Scoliosis Specialists

Scoliosis is a disorder in which there is a sideways curve of the spine, or backbone. Curves are often S-shaped or C-shaped. In most people, there is no known cause for this curve. This is known as idiopathic  scoliosis. 80% of the scoliosis cases are known as idiopathic. Since the true cause is unknown, the treatment can only be based on the symptoms. Until now, only two types of treatment have been known to be efficient: the first is the treatment using an orthopedic rigid brace, and the second one is surgery with a spinal system.

Despite some effectiveness, currently available braces, because of their rigidity, are damaging to a certain degree to the normal development of the neuro-musculo-skeletal system .

• Bone structures, especially the rib cage, have to stand significant mechanical constraints that can lead to some malformation and atrophy of mobile structures.

• Muscles are barely active and can only be maintained through a heavy physiotherapeutic treatment.

• Because of the pseudo-atrophy of the spine’s muscular system, it is not possible to guarantee that the correction obtained by the brace will be permanent.

• Finally the aesthetical results are generally poorly acceptable. In most cases, the adolescent prefers the cosmetic results following surgery in spite of the scars.

In order to have better results in idiopathic scoliosis, early treatment while reducing or eliminating any drawbacks as well as using the neuro-muscular corrective potential, we have developed a new therapeutic tool based on an innovative approach. SpineCor the Dynamic Corrective Brace is the first and non-rigid brace which aimed at correcting scoliotic deformation through self-maintained correction of the neuro-musculo-skeletal system. SpineCor full potential is achieved with skeletally immature pre-adolescents with progressive idiopathic scoliosis of less than 30°.

SpineCor changes the dynamic of the trunk while harmonizing the posture. It is a therapeutic means with less mechanical constraints and an acceptable comfort level that preserves and enhances movements with a double therapeutic action:

• Progressive correction of the spine deformation up to the limit imposed by the pre-existing bone deformation.

• Neuro-muscular stimulation and correction.

The design of SpineCor happened through a scientific process based on decades of knowledge on scoliosis and its treatment. Therefore, we can be optimistic about its efficiency.

Background. Orthopaedic bracing is used in conservative treatment of spinal curvatures. Apart from rigid braces, SpineCor dynamic braces with a flexible design have recently become available. The idea behind dynamic bracing is that derotational and con’ecting forces are transmitted via a system of corrective bands. The essence of this technique is maintenance of spine mobility while effecting a position in which all components of the three-plane deformity are corrected. The aim of this study is to evaluate early outcomes of SpineCor dynamic brace treatment for idiopathic scoliosis according to SRS methodology and criteria.

Material and methods. The study group included 50 patients who were using SpineCor braces due to idiopathic scoliosis. The indication for bracing was the fInding of a >15® spinal curvature in skeletally immature patients (Risser grade 0-3). Correction or stabilization ofthe scoliosis (Cobb angle change of +/-5°) were recognised as positive outcomes, while a negative outcome was defIned as progression of the curve of more than 5° or to a value necessitating operative treatment. The study group was divided into subgroups at enrolment, according to gender and degree of scoliosis.

Results. In the entire study group, correction was demonstrated in 24 patients (48%), stabilization in 14 (28%) and progression

in spite of bracing occurred in 7 patients (14%). Five patients in the entire study group (10%) required operative treatment due to rapid curvature progression.

Conclusions. I. Conservative treatment of scoliosis with the SpineCor brace during the skeletal immaturity period in the study group leads to curvature stabilization in approx. 70% of patients. 2. Introducing the SpineCor brace in patients with a scoliosis angle over 20° and Risser grade 0-3 very effectively prevented curve progression. 3. VerifIcation of the results needs to be ca.J.Tied out after at least 2 years post-treatment before defInitive conclusions regarding bracing efficacy can be drawn.

SpineCor is more effective in stopping curve progression than the most commonly used scoliosis Brace treatment .  It has shown to be over 70% more effective in preventing surgery than the Boston Brace.  It is vastly more comfortable, allows freedom of movement, and is nearly invisible under clothing.

The SpineCor brace works on a completely different principle to hard bracing. Rather than using brute force to try to straighten the spine, SpineCor uses a series of soft elastic bands to reverse the patient’s abnormal posture by using a “corrective movement“.

Unlike the Boston Brace, which weakens the muscles and stiffens the spine, the SpineCor Brace allows movement, keeps the spine flexible, and actually strengthens the supporting muscles of the spine.

The SpineCor brace was designed to meet specific functional requirements for the optimal treatment of idiopathic scoliosis. These requirements have been defined based on many years of research into the etiopathogenesis of idiopathic scoliosis. Instead of using 3-point pressure biomechanical principles, the SpineCor brace uses curve specific “corrective movements”. These “corrective movements” produce global postural changes that correct the postural abnormalities associated with a specific curve classification and in turn, progressively reduce the Cobb angle. Repetition of the “corrective movements” through wearing the brace 20 hours per day can prevent progression or correct the scoliotic deformity (1).

