<Modern braces are made to treat idiopathic adolescent scoliosis' frontal plane deformity (AIS). A soft-fabric brace for AIS called the Spinaposture brace (Spinaposture Aps, Copenhagen, Denmark) is intended to improve rotational axial stability by causing a kyphotic correction in the sagittal plane. In fifteen individuals with AIS, this prospective observational study evaluated the brace. Initial average CA was 16.8 degrees (SD: 2.8). They were observed prospectively every three to six months while wearing the brace until skeletal maturity at 25 months and at the 44-month mark of long-term follow-up. Six participants had both in-brace and out-of-brace radiographs taken at inclusion.
This caused a kyphotic effect of 14.9 percent (40.8°47.9°) and an instantaneous in-brace correction of 25.3 percent in CA (14.3°10.8°).This caused a kyphotic effect of 14.9 percent (40.8°47.9°) and an instantaneous in-brace correction of 25.3 percent in CA (14.3°10.8°). At the first follow-up, the average in-brace improvement was 4.5° in CA, while the CA at skeletal maturity was 11° (SD: 7.4°) and the long-term CA was 12.0° (SD: 6.8°). In conclusion, the Spinaposture brace had a thoracic kyphotic impact as well as an immediate in-brace deformity correction. When compared to natural history and observation and other soft braces, the abnormalities at skeletal maturity improved more than anticipated. There was no long-term deformity progression. Stronger designed investigations with more subjects are required to support these conclusions.
Due to the severity or advancement of the spinal deformity, idiopathic adolescent scoliosis (AIS) is a structural spinal condition that occasionally necessitates bracing or surgery [1,2]. The three points pressure-mediated correction in the frontal plane, along with derotation to stop curve progression, is the guiding principle of modern bracing [1,2,3,4,5,6]. Such rigid braces may have a detrimental psychological effect, which thus decreases compliance and lessens the corrective effect [3,7,8]. There has been discussion about the effectiveness of the current bracing treatment [9,10,11]. It has been asserted [11] that leaving out bracing has no consequences. But bracing has been proven effective in thorough scientific studies, and it reduces the need for corrective surgery.
Despite the rigorous scientific effort, questions remain regarding the effectiveness of bracing [9]. Soft braces, such those made of elastic corrective ribbons, have been studied in the past [12]. Although it appears to have a corrective impact, this is not as effective as rigorous bracing [12,13], particularly not during pubertal growth. The lack of correction has been attributed to the initial soft braces' poor sagittal profile correction [14]. With seemingly encouraging outcomes, bracing approaches have now advanced to include not only correcting the frontal plane deformity but also concentrating on sagittal alignment correction [12,15,16]. The Spinaposture brace is a soft brace with two sections that focuses on sagittal alignment. the first section It is a soft "suit" that is specially manufactured to fit each patient's unique anthropometric measurements using data from a whole-trunk optical 3D scan.
Sensotex, a unique elastic fabric made of Neopren and Sensotex Lycra that has a "memory effect," is used to create the brace (with the ability to return to its original shape). A kyphotic effect is intended to be produced by the brace. Both the tactile reaction to the elastic fabric's component and the "suit's" design work together to induce this. The brace features a second component, a hard shield with "fingers" that fit into a soft fabric "pocket" posteriorly at the level of the thorax. This results in an additional kyphotic effect. If the frontal plane deformity is advancing (increasing CA) or if the first repair is insufficient, the hard shield is applied later.
Numerous factors, including chronic intermittent hypoxia [6, 7, 8, 9], fragmented sleep [9, 10], and sympathetic overactivity [11], have been theorised to have a role in the dysregulation of lipid profiles in OSA patients. The need for effective therapy is further increased by the independent associations between OSA and dyslipidemia and an increase in all-cause mortality, vascular heart disease, and stroke [12]. The initial course of treatment for OSA is continuous positive airway pressure (CPAP) [13]. According to an observational study conducted over a period of 30 years, OSA patients who received CPAP treatment for more than 5 years were 5.6 times more likely to live [14]. However, there is little proof that CPAP can potentially lower lipid levels in CAD patients who also have OSA. Reduced levels of circulating triglycerides (TG), total cholesterol (TC), and high-density lipoprotein (HDL) were seen in earlier meta-analyses.
