the genetic problems from familial surveys and surveys of patients with twin scoliosis, but more patients cannot yet be explained by a single genetic abnormality. Therefore, the etiology of idiopathic scoliosis remains to be explored Important topics.

The pathogenesis of idiopathic scoliosis is unknown, and research has found that it may be related to the following factors:

(I) Genetic factors: Epidemiological studies of idiopathic scoliosis have shown that there are significant genetic factors affecting their occurrence, and the specific genetic model is still unknown. Most scholars believe that they are dominated by autosomal and incomplete sexual linkage and Diversity expression and so on. This seems to explain the gender characteristics of the disease distribution. In patients with scoliosis around 20 o, the ratio of men and women is basically equal; however, in patients with scoliosis greater than 20 o, females: males exceed 5: 1, and severe treatment needs Most patients with bending are girls. According to statistics, children with parents who have scoliosis are 50 times more likely to develop the disease than normal people.

(II) Hormone effect: Girls with idiopathic scoliosis are often taller than normal girls of the same age. This phenomenon suggests that scoliosis may be related to growth hormone, but a large number of studies believe that growth hormone is not the true cause of spinal deformity. Because growth requires the interaction of many factors, including growth factors, the control of growth is very complex.

(Three) abnormal connective tissue development: patients with idiopathic scoliosis can find abnormalities in the quality and quantity of collagen and proteoglycans in connective tissue. Whether this is the primary or secondary cause of scoliosis has not yet been determined.

(IV) Nerve-balance system dysfunction: The function of the human balance system is to control various gravity acting on the human body and maintain the balance in various states. It appears on a reflection link in the reflection arc of this balance system. Dysfunction, scoliosis may occur to adjust or establish a new balance.

(5) Neuroendocrine system abnormalities: Many scholars have shown that melatonin and serotonin play an important role in is formation. The scoliosis model that appears after the pineal gland is removed from chickens is one of the classic animal models for studying scoliosis. The main function of the pineal gland is to secrete melatonin, so some scholars have speculated that the serum melatonin Decreasing serotonin may be an important initiating factor for the occurrence of scoliosis and is related to the progression of scoliosis.

(6) Others: Some clinical observations have found that the offspring of elderly mothers are susceptible to idiopathic scoliosis and progress rapidly. In addition, abnormal copper metabolism may play a role in the occurrence of idiopathic scoliosis.

The causes of scoliosis are different, and the pathological changes are similar. According to the characteristics of pathological changes, they are divided into reversible and irreversible. Reversibility generally occurs in functional (compensatory) orthoracic scoliosis, which is common in the thorax or thoracolumbar, most of which are convex to the right, and less to the left, mainly unilateral, standing Or walking was obvious, disappeared when lying down or suspended, X-ray examination showed a scoliosis arc, no change in bone structure. Irreversible scoliosis usually refers to structural scoliosis. Reversible scoliosis, such as delayed treatment, and long-term soft tissue contractures on one side of the spine, can also lead to structural changes in the spine (such as vertebral wedge deformation, thoracic deformity, etc.). Structural scoliosis deformity is relatively fixed, does not disappear or increase for body odor changes, often combined with thoracic deformity, scoliosis anterior chest wall depression, posterior wall bulging; concave anterior chest wall convex, posterior wall depression, abnormal lung function . The X-ray orthophoto shows three scoliosis, also called sigmoid deformities, with the middle scoliosis as the primary, and the upper and lower scoliosis as compensation. Scoliosis is accompanied by spinal deformity. Scoliosis and ribs protrude backward to form a side ridge, which is called a razor deformity.

Clinical manifestations

I. Toddler

Idiopathic Scoliosis / Scoliosis

Infantile scoliosis refers to structural scoliosis that occurs before 3 years of age. Idiopathic scoliosis is relatively rare at this stage. It is characterized by more men than women, mostly thoracic thoracic vertebrae, often with other malformations, the most common oblique deformity, followed by mental retardation or congenital hip dislocation. Suspend the child from the armpit during the examination, observe the stiffness and stiffness of the scoliosis, perform a neurological examination, and check whether there is any other congenital malformation. Take a picture of the spine in the suspended or supine position. A full-length orthotopic radiograph was performed to observe the differences in Cobb angle, Mehta sign, and costal vertebra angle.

