Scoliosis Specialists

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.

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 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.

Still, today, 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 orthopaedic rigid brace and the second one is surgery with a spinal system.

In both cases, the therapeutic benefits can unfortunately be associated with non-negligible drawbacks that limit their uses.  Because of a better understanding of the risk associated and of the disease evolution, we have seen a shift towards earlier treatment.

The correlation between growth potential of the child, and, more specifically, of the adolescent, and the evolution of the scoliosis has been clearly established. It was demonstrated by Duval-Beaupère  and many others ^[inc. . This means that the earlier the scoliosis appears, the greater the risks of evolution. Lonstein & Carlson analysed the natural evolution of scoliosis in a population of 729 adolescents. They concluded that a child with an angle between 20° and 29° and a Risser of 0,1 or 2, will see his/her scoliosis evolve in 68% of the cases. Stagnara and Clarisse and other authors have named the 30° limit “the critical limit” because, beyond this point, during high velocity growth periods, evolution of the disease is guaranteed.

Title:
Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the S.R.S. for adolescent idiopathic scoliosis
Published:
Journal of Pediatric Orthopaedics, June 2007, P. 375-379
Authors:
Coillard C
Vachon V
Circo C
Beauséjour M
Rivard CH

JPOS Spinal Core Paper.pdf

Title:
Survival analysis of a group of 365 idiopathic scoliosis patients treated with the Dynamic SpineCor Brace
Published:
Résonances Eurospéenes Du Rachis. 14(43):p. 1782-1786. French.
Authors:
Vachon V
Coillard C
Zabjek KF
Rhalmi S
Rivard CH

Survival-Analysis2006.pdf

Title:
Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management
Published:
Spine, v. 30, no. 18, p. 2068-2075.
Authors:
Richards BS
Bernstein RM
D’Amato CR
Thompson GH

Richardsetal2005.pdf

Title:
SPINECOR: A non-rigid brace for the treatment of Idiopathic Scoliosis: Initial Post-Treatment Results.
Published:
Eurospine 2003 12: 141-1
Authors:
Christine Coillard, M.D.
Michel A Leroux, Ph.D.
Karl F Zabjek, MSc.
Charles Hilaire Rivard, M.D.

posttreatmentresults.pdf