Depending on the specific curve pattern, the brace may cause a sagittal plane thoracic kyphotic effect and, if necessary, a derotation in the spine to increase axial stability. The brace is designed to realign or repair the thoracic kyphosis by creating an essentially proprioceptive "hyper-kyphotic effort" and to only slightly to no direct frontal plane correction. The autocorrection principle, which was developed through physiotherapeutic practise, is used to induce the striving [17].
The goal is to specifically realign the transient, naturally occurring thoracic hyperkyphosis that develops during adolescent growth [18]. This is thought to have contributed to the early onset of thoracic AIS [19]. AIS is frequently linked to female adolescents. According to some theories, AIS arises as a result of the spine developing into a mechanically unstable column and could advance in a self-sustaining "vicious cycle" as a result of the interaction between gravity and asymmetric stresses in a way that modifies growth. Both sexes experience a spinal growth spurt during adolescence, however adolescent girls are distinguished from males by much faster and earlier thoracic growth. For teenage girls, these characteristics correspond to a temporal sagittal flattening of the thoracic vertebrae.
This assists with spine rotational instability. By realigning or correcting the sagittal plane, the brace aims to enhance or restore axial stability. The goal is to stop curve advancement without putting as much strain on the body as traditional hard braces would. The brace is made to seem like an advanced t-shirt/body stocking, and it is less uncomfortable than a hard brace, which is something we believe is good for encouraging compliance and subsequently effective treatment [8]. Justified bracing smaller curvature, early intervention, and being less taxing while likely having a less frontal plane correctional effect all have superior corrective effects [20]. As a result, we used AIS bracing with a Cobb's angle (CA) of 15° to 25° [21].
The Spinaposture brace's ability to modify posture was assessed in this study using in-and out-of-braces radiography for patients.In a prospective follow-up study, we assessed the initial correction when the brace was stopped at skeletal maturity and long-term at roughly four years for patients with AIS and out-of-brace radiographs.
Patients from our hospital's service area who had been AIS-referred were the participants of this convenience sample. The participating physician initially identified them as having AIS, and upon receiving informed consent, included them if they had thoracic or thoracolumbar AIS with a CA between 15° and 25°. The 'gold standard' treatment was explicitly explained to the patients and carers as being longitudinal radiological follow-up without bracing. Subjects with primary lumbar scoliosis, prior brace treatment, a general inability to tolerate bracing, or intraspinal disease confirmed by MRI were excluded from the study. After three months of wearing the brace, if the individuals' frontal plane deformity had corrected by around a quarter, this was kept up. If the adjustment was less than a quarter later came the introduction of the "hard shield." After another three months of wearing the brace, if the participants had a correction of roughly one-fourth in the frontal plane deformity, this was continued. If not, the subjects were disqualified. In order to offset the effects of gravity on the spine, the "body stocking" portion of the brace was worn during the day (16 h, classified as part-time) and not at night [13,22]. When the subjects were engaged in sports or the brace became too warm, we gave them the option of not wearing it. We urged them to engage in strengthening activities through a home exercise programme, professional physiotherapy, and/or participate in sports like crawl Swimming because we saw the brace as a passive corrective measure [19].We allowed all forms of physical exercises at the patient’s discretion throughout the study.
The subjects were asked to volunteer when the study first began to have the initial in-brace radiographs taken (both anteroposterior and lateral projections).
Anteroposterior out-of-brace radiographs were used to prospectively monitor the individuals every six months in general. However, as we had no prior experience wearing the brace, the initial radiographs were performed every three months as a precaution [12]. One day prior to the follow-up, the individuals were instructed not to wear the brace. We employed an anteroposterior low-dose local radiological examination [24]. A typical radiography follow-up utilising the low dose radiographic.
