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European Spine Journal

, Volume 28, Issue 6, pp 1286–1295 | Cite as

Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace

  • Claudio VergariEmail author
  • Isabelle Courtois
  • Eric Ebermeyer
  • Raphael Pietton
  • Houssam Bouloussa
  • Raphael Vialle
  • Wafa Skalli
Original Article

Abstract

Purpose

To determine the short-term effect of bracing of adolescent idiopathic scoliotic (AIS) patients on the relationships between spinopelvic parameters related to balance, by comparing their in and out-of-brace geometry and versus healthy subjects.

Methods

Forty-two AIS patients (Cobb angle 29° ± 12°, ranging from 16° to 61°) with a prescription of orthotic treatment were included retrospectively and prospectively. They all underwent biplanar radiography and 3D reconstruction of the spine and pelvis before bracing as well as less than 9 months after bracing. Eighty-three age-matched healthy adolescents were also included as control group and underwent biplanar radiography and 3D reconstruction.

Results

Sacral slope was higher in AIS than healthy patients (p = 0.005). Bracing induced large changes of pelvic tilt (between − 9° and 9°), although patients’ sagittal spinopelvic alignment tended to remain within the normality corridors defined by the healthy patients. Patients had flatter backs compared to healthy subjects and bracing further reduced their spinal curves. The head tended to remain above the pelvis in-brace.

Conclusion

Analysis of sagittal alignment from head to pelvis showed that bracing further flattened the patients’ backs and induced large compensating reorientations of the pelvis. Sagittal balance should be included in the planning and evaluation of brace treatment, since it could play a role in its outcome.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

Keywords

AIS Bracing Brace effect Sagittal balance Compensation 

Notes

Acknowledgements

The authors are grateful to the BiomecAM chair program on subject-specific musculoskeletal modelling (with the support of ParisTech and Yves Cotrel Foundations, Société Générale, Covea and Proteor) and to the DHU MAMUTH for funding. We are also grateful to Ms Fay Manning for her technical support.

Compliance with ethical standards

Conflict of interest

Wafa Skalli holds patents related to the EOS system and associated 3D reconstruction methods, with no personal financial benefit (royalties rewarded for research and education). Raphael Vialle received consulting fees from EOS Imaging unrelated to this study.

Supplementary material

586_2019_5981_MOESM1_ESM.pptx (458 kb)
Supplementary file1 (PPTX 458 kb)
586_2019_5981_MOESM2_ESM.mp4 (420 kb)
Online Resource 1: Changes of the spine, head and pelvis of a patient from pre-brace to in-brace (MP4 420 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.LBM/Institut de Biomécanique Humaine Georges CharpakArts et Métiers ParisTechParisFrance
  2. 2.Unite RachisCHU - Hopital BellevueSaint-ÉtienneFrance
  3. 3.Department of Pediatric Orthopaedics, Armand Trousseau HospitalSorbonne UniversityParisFrance
  4. 4.Spine Surgery DepartmentKaiser Oakland Medical CenterOaklandUSA

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