Asian Spine J > Volume 17(2); 2023 > Article |
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Author Contributions
Conception and idea: M. Kamali, F. Ghorbani, H. Ranjbar, M. Kamyab, T. Babaee, H. Razavi, P. Sharifi; intellectual content: M. Kamali, H. Ranjbar, T. Babaee; data analysis and interpretation: F. Ghorbani, T. Babaee, L. Janani; literature search and data extraction: F. Ghorbani, H. Razavi; manuscript preparation, writing, and revision: F. Ghorbani, H. Razavi; manuscript editing: P. Sharifi; manuscript editing and review: M. Kamali, H. Ranjbar, T. Babaee; supervision: M. Kamali, H. Ranjbar, M. Kamyab, T. Babaee, L. Janani; and approval of final manuscript: M. Kamali, H. Ranjbar, M. Kamyab, T. Babaee, P. Sharifi, L. Janani.
References (quality) | No. of patients (no. of men) | Age of total group (yr), mean (range) | Initial Risser stage, mean (range) | Type of brace | Prescribed wear-time (hr/day), mean (range) | Measurement method | Initial cobb angle (°), mean (range) | Follow-up, mean (range) | Selected quotation of conclusion |
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Zhang et al. [20] (2020) (high)a) | Retrospective; sample: 275 (0) | 12.74±1.21 (11–16) | (0–2) | Chêneau brace | 20 (12–23) | X-rays | 29.02±8.51 | (>2 yr) | “CL, TK, and LL decreased gradually and significantly during long-term bracing treatment, which lead to the aggravation of “flat back” in AIS patients. Nevertheless, pelvic parameters have not changed significantly in the global statistics.” |
Cheung et al. [22] (2019) (moderate)a) | Retrospective; sample: 265 (40) | 12.53±1.17 (10.0–15.9) | (0–2) | Boston brace | - | X-rays | 31.0±3.8 | 3.9±1.3 yr (>2 yr) | “Brace treatment leads to flatback deformity with thoracic hypokyphosis and lumbar hypolordosis. Changes in the thoracic spine are associated with similar changes in the lumbar spine. Increased sacral slope, reduced pelvic tilt, and pelvic incidence are associated with reduced lordosis in the lumbar spine after bracing.” |
Lateur et al. [19] (2016) (moderate)a) | Retrospective single-center; sample: 142 (25) | 11.6 (7–14) | Risser 0/1: 93; Risser 2: 27; Risser 3: 22 | Night-time brace | (8–10 non-stop; night-long) | EOS imaging system | 15.5 (10–25) | 45 mo (10–92 mo) | “The present study confirmed the efficacy of non-operative treatment by night-time brace in mild progressive idiopathic scoliosis (<25°) in a large majority of cases. A night-time brace thus seems to be an effective option for the treatment of adolescent scoliosis, ensuring a safe curve of around 20°.” |
Fang et al. [21] (2015) (high)a) | Retrospective; sample: 32 (3) | 12.9±0.9 (11.1–14.5) | (0–2) | Chêneau brace | Minimum 23 | X-rays | 30.6 | 24.4±12.5 mo | “This study reveals the high variability of the effect of brace treatment on sagittal alignment. Chêneau brace treatment may influence sagittal global balance.” |
Saeedi et al. [9] (2020) (moderate)b) | Retrospective and prospective; sample: 25 (2) | 12.7±1.6 (10–15) | - | Milwaukee brace | 23 | X-rays | 31.8±5.9 (22–44) | 17.1±12.5 mo (6–24 mo) | “Our study results show significant associations between the sagittal pelvic parameters and the spinal parameters during the brace treatment of adolescents with idiopathic scoliosis.” |
Vergari et al. [11] (2019) (moderate)b) | Retrospective and prospective; sample: 42 (15) | 13±2 | (Risser sign ≤2) | TLSO (30); night-time brace (12) | - | EOS imaging system | 29.2±12.1 (16–61) | <9 mo | “Analysis of sagittal alignment from head to pelvis showed that bracing further flattened the patients’ backs and induced large compensating reorientations of the pelvis..” |