To reach skeletal maturity, the brace was worn. Skeletal maturity was defined as having at least Risser 4 (Sanders stage 8), a 2-year menstrual cycle for girls, and skeletal hand ages of 14 and 16 for girls and boys, respectively. An additional three to six months of follow-up were given, followed by a final radiographic and clinical evaluation. To conduct one long-term radiographic follow-up, the individuals were called back.
Cobb's angle for the principal curves at skeletal maturity was the main result. Five degrees or more of change was categorised as either an advancement or a regression [13,25]. We classified the CA as "stable" if it stayed within five degrees of the measurement taken before the brace treatment began. We compared the spinal deformity's progression while wearing the brace to the anticipated results in light of the Risser classification at brace commencement [13]. At skeletal maturity, 71 percent of AIS for Risser 0-2 and 42 percent for Risser 0-1 are anticipated to improve or remain stable, respectively [13]. In this study, a successful outcome was defined as an improvement or stability.The predicted result for observation only is 50% (CI: 44-56%) [13].
The radiographic secondary parameters were assessed as categorical variables of altered or unchanged. The criteria included the descriptive Moe-Kettleson classification of scoliosis [26], changes in the level of the apex vertebrae (if there were more than two levels of difference), Nash and Moe's classification (if rotation changed more than one segment) at the apex vertebrae, changes in rib vertebrae angle differences/Metha angle (if there were more than 20° of difference), and changes in CA of the secondary curves, if present.
Two paediatric orthopaedic and spinal surgery specialists with 26 and 20 years of experience each served as the reviewers. Using the PACS system (Impax 6.4.0, Agfa® HealthCare, Mortsel, Belgium) and Synedra View Personal 19 (Ver. 19.0.0.2, Innsbruck, Austria), each measurement was carried out independently and blindly on a three-megapixel viewing station. We conducted an inter-class correlation for inter-observer variability between the assessors for statistical analysis. For comparisons between subjects and drop-outs, the Spearman correlation test and the chi-square cross-tabulation test were used. Using IBM SPSS Statistics, Version 25, all tests were run (IBM, Richmond, VA, USA). Using GPower, a post hoc power analysis was carried out (Ver 3.0.10, Aichach, Germany). The Declaration of Helsinki II's guidelines were followed when conducting the study. This study was rated by the regional ethical council as a clinical observational follow-up series (reference number H-17014162). All subjects that were involved gave their informed consent. There was no external support for this study.
22 patients underwent screening. Upon first assessment, seven patients were disqualified from the trial. Three participants were excluded due to syrinx or anisomelia, two subjects received the brace but never utilised it, and two subjects had CA bigger than 25° and prior brace treatment. There were 15 individuals total, and they had only undergone observational care. Five students withdrew. Following their enrollment in a formal Schroth therapy, two participants voluntarily adopted the Chêneau Gensigen brace. Their private physiotherapists encouraged this. One participant underwent bracing for back discomfort, one switched to Rolfing structural integration treatment, and one skipped the follow-up appointments. All three test individuals gave up bracing. The long-term follow-up was missed by two participants.
One subject was overloaded with academic work, and we couldn't think of one.They were seen as dropouts by us. In addition, there were no withdrawals or participants lost to follow-up. A flow chart of the subject's involvement, exclusion, and drop-out through time.
Radiographs in the anteroposterior and lateral projections were used to investigate six participants for the in-brace correction. Comparing the CA values recorded at the same levels on the in- and out-of-bracing radiographs allowed researchers to determine the frontal plane correction and kyphotic effect. The principal curve's frontal plane in-brace adjustment was 25.3 percent (14.3° to 10.8°). In the sagittal plane, the in-brace thoracic kyphosis increased by 14.9% (40.8° to 47.9°). An illustration of the radiographic in-brace correction.
