Skip to main content
SpringerLink
Log in

Short-term outcome of double-shelled braces in neuromuscular scoliosis

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Scoliosis in patients with neuromuscular disease is a common issue and leads to secondary impairment. It is thus important to help such patients to regain and retain best possible stability to improve their quality of life. One option is the double-shelled brace (DSB). The aim of this study was to provide information on the degree of correction when using a DSB on patients with neuromuscular scoliosis.

Methods

We included patients with neuromuscular scoliosis treated with double-shelled braces in this retrospective study. Radiographs of the full spine were taken with and without the DSB, the Cobb angles were measured and compared. The correction was expressed in percent of the lumbar and thoracic Cobb angles. In addition, compounding factors such as age, sex, type of the curves, and movement disorder were included.

Results

We analyzed data from 84 patients with scoliosis with different neuromuscular disorders. The mean age was 12.3 years (± 5.9). In the lumbar spine we detected an improvement of 27.5% (SD ± 32.9), in the thoracic spine 25.3% (SD ± 38.0).

Interpretation

Short-term corrections with a double-shelled brace in neuromuscular scoliosis present an average improvement of one fourth of the lumbar and thoracic Cobb angles and, independent of age, sex, movement disorder, shape or type of the curve. Only spasticity has an influence on the lumbar scoliosis outcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

DSB:

Double-shelled brace

CP:

Cerebral palsy

NMS:

Neuromuscular scoliosis

MMC:

Myelomeningocele

SMA:

Spinal muscle atrophy

GMFCS:

Gross Motor Function Classification System

AP:

Anterior–posterior

References

  1. Murphy R, Mooney J (2019) Currents concept in neuromuscular scoliosis. Pediatr Orthop 2:220–227

    Google Scholar 

  2. Berven S, Bradford DS (2002) Neuromuscular scoliosis: causes of deformity and principles for evaluation and management. Semin Neurol 22(2):167–178

    Article  Google Scholar 

  3. McCarthy RE (1999) Management of neuromuscular scoliosis. Orthop Clin North Am 30(3):435–449

    Article  CAS  Google Scholar 

  4. Miller F (2007) Spinal deformity secondary to impaired neurologic control. J Bone Jt Surg Am 89(Suppl 1):143–147

    Google Scholar 

  5. Saito N, Ebara S, Ohotsuka K, Kumeta H, Takaoka K (1998) Natural history of scoliosis in spastic cerebral palsy. Lancet 351(9117):1687–1692

    Article  CAS  Google Scholar 

  6. Vialle R, Thévenin-Lemoine C, Mary P (2013) Neuromuscular scoliosis. Orthop Traumatol Surg Res 99(1 Suppl):S124–S139

    Article  CAS  Google Scholar 

  7. Madigan RR, Wallace SL (1981) Scoliosis in the institutionalized cerebral palsy population. Spine (Phila Pa 1976) 6(6):583–590

    Article  CAS  Google Scholar 

  8. Miller A, Temple T, Miller F (1996) Impact of orthoses on the rate of scoliosis progression in children with cerebral palsy. J Pediatr Orthop 16(3):332–335

    Article  CAS  Google Scholar 

  9. Rutz E, Brunner R (2013) Management of spinal deformity in cerebral palsy: conservative treatment. J Child Orthop 7(5):415–418

    Article  Google Scholar 

  10. Soo B, Howard JJ, Boyd RN, Reid SM, Lanigan A, Wolfe R et al (2006) Hip displacement in cerebral palsy. J Bone Jt Surg Am 88(1):121–129

    Google Scholar 

  11. Larnert P, Risto O, Hägglund G, Wagner P (2014) Hip displacement in relation to age and gross motor function in children with cerebral palsy. J Child Orthop 8(2):129–134

    Article  Google Scholar 

  12. Yoshida K, Kajiura I, Suzuki T, Kawabata H (2018) Natural history of scoliosis in cerebral palsy and risk factors for progression of scoliosis. J Orthop Sci 23(4):649–652

    Article  Google Scholar 

  13. Oikonomidis S, Meyer C, Scheyerer MJ, Grevenstein D, Eysel P, Bredow J (2019) Lumbar spinal fusion of low-grade degenerative spondylolisthesis (Meyerding grade I and II): do reduction and correction of the radiological sagittal parameters correlate with better clinical outcome? Arch Orthop Trauma Surg 140:1155–1162

    Article  Google Scholar 

  14. Karampalis C, Tsirikos AI (2014) The surgical treatment of lordoscoliosis and hyperlordosis in patients with quadriplegic cerebral palsy. Bone Jt J 96-B(6):800–806

    Article  CAS  Google Scholar 

  15. Kotwicki T, Jozwiak M (2008) Conservative management of neuromuscular scoliosis: personal experience and review of literature. Disabil Rehabil 30(10):792–798

    Article  Google Scholar 

  16. Terjesen T, Lange JE, Steen H (2000) Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy. Dev Med Child Neurol 42(7):448–454

    Article  CAS  Google Scholar 

  17. Tsirikos AI, Chang WN, Dabney KW, Miller F, Glutting J (2003) Life expectancy in pediatric patients with cerebral palsy and neuromuscular scoliosis who underwent spinal fusion. Dev Med Child Neurol 45(10):677–682