The so-called rib angle difference refers to drawing a line perpendicular to the end plate at the center of the apex of the thoracic curve, and then drawing a median axis in the head and neck of the corresponding rib. The intersection of the two lines is the rib angle. The difference between the rib vertebra angles on both sides of a normal spine is 0. When the scoliosis is scoliosis, the rib vertebra angles on the convex side are smaller than those on the concave side, and the rib vertebra angle differences on both sides are greater than 0. In addition, Mehta described two signs, that is, in the upright X-ray film, the rib heads of early childhood scoliosis do not overlap with the vertebrae. This is the Mehta sign . For example, the rib head on the convex side overlaps with the vertebral body as Mehta sign II. If the change from sign to sign indicates the progression of scoliosis, Mehta uses this difference to the costal angle to distinguish infantile idiopathic scoliosis into recovery and progression. This has certain reference value for predicting the prognosis of infantile scoliosis.

Second, juvenile

Idiopathic scoliosis before puberty after about 3 years of age accounts for about 15%. At this time, part of the scoliosis that was found to be infantile-type scoliosis before 3 years of age were mostly thoracic lobes of the thoracic spine. Scoliosis that occurred during the age of 7 to 10 years often had adolescent scoliosis. Koop (1988) reports that juvenile idiopathic scoliosis is mostly a simple right thoracic spine, followed by thoracolumbar bilateral scoliosis.

Third, youth

Idiopathic scoliosis

Adolescence is a rapid stage of bone growth and development, and also a period of rapid progression of scoliosis. There are many factors that affect the progression of scoliosis, in addition to age, it is related to the type of scoliosis, menarche, Risser sign and Harrington factor. Lonstein census reports different incidences of scoliosis at different ages: 2.5% under 9 years old, 4.1% at 10 years old, 8.8% at 11 years old, 19.8% at 12 years old, 24.5% at 13 years old, 19.5% at 14 years old, and over 15 years old It was 20.8%. It illustrates the relationship between age and development.

Lonstein's opinion based on the results of the 1970-1979 census is that the progress of the scoliosis angle is positively related to the original angle, and is inversely related to age and the Risser sign. If the original scoliosis angle is less than 19 °, the Risser sign Grades 2, 3, or 4 (or , , degrees), only 1.6% progressed, while the other group had a scoliosis angle of 20 ° -29 °, and the Risser sign was grade 0 (non-ossified) or grade 1 (I degree) Its progress rate is as high as 68%. In addition, the Harrington factor has a certain relationship with progress: the number of spinal segments included in the scoliosis divided by the scoliosis angle. Non-progressive patients had an average of 2.7, and more than 3.4 were progressive. There is also a relationship between the type of scoliosis in a single factor. Bilateral scoliosis is more likely to progress than unilateral scoliosis. Scoliosis of the lumbar and thoracolumbar segments in bilateral bending is more likely to progress than thoracic scoliosis. Therefore, different treatment methods should be selected according to different ages, types of scoliosis, and different clinical manifestations of patients.

(1) Medical history

1. Early detection: Scoliosis was mostly unintentionally discovered by parents or teachers for the first time, showing unequal shoulder height, unilateral scapula protruding backwards. For ais, the initial detection is often between 10 and 13 years old.

2. Clinical Symptoms: Spine bending to one side is often the main symptom at the first diagnosis. In addition, there are manifestations of asymmetry of the trunk when standing, such as unequal shoulders, protruding back of the scapula on one side, and asymmetry of the front chest. Severe scoliosis can cause chest collapse, torso imbalance, shortened torso, decreased endurance due to decreased chest volume, shortness of breath, palpitations, etc. A few patients may experience low back pain. Scoliosis is found inadvertently in some patients, and the deformity may not be obvious.

3. Family history: Although the relationship between ais and heredity has not yet been clarified, clinical observations have found that ais has a certain genetic tendency. Understanding the usual health status, intelligence level, and mother's pregnancy and childbirth history is important to rule out non-idiopathic scoliosis. For example, understanding the patient's birth history and the history of polio can help distinguish cerebral palsy caused by dystocia from scoliosis after polio.

4, personal history: a detailed understanding of personal history is helpful to judge the natural course of scoliosis, such as the age of onset of scoliosis and the progress of the course. Idiopathic scoliosis mostly occurs during puberty and progresses rapidly during the rapid growth phase. Neuromuscular scoliosis can develop at any age.