Almansour et al. [23] (2019) (moderate)b) | Retrospective single-center; sample: 38 (9) | 12.6±2 (10–16) | (0–2) | Chêneau brace | - | EOS imaging system | 31.4±6.4 (19–41) | 4 mo | “The impact of the brace in this study on the sagittal profile was variable, including the loss of thoracic kyphosis and lumbar lordosis.” |
Diab et al. [7] (2017) (high)b) | Prospective; sample: 9 (3) | 16.89±2.15 (12–20) | (Risser sign >2) | SpineCor brace | 20 | X-rays; 3D Formetric II system | (20–40) | 6 mo | “The SpineCor brace with exercise as well as exercise alone comparing pre to post test were beneficial in reducing thoracic hyperkyphosis, lumbar lordosis, pelvic inclination as well as trunk imbalance in the short term, but comparing between groups, only the SpineCor brace with exercise improved thoracic hyperkyposis.” |
Donzelli et al. [18] (2016) (moderate)b) | Cross-sectional (prospective database); sample: 16 (0) | 14.01 | - | Sforzesco brace | 23 | EOS imaging system | 38.20±15.42 | - | “The Sforzesco brace mostly modifies the middle of the spine and preserves the sagittal balance.” |
Pepke et al. [24] (2021) (moderate)c) | Retrospective single-center; sample: 93 (23) | 13.3±2.5 | (0–2) | Chêneau brace | - | Conventional radiography, EOS imaging system | M curve: 30.2±8.0; S curve: 22.9±6.7 | Immediate | “The impact of the brace lead to loss of LL in all AIS patients of this study cohort. Loss of TK was noticed only in normokyphotic patients and was unchanged in hypokyphotic patients. No pelvic compensation was needed during brace treatment. In-brace patients revealed small changes of the lower cervical parameters such as T1-Slope and C2-slope, but without alteration of kyphotic CL. The upper cervical spine did not reveal any changes. Therefore, the influence of brace therapy on the lower cervical spine is marginal and not existent on the upper cervical spine.” |
Courvoisier et al. [25] (2013) (moderate)c) | Cross-sectional study; sample: 30 (7) | 11 (8–14) | (0–4) | Cheneau brace (18); Milwaukee (5); GTB (3); Lyonnais (2); Charleston (2) | - | EOS imaging system | 28±15 | Immediate | “The Cobb angle was significantly improved. It also showed a significant hypolordotic effect. However, the results showed a high variability of the brace treatment effect in almost every parameter.” |
Jiang et al. [3] (2010) (moderate)c) | Retrospective; sample: 28 (0) | 14.0 (12–16) | 1.8 (0–4) | Elastic orthotic belt; Milwaukee brace | - | X-rays | 29.6 (20–44) | Immediate | “Although Milwaukee brace leads to significant decreased TK in AIS patients, the change of TK is small. Elastic orthotic belt could result in a more severe thoracic hypokyphosis compared with Milwaukee brace.” |
Quality assessment criteria | Long-term | Short-term | Immediate | |||||||||
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1. Zhang et al. [20] (2020) | 2. Cheung et al. [22] (2019) | 3. Lateur et al. [19] (2016) | 4. Fang et al. [21] (2015) | 5. Vergari et al. [11] (2019) | 6. Saeedi et al. [9] (2019) | 9. Almansour et al. [23] (2019) | 7. Diab et al. [7] (2017) | 8. Donzelli et al. [18] (2016) | 10. Pepke et al. [24] (2021) | 12. Courvoisier et al. [25] (2013) | 11. Jiang et al. [3] (2010) | |
1. Representativeness of the exposed cohort | 1 | 1 | 0 | 1 | 1 | 1 | 1 | 0 | 0 | 1 | 1 | 0 |
