Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace

Claudio Vergari (1) , Isabelle Courtois (2) , Eric Ebermeyer (2) , Raphael Pietton (3, 4) , Houssam Bouloussa , Raphael Vialle (5, 4, 4, 4, 4) , Wafa Skalli (1)

1 Institut de Biomecanique Humaine Georges Charpak
2 LBM - Laboratoire de biomécanique
3 UPD5 Médecine - Université Paris Descartes - Faculté de Médecine
4 CHU Trousseau [APHP]
5 UGA UFR LLASIC LAS - Université Grenoble Alpes - UFR Langage, lettres et arts du spectacle, information et communication - Dpt Lettres et arts du spectacle

Purpose To determine the short-term effect of bracing of adolescent idiopathic scoliotic (AIS) patients on the relationships between spinopelvic parameters related to balance, by comparing their in and out-of-brace geometry and versus healthy subjects. Methods Forty-two AIS patients (Cobb angle 29° ± 12°, ranging from 16 to 61°) with a prescription of orthotic treatment were included retrospectively and prospectively. They all underwent biplanar radiography and 3D reconstruction of the spine and pelvis before bracing as well as less than 9 months after bracing. Eighty-three age-matched healthy adolescents were also included as control group and underwent biplanar radiography and 3D reconstruction. Results Sacral slope was higher in AIS than healthy patients (p = 0.005). Bracing induced large changes of pelvic tilt (between -9° and 9°), although patients’ sagittal spinopelvic alignment tended to remain within the normality corridors defined by the healthy patients. Patients had flatter backs compared to healthy subjects and bracing further reduced their spinal curves. The head tended to remain above the pelvis in-brace. Conclusions Analysis of sagittal alignment from head to pelvis showed that bracing further flattened the patients’ backs and induced large compensating reorientations of the pelvis. Sagittal balance should be included in the planning and evaluation of brace treatment, since it could play a role in its outcome.

Mots clés: Surgery; Orthopedics and Sports Medicine; AIS; Bracing; Brace effect; Sagittal balance; Compensation

Domaines: Sciences de l'ingénieur [physics]; Sciences du Vivant [q-bio]

Claudio Vergari, Isabelle Courtois, Eric Ebermeyer, Raphael Pietton, Houssam Bouloussa, et al.. Head to pelvis alignment of adolescent idiopathic scoliosis patients both in and out of brace. European Spine Journal, 2019, pp.1-10. ⟨hal-02129230⟩