Bonsignore-Opp Lisa, Givens Ritt R, Malka Matan S, Lu Kevin, Iyer Rajiv R, Bainton Nicole, Roye Benjamin D, Vitale Michael G
Department of Orthopedic Surgery, University of California, San Francisco, CA, USA.
Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8N, New York, NY, 10032-3784, USA.
Spine Deform. 2025 Aug 8. doi: 10.1007/s43390-025-01153-5.
Bracing has long been the mainstay of conservative management for adolescent idiopathic scoliosis (AIS) yet there is little data comparing treatment outcomes among different brace types. The purpose of this study is to compare curve progression and need for surgery between patients treated with Rigo Cheneau-style orthoses (RCSO) that focus on three-dimensional correction and traditional thoracolumbar-sacral orthoses (TLSO).
Patients who began treatment at a single institution with an initial major coronal curve between 20° and 45° and no previous scoliosis treatment were included. Study endpoints were skeletal maturity or definitive fusion surgery. The outcome measures were percent curve correction in-brace, coronal curve progression at study endpoint, major coronal curve progression > 5°, major coronal curve progression > 10°, and progression to surgery.
89 patients (47 RCSO and 42 TLSO) were included. Traditional TLSO patients had lower mean initial major curve compared to the RCSO cohort (30° vs. 33°, p = 0.021). TLSO patients had lower in-brace curve correction percent (22% vs. 48%, p < 0.001). Fifty-five percent of TLSO patients experienced curve progression of more than 5° compared to 30% of RCSO patients (p = 0.017). Forty-three percent of patients treated with TLSO experienced curve progression of more than 10° compared to only 13% of patients treated with RCSO (p = 0.001). By univariable analysis, there were no differences between TLSO and RCSO in risk of surgery recommended or performed (31% vs 30%, p = 0.905). However, the baseline predicted risk of progression ≥ 45° at initiation of bracing was lower in the TLSO cohort (49.1% vs. 61.5%, p = 0.079).
Patients treated with RCSO have a higher in-brace curve correction and lower odds of curve progression compared to patients treated with TLSO.
长期以来，支具一直是青少年特发性脊柱侧凸（AIS）保守治疗的主要手段，但比较不同类型支具治疗效果的数据很少。本研究的目的是比较接受注重三维矫正的里戈·切诺型矫形器（RCSO）治疗的患者与传统胸腰骶矫形器（TLSO）治疗的患者之间的曲线进展情况及手术需求。
纳入在单一机构开始治疗的患者，其初始主要冠状面弯曲度在20°至45°之间，且既往未接受过脊柱侧凸治疗。研究终点为骨骼成熟或确定性融合手术。结局指标包括支具内的曲线矫正百分比、研究终点时的冠状面曲线进展、主要冠状面曲线进展>5°、主要冠状面曲线进展>10°以及进展至手术的情况。
共纳入89例患者（47例RCSO组和42例TLSO组）。与RCSO队列相比,传统TLSO组患者的平均初始主要弯曲度较低（30°对33°，p = 0.021）。TLSO组患者的支具内曲线矫正百分比更低（22%对48%，p < 0.001）。55%的TLSO组患者出现超过5°的曲线进展，而RCSO组患者为30%（p = 0.017）。接受TLSO治疗的患者中有43%出现超过10°的曲线进展，而接受RCSO治疗的患者中只有13%（p = 0.001）。单因素分析显示，TLSO组和RCSO组在推荐或实施手术的风险方面没有差异（31%对30%，p = 0.905）。然而，TLSO队列在开始支具治疗时基线预测的进展≥45°的风险较低（49.1%对61.5%，p = 0.079）。
与接受TLSO治疗的患者相比，接受RCSO治疗的患者支具内曲线矫正更高，曲线进展几率更低。
