Use and impact of Cheneau brace in adolescent idiopathic scoliosis: a literature review

INTRODUCTION

Scoliosis is a lateral curvature of the spine with rotation of the vertebrae within the curve that deviates from the normal vertical line of the spine. Scoliosis is usually diagnosed when the posterior-anterior radiograph shows at least 10 degrees of spinal angulations along with vertebral rotation.¹

In Adolescent idiopathic scoliosis (AIS), an orthosis is the only potentially effective non-operative treatment for preventing curve growth (AIS). Several forms of orthoses, such as the cervicothoracolumbosacral orthosis or Milwaukee brace, Thoracolumbosacral (TLSO), and nighttime orthoses, such as the Providence and Charleston orthoses, have been used with varied degrees of efficacy. All of these orthoses with varying treatment criteria have been studied for their efficacy in the treatment of AIS, usually retrospectively. As a result, the efficacy of orthotic management remains debatable.²

The Cheneau brace is the most commonly used rigid TLSO orthosis in Europe. It is designed to de-rotate the apical segment of the curve and provide 3D correction of the spinal deformity. The primary mechanism of this orthosis is 3D correction of spinal deformity via a system of multipoint pressure zones and expansion chambers. The Cheneau brace applies pressure to the convexity of a curve, while wide expansion chambers in the frontal, sagittal, and horizontal planes are located on the opposite side. In terms of brace application outcomes, the Cheneau brace has been shown to prevent curve progression and reduce axial rotation. Most brace systems aim for frontal and horizontal curve correction, but sagittal plane correction, particularly preservation of Lumbar lordosis (LL), has been the focus since 2004 due to the development of sagittal plane measurement methods and the 3D reconstruction technique.³

The aim of the study was to highlight the impact of Cheneau brace on usage and compliance in adolescent idiopathic scoliosis.

A computerized search was conducted in Google Scholar, Science Direct, PubMed and Cochrane Database. The search queries used were- ‘AIS AND Orthotic management’, ‘AIS AND Spinal braces’ ‘AIS AND Cheneau brace’, ‘Cheneau brace AND Curve progression’, ‘Cheneau brace AND Axial rotation’, ‘Cheneau brace AND efficacy’, ‘Cheneau brace AND compliance’, ‘Cheneau brace AND usage’.

Total 11 articles were included in the study and based on their findings a review was made. Table 1 summarizes the details of the reviewed articles.

DISCUSSION

The purpose of this study was to determine how effective a cheneau brace was in adolescent idiopathic scoliosis. The results indicate that if high early correction and good compliance can be achieved, a successful outcome can be expected.

Kinel et al demonstrated that wearing the Cheneau brace for at least 16 hours per day resulted in less clinical deformity than non-treatment.¹⁴ Rahman et al found that highly compliant patients (85% compliance) had no curve progression at the end of treatment, whereas poorly compliant patients (62% compliance) had curve progression of more than 6°.¹⁵

Although Weiss and Rigo recommended aiming for an in-brace correction of more than 40%, not all curves can be corrected to the same extent.¹⁶

According to Landauer et al compliant patients with high initial correction can expect a final correction of approximately 7°, whereas compliant patients with low initial correction may not see a change in the curve degree, and poor compliance is always associated with curve progression. While compliance is always an issue that must be addressed, the study's findings suggest that its impact on in-brace correction should never be underestimated.¹⁷

According to Kim et al correction of the curve in the brace should be maximized through careful fitting and adjustment of the pads by an experienced orthotist. Best practices should aim for the best in-brace correction while also providing the most comfort for the patient to encourage compliance. The better the in-brace correction, the better the final outcome. In fact, the magnitude of the curve has a negative relationship with in-brace correction. Poor results can be attributed to insufficient bracing, which can be confirmed using in-brace radiographs to evaluate the obtained correction. Poor outcomes can also be attributed to poor patient management, which can have an impact on compliance. A successful treatment outcome can be achieved with careful monitoring of the patient's compliance and in brace correction.¹⁸

We do know that compliance is critical to the success of brace treatment and that there are ways to improve compliance. Using the appropriate psychological intervention is unquestionably one way to improve. If the doctor is not convinced that braces work, how can he properly instruct and guide the patient? According to the study, another way to improve compliance is to reduce material, or "make the braces smaller!" When patients experience less stress while wearing the brace, we can assume that compliance improves.¹²

CONCLUSION

According to the literature, brace compliance and brace wearing have an effect on curve progression. From this, it is possible to conclude that brace use has a positive effect on natural history. The Cheneau brace provides excellent clinical results in the treatment of mild to moderate AIS. Its additional benefit is that it allows for three-dimensional correction of a three-dimensional deformity. There is evidence that Cheneau braces built to a high standard of excellence change natural history. Compliance issues in treatment are well known, and a variety of factors can affect compliance, patient awareness, and patient-practitioner interaction, including scoliosis deformity features such as cobb angle, curve progression, riser grade, age, gender, and family physician expectations. Hundreds of research projects have included compliance as a topic for many investigators. Nonetheless, there is a lack of well-controlled treatment studies that can be used to develop and evaluate approaches to improve compliance. Starting brace wear at a younger age and taking into account the child's habits and preferences, as well as the treatment plan and prescribed regimen for the orthosis, can significantly improve overall compliance. The treatment's overall effect could then be improved (in both physical and psychological aspects).

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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