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med:scoliosis [2014/03/18 14:28] – V_L | med:scoliosis [2016/07/10 09:50] (현재) – 바깥 편집 127.0.0.1 | ||
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+ | {{tag> | ||
+ | ======척추측만증 (Scoliosis)====== | ||
+ | |||
+ | Indian J Orthop. 2011 Jan-Mar; 45(1): 7–14. | ||
+ | doi: 10.4103/ | ||
+ | PMCID: PMC3004085 | ||
+ | Copyright © Indian Journal of Orthopaedics | ||
+ | ======Adolescent idiopathic scoliosis: Indications and efficacy of nonoperative treatment====== | ||
+ | Federico Canavese and André Kaelin | ||
+ | University of Geneva Hospitals and Faculty of Medicine, Pediatric Orthopaedic Service, Department of Child and Adolescent, Rue Willy-Donzé, | ||
+ | Address for correspondence: | ||
+ | This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, | ||
+ | =====요약===== | ||
+ | The strategy for the treatment of idiopathic scoliosis depends essentially upon the magnitude and pattern of the deformity, and its potential for progression. Treatment options include observation, | ||
+ | Keywords: Brace, conservative treatment, scoliosis, adolescents | ||
+ | =====INTRODUCTION===== | ||
+ | The strategy for the treatment of idiopathic scoliosis depends essentially upon the size and pattern of the deformity, and its potential for progression. During the past decade, several studies have confirmed that the natural history of adolescent idiopathic scoliosis can be positively affected by nonoperative treatment, particularly bracing.1–6 The primary objective of nonoperative treatment is to successfully arrest progression of the curves or correct curves that cause or are likely to cause disability. Orthotic device selection is based on the type and level of curve and the anticipated tolerance of the patient. Avoidance of unnecessary surgery, cosmetic improvement and an increase of vital capacity, as well as pain control, are also of major importance.7–14 | ||
+ | In 1985, the Scoliosis Research Society (SRS) initiated a controlled clinical trial to investigate the effectiveness of bracing as treatment for scoliosis. Patients of the same age, same curve pattern and severity were divided into two groups: one treated with bracing; and the other, untreated. Results published in 1993 demonstrated that brace treatment is effective compared to natural history.2 In another study,3 the records and radiographs of more than 1000 scoliotic patients treated by bracing were reviewed and compared with those of unbraced patients.15 This retrospective study confirmed that bracing is a more effective treatment to slow or arrest the progression of most spinal curvatures in skeletally immature patients in comparison with treatment not involving bracing. Furthermore, | ||
+ | Other forms of nonsurgical treatment such as chiropractic or osteopathic manipulation, | ||
+ | The purpose of this review is to summarize the available literature related to the conservative treatment of adolescent idiopathic scoliosis in relation to which patient to brace, when to stop bracing and type of brace. | ||
+ | =====WHEN TO BEGIN TREATMENT===== | ||
+ | Observation is an appropriate treatment for small curves, curves that are at low risk of progression, | ||
+ | By contrast, contraindication for bracing is, a child who has completed growth; or a growing child with a curve of over 45°, or less than 25° without documented progression.2, | ||
+ | A prospective, | ||
+ | =====DURING TREATMENT===== | ||
+ | When patients are first fitted with a brace, there is an initial adjustment period of usually one to two weeks. Initially, the patient is prescribed to wear the brace for a specific number of hours per day, and the orthosis is left slightly loose to allow the patient to gradually adjust to it. The brace is increasingly tightened daily until the appropriate level of snugness is reached. If any areas of tenderness or skin irritation develop, the brace is adjusted for optimal fit. Roentgenograms are performed after four weeks with the brace in place to verify the fit and determine the degree of curve reduction. Repeated roentgenograms should be performed approximately every four to six months with the brace removed to follow the progression of the curve. The brace should be removed for a minimum of 12 to 24 hours before roentgenograms are taken so that the spine can go back to its deformed position and imaging can accurately detect curve deterioration. | ||
