Current Practice in Orthotic Treatment of AIS
Authors: Jang Sun Hae , Davis Kara L. , Thach Scott D. 
Published: November 2018

ABSTRACT

Introduction
The standard clinical practice and the biomechanical correction concepts of orthotic treatment for adolescent idiopathic scoliosis (AIS) have not been clearly defined. The purpose of this project was 1) to use a survey tool that polls expert opinions of experienced spinal orthotists to identify areas of agreement or disagreement regarding the current practice of orthotic treatment and the key biomechanical elements in treating AIS and 2) to share the literature review results of all topics identified with significant disagreement in the survey.

Materials and Methods
Online-based survey and literature review methods were used. Twenty-one survey questions related to orthotic biomechanical concepts along with the posteroanterior view and lateral view x-rays of typical case examples were developed using multiple-choice style including three questions for defining qualification for data. The participant inclusion criteria were either a certified orthotist or a certified orthotist and prosthetist, who has at least 2 years of scoliosis orthotic treatment experience. A review of the literature was conducted on each of the areas identified as a topic of disagreement from the survey.

Results
Fifty people were surveyed, and 46 people were qualified for inclusion. Participants agreed with 11 biomechanical orthotic correction topics. The majority of participants considered reducing Cobb angle in orthosis as well as aligning to the neutral alignment of the spine and trunk in all three planes as the important orthotic biomechanical goal in treating AIS. They selected the derotational force(s) as a primary correction force(s) for the thoracic curve and the lumbar curve. The placements of the lumbar corrective force for the lumbar curve and the sagittal corrective forces for the double major curves case were agreed between participants. They also reached a clear agreement for the questions regarding the orthotic design for the axillary area, orthotic recommendations for the C7 decompensation, and considerations for the usage of a trochanter extension. However, seven topics failed to find a clear agreement: the level of a thoracic pad for right thoracic curve case; the placement(s) of a primary corrective force(s) in the sagittal plane to address the thoracic hypokyphosis case; the necessity of abdominal compression for nonlumbar hyperlordosis case; the necessity of reducing lumbar lordosis for nonlumbar hyperlordosis case; orthotic recommendation for a single primary curve case (more than 35° Cobb angle), where the apex is located at or below T12/L1; orthotic recommendation for an upper thoracic curve (with an apex T2–T6)/cervicothoracic curve (with an apex C7–T1) case; and the treatment necessity for pelvic obliquity case, secondary to scoliosis.

Conclusions
Experts agreed with 11 biomechanical orthotic correction topics. Some answers for seven topics, on which participants failed to reach an agreement, were found through the literature review. The area that had the most disagreement occurred on questions regarding treatment of the sagittal plane. The question regarding the placement of a thoracic pad for a single thoracic curve was not yet clear. More quantitative investigations are still needed to understand biomechanical correction concepts while treating AIS with an orthosis.