Rib cage spine coupling patterns involved in brace treatment of adolescent idiopathic scoliosis

Study Design. The three-dimensional (3-D) interrelations in the correction of the spine and rib cage produced by the Boston brace were analyzed in a group of adolescents with idiopathic scoliosis. Objectives. To investigate the coupling movements between the spine and rib cage initiated by brace wear (i.e., the displacements of the spine that take place in other directions than the ones generated by brace pressures on the thorax). Summary of Background Data. The effects of thoraco-lumbo-sacral orthosis in the frontal plane have been well documented, but they have never been studied in terms of 3-D coupled movements between the spine and rib cage. Methods. The spine and rib cage of 36 adolescents with idiopathic scoliosis with and without their Boston brace were reconstructed in 3-D using a stereo-radiographic technique. Several geometric indices were evaluated on the trunk, and the relative motions of the spine and rib cage resulting from brace wearing were compared by means of Student t tests, Pearson correlation matrices, and linear regressions. Results. Rib cage transverse plane translations resulting from brace pressures are related to those of the spine. Coupled movements between the spine and rib cage were found to alter substantially the expected 3-D correction of the trunk. Significant anterior displacements of the thorax were observed and were statistically associated with lateral displacements of the spine. and with an increase of spinal thoracic curvatures in the : frontal and sagittal planes. Conclusion. Brace loads are not applied in an optimal way to correct the 3-D deformities associated with thoracic idiopathic scoliosis. Loads applied on the posterior rib hump should be reequilibrated to reduce anterior displacement of the trunk.