title: Cervical sagittal alignment variations in adolescent idiopathic scoliosis patients treated with thoraco-lumbo-sacral orthosis.
abstract: Thoraco-lumbo-sacral orthosis (TLSO) is an effective treatment in adolescent idiopathic scoliosis (AIS) patients, but cervical sagittal alignment (CSA) variations after bracing have never been evaluated. The purpose of this study was to assess changes in CSA before, during and after TLSO treatment, and to determine whether patients developed cervical pain.
  
  
  
  This was a retrospective study in 38 AIS patients (33 females; mean age 10.8 years) treated by TLSO. Patients were Risser 0 (n = 34) or 1 (n = 4). Major curve deformity (MC) in the coronal plane and cervical (CSA), thoracic (TSA) and lumbar (LSA) sagittal alignment were evaluated radiographically at start of treatment (t0), after 1 month of brace treatment (t1), and 1 year after end of treatment (t2). Cervical pain was evaluated at t2using a visual analogue scale (VAS).
  
  
  
  The TLSO was worn for an average of 4.6 years. Mean CSA, TSA and LSA were significantly lower at t2than at t0: 0 ± 2.5° vs. 9.4 ± 2.3°, 24.1 ± 2.6° vs. 29.3 ± 2.4° and 5 ± 1.9° vs. 44.2 ± 2.5°, respectively (p < 0.05). CSA and TSA showed moderate-good correlation (r = 0.57). CSA was normolordotic in 1/38 patients at t2compared to 18/38 at t0(p < 0.05). MC did not progress during treatment (p > 0.8). VAS score was 0 in all patients.
  
  
  
  The TLSO can control progression of the deformity in the frontal plane, but it influences CSA, TSA and LSA. In particular, it decreases cervical spine lordosis, with reduction maintained 1 year after the end of treatment. Numerical differences, although statistically significant, were not clinically relevant.
authors.affiliation: Service de Chirurgie Infantile, Department of Pediatric Surgery, Centre Hospitalier Universitaire Estaing, 1 place Lucie-et-Raymond-Aubrac, 63003, Clermont-Ferrand, France.
authors.forename: Marco
authors.initials: M
authors.lastname: Corradin
authors.affiliation: Service de Chirurgie Infantile, Department of Pediatric Surgery, Centre Hospitalier Universitaire Estaing, 1 place Lucie-et-Raymond-Aubrac, 63003, Clermont-Ferrand, France. canavese_federico@yahoo.fr.
authors.forename: Federico
authors.initials: F
authors.lastname: Canavese
authors.affiliation: Faculty of Medicine, University of Montpellier, 1, rue de l'Ecole de Medicine, 34000, Montpellier, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Dimeglio
authors.affiliation: Académie Nationale de Médecine, 16 rue Bonaparte, 75006, Paris, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dubousset
mesh_terms: D000293:Adolescent; D001915:Braces; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging*; D002648:Child; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging; D064232:Visual Analog Scale
keywords: Adolescent idiopathic scoliosis; Brace; Cervical spine; Neck pain; Sagittal alignment; TLSO