Have any adults used the spinecore brace?

[tommyo]

Has it been effective for you? Does it relieve pain? How comfortable is it? How difficult to put on is it? Did Insurance cover the costs?

Thanks!

[orthotist]

Tommyo,

The spinecor brace is designed for adolescent population and should not be used for adults, and, the results for its use even in this population are suspect.

Patrick

[Celia Vogel]

Hi Patrick,

Why is it suspect ? If you look at the literature on:
http://www.spinecorporation.com/English/index.htm
the results seem quite promising ! So... I don't understand your comment.




Celia

[orthotist]

The results are from studies of children:

For example:
"For the two groups of patients the initial Risser sign was 0 for 86 and 45 patients, Risser 1 for 7 and 11 patients, Risser 2 for 12 and 7 patients, Risser 3 for 10 and 13 patients, and 2 patients with a Risser 4."

Case studies posted on site reflect treatment in adolescence.

Therefore, treatment for an adult is unsubstantianted. In regards to the existing studies, I still would like to see more long term results before I pass judgement.

One question - do the authors of those studies have any financial interest in SpineCorporation?

[LindaRacine]

Dr. Rivard, the inventor, did have a financial interest. Whether or not he still has a financial interest, I have no idea.

--Linda

[Celia Vogel]

Hi Patrick,

"I still would like to see more long term results before I pass judgement."

When you wrote "suspect" you were referring to the adolescent population and yes...you were passing judgement. If you read the scientific literature on the spinecorporation site under "papers" you will find an independent study "Experiences Gained With The SpineCor Dynamic Brace In Hungary" which again looks quite promising. I'm not here to criticize you, I just want to understand why there is such a negative perception in the medical community about the SpineCor brace. I don't care who has a vested financial interest in the brace, all I care is whether it really does work. Have you any experience with the SpineCor brace or are you aware of failed studies ?


Celia

[SandyC]

Celia,
You should be concerned with who has a financial interest. The reason you should be concerned is because if you buy into what every is being sold, in this case Spincore, it is the doc and his corp. that is going to finanually gain. So the more people that buy into it, the more $$$$ he/they make, never mind that it doesn't work :eek: It's kind of like a medical car salesman. In this case it is very much a "buyer beware"

[orthotist]

Celia,

This is forum for constructive discussion, and I view it only as constructive. Expressing my opinion is not passing judgement - I am very open to new ideas and am capable of changing my opinion, in my opinion.

It's coincidental that you refer to the independent "study" posted on the spinecor site. This "study" was a powerpoint presentation at a roundtable conference in spain that reviewed 18 cases. I have more confidence in peer reviewed, well controlled, large sample population type studies that are published in a respected medical journals. I say coincidental because two colleagues of mine were in attendance at that meeting in Barcelona. One of the major concerns of that presentation is that out of the 18 cases, 9 were cases with initial cobbs <= 20 degrees. Given the natural history literature, most physicians do not brace until the curve reaches 25 degrees with history of progression given that the risk of progression is low i.e. many of the curves potentially could have stabilized/not progressed in the absence of any treatment. That presentation reported 15 cases that either stabilized or improved, but, with just that variable in question, 9 of the 15 results are, and I will use that word again, suspect.

In regards to not caring about who has financial interest, well, you are entitled to that opinion. Personally, given that people who have a vested financial interest in the success of a given product that has (at least here in US) a large designated reimbursement involved in the published research about the product, well, it makes me wonder.

I have observed a fitting of the spinecor product by a local physician. I have read about it and examined it in booths at the national spine meetings. I have discussed the spinecor with colleagues - one published a 7 case review about it - http://www.oandp.org/jpo/library/2002_01_013.asp.

My opinion, I am suspicious and skeptical BUT, if a nice big independent well controlled study/ies come/s out that defines parameters and successes with the brace, I will listen and change my mind.

My three cents.