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2. Selection of the non-exposed cohort | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
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3. Ascertainment of exposure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
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4. Precision of exposure dose ascertainment | 1 | 0 | 1 | 1 | 0 | 1 | 0 | 1 | 1 | 0 | 0 | 0 |
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5. Ascertainment of exposure done prospectively or retrospectively | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | 1 | 0 | 0 | 0 |
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6. Demonstration that outcome of interest was not present at start of study or baseline assessment | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
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7. Adjustment for confounding (rendering comparability of cohorts on the basis of the design or analysis) | 0 | 0 | 0 | 1 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 1 |
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8. Assessment of outcome | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
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9. Was follow-up long enough for outcomes to occur? | 1 | 1 | 1 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 |
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10. Adequacy of follow-up of cohorts | 1 | 1 | 1 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
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Total | 7 | 6 | 6 | 8 | 6 | 6 | 4 | 7 | 5 | 4 | 4 | 4 |
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Quality | High-quality | Moderate | Moderate | High-quality | Moderate | Moderate | Moderate | High-quality | Moderate | Moderate | Moderate | Moderate |
Radiological parameters | Level of measurement | References | Brace effect | Mean difference | Statistical analysis p-value |
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Cobb angle | The uppermost and lowermost vertebrae in the curve (°) | Zhang et al. [20] | Decrease | Pre–post: 29.02±8.51 to 25.66±6.92 | Not provided |
Cheung et al. [22] | Increase | 5.4±11.1 | <0.001 | ||
Fang et al. [21] | No change | −3.3±12.0 | 0.13 | ||
Vergari et al. [11] | Decrease | Pre–post: 29.2±12.1 to 19.1±9.8 | 0.000 (in-brace<pre-brace) | ||
Donzelli et al. [18] | Decrease | 5.72 ± 5.50 | 0.0008 | ||
Saeedi et al. [9] | Decrease | Pre–post: 31.8±5.9 to 22.5±6.9 | <0.001 | ||
Cheung et al. [22] | Increase | 16.9±10.2 | <0.001 | ||
Donzelli et al. [18] | Decrease | 10.30±7.60 | 0.001 | ||
Almansour et al. [23] | Decrease | T: 10.6±6.0; TL: 16.5±5.5; L: 12.4±6.7 | 0.0001 | ||
Courvoisier et al. [25] | Decrease | −6 | 0.001 | ||
Pepke et al. [24] | Decrease | Pre: 30.2 ±8.0 to 19.8±9.4; post: 22.9±6.7 to 19.0±7.7 | <0.001 | ||
Lateur et al. [19] | Increase | Pre–post: 15.5 to 16.3 | 0.04 | ||
Cervical parameters | CL (°) | Zhang et al. [20] | Decrease | Pre–post: 14.13±7.15 to 8.94±5.33 | 0.021 |
Pepke et al. [24] | No change | Pre–post: 10.7±13.6 to 10.5±13.9 | 0.877 | ||
C2 slope angle (°) | Zhang et al. [20] | No change | - | >0.05 | |
Pepke et al. [24] | Decrease | Pre–post: 26.8±8.8 to 24.1±9.1 | 0.001 | ||
C2–7 SVA (mm) | Zhang et al. [20] | No change | - | >0.05 | |
Pepke et al. [24] | Decrease | Pre–post: 25±9.9 to 22.1±8.2 | 0.003 | ||
