Optimizing Bracing Strategies for Idiopathic Scoliosis: Classification, Prediction and Monitoring

Abstract

Scoliosis is a complex disease; it develops three-dimensionally, often in adolescent girls that have previously developed in an absolutely normal manner. A variety of factors influence its natural evolution during growth and during adulthood, related to joint and intervertebral disc degeneration. This thesis aims to optimize—especially conservative—care for idiopathic scoliosis patients , by exploring diagnostics and prognostic predictors of scoliosis as well as objective measures for brace treatment monitoring. Prevention is the essence of scoliosis treatment. Clinicians demand from science to use clinical data to provide clinical prediction rules identifying relevant risk factors to be monitored over time and allowing discriminate, in an early stage, subjects with scoliosis in the general population , or subjects affected by more severe scoliosis in the already diagnosed scoliosis population. The systematic review reported in chapter 1 reports on scoliosis three-dimensional classification systems to identify the simplest to use in the everyday clinical activity and eventually develop and propose with further studies a new classification system. In chapter 2 a longitudinal screened cohort of subjects affected by 22q.11.2DS has been investigated to elucidate prognostic factors for later structural scoliosis curve development. This is the unique feature of the present research, attempting to explore the potential earliest predictors of scoliosis onset in those showing the most severe forms. It showed that growth is one of the strongest factors in determining scoliosis progression therefore, a younger age means more growth and more time to progress. Nevertheless, curve magnitude at diagnosis is inversely related to success. Chapter 3 provides evidence showing that the age of onset, can be easily confounded by brace treatment, brace-wearing time, and curve magnitude at diagnosis. Chapters 4 and 5 test multiple predictors of brace results, considering different outcome measures and highlighting the importance of in brace x-ray as well as the x-ray taken without the brace after the first six months of treatment. These two studies give relevant contributions to the insight of brace management and X-ray protocols. Chapters 6, 7 and 8 focus on compliance monitors and highlight their role in providing objective measures of brace use relevant for research as well as for clinical practice. A survey reports that the use of these device is well perceived by the patients and their families, and it does not negatively affect the relationship with the treating doctor The research work presented in this thesis adds some basis of knowledge to the field of scoliosis for future development of stronger clinical prediction rules.