(Two) physical examination

1. The forward flexion test is an important test for idiopathic scoliosis. Patients are instructed to stand with their feet close together, knees straight, waist forward flexion, hands aligned, arms down, and doctors observe from the patient's front, back and sides. Are there two sides of the back high, one low, and kyphosis or lordosis. Use a scoliometer to measure the asymmetric angle. If it is 5 ~ 7o, the cobb angle on the x-line is 15 ~ 20o. The standing position of the patient can be checked for trunk inclination and the softness of the spine. In addition, it is necessary to check whether the shoulders and the zygomatic spines on both sides are the same. When there is back pain, pay attention to check the pain.

2. Detailed neurological examination, check carefully for abnormalities in sensation, movement, muscle strength, muscle tone, and reflexes, and for any weakening, disappearance and asymmetry of abdominal wall reflexes and pathological signs. Check the skin for milk coffee spots, excessive looseness of the skin and joints, and marfan syndrome. Helps exclude non-idiopathic scoliosis such as: congenital scoliosis, cerebral palsy, polio, spina bifida, neurofibromatosis, marfan's syndrome, ehlers-danlos syndrome, chiari deformity, etc. Scoliosis.

(Three) imaging inspection

X-ray film is the main method to diagnose and evaluate adolescent idiopathic scoliosis. The type, location, severity, and flexibility of the scoliosis can be determined, which can help determine the cause and perform preoperative design.

The x-ray characteristics of adolescent idiopathic scoliosis are as follows: changes in the invertebral bone structure: a small number of early scoliosis apex may have mild wedge deformation. The curvature of the scoliosis changes uniformly, and short arcs and sharp arcs will not appear. The ridge has a certain uniform flexibility, and the flexibility gradually increases from the parietal vertebra to the distal vertebra. Scoliosis is more common on the right side of the thoracic spine. If the left side is convex, the possibility of non-idiopathic scoliosis should be considered. Idiopathic thoracic scoliosis mostly appears on the sagittal plane as a reduction or disappearance of the physiological kyphosis of the thoracic spine. The anterior column (ie vertebra) of idiopathic scoliosis mostly turns to the convex side, while the posterior column (spinous process) turns to the concave side. If the direction of rotation is opposite, the scoliosis caused by tumor or other reasons should be ruled out.

X-ray plain film requirements are anterior chest 1 to palate 1 full spine film after standing, and the operator needs to take lateral and bending films. The cobb method is often used to measure the angle of scoliosis on the coronal plane. First, the upper and lower end vertebrae of the scoliosis are determined on the orthotopic film. The end vertebra is the most inclined in the entire curvature, and it follows the upper end plate of the upper vertebra and the lower end Draw a straight line on each end plate. The intersection angle of the two vertical lines is the cobb angle. Evaluation of bone maturity is very important in predicting the progression of scoliosis and deciding treatment measures. The most commonly used skeletal epiphysis is estimated, that is, risser. The ossification gradually moved from the front of the palate to the back of the palate. The palate was divided into four equal parts. The movement of the palate was 25% for grade i; 50% was grade ; 75% was grade; Level, the epiphysis and patella are fused to level V, at which point the development of the epiphysis system stops.

Idiopathic scoliosis generally does not require ct and mri examinations. For "atypical" idiopathic scoliosis, such as left thoracic vertebrae, accompanied by loss of local sensation or movement, abnormal abdominal wall reflexes, positive pathological reflexes, abnormal skin manifestations, etc., mri can exclude intraspinal lesions, Such as spinal cavity, chiari deformity, tethered spinal cord and longitudinal spina bifida.

Treatment options

Functional scoliosis is mainly for prevention. School-age children should maintain correct posture, strengthen the back muscles, abdominal muscles, diaphragm muscles and shoulder muscles. The light ones correct themselves without treatment. Idiopathic scoliosis, without structural abnormalities, can wear scaffolds or short jackets with spirals to prevent the development of deformities. The disease can reach 12-16 years of age, that is, the period of puberty, and the deformity easily deteriorates. It should be closely observed and effective treatment measures should be actively taken.

Surgical treatment of abnormal spinal structures (such as congenital hemivertebrae, longitudinal spinal cord, cervical ribs, and ribs), pathological changes of spine structures (such as tuberculosis, tumors, etc.) and various abnormalities of the spine, such as thorax formation and burns Remaining scars, etc., should actively take measures to fully treat these pathological changes and deformities of the external spine structure, laying a foundation for the correction of scoliosis.

The surgical methods to correct scoliosis are: (1) special correction equipment: Harlington equipment, including a strut and a compression rod; (2) spinal fusion: cancellous bone implanted next to the spinous process. Sometimes both methods are applied simultaneously.