+ | This is not, however, a clinical practice accepted by all surgeons. Another option is to assess patients at follow-up with roentgenograms taken with the brace on to monitor the effectiveness of the orthosis in controlling the deformity. This will allow for brace adjustments, | ||
+ | A progression of 6° or more during brace treatment or need for surgical stabilization is considered failure of brace treatment. | ||
+ | =====HOURS PER DAY===== | ||
+ | Studies conducted on the number of hours per day of brace-wearing show that the more hours per day the brace is worn, the better the result. The brace is usually prescribed for full-time wear with time out for bathing, swimming, physical education and sport. The child should be encouraged to be active in sporting activities while continuing to wear the brace if possible. Contact sports are not allowed with the brace to protect other participants. These activities generally represent an average of two to four hours a day to ensure brace-wearing of 21 to 23 hours daily. | ||
+ | Use of the brace part-time or only at night has been advocated by some physicians and is widely used in some institutions. However, there is a paucity of long-term follow-up data to prove the effectiveness of this wearing regimen in adolescents, | ||
+ | Wiley et al. analyzed the results of bracing according to the wearing regimen.26 Patients were divided into noncompliant (less than 12 hours per day), part-time (between 12 and18 hours per day) brace-wearing and full-time brace-wearing (between 18 and 23 hours per day) groups. The initial curves were similar in the three groups. Patients who wore the brace less than 12 hours per day were associated with an average curve progression from 41.3° to 56.3°, and those who wore the brace part-time progressed from 37.6° to 41.2°. Significant curve improvement was noted in the full-time patient group, and curves measured 35.7° at final follow-up compared to 39.3° at brace-fitting. In addition, the surgical rate also depended on brace compliance, the rate being 73% in noncompliant patients compared to 9% in the fully compliant group.26 | ||
+ | Green27 reported that 16 hours per day of bracing was effective in slowing curve progression. He studied a heterogeneous group of patients with curves between 23° and 49° and found that only 9% curves progressed 5° or more. However, both Boston and Milwaukee braces were used for treatment, and follow-up was limited. Similarly, Emans et al.28 found part-time brace-wear to be as effective as full-time wear for smaller curves. Allington and Bowen29 reported no difference in the efficacy of full-time versus part-time wear using the Wilmington brace for curves of 30° to 40°, but observed that 58% of patients progressed more than 5° degrees in the brace. Peltonen et al.30 also noted that the results of 12 hours per day of bracing were similar to the results of 23 hours per day of bracing. | ||
+ | =====WHEN TO STOP TREATMENT===== | ||
+ | Brace-weaning begins when the patient reaches **skeletal maturity**, determined as the finding of a **[[http:// | ||
+ | =====COMPLICATIONS OF BRACE TREATMENT===== | ||
+ | Brace treatments have some disadvantages. Treatment with a brace can be rather bothersome.31, | ||
+ | Other problems encountered due to brace treatment include skin irritation, a temporary decrease in vital capacity, and mild chest wall and inferior rib deformation. Skin irritation is a common problem and more frequent in warm climates and during the summer months due to the increase in heat and sweat. To reduce the likelihood or occurrence of skin irritation, frequent changing of the cotton undergarment is recommended, | ||