The average CA when bracing was initiated in the prospective follow-up was 16.8° (SD: 2.8°). At the initial follow-up, the average CA correction was 4.5° (SD: 3.2°). Initially, 11 (15) patients remained constant and four (4/15) subjects had CA improvements of more than 5 dg. The typical time spent bracing was 21 months (range: 12.4–37.63 months; SD: 9.5 months). At the conclusion of bracing, the average CA was 11.0° (SD: 7.2°). Six participants (6/10) had straight spines with a CA of less than ten degrees at the conclusion of bracing, whereas four (4/10) remained stable. The projected results for bracing at skeletal maturity were 6/11 and 9/15 for the Risser stage 0-1 and 0-2 at brace beginning, respectively, according to Costa et al. (2021) [13].
When using the brace, the results were 11/11 and 15/15 for the Risser stages 0-1 and 0-2, respectively. The observed result is anticipated to be 50% (CI 44-56%) [13]. Thus, based on observation and natural history, 8/15 were projected to either become better or stay the same. None of the subjects' conditions deteriorated over time. The projected outcome for bracing long-term was 4/9 and 7/10 for the Risser stage 0-1 and 0-2 at brace commencement, respectively, when extrapolating the expected outcome from Costa et al. (2021) [13]. When employing the brace, the results were 9/9 and 10/150 for the Risser stages 0-1 and 0-2, respectively. A 24-month follow-up was the most recent (SD: 7.5 months). At the most recent follow-up, the average CA was 10.0°. (SD: 6.8).
the typical At 44 months, there was a long-term follow-up (SD: 9.3 months). At the long-term follow-up, the average CA was 12.0° (SD: 6.8°). Five (5/8) of the individuals remained stable, while three (3/8) had straight spines. The Supplementary Materials display each individual curve development.
At every follow-up, the subjects and caregivers were urged to express non-compliance and discomfort with the brace in an open-minded conversation in order to assess the compliance of brace usage and events. Warm weather periods were characterised by non-compliance and brace incidents, and the participants frequently progressed in deformity by the time they were examined again. As a result of the deterioration, the patients used the braces more rigorously (see supplement S1). Heat sensors were inserted into the braces of two patients. This method of monitoring brace wear compliance by body heat is regarded as being objective [27]. When the brace was worn, the heat sensor would detect a rise in temperature. These two subjects appeared to have sufficient compliance.
In this study, a novel brace for adolescent idiopathic scoliosis was investigated. The proprioceptive-mediated "strive" of the brace caused a thoracic sagittal kyphotic effect when tested for rapid correction using in- and out-of-brace radiographs. The AIS deformity was immediately corrected in the thoracic frontal plane as a result. This shows that the frontal and sagittal plane spinal curves of the spine may interact in a way that Panjabi and White [28] refer to as "coupled motions." This hasn't been proven in vivo on humans, as far as we know. At the initial follow-up visit in the follow-up trial, there was a one-fourth deformity repair. All subjects' frontal plane deformities either got better or stayed the same at skeletal maturity.when contrasted to what is anticipated.
When stratified to the Risser stage 0-1 and 0-2 at brace commencement, more participants were improving or keeping stable when using the soft brace [13] compared to outcomes for observation only (50% success rate) or other soft braces (62.5% success rate). None of the subjects' conditions deteriorated over time. Based on these results, this soft brace's brace efficacy was higher than that of earlier trials that merely used soft bracing and observation. However, just a small cohort of participants were included as a precautionary measure. It is possible to claim that more subjects are required to detect an effect (particularly over the long term). As a result, when used intermittently and for short periods of time, the Spinaposture brace's outcomes are equivalent to those of earlier experiments with soft braces.
The following considerations were made while interpreting our findings. We took radiographs of the individuals while they were wearing and without braces during the first examinations, as well as closer follow-ups at intervals of three months during the initial brace wearing period. The subjects chose not to have the in- and out-of-brace radiographs since they exposed themselves to more radiation [29]. For this reason, we avoided taking radiographs while in and out of braces throughout the whole trial. As a precaution, the initial closer follow-up was conducted. We used a locally developed low dose radiography approach [24] to justify the more frequent follow-up and excess radiation [30].
