PMC8661293_01
Significant progression of the curve within 18 months from 45  (a and b) to approximately 65  Cobb (c and d). Whilst the trunk of the patient was compensated at the age of eight (a), at the start of treatment at 9.9 years, the patient showed signs of a collapsing spine with a drastic decompensation of the trunk to the right side.
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F0001
Cobb angle measurement may have been prone to a technical error on this X-ray. Compared to the X-ray taken in April 2018 when the patient was 8 years old, the main thoracic curve had progressed by 20  Cobb (Figure 1).
PMC8661293_02
The patient with two operations for congenital heart disease with a collapsing spine at the age of 9.9 years at the start of treatment. (a) X-ray taken on November 2019 with a Cobb angle of approximately 65  Cob, (b) picture from the same time showing the patient from the rear with a collapsing spine, (c) after the application of the Schroth Best Practice Programme whilst waiting for the brace and (d) after a few nights spent in the brace.
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F0002
The three braces made for the patient. (a) A Gensingen brace pattern 3C for large curves (11/2019), (b) a Gensingen brace pattern 4C to address the clinical pattern change (9/2020) and (c) third Gensingen brace pattern 3C again (2/2021).
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F0003
Over the following 18 months, the patient received two additional braces sent to Cuba from Germany, both manufactured by the second author (Figure 3). The patient continued an improved cosmetic result prior to the third brace at Risser 2 (Figure 3).
Clinical aspects of the patient during the follow-up. (a) Initial finding (November 2019), (b) intermediate result with pelvic prominence to the right indicating a clinical 4C pattern and (c) clinical result of the patient at Risser 2 prior to application of the third brace (2/2021).
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F0004
The clinical changes are documented in Figure 4.