    Article  Google Scholar 

  18. Obid P, Yiu K, Cheung K, Kwan K, Ruf M, Cheung JPY (2020) Magnetically controlled growing rods in early onset scoliosis: radiological results, outcome, and complications in a series of 22 patients. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03518-z

    Article  PubMed  Google Scholar 

  19. Bohtz C, Meyer-Heim A, Min K (2011) Changes in health-related quality of life after spinal fusion and scoliosis correction in patients with cerebral palsy. J Pediatr Orthop 31(6):668–673

    Article  Google Scholar 

  20. Canavese F, Marengo L, Corradin M, Mansour M, Samba A, Andreacchio A et al (2018) Deep postoperative spine infection treated by negative pressure therapy in patients with progressive spinal deformities. Arch Orthop Trauma Surg 138(4):463–469

    Article  Google Scholar 

  21. Bosshard A, Nadarajalingam M, Keller S, Brunner R, Camathias C, Rutz E (2019) Double-shelled brace to correct spinal deformity in non-ambulatory patients with cerebral palsy—a STROBE-compliant study. J Pediatr Perinatol Child Health 3:152–162

    Article  Google Scholar 

  22. Cobb J (1948) Outline for the study of scoliosis. American Acad Orthop Surg Instr Course Lect 5:261–275

  23. Marklund T (1978) Scoliosis angle. Conceptual basis and proposed definition. Acta Radiol Diagn (Stockh) 19(1A):78–88

    Article  CAS  Google Scholar 

  24. McMaster WC, Clayton K (1980) Spinal bracing in the institutionalized person with scoliosis. Spine (Phila Pa 1976) 5(5):459–462

    Article  CAS  Google Scholar 

  25. Olafsson Y, Saraste H, Al-Dabbagh Z (1999) Brace treatment in neuromuscular spine deformity. J Pediatr Orthop 19(3):376–379

    CAS  PubMed  Google Scholar 

  26. Thometz JG, Simon SR (1988) Progression of scoliosis after skeletal maturity in institutionalized adults who have cerebral palsy. J Bone Jt Surg Am 70(9):1290–1296

    Article  CAS  Google Scholar 

  27. Hollenbeck MDSM (2019) The pros and cons of operating early versus late in the progression of cerebral palsy scoliosis. Spine Deform 7:489–493

    Article  Google Scholar 

  28. Forst J, Forst KD, Hengstler K (1997) Besonderheiten in der Behandlung von Skoliosen bei Muskelsystemerkrankungen. Z Orthop Unfall 135(2):95–105

    Article  CAS  Google Scholar 

  29. Piggott H (1980) The natural history of scoliosis in myelodysplasia. J Bone Jt Surg Br 62-B(1):54–58

    Article  CAS  Google Scholar 

  30. Samuelsson L, Eklöf O (1988) Scoliosis in myelomeningocele. Acta Orthop Scand 59(2):122–127

    Article  CAS  Google Scholar 

  31. Müller EB, Nordwall A (1994) Brace treatment of scoliosis in children with myelomeningocele. Spine 19(2):151–155

    Article  Google Scholar 

  32. Thomson JD, Banta JV (2001) Scoliosis in cerebral palsy: an overview and recent results. J Pediatr Orthop B 10(1):6–9

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

Many thanks to the participants and their parents. Special thanks to my loving husband for moral support and to my father and grand-father, which both made it possible for me to pursue a medical career.

Author information

Authors and Affiliations

  1. Department of Orthopedic, University Children’s Hospital UKBB, Spitalstrasse 33, 4056, Basel, Switzerland

    Natalia D. Vogel-Tgetgel, Michèle Kläusler, Reinald Brunner, Carlo Camathias & Erich Rutz

  2. University of Basel, Basel, Switzerland

    Reinald Brunner, Carlo Camathias & Erich Rutz

  3. Praxis Zeppelin, St. Gallen, Switzerland

    Carlo Camathias

  4. Orthopedic Department, Hospital of Solothurn, Solothurn, Switzerland

    Michèle Kläusler

  5. Murdoch Children’s Research Institute, MCRI, The Royal Children’s Hospital, Parkville, VIC, Australia

    Erich Rutz

Authors
  1. Natalia D. Vogel-Tgetgel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michèle Kläusler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Reinald Brunner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carlo Camathias
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erich Rutz
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Design (NV, ER, RB), Data acquisition (NV, MK), Analysis and interpretation of data (CC, ER, NV, RB), Drafting and critical revision of the manuscript (NV, MK, RB, CC, ER).

Corresponding author

Correspondence to Natalia D. Vogel-Tgetgel.

Ethics declarations

Conflict of interest

Each author declares that they have no conflict of interest.

Ethical approval

This study, approved by the local ethical committee (EKNZ, ID 2017-01076), was conducted according to the current version of the World Medical Association Declaration of Helsinki.

Consent

There was no patient consent given. The further use of the radiographs that were already made is ethically sound. A signed consent would be difficult to acquire due to the high number of subjects. Although it is a single center study the patients are coming from all over Switzerland. This is also a reason why it would be difficult to get a signed consent. However, the data was of course made anonymous and untraceable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vogel-Tgetgel, N.D., Kläusler, M., Brunner, R. et al. Short-term outcome of double-shelled braces in neuromuscular scoliosis. Arch Orthop Trauma Surg 142, 115–122 (2022). https://doi.org/10.1007/s00402-020-03600-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-020-03600-6

Keywords

Search

Navigation