Compared to the usual posteroanterior radiographs, the radiation doses to the individuals were eight times lower. Because this investigation was a clinical follow-up study and only a limited cohort of participants were included as a precautionary measure when evaluating a new brace, we performed a posthoc power analysis and found that our findings were sufficiently powered at skeletal maturity. We are aware of posthoc power analysis's limitations, albeit [31]. Because our participants were picked at random, selection bias may have affected the results of our study. However, when compared to earlier research [3,32], there were no differences in the gender and age distribution of the population, indicating that our participants were comparable.
Due to our exclusions and drop-outs, selection bias might also have an impact on our study. Despite nobody of the participants developing in deformity prior to switching to other treatments, five of the seven first exclusions were because private therapists encouraged the use of various braces and exercise therapy. Another reason for exclusion was non-compliance with any spine-related intervention, and those who dropped out later on in the trial were either unreachable or too busy to show up for the follow-up. Since there were no appreciable variations between subjects and dropouts when comparing the parameters, we were unable to pinpoint specific parameters that contributed to the drop-outs.However, we discovered a link between the brace's initial corrective efficacy, the length of treatment, and dropout.
The brace was being examined for two reasons: to see if the induced frontal plane distortion could be corrected with a sagittal plane effort and to see if the brace would work long-term and for skeletal maturity. The hard braces that are currently in use are demanding, resulting in pressure sores, overall discomfort, and low compliance [2,7,8]. The Spinaposture brace was created to be less demanding and to support our present non-operative treatment of careful follow-up and physical therapy. We agree that temperature monitoring is required for all individuals in order to conduct an adequate and quantifiable brace compliance evaluation [3].
The brace can still be employed as an early intervention option in AIS for smaller thoracic and thoracolumbar curves with a CA between 15° and 25°, despite the limitations of the original study. However, more research is required, such as a stronger prospective randomised design with a control group and more participants [13], to support this. These investigations ought to include quantified brace compliance monitoring, a more thorough assessment of skeletal development, and a more thorough stratification of outcome than the initial Risser stage.
In summary, this prospective observational study showed that six participants' frontal deformities caused by AIS were immediately corrected in braces. One-fourth of the abnormality was immediately corrected in a follow-up. When compared to natural history and observation and other soft braces, the abnormalities at skeletal maturity improved more than anticipated. There was no long-term deformity progression.
1.Negrini, S.; Minozzi, S.; Bettany-Saltikov, J.; Chockalingam, N.; Grivas, T.B.; Kotwicki, T.; Maruyama, T.; Romano, M.; Zaina, F. Braces for idiopathic scoliosis in adolescents. Cochrane Database Syst. Rev. 2015, 6, CD006850. [Google Scholar] [CrossRef][Green Version]
2.Weiss, H.-R. Is there a body of evidence for the treatment of patients with Adolescent Idiopathic Scoliosis (AIS)? Scoliosis 2007, 2, 19. [Google Scholar] [CrossRef][Green Version]