+ | Chest wall and rib deformation commonly occurs if bracing is performed at ages where the chest is very plastic and easily deformed with drooping of the ribs on the convexity of the scoliosis, where corrective forces are applied. When brace use is discontinued, | ||
+ | =====BRACE TYPES===== | ||
+ | ====Cervico-thoraco-lumbo-sacral orthosis (Milwaukee brace)==== | ||
+ | The Milwaukee brace, also named cervico-thoraco-lumbo-sacral orthosis (CTLSO), is a full torso brace extending from the pelvis to the base of the skull.15–19 It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization, | ||
+ | Curve patterns that should be treated in a Milwaukee brace are thoracic curves that have an apex at or above T8, double thoracic, and other double curves when the apex of the thoracic component is above T8, i.e., double thoracic and lumbar, or double thoracic and thoracolumbar patterns. | ||
+ | Success rate: Curves between 20° and 29° with a Risser sign between 0 and 1 progressed 28% less than untreated curves of similar magnitude (40% versus 68%, respectively). Treated curves of similar magnitude but with a Risser sign of 2 or more progressed 13% less than untreated curves (10% versus 23%, respectively). Similarly, curves between 30° and 39° with a Risser sign between 0 and 1 progressed 14% less than untreated curves of similar magnitude (43% versus 57%, respectively). Treated curves of similar magnitude but with a Risser sign of 2 or more progressed 21% less than untreated curves (22% versus 43%, respectively).3, | ||
+ | ====Thoraco-lumbo-sacral orthosis==== | ||
+ | To improve patient compliance, substantially less bulky and lightweight thoraco-lumbo-sacral orthoses (TLSOs) were developed. TLSO is the generic name for a group of orthoses characterized by a pelvic portion similar to the pelvic section of the Milwaukee brace and an upper portion extending up to one or both axillae or only to the lower thoracic area. Although there are many variations in their design, generally named after the city or center of origin, they all function basically on the same principle. This type of brace is generally prescribed for lumbar and thoracolumbar curves, and thoracic curves with an apex at or below T8. | ||
+ | ====Boston brace==== | ||
+ | Hall and Miller jointly created the Boston brace in 197233 ; and Watson, Hall and Stanish first reported on its efficacy in 1977.35 The brace opens at the back and corrects curvatures by pushing the spine with small pads placed against the ribs, which are also used for partial rotational correction. These pads are usually placed in the back corners of the brace so that the body is thrust forward against the front of the brace, which acts to hold the body upright. Areas of relief are provided opposite the sites of corrective force to allow the patient to pull the spine away by active muscular effort.28 The brace also has a 15° lumbar lordosis built into it. The brace runs from just above the seat of a chair (when a person is seated) to around shoulder blade height and is not particularly useful in correcting very high curves.5, | ||
+ | Success rate: The brace has been shown to be particularly effective for curves ranging from 20° to 59° between T8 and L2. At the beginning of treatment, brace correction is about 50%, decreasing to 15% by the time of brace discontinuance. With Boston brace treatment, approximately half (49%) of the curves remain unchanged, 39% are stabilized with a final correction of 5° to 15°, 4% are stabilized with a correction superior to 15°, 4% lose between 5° to 15°, and 3% progress more than 15°. A study by Emans et al. reported that 11% of patients underwent surgery during the period of bracing.28 | ||
+ | ====Wilmington brace==== | ||
+ | G. Dean MacEwen (1970) developed the Wilmington brace, also known as the DuPont brace. It is a custom-made, | ||
