Hyperlordosis Secondary to Myasthenia Gravis Successfully Treated With Brace-wearing and Lordosis Exercises: A Case Report

Spinal deformities secondary to Myasthenia Gravis (MG) are rarely reported and mainly include scoliosis. In this study, we report a case of hyperlordosis with MG origin, which has not been reported earlier. The patient was a 12-year-old boy who underwent thymectomy at the age of three, and the disease was well-controlled afterward. One year ago, the patient presented with fatigue and severe low back pain associated with walking, while his parents noticed his buttocks jut out more than normal. The radiologic evaluation revealed a hyperlordosis of 100º. The patient was treated with a Milwaukee brace and lordosis exercises. One year after the treatment, an improvement of 27º was observed in the hyperlordosis of the patient. While bracing does not typically treat a neuromuscular deformity, the present case reveals the value of bracing in the treatment of hyperlordosis with MG origin.‎

Measurement of Milwaukee Brace Pad Pressure in Adolescent Round Back Deformity Treatment

<sec><title>Study Design</title><p>In this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment.</p></sec><sec><title>Purpose</title><p>We evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace.</p></sec><sec><title>Overview of Literature</title><p>A fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction.</p></sec><sec><title>Methods</title><p>Interface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation.</p></sec><sec><title>Results</title><p>The mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (<italic>p</italic>=0.001).There were no statistically significant differences between right and left shoulder pad pressures (<italic>p</italic>&gt;0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (<italic>p</italic>&lt;0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (<italic>p</italic>=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction.</p></sec><sec><title>Conclusions</title><p>In the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.</p></sec>

NUMERICAL ANALYSIS (FINITE ELEMENT METHOD) OF BRACE EFFECTS ON THE ADOLESCENT IDIOPATHIC SCOLIOSIS DURING 24 HOURS

In the adolescent idiopathic scoliosis (AIS) treatment, a brace is prescribed to the patients who have 20 to 45° curves on their spines to prevent the disorder's advancement. For the analysis of Milwaukee brace effects during time, finite element models (FEMs) of the spine (the thoracolumbar region) and the ribcage (contained 10 pairs of the ribs and the sternum) were prepared for two patients. For modeling the spine part, a new element was used in which a disc (as viscoelastic 3D beam) and a vertebra (as rigid link) were modeled as an element and the ribs and the sternum modeled by 3D elastic beams. The gravity, Milwaukee brace constraints and the forces of the brace's different regions were considered as the FEM boundary conditions. By running the patients' FEMs, the spine deformities of each patient were predicted for 24 h. For AIS patients, the brace should not only correct the deformity of the spine by inserting the forces, but also support the spine from the bending moments being caused by the gravity forces in different spine regions. Moreover, in studying scoliosis pathomechanisms, the stresses in different levels of the vertebra are important. Therefore, the bending moments and compressive stresses, caused by the gravity forces, were calculated in each level of the vertebra and the brace forces effects on them were analyzed. According to the patients' FEM responses, for the female patient: lumbar scoliosis was increased, thoracic scoliosis was decreased and kyphosis and lordosis were increased, and for the male patient: lumbar scoliosis was increased, kyphosis was increased and lordosis was decreased. In standing position, the brace forces reduced the bending moment and the compressive stress in vertebral levels of thoracolumbar region for the female patient and increased them for the male patient.

Treatment stability of Milwaukee brace in idiopathic hyperkyphosis

Background:The Milwaukee brace is an efficient method for correcting hyperkyphosis before skeletal maturity. However, loss of correction in long-term follow-up is inevitable.Objectives:To determine loss of correction and factors affecting the loss of correction.Study design:Retrospective study.Methods:A total of 49 corrected patients by Milwaukee brace participated minimum 2 years after treatment completion. The participants were categorized into two groups based on their roentgenograms: Group 1 (n = 36) had kyphotic curves of 45° or less and Group 2 (n = 13) had kyphotic curves of more than 45°.Results:The mean loss of corrections for Group 1 and Group 2 were 3.80° (ranges = 0°–13°) and 12.92° (ranges = 8°–22°), respectively. Group 1 showed no significant difference between the average hyperkyphosis of the patients for the part-time and full-time treatment duration (p = 0.02). By contrast, a significant difference was observed between the average hyperkyphosis of patients in Group 2 for the part-time and full-time treatment duration (p < 0.05).Conclusions:Patients with kyphosis of 60° or less who can save the correction in full-time orthotic treatment in part-time treatment may have the least loss of correction over time.Clinical relevanceAs the orthotic treatment is a time-consuming method that needs the close collaboration of patient and treatment team, it is possible that clinicians predict the probable result of treatment and efficiency of orthotic treatment. Thus, a clinician can abandon orthotic treatment and refer the patient for an operation.