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Dr Theodoros B. GRIVAS, MD PhDOrthopaedic & Spinal Surgeon

Director of the Trauma and Orthopaedic Department

“Tzaneio” General Hospital of Piraeus, Greece

“Scoliosis” Chief Editor

President of International Research Society of Spinal Deformities (IRSSD) &

Past President of Society on Scoliosis Orthopaedic and Rehabilitation Treatment SOSORT

Overview on Braces used more in

Europe

11th International Conference on Conservative Management of Spinal Deformities4th SOSORT Educational Course, 6-7 May

2014, Wiesbaden (Germany)

Disclosuresno Relationships

11th International Conference on Conservative Management of Spinal Deformities4th SOSORT Educational Course, 6-7 May

2014, Wiesbaden (Germany)Tr

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European Braces

1. Cheneau Brace (France)

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European Braces

During the 60’s Dr Jacques Chêneau built the brace World - wide accepted & used

Dr Jacques Cheneau

http://cheneau.info

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European Braces

rigid brace - 3D correction

Passive mechanisms1) convex to concave tissue transfer, achieved by multiple three‐point systemacting in 3D, with the aim of curve hypercorrection2) elongation and unloading3) Derotation of the thorax4) bending

Active mechanisms1) vertebral growth acting as a corrective factor2) asymmetrically guided respiratory movements of the rib‐cage (RG)3) repositioning of the spatial arrangement of the trunk muscles to provide theirphysiological action4) anti‐gravitational effect

mechanisms of correction of Chêneau Brace

Kotwicki & Cheneau 2008

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European Braces

elongation & unloadingconvex to concave tissue transfer

Derotation of the thorax

Passive mechanisms

Bending

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European Braces

asymmetrically guided respiratory movements of R‐Gvertebral growth

Bending & anti‐gravitational effectrepositioning of the trunk muscles

Active mechanisms

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European BracesHuge free spaces

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European Braces

outcomes

The Cheneau‐Toulouse‐Munster brace decreased the coronal shift forward, the coronal tilt, the axial rotation, and increased the sagittal shift forward and the sagittal vertebral tilt (3‐D correction)

Périé  et al: Clin Biomech (Bristol, Avon). 2001 Feb;16(2):129‐37

primary correction 41% (thoracic, lumbar, double) N = 52 patients

Long term correction 14.2% thoracic, 9.2% Lumbardouble curves:  5.5% in thoracic & 5.6% in lumbar

Hopf and Heine Z Orthop Ihre Grenzgeb. 1985,  123(3):312‐22.

average primary correction 43 % 

at long term FU curve progression was prevented in 58 %

Bullmann et al Z Orthop Ihre Grenzgeb. 2004, 142(4):403‐9.

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European Braces

1. Cheneau Brace derivatives

1a Rigo System Cheneau Brace (Spain)

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European Braces

Developed byDr Manuel Rigoduring early 90sBarcelona Spain

Dr Manuel Rigo

http://www.ortholutions.de/start_english.php

Instituto Èlena SalváBarcelonaSpain

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imbalanced thoracic (Three - curve scoliosis pattern)Tr

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European Bracestrue double (or 4 curve pattern)

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balanced thoracic & false double (non 3 non 4)Tr

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Single lumbar/thoracolumbar lumbar

Three‐point systems

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European BracesBiomechanics of the RSC

Regional derotation: The brace derotates the thoracic section (b) against the lumbar section (a), with a counter‐rotation pad at the upper thoracic region

Rigo & Weiss 2008

Three‐point systems

Sagittal Normalization

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Physiological sagittal profile

Biomechanics of the RSC

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European BracesoutcomesInitial reports

31.1% primary Cobb angle correction &

22.2% primary torsion angle correction

FU of 16.8 months 54% of curves were stable

27% improved

19% progressed

Rigo et al 2002

w/ a recently described RSC brace design (three-curve-scoliosis brace w/ pelvis open)

In long thoracic curves treated there was in-brace correction

76.7 % Cobb angle &

55.9% axial rotation Rigo & Gallo 2009

81%Good

results

FU 16.8 months

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European Braces

1. Cheneau Brace derivatives

1b ScoliOlogiC® “Chêneau light” (Germany)

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European BracesScoliOlogiC® “Chêneau light”

the brace was invented by Dr. Hans-Rudolph Weiss

April 2005 application for the patent

May 2005 the first braces were built

http://www.koob-scolitech.com/scoliologic.php

Gensingen brace - 2010

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2007

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The Cobb angle in the whole group was reduced by an 

average of 16,4 degrees    51% correctionlumbar & thoracolumbar curve pattern

…………….. 62 % correction

thoracic scoliosis ……………... 36 % correction 

double major curve pattern …. 50 % correction

The correction effect correlatednegatively with age (r = ‐0,24; p = 0,014)negatively with the Risser stage (‐0,29; p = 0,0096)negatively with Cobb angle before treatment (r = ‐0,43; p 

European Braces

2. Lyonnaise Brace (France)

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European Braces

1947: The Lyon Brace was created by Pierre Stagnara.1958: Allègre and Lecante modify it to the actual using aluminium bars and plexidur (high rigidity material)It is an adjustable rigid brace, without any collar

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two main principles of treatment- Plaster cast to stretch the deep ligaments before the Lyon brace- Adjustable brace of 7 cm in length and 7 kg of weight

Design: 14 types according to Lenke classificationIndication: 11-15 years, not earlier to prevent tubular deformation of the thorax

Results: Effectivity index (SRS - SOSORT criteria)Lumbar curve : 0,97Thoraco-lumbar curve: 0,88Thoracic curve: 0,80