+ | Success rate: Progression of the deformity by 5° or more is generally observed in 36% of patients treated with full-time bracing for a curve of less than 30° degrees compared to 41% of patients managed with part-time bracing. Failure rates are higher in patients with curves between 30° and 40° managed with both full-time (58%) and part-time bracing (59%).27 | ||
+ | ====Lyon brace==== | ||
+ | The Lyon brace was designed by Stagnara (1947) and is also known as the Stagnara brace. It is composed of a pelvic section with axillary, thoracic and lumbar plates connected in units by two vertical aluminum rods, one anterior and one posterior. The pelvic section is composed of two lateral valves, one for each hemipelvis. The valves are connected by metal pieces to the vertical aluminum rods. Forces are applied at the two neutral vertebrae, and a counterforce is applied at the apex of the curve. It is usually prescribed for progressive scoliosis with lumbar or low thoracolumbar curves between 30° to 50°.36,37 | ||
+ | Success rate: The overall reported efficacy of the Lyon brace is 95%. However, it drops to 87% for thoracic curves and to 80% in patients with Risser sign 0.37 | ||
+ | ====Chêneau brace==== | ||
+ | Jacques Chêneau designed the original Chêneau brace in 1979.38–40 The brace is commonly used for the treatment of scoliosis and thoracic hypokyphosis in many European countries, Israel and Russia. However, it is not commonly prescribed in North America and the United Kingdom. The Chêneau brace utilizes large, sweeping pads to push the body against its curve and into blown out spaces, and is usually coupled with the Schroth physical therapy method. The Schroth theory holds that the deformity can be corrected through retraining of muscles and nerves to learn what a straight spine feels like, and by breathing deeply into areas crushed by the curvature to help gain flexibility and expand.38, | ||
+ | ====Rigo-Chêneau system (RCS brace)==== | ||
+ | Rigo et al. have further developed the original Chêneau brace by designing the Rigo-Chêneau system (RCS) brace. The main indication are curves up to 60° (First grade scoliosis: angle up to 40°; and Second grade scoliosis, between 40° and 60°; according to the Rigo classification.41 | ||
+ | ====Malaga brace==== | ||
+ | The Malaga brace is a custom-made TLSO, commonly prescribed in southern Spain but relatively unknown outside that country. It is a corrective spinal orthosis used in the treatment of coronal plane curves, but with no de rotation element incorporated in the brace. | ||
+ | The brace is of monovalve construction with a posterior opening that closes with metal fasteners. The patient wears the brace for approximately 23 hours per day, and it is indicated for progressive curves between 20° and 30°.42 | ||
+ | ====SPoRT brace (also known as “Sforzesco” brace)==== | ||
+ | The SPoRT (symmetric, patient-oriented, | ||
+ | Success rate: In terms of Cobb’s angle, most curves have been shown to remain stable or to slightly improve. The SPoRT brace developing team found that it is possible to obtain scoliosis correction similar to cast in the corrective phase of adolescent idiopathic scoliosis treatment.44 | ||
+ | ====Nighttime braces==== | ||
+ | Despite the development of low-profile TLSO, such as the Boston brace, full compliance with a brace program that demands 18 to 23 hours of daily wear through skeletal maturity is difficult for adolescents. Nighttime bracing systems were developed to improve patient compliance by reducing the total time in the brace and eliminating the social anxiety created by daytime wear. | ||
+ | Nighttime braces are more effective in patients with isolated, flexible thoracolumbar and lumbar curves. They are also recommended to patients noncompliant with a full-time wear program, patients in whom other types of orthotic management had failed, and patients nearing skeletal maturity who may not require full-time wear.17, | ||
+ | There have been previous studies comparing a nighttime orthosis to more traditional methods.17, | ||
