Variability of strap tension in brace treatment for adolescent idiopathic scoliosis.

Abstract

A mechanical evaluation of brace strap tensions to document their variability in different patient positions and to assess their biomechanical effectiveness. To measure the strap tensions at which adolescents with scoliosis are wearing their braces and to determine the variations in strap tension in different patient positions. The biomechanical action of thoracolumbosacral orthoses in still not well understood, and there is no standardized strap tension at which the brace should be fastened to obtain optimal results. This study was conducted in 34 adolescents with idiopathic scoliosis wearing thoracolumbosacral orthoses. Brace straps were instrumented with load cells and tightened at four tensions (the ones prescribed by their treating physician and three standardized values: 20, 40, and 60 N). In each case, the tension was recorded while the patients assumed nine positions corresponding to normal daily tasks. The variability of strap tension was evaluated by comparing the changes from the original standing position. The prescribed tensions measured in thoracic and pelvic straps were markedly variable. The greatest changes in tension occurred when the patients were lying down. Relaxation of strap tension was found when the patients returned to the standing position after having completed the tasks. If strap tension affects the biomechanical actions of the brace, these results indicate that regular brace strap tension adjustments are needed and raise questions about the efficacy of nighttime bracing to correct spinal deformities.