**3. Results**

### **3.1 July 2011 until January 2012**

From July 2011 to January 2012, I continued to alternate the days when I wore the corset and days when I did not as I found this to be more effective than continuous wear as far as derotation was concerned. The corset improved the position of the ribs and arched my back, but it could not decrease the vertebral rotation and therefore did not reduce the hump immediately. But after I have taken off the corset, by pressing the hump from behind against the floor when lying or against the backrest when sitting and with contractions of the back muscles, I could decrease the hump slightly, moving the vertebrae slightly toward the correct position.

The comparison of images taken in July 2011 and January 2012 documents a substantial improvement. In side view from July, the hump was of a semicircular shape and at a right angle to back. The skin of the chest and abdomen in the front was loose and wrinkled as it was not supported by the ribs. On 10 January 2012, the back was evenly narrowing toward the waist in side view. At the front, the ribs supported the skin of the chest and abdomen. A skin mark which was located laterally in the earlier image moved to the front (**Figure 4**).

### **3.2 March 2012**

I photographed myself again on 23 March 2012. The view from the rear, in comparison with the image taken in January, showed improvement on the left concave side where previously the ribs were hidden as they were shifted forward because of the rotation of the spine and chest (**Figure 5**).

If a line is drawn from the extremity of the curve to its upper and lower end, and the angle measured that is formed by these lines, we find that the angle was 140° in January and 150° in March: the apparent curve on the surface was reduced. In an upright spine, this angle would measure 180°; a smaller angle thus means a larger

*Living with a Severe Spinal Deformity: An Innovative and Personal Patient Account… DOI: http://dx.doi.org/10.5772/intechopen.90294*

### **Figure 4.**

*The left image was taken on 1 July 2011. The hump is of a semicircular shape and connects with the back at a right angle. The skin of the chest and abdomen at the front is loose and wrinkled, because it is not supported by the ribs. The right view was created on 10 January 2012. The difference is obvious. From the side the blade down the back is evenly narrowing toward the waist. At the front, the ribs support the chest and skin of the abdomen. A skin mark (pointed by the arrows), located laterally in July 2011, moved to the front side in January 2012.*

### **Figure 5.**

*Comparison of the back, photographed in January 2012 (left) and March 2012 (right). The apparent curve has been reduced in March, and on the left side of the body we see the ribs, which were not seen in January (left) as they were shifted forward because of rotation of the spine in its axis. We can only see the wrinkled skin in the place of ribs seen in the march image.*

curvature. Digital photographs can be taken without limitations as the body is not exposed to radiation like in X-ray imaging. To measure the angles, the lines from the photos were transferred to a picture of a protractor in the Adobe Photoshop program. The apparent curve on the surface does not correspond with the curvature of the spine, however. It is just a simple indicator used in monitoring the development of the curve and is dependent of several factors. As proven in my case, it was an indicator of the degree of rotation.

In side view, in comparison with January, the hump seemed to have increased again at first sight. But a closer examination revealed that the scapula, which was previously raised by the hump, was lowered. The ribs, which previously had raised it, formed the curve of the hump. But the chest and abdomen at the front were supported well and were not loose, as they have been in July 2011. This means that the derotation, achieved between July 2011 and January 2012, was preserved.

### **3.3 April 2012**

To find out the cause for a benefit of alternating days when wearing a corset or not, I wore the corset for 5 days in a row during the day and then had my back photographed on 6 April 2012. I found that in lateral view, the hump was reduced and the scapula was lifted. The view from behind showed that the apparent curve sideways measured 144°. Thus, it was more pronounced than in the previous image taken on 27 March 2012 (151°). The next day, the curve measured 151° again. I found that the corset could therefore temporarily increase rotation, but this was rapidly corrected when corset wear was interrupted. The chest easily rotates to a certain degree when the corset is tightened too much because of pressure to the ribs, diminishing the circumference of the chest. Then it derotates again when the corset is taken off. When this happens often, therapy should be discontinued for a longer time to allow ligaments to stiffen and prevent rotation. Care must also be taken not to tighten the corset too much.