+ | ====Charleston brace==== | ||
+ | The Charleston bending brace was designed with the idea that compliance would increase if the brace was worn only at night. Hooper and Reed6, | ||
+ | Success rate: Patients with a curve over 25° and a Risser sign between 0 and 2 showed a rate of surgery between 12% and 17%.46, | ||
+ | ====Providence brace==== | ||
+ | The Providence brace was developed by D’Amato, Griggs and McCoy in the mid-1990s.53 The brace works by the application of controlled, direct, lateral and rotational forces on the trunk to move the spine toward the midline or beyond the midline. It does not bend the spine as with the Charleston bending brace. The goal is to use the centerline as a reference and bring the apices of the scoliotic curve to that line or beyond through the application of lateral forces. This involves the use of three-point pressure systems and void areas that are located opposite these pressure points. Compared with natural history and on the basis of the prospective data from the study by Nachemson et al.,2 the Providence brace is found to be effective in preventing curve progression of deformities less than 35° and low apex curves of over 35°. It is more successful in curves with apex at or below T9 compared to curves with apex cephalad to T8.48,53 | ||
+ | Success rate: Recent studies showed that the Providence night brace generally achieves an average of about 90% for brace correction of the primary curve; and during followup, progression of the curve of more than 5° should be expected in about 25% of cases. The night brace may be recommended for the treatment of adolescent idiopathic scoliosis with curves less than 35° in lumbar and thoracolumbar cases.48,53 | ||
+ | ====Soft brace: The SpineCor brace==== | ||
+ | The SpineCor brace was developed by Coillard and Rivard in the mid-1990s. The brace has a pelvic unit made of plastic, from which strong elastic bands wrap around the body, pulling against curves, rotations and imbalances. It is most successful when patients have relatively small and simple curvatures and are structurally young and compliant. The SpineCor bracing method is an adjustable, flexible and noninvasive technique providing correction that continues as a child moves and grows. The brace is usually worn 20 to 22 hours a day, and the patient can remove it for no more than two to three hours a day. | ||
+ | Success rate: A 2003 study reported that after two years, the SpineCor brace was able to correct scoliotic curves by 5° in 55% of patients. The remaining 45% were stabilized (38%) or worsened by more than 5° (7%). Recent studies demonstrated a trend different from the findings of the SpineCor developing team and reported a lower success rate than rigid spinal orthosis.54–56 According to Wong et al.,54 in patients with curves between 20° and 30° before skeletal maturity, a rigid brace showed better results than the elastic one in the follow-up at 45 months: 31.8% in the SpineCor group had 5° or more of curve progression versus 4.7% in rigid brace. | ||
+ | ====Other conservative treatments==== | ||
+ | Opinions differ in the international literature on the efficacy of conservative approaches to scoliosis treatment. Alternative forms of nonsurgical treatment such as chiropractic or osteopathic manipulation, | ||
+ | Although a subject of debate, most experts agree that physiotherapy alone will not affect the progression of a structural scoliosis. However, there is agreement that a selective physical therapy program in conjunction with brace treatment is beneficial. The triad of outpatient physiotherapy, | ||
+ | Acupuncture involves penetration of the skin by thin, solid, metallic needles that are stimulated either manually or electrically, | ||
+ | Electrotherapy was hailed as a promising therapy but failed to alter the natural history of idiopathic scoliosis. With electrotherapy, | ||
+ | =====CONCLUSION===== | ||
