Gubbels Christopher M, Oakely Paul A, McAviney Jeb, Harrison Deed E, Brown Benjamin T
Private Practice, USA.
Private Practice, Canada.
J Phys Ther Sci. 2019 Feb;31(2):159-165. doi: 10.1589/jpts.31.159. Epub 2019 Feb 7.
[Purpose] There is a paucity of high-quality data pertaining to the conservative management of adult spinal deformity, particularly Scheuermann's kyphosis. Long-term follow-up data for both treated and untreated Scheuermann's patients is also lacking. Given that changes in sagittal balance are associated with increased morbidity, and that these changes are increasingly prevalent in the spines of ageing populations, it is imperative that potential strategies aimed at reversing or minimizing this type of deformity are explored. As the number of elderly patients in developed countries increases, so does the need for a safe and effective non-surgical management option for patients with spinal deformity/sagittal imbalance. This case study details the influence of ScoliBrace rigid TSLO bracing in combination with a specific rehabilitation program in an adult patient with Kypho-scoliosis. [Participant and Methods] The authors describe a case involving the treatment of a 26-year-old male with Scheuermann's kyphosis and a lumbar scoliosis. The patient received 12 months of bracing with a supplemental exercise program. The patient was followed for a period of approximately 12 months. Patient progress was assessed using ODI, SRS-22r, NPRS, and radiographic Cobb angle measurements throughout treatment. [Results] The patient presented with an initial ODI score of 18/100, a SRS-22r score of 3.0, and an average NPRS score of 4/10. Initial Cobb angle measurements demonstrated a 79° thoracic kyphosis and a 30° (coronal plane) lumbar scoliosis. At the final assessment, the patient reported an ODI score of 6/100, an SRS-22r score of 3.91, and an average NPRS score of 0/10. The coronal plane Cobb angle measured 63°, and the thoracolumbar scoliosis had reduced to 25°. [Conclusion] The findings from this case study highlight that this type of brace in combination with exercise rehabilitation may be useful for reducing the magnitude of curves and reducing symptoms in patients presenting with adult kypho-scoliosis. Further investigation of this style of treatment is warranted in patients with sagittal plane imbalance.
[目的] 关于成人脊柱畸形，尤其是休门氏后凸畸形的保守治疗，高质量数据匮乏。同时，也缺乏对接受治疗和未接受治疗的休门氏病患者的长期随访数据。鉴于矢状面平衡的改变与发病率增加相关，且这些改变在老年人群的脊柱中越来越普遍，探索旨在逆转或最小化这类畸形的潜在策略势在必行。随着发达国家老年患者数量的增加，对于脊柱畸形/矢状面失衡患者而言，对安全有效的非手术治疗方案的需求也日益增长。本病例研究详细阐述了ScoliBrace刚性胸腰骶矫形器结合特定康复计划对一名患有脊柱后凸-侧凸畸形的成年患者的影响。[参与者与方法] 作者描述了一例涉及一名26岁患有休门氏后凸畸形和腰椎侧凸男性患者的治疗案例。该患者接受了12个月的支具治疗并辅以运动计划。对患者进行了约12个月的随访。在整个治疗过程中，使用脊柱功能障碍指数（ODI）、脊柱侧凸研究学会22项修订版问卷（SRS-22r）、数字疼痛评分量表（NPRS）以及影像学Cobb角测量来评估患者的进展情况。[结果] 患者初始的ODI评分为18/100，SRS-22r评分为3.0，平均NPRS评分为4/10。初始Cobb角测量显示胸椎后凸为79°，腰椎侧凸（冠状面）为30°。在最终评估时，患者报告ODI评分为6/100，SRS-22r评分为3.91，平均NPRS评分为0/10。冠状面Cobb角测量为63°，胸腰段侧凸已降至25°。[结论] 本病例研究结果表明，这类支具结合运动康复可能有助于减小患有成人脊柱后凸-侧凸畸形患者的侧弯程度并减轻症状。对于矢状面失衡患者，有必要对这种治疗方式进行进一步研究。