### **3.4 June 2012**

The apparent curvature (rotation) diminished over time during the therapy. The exceptional case of the 6th of April cannot be considered because it was not documented under the same conditions. On 10 January 2012, the curve was 140°; 23rd of March, 150°; 27th of March, 151°; and 14th of April, 154°. If a graph is drawn on these data points, a straight line can be drawn through. However, on the 4th and 22nd of May and on the 9th of June 2012, the curve remained the same as in the 14th of April. The limits of any possible derotation had probably been reached.

The imaging on the 9th of June 2012 showed an important change from the previous state, however. My pelvis was no longer tilted as much as before, and the analysis of the photographs showed a significant difference. The pelvic obliquity may be the consequence of unequal leg length, but the pelvis could also be shifted due to rotation in the lumbar part of the spine that is present in scoliosis. Scoliosis can develop because of pelvic obliquity, but scoliosis also causes or increases pelvic tilt. It is difficult to determine what occurred first. I linked the iliac crests on the photos with a line and drew a line along the middle of the body (**Figure 6**). Then I measured the angle between these lines. It would measure 90° if the pelvis was not inclined as in a healthy person. In me, the angle at the right side of my body measured 96° on 4 May 2012, but only 92.5° on June 9. A mistake due to changes in posture was possible, so I waited for the imaging of June 22. The angle was the same, so the pelvic tilt was actually reduced.

*Living with a Severe Spinal Deformity: An Innovative and Personal Patient Account… DOI: http://dx.doi.org/10.5772/intechopen.90294*

### **Figure 6.**

*Pelvic tilt measured on 17 August 2012. Thumbs are put to the iliac crests of the pelvis to mark them. The angle at the right side was 91°.*

### **3.5 October 2012 and further**

According to appearance, the scoliosis improved substantially since the beginning of treatment. The hump was markedly reduced. However, it is important to note that only X-rays can show the true state of the curves, so I was X-rayed on 8 October 2012. The comparison with X-ray image from 2010 showed that there was almost no change in spinal curvature (**Figure 7**). I have achieved derotation of the chest and improvement of the shape of the ribs as well as the lumbar lordosis. This reduced the hump and led to better rib support of the right side of the chest in front and left side in the rear (concave side). The changes had a positive effect on breathing and possibly prevented further deterioration of the curves. Lung volume reduction, which can be life-threatening, is not caused by curvature of the spine, but by the rotation of the rib cage which becomes flattened. Radiographs from 4 March 2015 also showed that the curvature did not improve. In years to come, I was still using the corset for at least some hours a week. I obtained a better corset in October 2016, which was much stiffer acting almost like a true brace (Vollers Eye Candy: https://www.vollers-corsets.com/eye-candy-made-in-england). But without reduction of the curve, additional derotation and rib hump reduction were not possible either.

### **Figure 7.**

*At the left an X-ray image from 2010 with cobb angles measured. The thoracic curve measured 104° and lower lumbar 57°. At the right the X-ray image of the spine from 8 October 2012. The same angles are inserted as on the left image; there is almost no change.*

I have never experienced back pain. Only when I started going on walks without the corset after I wore it almost every day for some time that a muscle started to ache on the left (concave) side of the back, which was shortened due to scoliosis and weakened during corset wear. But I persisted. If the pain was severe, I stopped for a rest and then went on. When the muscle strengthened again, the pain no longer occurred. The curves of my spine seem to be quite stiff and not mobile as they do not change between imaging sessions. But I do not have any problems with spine mobility during my activities. I have reduced lung capacity, however, and was never able to run over longer distances. With a long walk I had no problems; only when walking uphill, I was slower than others.

### **4. Discussion**

Although corsets from textiles in the nineteenth and the first half of the twentieth century were sometimes used to treat or at least alleviate scoliosis, they were not accepted by the leading physicians at the time. Albee [23] published a picture of a textile corset for the treatment of scoliosis, but he recommended it only for the immobilization of the spine after spine surgery. A textile corset is more comfortable than a rigid brace as it adapts to the shape of the body. Since it is made of cloth, it is permeable to the air and moisture. Also the feeling of a hug given by the bodice is pleasant.