Effectiveness of conservative treatment depends on patient maturity, curve properties and gender. More recently, body habitus has been found to be a predictive factor (2) in the orthotic treatment of AIS. Overweight patients will have greater curve progression and less successful results following treatment with rigid braces than those who are not obese. This finding is alarming, as more and more children are becoming overweight in developed countries (3).

Since the SpineCor brace uses a different treatment approach, we believe that body habitus will not interfere with the success of the brace. The purpose of this study was to compare outcomes of SpineCor brace treatment in AIS patients who were overweight with the outcome in patients who were not obese.

From December 1994 to May 2006, 503 patients were treated using the SpineCor brace. 190 patients were still actively being treated and 133 patients did not fit the research inclusion criteria proposed by the Scoliosis Research Society (4). To date, 180 patients have a definitive outcome. The cohort of patients was divided into two groups according to body habitus. Obese patients were defined as those with a body mass index in the 85% or greater. 

Assessment of the brace included:

• ^{number of patients who have 5º or less curve progression}
• ^{number of patients who have 6º or more progression}
• ^{number of patients with curves exceeding 45º at the end of treatment}
• ^{number of patients who have been recommended/who have undergone surgery before skeletal maturity}

Successful treatment (correction >5º or stabilization ±5º) was achieved in 110 patients of the 167 not overweight patients (65,9%) from the time of the fitting of the SpineCor brace to the point in which it was discontinued . 38 immature not obese patients (22,8%) required surgical fusion whilst receiving treatment and two patients out of 167 (1,2%) had curves exceeding 45º at maturity.

Successful treatment (correction >5º or stabilization ±5º) was achieved in 8 patients of the 13 overweight patients (61,5%) from the time of the fitting of the SpineCor brace to the point in which it was discontinued (Table 1). Tree immature obese patients (23,1%) required surgical fusion whilst receiving treatment and one patients out of 13 (7,7%) had curves exceeding 45º at maturity.

The results of the present study demonstrate that both overweight and normal AIS patients treated by the SpineCor brace have a positive outcome (62% and 66% of success respectively). This level of success has not been demonstrated for obese AIS patients using conventional 3-point pressure braces. We believe that SpineCor bracing is more successful in obese AIS patients because the application of dynamic corrective movements through the shoulders, thorax and pelvis is not adversely effected by excess subcutaneous tissue. Rigid 3-point pressure braces in contrast cannot effectively apply forces to the spine of an obese patient. However, future studies that will support and reinforce this finding are necessary.

REFERENCES

1. 1. Coillard C, Leroux MA, Zabjek KF, Rivard CH. SpineCor–a non-rigid brace for the treatment of idiopathic scoliosis: post-treatment results. Eur Spine J. 2003; 12:141-48.
2. 2. O’Neill PJ, Karol LA, Shindle MK, Elerson EE, BrintzenhofeSzoc KM, Katz DE, Farmer KW, Sponseller PD. Decreased orthotic effectiveness in overweight patients with adolescent idiopathic scoliosis. J Bone Joint Surg Am. 2005 May; 87(5):1069-74
3. 3. Dehghan M, Akhtar-Danesh N. Merchant AT. Childhood obesity, prevalence and prevention. Nutrition Journal. 2005 Sep 2; 4:24.
4. 4. Richards BS, Bernstein RM, D’Amato CR, Thompson GH. Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine. 2005;30: 2068-75.

Results: For the total group of patients (Initial Cobb angle: 30 9) the trend during treatment wasa decrease in spinal curvature at three months with a mean difference of 9 (SD: 6), at termination of treatment (time ¼ 23 months) a mean difference of 5 (SD: 7); and at a follow-up time of 1, 2, 3 and 4 years there was a difference of 2  (SD: 7), 6  (SD: 5), 0  (SD: 8), and 8  (SD: 4) in reference to the initial condition. The survival analysis (G1 and G2) indicated a cumulative probability of success during follow-up without brace as follows. Year 1: probability (p) ¼ 1.00, 57

Abstracts (Confidence Interval (CI): 1.00 to 1.00) for G1,  p¼ 1.00 (CI: 1.00 to 1.00) for G2; Year 2: (p) ¼ 0.98 (CI: 0.93 to 1.00) for G1,  p¼ 0.92 (CI: 0.82 to 1.00) for G2; Year 3: p ¼0.92 (CI: 0.83 to 1.00) for G1, p¼ 0.92 (CI: 0.83 to 1.00) for G2; Year 4:  p¼ 0.88 (CI: 0.76 to 0.99) for G1, p ¼ 0.92 (CI: 0.73 to 1.00) for G2.