I. Toddler

First of all, a treatment plan should be made according to the X-ray film. If the X-ray film shows the first phase of Mehta sign, and the costal angle difference is less than 20 degrees, it is a recovery type. Generally, no treatment is needed. However, X-rays are reviewed every six months for follow-up examinations until complete recovery. After that, take a review every 1-2 years until the bones mature. If the X-ray film shows the Mehta sign as the second stage, and the rib angle difference is greater than 20 °, early treatment should be performed. Consider gypsum vest fixation under anesthesia. After the patient grows up, change to Milwaukee brace fixation treatment. If the brace cannot control its progress, subcutaneous support internal fixation can be considered, but not fusion. Unless necessary, the rigid scoliosis that cannot be controlled by conservative methods is considered the problem of spinal fusion.

Second, juvenile

The incidence of idiopathic scoliosis in men and women varies with the age of the patient. However, most scholars believe that there are more young women than men, and most think that the right side of the chest curve is more common. Treatment of adolescent idiopathic scoliosis is broader than treatment of adolescent scoliosis, because juvenile scoliosis tends to get worse. Physical therapy is available for scoliosis below 20 °. Stand-up films are taken every six months for follow-up observation. Milwaukee braces should be given to patients with thoracic and biflexion at 20 ° -40 °, and thoracolumbosacral braces should be used for thoracolumbar or lumbar flexion. If the brace treatment cannot control its development, the scoliosis angle is greater than 40 °, but the lateral curvature is softer and more flexible, and a subcutaneous rod support orthodontics can be used. If the scoliosis is stiff and poorly flexible, or whether the treatment is bracing or subcutaneous rod support, if the scoliosis continues to increase, the Cobb angle cannot be controlled within 50 °, and spinal fusion is considered. Otherwise, treatment should be as conservative as possible until the age of fusion.

Third, youth

Adolescent idiopathic scoliosis is the most common scoliosis. There are more women than men, and the right side of the chest curve is more common. The most important treatment for adolescent scoliosis is to evaluate the developmental stage of the patient according to Risser sign. Patients mature below 20 ° may not be treated. For immature patients, physical therapy is feasible, and follow-up observations are taken every six months until development is mature. If the scoliosis exceeds 25 ° and the growth and development is not yet mature, Milwaukee brace or thoracolumbosacral brace should be treated as early as possible, and combined with physical therapy or electrical stimulation until the growth of the entire spine is stopped and the risser sign is grade 4 ( degree ) Above, remove the brace. For those who still have adolescent scoliosis with Cobb angle above 40 °, they should not be treated conservatively. Instead, spinal orthopedic fixation and fusion should be performed directly. Harrington instruments are generally the most commonly used.

For adult patients who develop disease before mature bones, and are seen after adulthood, some authors have pointed out that those with a thoracic curve in the range of 50 ° -80 ° may still be able to progress, but less than 50 ° less than 80 ° Progress, advocates for progressive thoracic scoliosis after the bone matures, if the angle reaches 50 °, surgical fusion should be performed. If the thoracolumbar scoliosis angle exceeds 50 °, surgery can be considered to prevent back pain. In short, for the treatment of idiopathic scoliosis, an appropriate treatment method should be selected according to the different ages of the patients and the type of scoliosis.

Non-surgical treatments include physical therapy, physical therapy, surface electrical stimulation, plaster and braces. But the main and most reliable method is brace treatment.

Indications for brace treatment :

(1) Mild scoliosis between 20 and 40 degrees. Scoliosis over 40 degrees should not be treated with braces.

(2) Children with immature bone pathways should be treated with braces.

(3) When two structural bends to 50 degrees or a single bend more than 45 degrees, brace treatment is not suitable

(4) Scoliosis combined with thoracic lordosis should not be treated with braces.

(5) Long bending of the segment, good treatment effect of brace, waist or thoracolumbar scoliosis with better elasticity below 40 degrees.

(7) Patients and parents who do not cooperate should not be treated with braces.

Braces

When you start wearing, it takes 23 hours a day, and 1 hour is used for body treatment and breathing exercises. If the cooperation between the patient and the family cannot be obtained, it should be worn for at least 16 hours a day. If the Cobb angle can be reduced by 50% with the brace, a better therapeutic effect is expected. After one year of treatment, if the scoliosis can be reduced by 50%, the wearing time can be gradually reduced, and with the increase of Risser, it can be worn only at night. If the scoliosis begins to increase by more than 5 degrees, you need to increase the wearing time.