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European Bracesoutcomes

Cosmesis (hump in mm) 

De Mauroy et al Disabil Rehabil Assist Technol. 2008

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European Braces

3. Dynamic Derotating Brace DDB (Greece)

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European Braces

Dynamic Derotating Brace (DDB) 1986

Antoniou D, Valavanis J, Zachariou C, Smyrnis P (1986): “Dynamic Derotation Brace (DDB). A new aspect for the conservative treatment of 

Idiopathic Scoliosis” 21st common meeting of SRS and BSS

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DDB designs are based on the commonly used classification, which distinguishes scoliotic curves into thoracic (a), thoracolumbar (b), lumbar (c),

& double major (d) (Ponseti and Friedman)Trau

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BiomechanicsDDB feature derotating blade/s posteriorlyThis function as a force couple, which is added to theside forces (three point systems) exerted by the brace itself

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overallImprovement  35.70%Stable  46,42%Increase 7.83%Grivas et al 2003

overallInitial correction 49.54%2yrs FU 44.10%

Valavanis et al 1995

Cobb angle 

Cosmesis (Angle Trunk Inclination – ATI – hump) 

DDB improves the cosmetic appearance of the back of IS children with all but right thoracic curvesGrivas & Vasiliadis 2008

QoL – Brace Questionnaire (BrQ)

influenced school activity & social functioning, but not general healthperception, physical functioning, emotional functioning, vitality, bodily pain, self-esteem & aestheticsGrivas et al 2006Tra

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European Braces

4 TriaC brace (Nederland)

Dr Albert Gerrit Veldhuizen"

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European BracesInclusion criteria -indicationsPrimary thoracic apex between the 7th & 11th Th vertebraPrimary lumbar apex between the 2nd& 5th L vertebra and for Flexible curve (at least 40% correction on bending films)Trau

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European BracesoutcomesCobb angle 

controls or corrects

76% of IS curves

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5. Sforzesco brace (Italy)

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2004Sforzesco bracedeveloped by

Stefano Negrini MD w/ the Gianfranco Marchini CPOBased on

SPoRT concept

http://isico.it/approach/default.htm

Dr. Stefano Negrini

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European BracesThe SPoRT concept

(Symmetric, Patient- Oriented, Rigid, Three-Dimensional, Active)

Sforzesco brace

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4

Deflection actionPushes lateral distal convex, lateral proximal

concave, posterior convexEscapes superior-anterior & lateral superior

Drivers & stops

1

2 3

4

5

7

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10 43

46

R0

3

Pushes lateral distal convex, lateral proximal concave, posterior convex

Pushes lateral distal convex, lateral proximal concave, posterior convex

Pushes lateral distal convex, lateral proximal concave, posterior convex

Pushes lateral distal convex, lateral proximal concave, posterior convex

Correction of a thoracic right curve

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European Braces

outcomes

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European Braces

6. Progressive Action Short Brace PASB, (Italy)

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European BracesProgressive Action Short Brace PASB

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Deflexion DerotationTraction

Application of external actionsApplication of external actions

Phase I Plaster cast

Progressive Action Short Brace PASB

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European Braces44

thSR

S An

nual M

eetin

g & Cou

rse San An

tonio Texas, USA

Constrained dynamic of the spineConstrained dynamic of the spine

Inversion of the stress‐loading distributionInversion of the stress‐loading distribution

phase IICustom‐made polypropylene brace from plaster mould

Cast geometry

Progressive Action Short Brace PASB

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Pre treatment Cobb mean value 29,30 ± 5,16 SD Initial apical rotation 12.70 ± 6,14 SD Immediate Cobb correction to 14,67 ± 7,65 SD Apical correction at FU 8,95  ± 5,82 

curve correction     in 94% of patientscurve stabilization in 06% of patients

Thoraco-lumbar and lumbar curves

Aulisa et al, Scoliosis, 2009

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European Braces7. TLI (thoracolumbar lordotic intervention) brace

developed in 2002 by dr Piet van Loon, Orthopedic Surgeon & Jan Munneke, OrthotistTr

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European BracesTLI (thoracolumbar lordotic intervention) brace

is completely symmetricTLI is based on concept described by M.Jansen in 1913hypothesis that both thoracolumbar kyphotic & scoliotic spinal deformities are due to a

dislocation of the thoracolumbar joint from its normal/optimal position at the center. This dislocation was described by.Mechanically, The TLI bracing concept is a Ponseti-type interventionrepositioning the joint in its optimal position to reduce shearstress & deformative impulse.Outcomes: initial ‘in brace’ outcome -> reduction of the Cobb angles in kyphosis & scoliosis groups (sagittal p < 0.001, pelvic obliquity p < 0.001).FU one year of brace treatment in scoliosis and kyphosis group the measurements on radiographs made without brace revealed an improvement in all sagittal and coronal measurements.Tra

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European Braces1. Cheneau Brace (France and other European Countries)

1a Rigo System Cheneau Brace (Spain)

1b ScoliOlogiC® “Chêneau light” (Germany)

2. Lyonnaise Brace (France)

3. Dynamic Derotating Brace DDB (Greece)

4. TriaC brace (Nederland)

5. Sforzesco brace / SPoRT concept (Italy)

6. Progressive Action Short Brace PASB (Italy)

7. Thoracolumbar lordotic intervention brace TLI (Nederland)

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Orthopaedics and Traumatology Department

“Tzaneio” General Hospital of Piraeus, 2014

T z a n e i o H o s p i t a l 1 8 6 4

Moutsopoulou Coast

Thank you very much for your attention

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