“Brace Technology” Thematic Series - The ScoliOlogiC® Chêneau lightTM brace in the treatment of scoliosis

Background: Bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of polyethylene (PE) and soft braces. The plaster cast method worldwide seems to be the most practiced technique for the construction of hard braces at the moment. CAD (Computer Aided Design) systems are available which allow brace adjustments without plaster. Another possibility is the use of the ScoliOlogiCTM off the shelf system enabling the Certified Prosthetist and Orthotist (CPO) to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This Chêneau lightTM brace, developed according to the Chêneau principles, promises a reduced impediment of quality of life in the brace. The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principles of the Chêneau lightTM brace have shown a satisfactory in-brace correction exceeding 50% of the initial Cobb angle. Brace description: The ScoliOlogiC® off the shelf bracing system enables the CPO to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright. This brace, when finally adjusted is called Chêneau lightTM brace. The advantage of this new bracing system is that the brace is available immediately, is easily adjustable and that it can also be easily modified. This avoids construction periods of sometimes more than 6 weeks, where the curve may drastically increase during periods of fast growth. The disadvantage of this bracing system is that there is a wide variability of possibilities to arrange the different shells during adjustment. Results: The Cobb angle in the whole group was reduced by an average of 16,4°, which corresponds to a correction effect of 51%. The differences were highly significant in the T-test (T = 17,4; p < 0,001). The best correction effects achieved with Chêneau braces reported in literature so far are about 40% in two different studies. The correction effect was highest in lumbar and thoracolumbar curve patterns (62%; n = 18). In thoracic scoliosis the correction effect was 36% (n = 41) and in double major curve patterns 50% (n = 22). The correction effect was affected in a slightly negative way due to age (r = -0,24; p = 0,014), negatively with the Risser stage (-0,29; p = 0,0096) and correlated negatively with the Cobb angle measured before treatment (r = -0,43; p < 0,0001). Conclusions: The use of the Chêneau lightTM brace leads to correction effects above average when compared to correction effects of other braces described in literature. The reduction of material seems to increase patient’s comfort and reduces the stress patients may suffer from whilst in the brace. 80% of the adolescent population of scoliosis patients can be braced with the Chêneau lightTM brace. In certain patterns of curvature and in the younger population with an age of less than 11 years, other approaches have to be used, such as plaster based bracing or the application of CAD/CAM based orthoses. * Correspondence: [email protected] Orthopedic Rehabilitation Services, D-55457 Gensingen, Alzeyerstr. 23, Germany Full list of author information is available at the end of the article Weiss and Werkmann Scoliosis 2010, 5:19 http://www.scoliosisjournal.com/content/5/1/19 © 2010 Weiss and Werkmann; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction Bracing concepts in use today for the treatment of scoliosis include symmetric and asymmetric hard braces usually made of PE and soft braces. The latest developments in the field of bracing, aim at improving specificity (1) and at a proper sagittal realignment (2). The plaster cast method worldwide seems to be the most practiced technique for the construction of hard braces at the moment. CAD (Computer Aided Design) systems are available, which allow brace adjustments without plaster. Another development however, is the ScoliOlogiCTM off the shelf system enabling the CPO to construct a light brace for scoliosis correction from a variety of pattern specific shells to be connected to an anterior and a posterior upright [1]. This Chêneau lightTM brace, constructed according to the Chêneau principles, promises a reduced impediment of quality of life in the brace. The correction effects of the first 81 patients (main diagnosis Adolescent Idiopathic Scoliosis (AIS) [n = 64] or Early Onset Scoliosis (EOS) [n = 15]), treated according to the principles of the Chêneau lightTM brace have shown a satisfactory in-brace correction exceeding 50% of the initial Cobb angle [2]. Although the effect of brace treatment has been questioned, [3] there is evidence that brace treatment can stop curvature progression [4-9] (Fig.1.), reduce the frequency of surgery [10-12] and improve cosmetic appearance [13-15] (Fig. 2.). Poor cosmetic appearance for the patient may be the most important problem, which can be solved or at least reduced by the use of advanced bracing techniques including the best possible correction principles available to date [13]. History of the Chêneau lightTM brace The Chêneau lightTM brace in principle is a Chêneau derivative. The Chêneau brace was developed before 1978 [16]. As the first developments were made in Münster, Germany, the brace was initially called CTMbrace (Chêneau-Toulouse-Münster). Jacques Chêneau, who used to live in Toulouse, spent a few years in Münster, where he braced patients at the orthopedic department of the university there. In 1985 the first end-result study was published with in brace correction effects of more than 40% of the initial value [7] and final result superior to the end-results of the Milwaukee study from the same centre [17]. The initial Chêneau brace was upgraded in 1995 and from this year on, a new version each year was promoted by the inventor during the courses organized in Germany together with Dr. Weiss in Bad Sobernheim and Prof. Neff in Berlin. A working relationship between Dr. Chêneau, Dr. Weiss and Dr. Rigo began in Bad Sobernheim, Germany towards the end of the 90’s, which resulted in a collaboration in publishing a book presenting the 1999 standard of the Chêneau brace [18]. At the beginning of the new century Dr. Chêneau was working on the first CAD/CAM system supported by a company called IPOS in Germany. Other CAD/CAM systems developed in Germany applying the Chêneau principles, such as the Regnier system and the RSC-brace. The latter was developed by Dr. Rigo and was finally improved to be ready for marketing with the help of Dr. Weiss. While Dr. Rigo in Barcelona was producing plaster cast positives of as Figure 1 Overcorrection of a curve coming from 37° to -16° in a custom plaster based Chêneau brace from the 90’s. In this case, not only progression has been stopped. At weaning off the curve is at 14°, two years after weaning off final result: 16°. No further treatment necessary. (Weiss 2010). Weiss and Werkmann Scoliosis 2010, 5:19 http://www.scoliosisjournal.com/content/5/1/19 Page 2 of 14