SVA off-set (=C7-SVA) (mm) | Zhang et al. [20] | No change | - | >0.05 | |
C7-central sacral vertebral line shift (mm) | Cheung et al. [22] | Decrease | 2.3±13.9 | 0.008 | |
Cheung et al. [22] | Decrease | 2.3±13.9 | 0.002 | ||
C0C1 (=C0C1 angle) (°) | Pepke et al. [24] | No change | Pre–post: 2.6±7.4 to 1.7±11.6 | 0.696 | |
C1C2 (=C1C2 angle) (°) | Pepke et al. [24] | No change | Pre–post: −30.3±12.9 to −9.8±13.4 | 0.674 | |
T1–CL (=T1–CL mismatch) (°) | Pepke et al. [24] | Decrease | Pre–post: 26.2±11.5 to 23.1±11.9 | 0.032 | |
CPA (=C2-pelvic angle) (°) | Pepke et al. [24] | No change | Pre–post: 6.9±8.9 to 7.8±9.6 | 0.287 | |
CTPA (=cervical-thoracic pelvic angle) (°) | Pepke et al. [24] | Decrease | Pre–post: 2.7±1.3 to 2.2±1.1 | 0.000 | |
Trunk shift (mm) | Cheung et al. [22] | Increase | 4.6±13.0 | <0.001 | |
Cheung et al. [22] | Increase | 4.6±13.0 | <0.001 | ||
TK | T1 slope angle (T1S) (°) | Zhang et al. [20] | No change | - | >0.05 |
Pepke et al. [24] | Decrease | Pre–post:16.3±9 to13.5±8.6 | 0.001 | ||
T1–T12 TK (°) | Diab et al. [7] | Decrease | 8.66 | 0.000 | |
Donzelli et al. [18] | Decrease | 2.7 | 0.04 | ||
Donzelli et al. [18] | Decrease | 5.7 | 0.01 | ||
Almansour et al. [23] | No change | 2.3±8.3 | 0.095 | ||
Courvoisier et al. [25] | No change | −2 | 0.14 | ||
Pepke et al. [24] | Decrease | Pre–post: 32.8±14 to 26.4±13.3 | 0.000 | ||
T4–T12 TK (°) | Zhang et al. [20] | Decrease | Pre–post: 24.35±7.54 to 19.02±7.12 | 0.001 | |
Fang et al. [21] | Decrease | −7.1±10.8 | <0.01 | ||
Donzelli et al. [18] | No change | 2.1 | NS | ||
Saeedi et al. [9] | Decrease | Pre–post: 55.9±15.3 to 38.5±6.4 | <0.001 | ||
Donzelli et al. [18] | No change | −0.4 | NS | ||
Almansour et al. [23] | Decrease | 2.6±6.3 | 0.017 | ||
Pepke et al. [24] | Decrease | Pre–post: 26.2±12.3 to 23.2±10.6 | 0.000 | ||
Not mentioned | Lateur et al. [19] | No change | - | NS | |
T5–T12 TK (°) | Cheung et al. [22] | Decrease | −4.3±8.2 | <0.001 | |
Cheung et al. [22] | Decrease | −3.4±7.6 | <0.001 | ||
Jiang et al. [3] | Elastic belt: decrease; Milwaukee: decrease | Belt: 10.4; Milwaukee: 3.5 | El astic belt: <0.05; Milwaukee: <0.05 | ||
Maximum kyphosis (°) | Cheung et al. [22] | Decrease | −4.3±9.3 | <0.001 | |
Cheung et al. [22] | Decrease | −5.5±10.0 | <0.001 | ||
T2T5 (=T2T5 angle) (°) | Pepke et al. [24] | Decrease | Pre–post: 13.5±8.2 to 11.1±7.4 | 0.004 | |
T5T12 (=T5T12 angle) (°) | Pepke et al. [24] | Decrease | Pre–post: 21.5±11.4 to 19.2±9.4 | 0.002 | |
TL (=thoraco-lumbar alignment) (°) | Pepke et al. [24] | Decrease | Pre–post: −2±9.3 to −0.5±7.9 | 0.042 | |
LL | L1–S1 LL (°) | Zhang et al. [20] | Decrease | - | 0.005 |
Fang et al. [21] | Decrease | −7.1±8.2 | <0.01 | ||
Vergari et al. [11] | Decrease | Pre–post: −58.2±12.5 to 52.5±10.8 | 0.04 (in-brace>pre-brace) | ||
Diab et al. [7] | Decrease | 6.8 | 0.000 | ||
Donzelli et al. [18] | No change | 1.1 | NS | ||
Donzelli et al. [18] | Decrease | 7.6 | 0.0008 | ||
Almansour et al. [23] | Decrease | 3.8±7.5 | 0.004 | ||
Courvoisier et al. [25] | Decrease | 8 | 0.001 | ||
Pepke et al. [24] | Decrease | Pre–post: −54.3±17.2 to −48±20.1 | 0.011 | ||
Not mentioned | Lateur et al. [19] | No change | - | NS | |
L1–L5 LL (°) | Cheung et al. [22] | Decrease | −5.6±12.0 | <0.001 | |
Donzelli et al. [18] | No change | 0.4 | NS | ||
Saeedi et al. [9] | Decrease | Pre–post: 56.7±8.8 to 50.6±9.4 | 0.006 | ||
Cheung et al. [22] | Decrease | −3.8±11.2 | <0.001 | ||
Donzelli et al. [18] | Decrease | 4.7 | 0.0005 | ||
