Cervical sagittal alignment variations in adolescent idiopathic scoliosis patients treated with thoraco-lumbo-sacral orthosis

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 (t (0)), after 1 month of brace treatment (t (1)), and 1 year after end of treatment (t (2)). Cervical pain was evaluated at t (2) using 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 t (2) than at t (0): 0 +/- 2.5A degrees vs. 9.4 +/- 2.3A degrees, 24.1 +/- 2.6A degrees vs. 29.3 +/- 2.4A degrees and 5 +/- 1.9A degrees vs. 44.2 +/- 2.5A degrees, respectively (p < 0.05). CSA and TSA showed moderate-good correlation (r = 0.57). CSA was normolordotic in 1/38 patients at t (2) compared to 18/38 at t (0) (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.