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.
- 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. 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. Dehghan M, Akhtar-Danesh N. Merchant AT. Childhood obesity, prevalence and prevention. Nutrition Journal. 2005 Sep 2; 4:24.
- 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.