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 Principles:

The new SpineCor® Pain Relief Back Brace is a neuro-muscular-skeletal rehabilitation tool for treating abnormal spinal loading and abnormal posture; it is not a simple back support brace.

Modes of action:

• Corrective movements gently guide the posture and spinal alignment in an optimal direction.

• The elastic corrective bands act to resist the body’s movement back to the abnormal position.

• This constant “correction, relaxation, correction, relaxation” is in reality a corrective postural exercise.

• The brace is able to put a patient’s body through 10’s of 1000’s of repetitions per day instead of the10-50 repetitions that are typical with other rehabilitation techniques.

• It creates dynamic spinal offloading and neuromuscular rehabilitation with the ultimate goal of neuromuscular integration.

Treatment Principles-Adult Scoliosis should be cared for by a physician or chiropractor. Due to the nature of the adult spine, treatment should be based on a comprehensive evaluation which should include an Orthopedic/Neurological examination, recent upright X-rays and functional assessment exams. The Spinecor Adult Brace can be used to create spinal translation designed to de-weight the adult spine. However, chronic inflammatory condtions, arthritis, stenosis, and spondylosis must also be carefully considered when applying the orthosis. Principles of neuro-muscular-reeducation are employed to reduce chronic pain cycles, and improve muscle memory in postural restoration.

Treatment Objectives- Adult Scoliosis treatment is designed to improve activities of daily living (ADLs) and to provide pain relief. Curvature reduction through improved postural stability may also be a considered objective. Changes in bone shape are not realistic in the adult spine.

Treatment Outcomes-Patient satisfaction surveys confirm adult patients Strongly Recommend our program to other adults with Scoliosis.

Treatment Protocols-The Adult Spinecor brace wearing schedule varies depending upon the patients co-morbid conditions and treatment objectives. Typical wearing schedules are day time only to tolerance. Fatigue may limit brace use in the first few months of treatment, however the majority of adults find they can build up to full time wearing within the first 3 months. Patients with chronic active pain syndromes are typically fitted in an Adult configuration designed to de-weight the spine and reduce pain. Changes in brace configuration are based upon clinical measures specific to each patient. Brace fittings designed to restrict and re-educate movement patterns are typically used initially in patients without pain. Patients are typically under care for 24 months, however, some patients continue to be care for and monitored for many years when degeneration and spinal instability are an issue.

Indications- The Spinecor Adult Scoliosis is indicated for Adults with De-Novo (adult onset) Scoliosis, and Adolescent Idiopathic Scoliosis in Adulthood. Patients who are suffering due to pain, fatigue or weakness as a result of scoliosis are typically considered candidates for bracing. Indications also include those patients interested in improving the cosmetic appearance of their waist angles and ribcage. Patients with respiratory conditions secondary to Scoliosis may also be considered for treatment if there is no significant reduction in vital capacity or blood oxygen levels with the brace properly fitted.

Contraindications- Patients with severe stenosis resulting in neurological deficit may not respond well to Adult Scoliosis Bracing. There are contraindications for patients with recent pathological fracture or unstable spondylolysthesis with neurological deficit. Patients may also be refused treatment if expected outcomes are not reasonably possible

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.

The Dynamic SpineCor orthosis, developed in 1992-93, uses a specific Corrective Movement  which is dependant of the type of the curve. Curve classification was based on the classification of Leroux and Coillard. For the treatment, the curve specific Corrective Movement  is performed and the orthosis is applied according to definitions contained in the SpineCor Assistant Software.

All the health providers need to complete a two-phase training course before fitting the SpineCor orthosis. The first phase involves reviewing of all information necessary to understand the “Corrective Movement Principle”, the specific classifications and a workshop to fit the orthosis following these different corrective movements. The second phase consists of fitting the brace at their own practice of at least three or four patients with the help of a recognized trainer.

In order to be effective and to obtain a neuromuscular integration the orthosis must maintain and amplify the corrective movement over time. Additionally, the orthosis must be worn 20 hours a day for a minimum of 18 months to create a neuromuscular integration of the Corrective Movement  through active bio feedback.  Generally, the orthosis is stopped at skeletal maturity (at least Risser 4).

Adult scoliosis management differs from adolescent treatments due to the long standing nature of the problem. This leads to dysfunction of the motion segments in the spine and degeneration in the ligaments, which perpetuates the arthritic changes that may occur. Although not the goal, adults can achieve curvature reduction despite reaching maximal bone maturity. Adult patients can also respond well with a program that may include postural retraining, strengthening exercises, and chiropractic care.

Scoliosis in adults is typically the result of either having the disease as a child which has progressed to adulthood, or from the degenerative processes of abnormal aging. The scoliosis can be of any classification ( lumbar, thoracic, thoracolumbar, etc) and can result in chronic pain, leg discomfort, digestive, and lung complications.

Options for adults with scoliosis are somewhat limited. Bracing is a good way to manage scoliosis in an adult who has moderate to severe problems. Along with specific therapy and exercise the brace will offer the adult support, and increased opportunity to halt progression of the curve. It must be stated that adult scoliosis is rarely reversible. The goal through adult bracing is instead to decrease chronic pain and allow a way for the adult to regain a comfortable lifestyle.

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.