Dr. Hans-Rudolf Weiß MD; Dino Gallo; Jenny Voit

Introduction

Figure: TL scoliosis types of the Rigo classification.

Goldberg et al. (2001) have shown that American health care strategies cannot significantly reduce the incidence of surgery in scoliosis treatment.

In their investigation, they showed that not only Milwaukee corset care, but also American TSLO care did not have a significant impact on the proportion of operated patients. Therefore, she rightly questioned the health care strategies examined.

Although proven ineffective in comparison with other orthoses (Rowe et al., 1997; Howard et al., 1998), the Charleston-Bending-Brace is still being aggressively marketed today (TrivedI and Thomson 2001; Gepstein et al. 2002; Bowen et al., 2001). The authors report success rates of around 60%, but cannot show any control groups. Furthermore, the primary correction effect in the corset is not mentioned in any of the cited works.

Therefore, the quality control of the care is not objectified. Another night-time restoration (D’Amato et al., 2001) also showed treatment success with slightly more than 63% moderate success for thoracic and double major curvatures, whereas corsets for lumbar and thoracolumbar curvatures apparently had significantly better treatment results.

In this work, excellent correction effects are described to assess the quality, although the end results of this night care cannot be measured against the end results of the Central European corsets (Weiß 1995; Landauer 1999; Weiß et al. 2000; Weiß et al. 2002). Unfortunately, other American studies on corset care lose their significance if the documentation of the primary correction effect in the corset is omitted (Howard et al., 1998; Karol 200; Katz and Durrani, 2001).

Figure: T1-6 types according to Rigo

In contrast, treatment security in Central Europe appears to be significantly greater. In a literature review (Weiß, 1995) it was possible to prove that the primary correction effects of the Central European corsets were superior to the American methods of care and led to significantly better end results.

Landauer (1999) demonstrated that compliance and the correction effect in the corset are of crucial importance for the end result. This increased treatment security with the Central European corsets leads to a highly significant lower operation rate (Weiß, 2002).

All practices and centers with extensive treatment experience are familiar with the problem that sometimes similar, sometimes poor, effects are achieved with similar corsets. The unfavorable results are not shown!

The results were statistically quite good with the original Chêneau construction as well as with the deflection corset (Weiß et al. 200; Landauer 1999), but in individual cases, as with the original Chêneau restoration, even with the deflection corset, it could not always be clarified why some corsets worked and others not!

Middle thoracic right convex curvature with static decompensation and hanging shoulder on the left; on the left the RSC model (Rigo-System-Chêneau), which corrects decompensation and shoulder obliquity visibly; right clinical picture after 10 minutes of wear [/ caption]

The operators have left the King classification due to frequent incorrect planning and are now using the Lenke classification, from which Rigo derived the 15 curvature patterns of the Rigo classification.

The question is: How can the safety of treatment in corset care be improved?

The answer could be: by improving the pattern specificity.

Chêneau: 3- / 4-bow (Lehnert-Schroth 1981) – 2 curvature patterns
White: King classification (King et al. 1983) – 5 curvature patterns
Rigo: Rigo classification – 15 curvature patterns
Chêneau only uses two functional curvature patterns for corset planning, which do not offer sufficient treatment security. The application of the King classification has not been able to significantly change the safety of treatment. The Rigo classification is now available for planning a specific corset restoration, which is derived from the Lenke classification used by the surgical side, but is tailored to the needs of the corset mechanic.

Model classification by Rigo

Supply with CAD-manufactured trunk orthoses according to the Rigo classification

To adapt a Chêneau corset using CAD technology according to the RIGO system, you need certain static and dynamic measurement values ​​that describe the deformity and its erectability, a current x-ray image (full-length image while standing), photos of the fuselage (rear view, possibly on the front view and the side views).

The data is then sent to the experts via e-mail, who then first determine the pattern of curvature according to Rigo’s pattern classification, in order to then select the module that is most suitable for this pattern of curvature, for patient age and for the existing curvature. Only then is a foam model created on the basis of the static and dynamic patient measurements carried out, which is the basis for the final production of the corset.

The manufactured corset is delivered and then the corset is adjusted and touched up as part of the usual team meetings in orthopedic practice. Problems that are not always covered by normal orthopedic or orthopedic training must be solved.

Thoracic right convex curvature with static decompensation and

drooping shoulder on the left; middle: patient in the RSC Brace using CAD technology

(Rigo-System-Chêneau), crooked shoulder and decompensation are characteristic

for the RSC Brace, corrected, the rib hump is derotated [/ caption]

Since the higher degree of scoliosis requiring treatment is already a rarity in orthopedic practice, conservative scoliosis management should only be reserved for treatment teams that have the appropriate experience, the appropriate number of patients and appropriate training in this area. A course is planned to convey the knowledge required for this.

The course is intended for complete treatment teams who want to care for their scoliosis patients at the highest level.

This requires that the entire treatment team (orthopedic surgeon, orthopedic technician and physiotherapist, if possible with Schroth training) complete the course and bring one or more patients to be cared for. The patients brought along should have corset indication and the diagnosis of idiopathic adolescent scoliosis.

Patients with other scoliosis are also welcome so that their conservative management can be discussed together.

Figure: Frequent curvature patterns © M. Rigo

Discussion

In the operation planning, the King classification has been left, especially since these five curvature patterns were not sufficient for a specific operation planning. In the meantime, the Lenke classification (Lenke et al., 2001) has become standard in operation planning. The Rigo classification developed by Rigo from the Lenke classification with 15 different curvature patterns appears to be significantly more specific and may lead to better security of supply in the future.

The first results suggest that the correction effects are significantly better taking into account the Rigo classification, that these corsets are still more comfortable and that the primary fit can be significantly increased in contrast to handmade corsets.

Corset care is an effective measure to stop an increase in curvature. The correction effect and compliance determine the end result. With regard to supply standards, quality assurance is required, which must lead to greater security of supply.

The severely impaired quality of life for the corset treatment time has to pay off for those affected by the fact that cosmetic problems are sustainably improved and that surgery can be prevented with the greatest possible safety!

Literature

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Weiß HR, Weiß GM, Schaar HJ (2002) Operationsinzidenz bei konservativ behandelten Patientinnen mit Skoliose. Med Orth Tech 122: 148-155

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