Purpose : The purpose of surgical treatment is to prevent the further development of the deformity by fusing the spine, so as to minimize the impact of the deformity on the body. On this basis, the use of instruments to make a certain degree of orthopedics and promote the occurrence of bone fusion, orthopedics is not the main purpose.

Indications :

1. Brace treatment cannot control the development of deformity, and the degree of scoliosis continues to increase.

2. Pulmonary dysfunction and asymmetrical torso in adolescent scoliosis, severe deformity requires plastic surgery.

3. Pain in older patients who cannot be controlled by conservative treatment or those with neurological symptoms.

4. Adolescent scoliosis above 45 degrees.

5. Cobb's angle of 40 degrees, but with severe thoracic lordosis and obvious rib bulge.

Surgical treatment of abnormal spinal structures (such as congenital hemivertebrae, longitudinal spinal cord, cervical ribs, and ribs), pathological changes of spine structures (such as tuberculosis, tumors, etc.) and various abnormalities of the spine, such as thorax formation and burns Remaining scars, etc., should actively take measures to fully treat these pathological changes and deformities of the external spine structure, laying a foundation for the correction of scoliosis.

The surgical methods to correct scoliosis are: (1) special correction equipment: Harlington equipment, including a strut and a compression rod; (2) spinal fusion: cancellous bone implanted next to the spinous process. Sometimes both methods are applied simultaneously.

I. Toddler

First of all, a treatment plan should be made according to the X-ray film. If the X-ray film shows the first phase of Mehta sign, and the costal angle difference is less than 20 degrees, it is a recovery type. Generally, no treatment is needed. However, X-rays are reviewed every six months for follow-up examinations until complete recovery. After that, take a review every 1-2 years until the bones mature. If the X-ray film shows the Mehta sign as the second stage, and the rib angle difference is greater than 20 °, early treatment should be performed. Consider gypsum vest fixation under anesthesia. After the patient grows up, change to Milwaukee brace fixation treatment. If the brace cannot control its progress, subcutaneous support internal fixation can be considered, but not fusion. Unless necessary, the rigid scoliosis that cannot be controlled by conservative methods is considered the problem of spinal fusion.

Second, juvenile

The incidence of idiopathic scoliosis in men and women varies with the age of the patient. However, most scholars believe that there are more young women than men, and most think that the right side of the chest curve is more common. Treatment of adolescent idiopathic scoliosis is broader than treatment of adolescent scoliosis, because juvenile scoliosis tends to get worse. Physical therapy is available for scoliosis below 20 °. Stand-up films are taken every six months for follow-up observation. Milwaukee braces should be given to patients with thoracic and biflexion at 20 ° -40 °, and thoracolumbosacral braces should be used for thoracolumbar or lumbar flexion. If the brace treatment cannot control its development, the scoliosis angle is greater than 40 °, but the lateral curvature is softer and more flexible, and a subcutaneous rod support orthodontics can be used. If the scoliosis is stiff and poorly flexible, or whether the treatment is bracing or subcutaneous rod support, if the scoliosis continues to increase, the Cobb angle cannot be controlled within 50 °, and spinal fusion is considered. Otherwise, treatment should be as conservative as possible until the age of fusion.

Third, youth

Adolescent idiopathic scoliosis is the most common scoliosis. There are more women than men, and the right side of the chest curve is more common. The most important treatment for adolescent scoliosis is to evaluate the developmental stage of the patient according to Risser sign. Patients mature below 20 ° may not be treated. For immature patients, physical therapy is feasible, and follow-up observations are taken every six months until development is mature. If the scoliosis exceeds 25 ° and the growth and development is not yet mature, Milwaukee brace or thoracolumbosacral brace should be treated as early as possible, and combined with physical therapy or electrical stimulation until the growth of the entire spine is stopped and the risser sign is grade 4 ( degree ) Above, remove the brace. For those who still have adolescent scoliosis with Cobb angle above 40 °, they should not be treated conservatively. Instead, spinal orthopedic fixation and fusion should be performed directly. Harrington instruments are generally the most commonly used.

For adult patients who develop disease before mature bones, and are seen after adulthood, some authors have pointed out that those with a thoracic curve in the range of 50 ° -80 ° may still be able to progress, but less than 50 ° less than 80 ° Progress, advocates for progressive thoracic scoliosis after the bone matures, if the angle reaches 50 °, surgical fusion should be performed. If the thoracolumbar scoliosis angle exceeds 50 °, surgery can be considered to prevent back pain. In short, for the treatment of idiopathic scoliosis, an appropriate treatment method should be selected according to the different ages of the patients and the type of scoliosis.