The purpose of this prospective observational study was to evaluate the effectiveness of the Dynamic SpineCor brace for adolescent idiopathic scoliosis in accordance with the standardized criteria proposed by the Scoliosis Research Society Committee on Bracing and Nonoperative Management.

They proposed these guidelines to make the comparison among studies more valid and reliable. From 1993 to 2006, 493 patients were treated using the SpineCor brace. Two hundred forty-nine patients met the criteria for inclusion, and 79 patients were still actively being treated. Overall, 170 patients have a definitive outcome. All girls were premenarchal or less than 1 year postmenarchal. Assessment of brace effectiveness included (1) percentage of patients who have 5 degrees or less curve progression, and percentage of patients wh have 6 degrees or more progression; (2) percentage of patients who have been recommended/undergone surgery before skeletal maturity; (3) percentage of patients with curves exceeding 45 degrees at maturity (end of treatment); and (4) Two-year follow-up beyond maturity to determine the percentage of patients who subsequently underwent surgery. Successful treatment (correction, 95 degrees, or stabilization, T5 degrees) was achieved in 101(59.4%) of the 170 patients from the time of the fitting of the SpineCor brace to the point in which it was discontinued. Thirty-nine immature patients (22.9%) required surgical fusion while receiving treatment. Two (1.2%) of 170 patients had curves exceeding 45 degrees at maturity. One mature patient (2.1%) required surgery within 2 years of follow-up beyond skeletal maturity.

The conclusion drawn from these findings is that the SpineCor brace is effective for the treatment of adolescent idiopathic scoliosis. Moreover, positiveoutcomes are maintained after 2 years because 45 (95.7%) of 47 patients stabilized or corrected their end of bracing Cobb angle up to2 years after bracing.

The SpineCor bracing method is an adjustable, non-invasive technique that provides flexible, inconspicuous correction that continues as a child moves and grows.  The goal of the dynamic brace is to maintain and improve spinal deformity while re-educating the body to return to a more normal posture.

A 30-SECOND ANNUAL POSTURAL SCREENING BETWEEN THE AGES OF 10 AND 15 CAN MAKE A LIFETIME OF DIFFERENCE:

Normal (fig. 1)

• head centred over mid-buttocks

• shoulders level

• shoulder blades level, with equal prominence

• hips level and symmetrical

• equal distance between arms and body

Possible Scoliosis (fig. 2)

• head alignment to one side of mid buttocks

• one shoulder higher

• one shoulder blade higher with possible prominence

• one hip more prominent than the other

• unequal distance between arms and body

Normal (fig. 3)

• both sides of upper and lower back symmetrical
• hips level and symmetrical

Possible Scoliosis (fig. 4)

• one side of rib cage and/or the lower back showing uneven symmetry

Normal (fig. 5)

• even and symmetrical on both sides of the upper and lower back

Possible Scoliosis (fig. 6)

• unequal symmetry of the upper back, lower back or both

When the deformity is minimal, treatment is not normally indicated, medical observation is sufficient.

However, if the deformity progresses and becomes severe enough, there are two types of treatment possible :

• Brace (non-surgical)
• Surgery

The new SpineCor Pain Relief Back Brace is a neuro-muscular-skeletal rehabilitation tool for treating abnormal spinal loading and abnormal posture; it is not a simple back support brace.

Modes of action:

• Corrective movements gently guide the posture and spinal alignment in an optimal direction.

• The elastic corrective bands act to resist the body’s movement back to the abnormal position.

• This constant “correction, relaxation, correction, relaxation” is in reality a corrective postural exercise.

• The brace is able to put a patient’s body through 10’s of 1000’s of repetitions per day instead of the10-50 repetitions that are typical with other rehabilitation techniques.

• It creates dynamic spinal offloading and neuromuscular rehabilitation with the ultimate goal of neuromuscular integration.

The Musculoskeletal Affects of Abnormal Posture and Spinal Alignment:

• Scoliosis and other spinal conditions can affect the “balance” of body posture and spinal alignment.

• A loss of normal spinal balance creates abnormal loading on the vertebra, discs, ligaments, joints, tendons, muscles and nerves.

• Over a relatively short period of time, abnormal loads on the body tissues alter their functions.

• Over a long enough period of time the structure of body tissues will change in response to the abnormal loading further compromising function.

• These changes can damage the body .i.e. facet joint arthrosis, disc degeneration, nerve root irritation, spinal stenosis, all of which lead to pain.

• Promoting a change in the balance of the posture and the spine can help to correct the abnormal loading.