+ | Brace treatment is the only method that has been proven to alter the natural history of idiopathic scoliosis. However, different orthoses and many bracing regimens exist. Observation is appropriate for small curves, whereas bracing is generally indicated for **progressive curves** or **for curves over 29° in a skeletally immature child**. Braces are generally prescribed for **more than 20 hours a day**, and the results of brace treatment correlate to treatment compliance. Problems encountered with bracing are limited. | ||
+ | |||
+ | Footnotes | ||
+ | Source of Support: Nil | ||
+ | Conflict of Interest: None | ||
+ | |||
+ | =====REFERENCES===== | ||
+ | 1. Fernandez-Filiberti R, Flynn J, Ramirez N, Trautmann M, Alegria M. Effectiveness of TLSO bracing in the conservative treatment of idiopathic scoliosis. J Pediatr Orthop. 1995; | ||
+ | 2. Nachemson A, Peterson LE. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, | ||
+ | 3. Lonstein JE, Winter RB. The Milwaukee brace for the treatment of adolescent idiopathic scoliosis: A review of 1020 patients. J Bone Joint Surg Am. 1994; | ||
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+ | 7. Noonan KJ, Dolan LA, Jacobson WC, Weinstein SL. Long-term psychosocial characteristics of patients treated for idiopathic scoliosis. J Pediatr Orthop. 1997; | ||
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+ | 16. Noonan KJ, Weinstein SL, Jacobson WC, Dolan LA. Use of the Milwaukee brace for progressive idiopathic scoliosis. J Bone Joint Surg Am. 1996; | ||
+ | 17. Katz DE, Richards BS, Browne RH, Herring JA. A comparison between the Boston brace and the Charleston bending brace in adolescent idiopathic scoliosis. Spine. 1997; | ||
+ | 18. Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6 months follow-up. Pediatr Rehabil. 2003; | ||
+ | 19. Carr WA, Moe JH, Winter RB, Lonstein JE. Treatment of idiopathic scoliosis in the Milwaukee brace. J Bone Joint Surg Am. 1980; | ||
+ | 20. O’Neill PJ, Karol LA, Shindle MK, Elerson EE, BrintzenhofeSzoc KM, Katz DE, et al. Dec reased orthotic effectiveness in overweight patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2005; | ||
+ | 21. Maruyama T. Bracing adolescent idiopathic scoliosis: A systematic review of the literature of effective conservative treatment looking for end results 5 years after weaning. Disabil Rehabil. 2008; | ||
+ | 22. Weiss HR, Weiss G, Schaar HJ. Incidence of surgery in conservatively treated patients with scoliosis. Pediatr Rehabil. 2003; | ||
+ | 23. Rigo M, Reiter CH, Weiss HR. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil. 2003; | ||
+ | 24. Dolan LA, Weinstein SL. Surgical rates after observation and bracing for adolescent idiopathic scoliosis: An evidence-based review. Spine. 2007; | ||
+ | 25. Lange JE, Steen H, Brox JN. Long-term results after Boston brace treatment in adolescent idiopathic scoliosis. Scoliosis. 2009;4:17. [PMCID: PMC2743640] [PubMed: 19709435] | ||
+ | 26. Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves in adolescent idiopathic scoliosis. Spine. 2000; | ||
+ | 27. Green NE. Part-time bracing of adolescent idiopathic scoliosis. J Bone Joint Surg Am. 1986; | ||
+ | 28. Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME. The Boston Bracing system for idiopathic scoliosis: Follow-up results in 295 patients. Spine. 1986; | ||
+ | 29. Allington NJ, Bowen JR. Adolescent idiopathic scoliosis: Treatment with the Wilmington brace. J Bone Joint Surg Am. 1996; | ||
+ | 30. Peltonen J, Poussa M, Ylikoski M. Three year results of bracing in scoliosis. Acta Orthop Scand. 1988; | ||
+ | 31. Matsunaga S, Hayashi K, Naruo T, Nozoe S, Komiya S. Psychologic management of brace therapy for patients with idiopathic scoliosis. Spine. 2005; | ||
+ | 32. Tones M, Moss N, Polly DW., Jr A review of quality of life and psychosocial issues in scoliosis. Spine. 2006; | ||
+ | 33. Fayssoux RS, Cho RH, Herman MJ. A history of bracing for Idiopathic Scoliosis in North America. Clin Orthop Relat Res. 2010; | ||
