Scoliosis Specialists

The 89 patients were classified in relation to the apex of the scoliosis curves: thoracic (n = 29); thoracolumbar (n = 40); lumbar (n = 7) and double (n = 13). With the dynamic corrective brace, the patients showed a mean decrease of 8.3° for the major Cobb angle, and a mean decrease of 2.3° for their gibbosity. There was a significant positive relationship between gibbosity and Cobb angle with and without the brace for the thoracic and thoracolumbar curves. A linear regression analysis identified a small mean estimation error for the thoracic curves (7.4° no-brace; 2.7° with brace) and thoracolumbar curves (5.2° no-brace; 5.3° with brace), indicating a predictive potential of the scoliometer. The measure of gibbosity with the scoliometer provides a fairly reliable estimation of Cobb angle at the initial clinical examination of a scoliosis patient. However, when initial Cobb angle and gibbosity are considered, the measure of gibbosity when wearinga brace provides the clinician with a highly reliable estimation of the Cobb angle while in a brace. This relationship also exists for the follow-up with a brace, permitting a judgement of the patient’s evolution under the treatment with SpineCor.

After the diagnosis of idiopathic scoliosis using clinical and radiological evaluations, the measure of gibbosity with the scoliometer provides only a fairly reliable estimation of Cobb angle prior to the treatment. A similar relationship also exists during the follow-up with the SpineCor brace. The gibbosity cannot be utilised as the only criterion by which to judge the prognosis of idiopathic scoliosis. However, when the measure of gibbosity in the brace is used in combination with the initial Cobb angle and gibbosity, it is possible to limit the necessity of a radiograph at each visit. In this situation, the gibbosity provides more information regarding the thoracic than the thoracolumbar region.

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.

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.