[Celia Vogel]

Patrick,

Thanks so much for your 3 cents, I really appreciate it. :)





Celia

[Celia Vogel]

Sandy,

I never thought of it that way. Dr. Rivard is a member of the Scoliosis Research Society and obiviously cares enough to develop a revolutionary brace to change the natural history of scoliosis. If someone develops a better mouse trap and profits from it, then who loses ? (the mouse obviously :eek: )


Patrick,


Conventional rigid braces leave much to be desired, often resulting in abdominal atrophy, rib cage compression and many times the best that can be hoped for is a pre-brace curve at the end of many years of bracing ! So why not embrace new methods if old methods are obviously inadequate ? Why is it taking so long to conduct independent control studies on the effectiveness of the SpineCor brace ? If there are failed studies, why isn't anyone letting us know ? Is there a brace out there that you really believe in - that makes your heart skip a beat ? :)




Celia

[LindaRacine]

Hi Celia...

While I think innovation is great, I think we should always be very careful when it comes to adopting unproved therapies as the "be all and end all." The published studies on the Spinecor brace look promising, but so have lots of other studies of products that have later been shown to be detrimental to one's health.

I'm not sure why, but some scoliosis specialists who initially signed up to provide the Spinecor brace to some of their patients, have gone back to the gold standard (Boston and Milwaukee) braces.

Since kids have a relatively short amount of time to have their curves halted, I think we (as consumers) should tread lightly, instead of blindly adopting a new and unproved therapy.

Regards,
Linda

[Celia Vogel]

Linda,

Thanks so much for your pearls of wisdom. I'm at a crossroads right now not knowing which brace to go with - I was considering the SpineCor and I even scheduled an appointment to see Dr. Rivard to discuss the possibility of going that route, but as you say it is very risky to blindly accept new untested treatments. Nevertheless we are going ahead with a mold for a rigid brace and hopefully everything will work itself out. :)




Celia

[Celia Vogel]

Hi,

Sorry for hijacking this discussion, I NOW know what my dilemma is ! Let's say my daughter's curve is stable at 15 - 20 degrees out of cast for a 24 hour period, what will the doctor say ? He'll probably say let's try part time bracing - first 12 hours without any support and if that works, six months with no support even though the curve is still above 10 degrees AND scoliosis by definition. So for us, the choice is not between a rigid brace and SpineCor but doing nothing and SpineCor ! Leaving a curve as is at 15 degrees and hoping to God that it doesn't increase with growth is not something I even want to consider because as you know it can get out of hand during growth spurts.

What do you all think ? Am I losing my mind ? Do I need a vacation ? :D





Celia

[LindaRacine]

Hi Celia...

My main argument against casting kids with very small curves was that it would be difficult to know what to do afterward, and until the child is skeletally mature. In other words, have her curve(s) remained small because that was their natural history, or because of the cast? <rhetorical question>

So, if you put your daughter into a Spinecor brace, and her curve remains stable for another year, what will you do then?

I'm actually surprised that insurance companies haven't stepped in to say they won't pay for braces for kids with curves under 25 degrees.

Regards,
Linda

[Celia Vogel]

Hi Celia...

So, if you put your daughter into a Spinecor brace, and her curve remains stable for another year, what will you do then?

I'm actually surprised that insurance companies haven't stepped in to say they won't pay for braces for kids with curves under 25 degrees.

Regards,
Linda


Linda,

I was hoping that the curve would resolve completely - but that's wishful thinking on my part. :) I don't know what the protocol is for curves that are stable at 15 degrees. Isn't better to do something rather than nothing ? Wouldn't we stand a better chance with something such as the SpineCor brace ? Given her age and potential for growth, anything can happen with her curve.

As for your second statement, once a curve progresses beyond 30 degrees it becomes very difficult to treat - I read somewhere that wedging occurs. I'm all for treating curves when they're small AND show signs of progression. The study that we discussed above underscores the importance of treating curves early.



Celia

[LindaRacine]

Hi Celia...

If someone has structural scoliosis, I believe the vertebrae are wedge shaped, no matter what the degree.

I don't know your daughter's Risser score, but at worse, she only has a 25% chance of her curve ever progressing:

http://www.vh.org/pediatric/provider/orthopaedics/AIS/06Probabilities.html

I know it's a difficult decision, but if you think of it from the perspective of what's good for all of us, I think you'll see that we shouldn't be doing anything with kids with very small curves. For example, if we treat everyone with a curve less than 20 degrees, we'll be putting around 75% of them in a brace or cast for no good reason. That's actually a huge number of kids. While that may not be terrible for the individual child, think what the cost is to society. What would it cost to put 100,000 kids a year into braces, when 75% of them wouldn't need the brace? Do we want to live somewhere where the cost of insurance (or the tax rate for countries with socialized medicine), is huge? If not, where should we draw the line? Do we treat kids with 20 degree curves, but not with 19 degree curves? And, what about other diseases? As you can image, it would get prohibitively expensive.

