Scoliosis Specialists

The revolutionary SpineCor system for scoliosis will soon become the primary conservative management for scoliosis in the Carribean. Dr. Charles Isadore of Castries, St. Lucia will be offering the system at his clinic. Dr. Tom Pappas of Scoliosis Specialists will be in St. Lucia training providers on the SpineCor brace and protocol.

SpineCor Scoliosis Brace is the first and only truly dynamic brace, which provides a progressive correction of Idiopathic Scoliosis. Traditional rigid braces are non-dynamic and create muscle atrophy.

Dr. Pappas has been working with scoliosis for over 15 years and training providers on scoliosis management for over 5 years, and is considered one of the most knowledgeable sources on conservative management of scoliosis. Along with bracing, specific exercises will be discussed.

Recent research has shown that bracing with a dynamic brace along with SpineCor exercises can reduce a curve degree. The SpineCor Physiotherapy Program has been designed to complement the action of the brace and reinforce the principles of the treatment. Precise exercises have been designed for each type of scoliosis curve, according to the specific spine deformation and postural disorganization of the patient.

To take advantage of this opportunity and to schedule an appointment, please call Dr. Isadore’s office at (758) 572-6000. Please note that appointment time is very limited. Dr. Isadore will be seeing scoliosis patients with Dr. Pappas from March 25th - 27th.

Treatment Objectives-The objective of the Spinecor Brace in Adolescence is to stabilized the spine by re-training movement patterns while holding the spine in a corrected (de-rotated) position. Treatment is applied with the compressive force of gravity and the brace in order to influence the shape of growing bones.

Treatment Protocols-The Spinecor brace if custom fitted and configured specifically for each patient depending upon the location and direction of the scoliosis. Curvatures as small as 10 degrees may be treated at the discretion of the physician or chiropractor. Brace wearing schedules are similar for most adolescence; 20 hours of brace wearing with two breaks separated by 4 hours. Full time wearing is expected within two weeks of the initial fitting. length of treatment depends upon when the diagnosis is made. Females typically wear the brace beginning at diagnosis and ending two years beyond their menses, or when the growth plates are completely fused.

Treatment Outcomes-The Spinecor brace is the only orthosis which has been reported to permanently reverse the curvature associated with Scoliosis. Due to the ease of use, compliance is much higher with Spinecor, as is psychological well being of patients as compared to those who did not receive treatment, or were prescribed a rigid orthosis.

Treatment Indications-Patients diagnosed with Scoliosis from ages 1 thru adolescence with curvatures measuring from 12-50 degrees at the time of diagnosis are considered candidates for bracing. Candidates with smaller curvatures who are less mature are considered ideal, however, individual cases may be accepted on an elective basis with informed consent.

Contraindications- Neuromuscular scoliosis is considered a contraindication, however individual cases may be accepted on an elective basis with informed consent. Patients who experience significant progression (5 degrees or more) on three consecutive follow up evaluations may also be released from care, however individual cases may be exempt from release with informed consent.

SpineCor is a new breakthrough treatment for idiopathic scoliosis utilizing a dynamic corrective brace (DCB), clinical assistant diagnostic software (SAS) and postural measurement equipment (Freepoint). In worldwide clinical use, this new treatment has been shown to be effective in 89% of cases (either by stabilization or improvement in (Cobb) angle of the curve).

The SpineCor treatment approach is completely different to that of traditional 3-point pressure rigid braces; it is the first and only true dynamic bracing system for idiopathic scoliosis. SpineCor 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.

SpineCor offers:

• A treatment approach based on the latest understanding of the cause and progression factors of Idiopathic scoliosis.
• A much more acceptable treatment to patients, being cooler to wear, less restrictive, more easily concealed under clothing and 4 hours of out of brace time per day.
• No side effects. Rigid braces cause muscle atrophy and can be harmful to normal development in a growing child.
• Excellent treatment results, particularly when treatment is started early.
• Excellent stability of treatment results post bracing.
• Neuromuscular integration for maintenance of improved posture.
• Potential to reduce incidence of surgical intervention.

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.

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 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.

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 system is a flexible brace that is principally prescribed for Idiopathic Scoliosis patients with a Cobb angle between 15° and 50° and Risser sign 0 to 3.  The brace is fitted on the patient in accordance to a sub-classification of the traditional SRS definition of curve types.  The SpineCor Assistant Software guides the treatment provider through the fitting process.  The brace is prescribed to be worn by the patients 20 out of 24 hours per day until they have reached maturity, with radiological evaluations performed prior to and immediately following the fitting of the brace, and every 4 to 6 months afterwards.  To accommodate for growth and postural changes, corrective bands need to be adjusted frequently and require replacement each 6-12 months for optimum brace performance.