+ | 34. Bunge EM, de Bekker-Grob EW, van Biezen FC, Essink-Bot ML, de Koning HJ. Patients’ Prefe rences for Scoliosis Brace Treatment: A Discrete Choice Experiment. Spine. 2010; | ||
+ | 35. Watts HG, Hall JE, Stanish W. The Boston brace system for the treatment of low thoracic and lumbar scoliosis by the use of a girdle without superstructure. Clin Orthop. 1977; | ||
+ | 36. Stagnara P, de Mauroy JC. In: Actualités en rééducation fonctionnelle et réadaptation. Ed. Masson, Paris: 1977. Résultats à long terme du traitement orthopédique lyonnais. | ||
+ | 37. Stagnara P, Desbrosses J. Scolioses essentielles pendant l‘enfance et l’adolescence: | ||
+ | 38. Weiss HR. Conservative treatment of idiopathic scoliosis with physical therapy and orthoses. Orthopade. 2003; | ||
+ | 39. Weiss HR. Rehabilitation of adolescent patients with scoliosis- -what do we know? A review of the literature. Pediatr Rehabil. 2003; | ||
+ | 40. Chêneau J. Orthese de scoliose. In: Chéneau J, editor. 1st Ed. Saint Orensm: 1990. | ||
+ | 41. Rigo M. Intra-observer reliability of a new classification correlating with brace treatment. Pediatr Rehabil. 2004;7:63. | ||
+ | 42. Hidalgo AH. Ph.D. Thesis, Sevilla. Spain: Universidad de Sevilla; 1993. Nueva aportación del corsé de Málaga al pronóstico y tratamiento de la escoliosis. | ||
+ | 43. Negrini S, Marchini G. Efficacy of the sym metric, patient-oriented, | ||
+ | 44. Negrini S, Marchini G, Tomaello L. The Sforzesco brace and SPoRT concept (Symmetric, Patient-oriented, | ||
+ | 45. Trivedi JM, Thomson JD. Results of Charleston bracing in skeletally immature patients with idiopathic scoliosis. J Pediatr Orthop. 2001; | ||
+ | 46. Price CT, Scott DS, Reed FE, Riddick MF. Nighttime bracing for adolescent idiopathic scoliosis with the Charleston bending brace. Preliminary report. Spine. 1990; | ||
+ | 47. Price CT, Scott DS, Reed FE, Sproul JT, Riddick MF. Nighttime bracing for adolescent idiopathic scoliosis with the Charleston Bending Brace: Long-term follow-up. J Pediatr Orthop. 1997; | ||
+ | 48. Yrjönen T, Ylikoski M, Schlenzka D, Kinnunen R, Poussa M. Effectiveness of the Providence nighttime bracing in adolescent idiopathic scoliosis: A comparative study of 36 female patients. Eur Spine J. 2006; | ||
+ | 49. Howard A, Wright JG, Hedden D. A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis. Spine. 1998; | ||
+ | 50. Gepstein R, Leitner Y, Zohar E, Angel I, Shabat S, Pekarsky I, et al. Effective ness of the Charleston bending brace in the treatment of single-curve idiopathic scoliosis. J Pediatr Orthop. 2002; | ||
+ | 51. Janicki J, Poe-Kochert C, Armstrong DG, Thompson GH. A comparison of the thoracolumbosacral orthoses and providence orthosis in the treatment of adolescent idiopathic scoliosis: Results using the new SRS inclusion and assessment criteria for bracing studies. J Pediatr Orthop. 2007; | ||
+ | 52. Federico DJ, Renshaw TS. Results of treatment of idiopathic scoliosis with the Charleston Bending Brace. Spine. 1990; | ||
+ | 53. D’Amato CR, Griggs S, McCoy B. Nighttime bracing with the providence brace in adolescent girls with idiopathic scoliosis. Spine. 2001; | ||
+ | 54. Wong MS, Cheng JC, Lam TP, Ng BK, Sin SW, Lee-Shum SL, et al. The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis. Spine. 2008; | ||
+ | 55. Coillard C, Vachon V, Circo AB, Beauséjour M, Rivard CH. Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the scoliosis research society for adolescent idiopathic scoliosis. J Pediatr Orthop. 2007; | ||
+ | 56. Coillard C, Leroux MA, Zabjek KF, Rivard CH. SpineCor – a non-rigid brace for the treatment of idiopathic scoliosis: Post-treatment results. Eur Spine J. 2003; | ||
+ | 57. Weiss HR, Bohr S, Jahnke A, Pleines S. Acupucture in the treatment of scoliosis - a single blind controlled pilot study. Scoliosis. 2008;3:4. [PMCID: PMC2266704] [PubMed: 18226193] | ||
+ | 58. Cassella MC, Hall JE. Current treatmen t approaches in the nonoperative and operative management of adolescent idiopathic scoliosis. Phys Ther. 1991; | ||
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