Almansour et al. [23] | Decrease | 2.6±6.7 | 0.020 | ||
Jiang et al. [3] | Elastic belt: no change; Milwaukee: decrease | Belt: -; Milwaukee: 3.0 | Elastic belt: >0.05 Milwaukee: <0.05 | ||
L1L4 (=L1L4 angle) (°) | Pepke et al. [24] | Decrease | Pre–post: −24.7±10.5 to −19.3±12.7 | 0.000 | |
L4S1 (=L4S1 angle) (°) | Pepke et al. [24] | No change | Pre–post: −34.8±12.6 to −33.5±13.9 | 0.480 | |
Pelvic parameters | PI (°) | Zhang et al. [20] | No change | Pre–post: 38.44±18.72 to 32.13±23.44 | >0.05 |
Cheung et al. [22] | No change | 1.9±20.1 | 0.134 | ||
Fang et al. [21] | No change | 2.3±7.9 | 0.11 | ||
Donzelli et al. [18] | No change | 3.8 | NS | ||
Saeedi et al. [9] | No change | Pre–post: 49.2±16.4 to 51.8±16.0 | 0.57 | ||
Cheung et al. [22] | No change | 0.4±18.5 | 0.867 | ||
Donzelli et al. [18] | Decrease | 5.3 | 0.04 | ||
Almansour et al. [23] | No change | 1.7±6.3 | 0.109 | ||
Jiang et al. [3] | Elastic belt: no change; Milwaukee: no change | - |
Elastic belt: >0.05 Milwaukee: >0.05 |
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Courvoisier et al. [25] | Decrease | −4 | 0.003 | ||
Pepke et al. [24] | No change | Pre–post: 49.7±14.1 to 49.1±14.1 | 0.211 | ||
Pelvic inclination (°) | Diab et al. [7] | Decrease | 4.5 | 0.001 | |
Pelvic tilt (°) | Zhang et al. [20] | No change | - | >0.05 | |
Cheung et al. [22] | Increase | 3.8±13.6 | <0.001 | ||
Fang et al. [21] | Increase | 3.8 ± 6.4 | 0.002 | ||
Donzelli et al. [18] | No change | 1.4 | NS | ||
Saeedi et al. [9] | No change | Pre–post: 10.9±7.5 to 11.1±7.5 | 0.29 | ||
Cheung et al. [22] | No change | −0.5±12.6 | 0.531 | ||
Donzelli et al. [18] | Increase | −3.8 | 0.023 | ||
Almansour et al. [23] | No change | −1.6±4.9 | 0.057 | ||
Courvoisier et al. [25] | Increase | −4 | 0.001 | ||
Pepke et al. [24] | No change | Pre–post: 10.3±6.7 to 11.1±7.5 | 0.144 | ||
Pelvic obliquity (mm) | Almansour et al. [23] | No change | 0.3±2.5 | 0.446 | |
PI–LL (=PI–LL mismatch) | Pepke et al. [24] | Decrease | Pre–post: −5.9±12.5 to −1.9±12.1 | 0.000 | |
Sacral slope (°) | Zhang et al. [20] | No change | - | >0.05 | |
Cheung et al. [22] | Decrease | −2.0±14.5 | 0.028 | ||
Fang et al. [21] | No change | −1.5±6.9 | 0.23 | ||
Donzelli et al. [18] | No change | −2.8 | NS | ||
Saeedi et al. [9] | No change | Pre–post: 38.3±10.8 to 37.7±8.6 | 0.74 | ||
Cheung et al. [22] | No change | 0.9±13.8 | 0.386 | ||
Donzelli et al. [18] | Decrease | 3.4 | 0.003 | ||
Almansour et al. [23] | Decrease | 3.3±6.5 | 0.004 | ||
Courvoisier et al. [25] | No change | 0 | 0.82 | ||
Pepke et al. [24] | Decrease | Pre–post: 41.1±10 to 38.8±10 | 0.002 | ||
SVA (mm) | Cheung et al. [22] | Decrease | 18.7±34.6 | <0.001 | |
Cheung et al. [22] | Increase | 23.1±34.9 | <0.001 | ||
Almansour et al. [23] | No change | −1.6±31.6 | 0.752 | ||
Spinopelvic parameters | T1SPi (=T1 spinopelvic inclination) (°) | Almansour et al. [23] | No change | −0.06±4.0 | 0.921 |
T9SPi (=T9 spinopelvic inclination) | Almansour et al. [23] | No change | 0.07±4.7 | 0.930 | |
SSA (=spinosacral angle) (°) | Almansour et al. [23] | Decrease | 2.4±6.2 | 0.019 | |
Sagittal balance | Measurement of the sagittal balance includes two lines. The A-line is drawn from the midpoint of C7 perpendicular to the vertical margin of the radiograph. The B-line is drawn from the upper posterior corner of S1 perpendicular to the vertical margin of the radiograph. | Fang et al. [21] | Increase | 13.8±32.1 | 0.02 |