The biomechanics of spinal orthoses for adolescent idiopathic scoliosis : a systematic review of the controlling forces

Abstract

Background: Orthotic treatment is a well-acknowledged conservative treatment for moderate adolescent idiopathic scoliosis (AIS). The efficacy of this treatment is significantly determined by the forces applied to the bodies of patients. However, there is uncertainty regarding the optimal force levels that should be applied to the patient's torso by spinal orthosis. This study aims to identify reference values for the controlling forces in AIS management. Methods: A comprehensive literature search was performed in five databases (PubMed, Scopus, Cochrane Library, CINAHL, and Web of Science). Only studies written in English and covering the force/pressure measurements of spinal orthosis for the treatment of AIS were included, without publication date restrictions. The methodological index for non-randomized studies (MINORS) was employed for the methodological quality assessment, and force measurements were standardized to pressure in kilopascals (kPa) for comparison. Results: From the initial 10,452 records, 10 studies were admitted for the final analysis. All the included studies reported the interface pressure between the thoracic (T) pad and patient's trunk, and seven studies evaluated the pressure from the thoracolumbar/lumbar (TL/L) pad. These studies used different pressure sensors or transducers with the range from 5.6 to 82.5 kPa for the T pads, and 4.8 to 85.1 kPa for the TL/L pads. Four studies reported strap tensions of 26.8 to 60.4 N. Higher strap tension was correlated with increased interface pressure (r = 0.84). Conclusion: The mean strap tension was 42.5 N, the median interface pressure of the T pads was 8.75 kPa, and the median pressure of TL/L regions was 7.11 kPa without the outliers. The findings provide a baseline value for designing adjustable straps and strategically distributing pressure in orthoses.