3.Weinstein, S.L.; Dolan, L.; Wright, J.G.; Dobbs, M.B. Effects of Bracing in Adolescents with Idiopathic Scoliosis. N. Engl. J. Med. 2013, 369, 1512–1521. [Google Scholar] [CrossRef][Green Version]
4.Nachemson, A.L.; Peterson, L.E. Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J. Bone Jt. Surg. Am. 1995, 77, 815–822. [Google Scholar] [CrossRef]
5.Wiley, J.W.; Thomson, J.D.; Mitchell, T.M.; Smith, B.G.; Banta, J.V. Effectiveness of The Boston Brace in Treatment of Large Curves in Adolescent Idiopathic Scoliosis. Spine 2000, 25, 2326–2332. [Google Scholar] [CrossRef] [PubMed]
6.Negrini, S.; Grivas, T.B. Introduction to the “Scoliosis” Journal Brace Technology Thematic Series: Increasing existing knowledge and promoting future developments. Scoliosis 2010, 5, 2–6. [Google Scholar] [CrossRef] [PubMed][Green Version]
7.Rivett, L.; Rothberg, A.; Stewart, A.; Berkowitz, R. The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: A comparative study. BMC Musculoskelet. Disord. 2009, 10, 5. [Google Scholar] [CrossRef][Green Version]
8.Reichel, D.; Schanz, J. Developmental psychological aspects of scoliosis treatment. Pediatr. Rehabil. 2003, 6, 221–225. [Google Scholar] [CrossRef] [PubMed]
9.Dolan, L.A.; Wright, J.G.; Weinstein, S.L. Correspondence: Effects of Bracing in Adolescents with Idiopathic Scoliosis. N. Engl. J. Med. 2014, 370, 680–681. [Google Scholar] [CrossRef][Green Version]
10.Davies, E.; Norvell, D.; Hermsmeyer, J. Efficacy of bracing versus observation in the treatment of idiopathic scoliosis. Evid. Based Spine Care J. 2011, 2, 25–34. [Google Scholar] [CrossRef] [PubMed][Green Version]
11.Goldberg, C.J.; Moore, D.P.; Fogarty, E.E.; Dowling, F.E. Adolescent Idiopathic Scoliosis: The effect of brace treatment on the incidence of surgery. Spine 2001, 26, 42–47. [Google Scholar] [CrossRef] [PubMed]
12.Weiss, H.-R.; Werkmann, M. Soft braces in the treatment of Adolescent Idiopathic Scoliosis (AIS)—Review of the literature and description of a new approach. Scoliosis 2012, 7, 11, Retraction: Scoliosis 2013, 8, 7. [Google Scholar] [CrossRef][Green Version]
13.Costa, L.; Schlosser, T.P.C.; Jimale, H.; Homans, J.F.; Kruyt, M.C.; Castelein, R.M. The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis. J. Clin. Med. 2021, 10, 2145. [Google Scholar] [CrossRef] [PubMed]
14.Weiss, H.-R. SpineCor vs. natural history—Explanation of the results obtained using a simple biomechanical model. Stud. Health Technol. Inform. 2008, 140, 133–136. [Google Scholar] [PubMed]
15.van Loon, P.J.M.; Kühbauch, B.A.G.; Thunnissen, F.B. Forced Lordosis on the Thoracolumbar Junction Can Correct Coronal Plane Deformity in Adolescents with Double Major Curve Pattern Idiopathic Scoliosis. Spine 2008, 33, 797–801. [Google Scholar] [CrossRef]
16.Weiss, H.-R.; Tournavitis, N.; Seibel, S.; Kleban, A. A Prospective Cohort Study of AIS Patients with 40° and More Treated with a Gensingen Brace (GBW): Preliminary Results. Open Orthop. J. 2017, 11, 1558–1567. [Google Scholar] [CrossRef] [PubMed][Green Version]
17.Negrini, S.; Fusco, C.; Minozzi, S.; Atanasio, S.; Zaina, F.; Romano, M. Exercises reduce the progression rate of adolescent idiopathic scoliosis: Results of a comprehensive systematic review of the literature. Disabil. Rehabil. 2008, 30, 772–785. [Google Scholar] [CrossRef] [PubMed]
18.Adams, W. Lectures on the Pathology and Treatment of Lateral and Other Forms of Curvature of the Spine; Churchill: London, UK, 1882, 2nd ed. Available online: https://wellcomecollection.org/works/qc5xzydx (accessed on 1 December 2021).