The corset should absolutely not be tightened too much, however. If it starts to pinch, then this means the grip must be released by loosening the lace at the back. This allows one to constantly adapt the corset to ones' body state. The body changes

### *Living with a Severe Spinal Deformity: An Innovative and Personal Patient Account… DOI: http://dx.doi.org/10.5772/intechopen.90294*

its circumference with food intake and the degree of hydration. If the corset is tightened too much, it forces the ribs to rotate the vertebrae and diminish the chest circumference. It needs to be tightened only as much as is needed for good support and pressure to the prominent angles of the ribs; it should not press on the concave sides of the chest. Excessive tightening of the corset known as tightlacing or waist training was probably the cause of the bad reputation of wearing corsets as stated by medical experts in the Victorian times. The doctors cited corset wear in young women of the higher social classes as one of the main causes of scoliosis.

Textile corsets embrace the whole body, but the strongest pressure needs to be directed at the most prominent angles of the ribs to push them forward and inward posteriorly and backward anteriorly. Since the bodice acts with the same force on the ribs from the other side also, the ribs slowly get a more rounded shape, thus gaining a better form. Consequently the deformation of the chest is reduced. However, since the corset does not have empty spaces where the chest can expand into, treatment with a textile corset needs to be periodically interrupted.

After the corset is taken off, derotation forces directed to the back of the rib hump forward can then be applied to the thorax to derotate it, pushing the ribs in the opposite direction to the rotating forces. The hump needs to be pressed from behind, not laterally as this flattens the rib cage. A similar type of manipulation was performed to correct spinal deformities by Hippocrates and Galen millennia ago. While extending the body, they pressed the hump with the leg, whole body or with a plank, attached to the wall for leverage [5]. But pressing against the chair backrest or the hard floor when lying is sufficient. In the days when the corset is not worn, the chest can expand, and the muscles are more active and can be strengthened.

Corset wear also has an important effect on learning how to correct the erect posture. Patients with scoliosis have a distorted feeling of upright posture. When the corset forces them into it, they learn to keep an upright posture even when they are not braced.

While partial derotation was achieved with the help of a textile corset, the corset was not effective in diminishing the side curvatures of the spine as it is symmetrical. Modern rigid braces are far better at in-brace curve reduction, necessary for longterm improvement. But rigid braces for side curves of about 100° Cobb do not exist yet. In such cases we should be satisfied when deterioration is prevented.

The side curvature of the spine is always accompanied by rotation of the vertebrae and rib cage. Ribs are connected by intercostal muscles and cannot spread apart on the convex side when the spine bends. The curvature of the spine in the thoracic region is not possible without rotation of the vertebrae and deformation of the ribs. The ribs at the apex of the curve are pulled inward toward the vertebrae. Intercostal muscles under stress pull them up and down, but the composite force is directed toward the spine because the ribs at the apex of the curve are shifted further from the midline than other ribs [24]. The side curvature of the spine stretches the intercostal muscles like an archer pulls a bow string and the taut muscles push the ribs like the bow string pushes the arrow.

With rotation of the vertebrae at the apex of the curve, which are compressed between the ribs, the thoracic circumference diminishes, and the tension in the chest wall is alleviated. The deformation becomes irreversible if new growth or bone resorption and remodeling change the shape of the ribs and vertebrae or if the ligaments are not firm enough. When the rib cage and vertebrae become structurally rotated, the vertebrae lose the balanced support from the ribs from both sides. Shear forces from the ribs turn the vertebrae further and push the vertebral bodies toward the convexity (**Figure 8**). Continuous progression of scoliosis starts. With therapy one is able to diminish only the excessive rotation, while some rotation is

### **Figure 8.**

*In a rotated chest, forces transmitted by the ribs turn vertebrae and bend the spine sideways. Ribs on one side of the vertebrae are not opposed by equal support from the ribs on the contralateral side, so ribs on the concave side push vertebral bodies toward convexity, bending the spine [24].*

necessary at a given curvature. The side curvature in the frontal view must be reduced for further improvement.
