Cosmetic outcome after conservative treatment of idiopathic scoliosis with a dynamic derotation brace.

Improved cosmesis is a major concern for the adolescents with Idiopathic Scoliosis (IS). We hypothesized that if we correct the rotation simultaneously to the lateral curvature of the spine with a dynamic brace we may decrease the asymmetry of the back and ultimately improve the cosmetic appearance of the scoliotic child. Thirty six scoliotic children (32 girls and 4 boys) with a mean age of 13.9 (range 12-17) years, a mean Cobb angle of 28.2 degrees (range 19-38 degrees ) and a mean ATI 7.8 degrees (range 4 degrees -17 degrees ) were studied. The examined children were divided in 3 subgroups according to the curve type. All children wore the Dynamic Derotation Brace (DDB), which is a modified Boston brace with antirotatory blades, for 23 hours per day, for a minimum duration of 2 years. The ATI was assessed using the Pruijs scoliometer at baseline and at the end of treatment. ATI was improved statistically significant in the thoracolumbar (p < 0.01) and lumbar region (p < 0.013) of double curves and in the thoracolumbar (p < 0.018) and lumbar region (p < 0.027) of thoracolumbar curves. ATI improvement in the thoracic region was not statistically significant either in double curves (p < 0.088) or in thoracolumbar curves (p < 0.248). For right thoracic curves, ATI improvement was not statistically significant for all the examined regions. The above findings indicate that in double and thoracolumbar curves, a deforming torsional force is present, blocked by the antirotatory action of the blades of the DDB, and seems to be more active in the "lower" spine. In conclusion, DDB improves the cosmetic appearance of the back of IS children with all but right thoracic curves.