Scoliosis Specialists

The Department of Paediatric Orthopaedics and Traumatology at Pomeranian Medical University did a study of SpineCor dynamic Bracing for idiopathic Scoliosis. 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 correcting 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.

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(5) spinal curvature in skeletally immature patients (Risser grade 0-3). Correction or stabilization of the scoliosis (Cobb angle change of +/- 5 degrees ) were recognised as positive outcomes, while a negative outcome was defined as progression of the curve of more than 5 degrees or to a value necessitating operative treatment. The study group was divided into subgroups at enrollment, according to gender and degree of scoliosis.

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.  SpineCor bracing led to stabilization of scoliosis in the majority of the patients. Introducing the SpineCor brace in patients with a scoliosis angle over 20 degrees and Risser grade 0-3 very effectively prevented curve progression.

Scoliosis is a an abnormal lateral curve to the vertebral column.  The degree of scoliosis can range from mild to severe. Scoliosis is most commonly an incidental and harmless finding. Patients with milder curves may only need to visit their doctor for periodic observation. Scoliosis may be congenital (a birth defect) or acquired (degenerative, arthritic, or traumatic).

Majority 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 orthopaedic rigid brace and the second one is surgery with a spinal system. Unfortunately only a few treatments have actually been shown to affect the outcome of scoliosis.

The treatment options of scoliosis depend on the severity and the age of the person.  Scoliosis bracing has been shown to be an effective method to prevent curves from getting worse. Until recently, this treatment was reserved for children and adolescents in whom the prediction of a rapid increase in the curve needs to be thwarted.  Today, there is spinecor, a revolutionary new soft flexible scoliosis brace that has changed the way we look at scoliosis treatment both in kids and adults.

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 and Neuro-muscular stimulation and correction.

SpineCor  treatment was developed in the early 1990s and utilises a Dynamic Corrective Brace (DCB), together with a completely new treatment approach requiring clinical assistant diagnostic software (SAS) to allow accurate fitting and treatment follow up.

Following 12 years of clinical research and trials, SpineCor is now rapidly being made available to patients around the world and by the leading provider http://www.scoliosisspecialists.com/ in the USA.  The initial excellent clinical results produced by the research centre at Ste Justine Hospital and the University of Montreal, Canada, have since been replicated by more than 80 other treatment centres around the world. SpineCor has shown to be effective in 89% of cases (either by stablisation or improvement in (Cobb) angle of the curve).

SpineCor’s unique treatment approach offers improvement over traditional braces, which are essentially static or allow minimal movement, due to its true totally dynamic action. Fundamental research by independent research groups now indicates that a significant dynamic action is required on the spine (vertebral growth plates) to alter the abnormal growth progressing the deformity in scoliosis patients.

The SpineCor treatment approach is completely different to that of traditional braces that use 3-point pressure and distraction; it is the first and only true dynamic bracing system for idiopathic scoliosis. SpineCor’s unique approach to treatment by global postural re-education has been shown to give progressive correction over time which, unlike any previous brace treatment, is extremely stable post brace weaning.

The objective of this study was to quantify the relationship between gibbosity and spinal deformation expressed by the angle of Cobb before and during treatment with a brace for different classes of idiopathic scoliosis patients. As part of the standard treatment with the Dynamic Corrective Brace (SpineCor), 89 idiopathic scoliosis patients underwent an initial radiological examination and gibbosity measurement with a scoliometer wearing and not wearing the brace.

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 most common of all types of scoliosis is adolescent idiopathic and is seen with equal frequency in boys and girls at low curve magnitudes. Girls, for unknown reasons, have a significantly higher risk for development of curve progression than boys. Pulmonary and cardiac function are not impeded with lumbar curves and significant changes of pulmonary function are not seen in patients with thoracic curves until the curve reaches a level greater than 70° , i.e., a severe curve. This amount of curve and subsequent cardiac and pulmonary changes are often seen later in life in untreated idiopathic infantile and juvenile scoliosis patients and present a threat to life. Patients with adolescent onset idiopathic scoliosis do not usually have such compromise unless severe curves develop. The time of highest risk for curve progression in adolescent idiopathic scoliosis occurs around puberty, i.e., when the growth rate is the fastest.

On September 16, 1998, at an orthopedics symposium in New York City, Dr. Christine Coillard and Dr. Charles Rivard, pediatric surgeons from Sainte-Justine Hospital in Montreal, presented clinical findings on a promising, new, therapeutic approach for idiopathic scoliosis. Drs. Coillard and Rivard had long concurred that bracing was the most conservative option available for children with minor scoliosis. However, they also realized the challenges presented by a child’s growth patterns as well as his or her physical and psychological need for normal mobility. Their studies were based upon these challenges, and as a result of their research, the SpineCor bracing system evolved. Together with their team of researchers from anthropology, biomechanics, and physiotherapy they seek to minimize the three dimensional deformity of scoliosis by addressing what they believe to be four important aspects of the condition, deformation of the spine, postural disorganization, muscle dysfunction, and unsynchronized growth.

The benefits of the SpineCor brace are that it allows patients four hours per day out of brace, and provides total freedom of movement. The brace is more easily concealed under clothing, is more comfortable and cooler to wear, and is less restrictive. SpineCor has no side effects from muscle atrophy which may be caused by rigid bracing, and excellent treatment results, particularly when treatment is started early.

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.

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.