19.Wong, C. Mechanism of right thoracic adolescent idiopathic scoliosis at risk for progression; a unifying pathway of development by normal growth and imbalance. Scoliosis 2015, 10, 1–5. [Google Scholar] [CrossRef][Green Version]
20.Donzelli, S.; Zaina, F.; Negrini, S. End growth results analysis related to Risser score, Cobb degrees, and curve types at the beginning of the treatment. Scoliosis 2013, 8, O10. [Google Scholar] [CrossRef][Green Version]
21.Coillard, C.; Circo, A.B.; Rivard, C.H. A prospective randomized controlled trial of the natural history of idiopathic scoliosis versus treatment with the SpineCor brace. Sosort Award 2011 winner. Eur. J. Phys. Rehabil. Med. 2014, 50, 479–487. [Google Scholar] [CrossRef][Green Version]
22.Kouwenhoven, J.-W.M.; Smit, T.H.; van der Veen, A.J.; Kingma, I.; van Dieën, J.H.; Castelein, R.M. Effects of Dorsal Versus Ventral Shear Loads on the Rotational Stability of the Thoracic Spine: A biomechanical porcine and human cadaveric study. Spine 2007, 32, 2545–2550. [Google Scholar] [CrossRef][Green Version]
23.Lomax, M.; Tasker, L.; Bostanci, O. An electromyographic evaluation of dual role breathing and upper body muscles in response to front crawl swimming. Scand. J. Med. Sci. Sports 2014, 25, e472–e478. [Google Scholar] [CrossRef]
24.Wong, C.; Adriansen, J.; Jeppsen, J.; Balslev-Clausen, A. Intervariability in radiographic parameters and general evaluation of a low-dose fluoroscopic technique in patients with idiopathic scoliosis. Acta Radiol. Open 2021, 10. [Google Scholar] [CrossRef]
25.Langensiepen, S.; Semler, O.; Sobottke, R.; Fricke, O.; Franklin, J.; Schönau, E.; Eysel, P. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: A systematic review. Eur. Spine J. 2013, 22, 2360–2371. [Google Scholar] [CrossRef][Green Version]
26.Moe, J.H.; Kettleson, D.N. Idiopathic scoliosis. Analysis of curve patterns and the preliminary results of Milwau-kee-brace treatment in one hundred sixty-nine patients. J. Bone Jt. Surg. Am. 1970, 52, 1509–1533. [Google Scholar] [CrossRef]
27.Rahman, T.; Borkhuu, B.; Littleton, A.G.; Sample, W.; Moran, E.; Campbell, S.; Rogers, K.; Bowen, J.R. Electronic monitoring of scoliosis brace wear compliance. J. Child. Orthop. 2010, 4, 343–347. [Google Scholar] [CrossRef][Green Version]
28.Panjabi, M.M.; Brand, R.A., Jr.; White, A.A., 3rd. Mechanical properties of the human thoracic spine as shown by three-dimensional load-displacement curves. J. Bone Jt. Surg. Am. 1976, 58, 642–652. [Google Scholar] [CrossRef]
29.Simony, A.; Hansen, E.J.; Christensen, S.B.; Carreon, L.Y.; Andersen, M.Ø. Incidence of cancer in adolescent idiopathic scoliosis patients treated 25 years previously. Eur. Spine J. 2016, 25, 3366–3370. [Google Scholar] [CrossRef] [PubMed]
30.Knott, P.; Pappo, E.; Cameron, M.; Demauroy, J.C.; Rivard, C.; Kotwicki, T.; Zaina, F.; Wynne, J.; Stikeleather, L.; Bettany-Saltikov, J.; et al. SOSORT 2012 consensus paper: Reducing X-ray exposure in pediatric patients with scoliosis. Scoliosis 2014, 9, 4. [Google Scholar] [CrossRef][Green Version]
31.Zhang, Y.; Hedo, R.; Rivera, A.; Rull, R.; Richardson, S.; Tu, X.M. Post hoc power analysis: Is it an informative and meaningful analysis? Gen. Psychiatry 2019, 32, e100069. [Google Scholar] [CrossRef][Green Version]
32.Soucacos, P.N.; Zacharis, K.; Gelalis, J.; Soultanis, K.; Kalos, N.; Beris, A.; Xenakis, T.; Johnson, E.O. Assessment of curve progression in idiopathic scoliosis. Eur. Spine J. 1998, 7, 270–277. [Google Scholar] [CrossRef] [PubMed][Green Version]
Christian Wong,Thomas B.Andersen. A Four-Year Follow-Up for the Soft Brace Spinaposture Evaluation of Brace Treatment. Insights of Clinical and Medical Images 2022.