SCOLIOSIS BRACE

Spinecor scoliosis brace is the first and only truly dynamic brace, which provides a progressive correction of Idiopathic Scoliosis from 15º Cobb angle and above. Spinecor Preserves normal body movement and growth and allows normal activities of daily living. Spinecor soft brace Increases patient's treatment acceptance leading to better compliance.

The SpineCor brace offers scoliosis patients an excellent alternative to surgery and traditional braces. In fact it stabilizes 87% of scoliosis cases, while not restricting movement, offering far more comfort and being virtually invisible under clothing.

SpineCor is a highly effective for the early treatment of idiopathic scoliosis as demonstrated in the case study and also offers significant benefits to patients who present late. The real challenge is, therefore, to increase awareness of the absolute importance of early diagnosis and, that a viable treatment for early intervention is now available. Clearly it is easier to prevent progression of a small curve than to reverse the deformity in a large curve. Timing is of absolute importance - the later treatment is started the lesser the possibility there is to change the curve, as the child's growth runs out so does the possibility to make any change.

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. Major brace components can last from 1.5 - 2 years. A patient manual is provided that guides the patient in properly wearing the brace, as well as maintenance.

The SpineCor brace must only be fitted by a SpineCor accredited practitioner who has attended 4 days of intensive training and fitted a minimum number of patients under supervision. It is also suggested that prescribing doctors attend some training in order to effectively monitor and manage this treatment using very different treatment principles and protocols.

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.

The initial excellent clinical results produced by the research centre at Ste Justine Hospital and the University of Montrea, 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. Clinical experience to date also shows better compliance and cosmetic results.

The SpineCor Physiotherapy Program exercises comply with and follow the Corrective Movement Principle, helping to integrate it, in order to:

-Obtain a faster consolidation of progressive curve reduction.
-Improve the neuro-muscular integration and postural reorganisation.

The SpineCor Physiotherapy Program mainly addresses:

-POSTURAL RE-EDUCATION EXERCISES: to encourage the integration of the Corrective Movement.
-MUSCULAR RE-BALANCE EXERCISES: global muscular work, by eccentric contraction of shortened muscles and concentric contraction of extended counter lateral muscles at the same time, starting from Corrective Movement position, reinforcing this Corrective Movement and looking for postural over-correction.
-RESPIRATORY EXERCISES: done in combination with postural re-education and muscular re-balance exercises.

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.

Patients treated with the SpineCor brace must only carry out the exercises exclusively designed for his/her type of scoliosis curve to avoid interfering with the action of the brace. Patients treated with the SpineCor brace must not carry out any other exercises program than the one designed to be performed in conjunction with the SpineCor brace treatment.

Therefore, all physiotherapists working with patients treated with the SpineCor System must follow a specific SpineCor Physiotherapy Training Program, in order to learn the treatment principles and understand the new treatment approach, to be accredited as Authorized SpineCor Physiotherapists.

Patients will be asked to visit regularly their bracing practitioner (doctor, orthotist or therapist) along the duration of the treatment for regular readjustments of the brace and to control effectively the progression of the curve. The frequency of the visits and the evaluations to be performed are as shown in the Standard SpineCor Protocol.

* Follow –up visits after the first 3 months of treatment are advised at 3 month intervals. This review period may be extended to 4 or 5 months only in cases where the prescribing doctor is confident that the progression risk is low. Extended review periods are not advised without great experience of SpineCor Treatment.

1 new frontal x-ray in brace is required to confirm the result.
(N.B. This is to confirm a positive action of the brace and does not indicate the maximum correction, unlike rigid braces the SpineCor brace provides slow progressive changes.)

At the end of the visit, all patients/parents will be shown how to perform their specific Corrective Movement and shown how to correctly fit the brace, maintaining an optimal corrective movement position, and how to take it off. Patients/parents should demonstrate by fitting the brace independently 2 – 3 times that they fully understand the correct fitting procedure. Each patient is provided with a Patient Manual with the instructions to fit the brace correctly and indications for its correct maintenance.

In the 1st visit, some evaluations are required in order to fit the SpineCor brace. To help to perform these evaluations, some anatomical points can be mark on your back with a make-up pencil, which will be erased at the end of the visit.

For all the evaluations, you will be asked to place your feet in a foot template to avoid any influence of an eventual change of your position on the evaluations.

Then, the following evaluations will be performed:

1st. Clinical Evaluation: to evaluate your growth pattern and any postural abnormalities.

2nd. Radiological Evaluation: a radiological study is needed to evaluate the type of curve and its potential of progression. The x-rays required for this study are the following:

-rontal x-ray
-ateral x-ray
-rone x-ray (optional)

Note: All x-rays used for evaluation should be less than one month old in order to have accurate information to evaluate the scoliosis curve. If x-rays are older than one month the films should be repeated on the day of the evaluation. The data resulting from the clinical and radiological exams are entered in the SpineCor Assistant Software, which will provide information to fit the brace correctly.

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.

The dynamic corrective brace is made up of two components:

1.The first component consists of the pelvic base, the crotch bands and the thigh bands. Its role is to act as an anchoring point and support for the actions applied to the patient’s trunk by the elastic bands. When the pelvic base is stable, the traction by the elastic bands is provided along the stable lines. The flexible nature of the pelvic section of the brace permits free movements of the trunk and engagement of the pelvis in the corrective movement.

2.The second component consists of the bolero and the corrective elastic bands. Its function is directly related to the active principle of the dynamic corrective brace. It allows a custom fitting of the brace aimed at modifying the postural geometry of the moving spinal column.

The corrective elastic bands of different length allow for many possibilities in brace adjustment for an optimal correction. Overall, there are 4 major ways to fit the corrective bands, corresponding to the thoracic, thoracolumbar, lumbar and double scoliosis. The SpineCor Assistant Software provides the guidelines for the choice of the bands and snaps.

To really change the natural progression of idiopathic scoliosis, it is essential to reduce the curvature enough to eliminate the negative impact of abnormal biomechanics and growth. Therefore, it is possible to achieve a complete or almost complete correction of moderate curves, if the treatment is started before the main growth spurt (before Risser 1 and menarche). In curves over 30 degrees of Cobb angle, or when the treatment started during or after the main growth spurt, the goal of the treatment is a stabilization of the deformity. The therapeutic success is possible in more than 80% of cases. The reference reducibility calculated as early as at 3/4 months of treatment, is useful in defining the prognosis. However, for individual prognoses, the impact of the severity of the bone deformation, pattern of the growth and compliance must be considered.

In order to obtain an accurate diagnosis, that would specify a particular class and subclass for the patient, the evaluation combines a clinical exam, radiological and postural evaluation.

A specific corrective movement is performed, and the brace is applied according to the SpineCor Assistant Software instructions. The moderate tension in the elastic bands allows the repetition and amplification of the corrective movement as the child undertakes everyday activities. This results in a progressive curve reduction. The brace is worn 20 hours out of 24. The four hours out of the brace must not be taken at once, usually the patient divides them into two breaks: morning and evening.

Sports are to be encouraged and done while wearing the brace. To obtain a neuro-muscular integration of the new strategy of movement, the minimum duration of the treatment is 18 months. Because of the progressive changes, absence of external support during the treatment, and intact muscles, there is no loss of correction after the brace discontinuation. Physical therapy is NOT a necessity in the SpineCor program (SpineCor itself may be considered a physiotherapy 20 hours out of 24). However, when the patient is willing to undergo a physio program, or a faster consolidation of the reduction of the curve is desired, the Global Postural Re-education (GPR) program is considered. For the patients at the beginning of the treatment, the physio is carried out with the brace on; for the patients in the weaning period the exercises are done without the brace.

SpineCor has been designed for the treatment of idiopathic Scoliosis only. Its efficacy for treating neuromuscular, neurological or other types of scoliosis is unknown and generally non-idiopathic scoliosis is contraindicated.

Indications are that Idiopathic Scoliosis diagnosed and confirmed. Boy or Girl from 5 years of age +. Initial Cobb angle equal or above 15°, proven progression of more than 5° in last 6 months or strong family history. Initial Cobb angle equal or below 50°. Risser 0, 1, 2, 3 or pre-menarchial. Curve Types: All classes including curves that are inverse to normal patterns (e.g. Left Thoracic, Right Lumbar)

The therapeutic approach is based on the etiology and pathogenesis of idiopathic scoliosis and uses a new treatment concept. It is a pathology of the neuro-musculoskeletal system in growth and maturation. The cause is genetic, and the pathogenesis involves a three-dimensional deformation of the spine, postural disorganization, unsynchronized growth and particular movement pattern of the body.

The SpineCor Assistant Software was developed to assist doctors, orthotists and physiotherapists using SpineCor to accurately classify the patient's specific curve type and choose the correct brace fitting. The software also allow for easy patient data collection and storage essential to effective management of the patient's condition.

In addition to being user friendly, another important characteristic of the SAS is that all information related to patient's files and examinations is kept in a database compatible with Microsoft Access and is therefore, easily accessible.