If, on the other hand, one wants to pay for a brace out of their own pocket, than the only dilemma is that their child probably will be wearing an uncomfortable brace for many years for possibly no good reason.

Regards,
Linda

[Celia Vogel]

Hi Celia...

If someone has structural scoliosis, I believe the vertebrae are wedge shaped, no matter what the degree.

I don't know your daughter's Risser score, but at worse, she only has a 25% chance of her curve ever progressing:

Regards,
Linda


I've always been under the impression that vertebral deformities occur at the apex of the curve as it progresses, hence wedging. It doesn't start out that way, does it ? Oh, Deirdre is a Risser 0 and her curve was initially 60 degrees when we started treatment with serial casts, so I think given her age (almost 5) she's high risk.


Edit:

The costs to society of not treating progressive infantile/juvenile scoliosis is far greater - think surgical costs, not to mention costs to the family and society at large.




Celia

[LindaRacine]

Hi Celia....

To be honest, I know very little about infantile scoliosis, other than the vast majority of cases resolve on their own. If I were making the decision on your daughter, I'd probably keep her out of the brace for 3-6 months to see if there's any increase. If there's not, there's probably a reasonably good chance that she would never require additional treatment.

What we have to remember about the cost of bracing kids that fall below the recommended bracing numbers vs. the cost of those kids having surgery, is that the vast majority would never require surgery. It would be interesting to get someone like Drs. Winter or Lonstein to do an analysis. Or, perhaps Orthotist has a comment??

Regards,
Linda

[orthotist]

Hey back here again.

Celia/Linda,

First, Celia, I think you have a great point, and it is a continuing dilemma for kids and parents of kids with scoliosis. You go to the doctor, doctor says your child has something wrong with their spine, you see the xray, nervousness ensues, and the doctor says, well, let's just watch and wait. Or, as in your case, things are looking good, and the treatment is halted and again the wait and see game is played. How can u not do anything??!! It's a big and valid question.

It's very difficult for most to not actively partake in the treatment of their own or esp. their kids' diagnosis. Something's wrong?? Do something!!However, there is a good chunk of literature that is out there that gives us a guideline for risk factors-it's not perfect, but it's the best we can work from- there are so many variables to consider when talking about scoliosis - so much is not known, but, as Linda alluded to and many argue, it would be unfair and costly to the system to lump everyone with a curve into a 'must be treated' group because there is evidence that some cases won't or have low chances for progression. And that's how things operate currently.

Celia, in your child's case, a 60 degree curve in the infantile group was deemed risky for progression per known guidelines -serial risser casting was chosen because there is evidence in the literature that curves greater than 50 degrees respond, or correct, better under traction/stretching of the torso which can be accomplished safely thru this method.

Linda is correct, in that this is the only group (infantile, and by the way, the classification of these categories isn't perfect either imo), that has shown potential to "spontaneously correct". 2 bigger considerations in determining the treatment for infantile scoli : Mehta defined the rib vertebral angle of deformity (angle between rib and vertebrae at apex of curve) which can be measured. Curve pattern might also makes a difference. Left thoracic curves which are common in this population might have a better chance of spontaneously resolving according to one study out of Spain vs. double curve patterns. In general:

Curves less than 25° with an RVAD less than 20° - observed and monitored with xray at regular intervals.
Curves exceeding these parameters are typically braced or undergo Risser casting.
Surgery is considered for curves not adequately controlled with nonoperative measures.

other comments..
Cost analysis: Boy I would love to see this, and I think we will in some form in the near future.
Doing nothing, observing? Yes, I go along with the program, but I have problems with just doing nothing. One question might be, is there something more cost effective that can be done vs. bracing everyone for example? There are some interesting studies coming out of Europe, and I have seen it practiced firsthand, about the Schroth method and other exercise rehab techniques that could play an alternative role to bracing in those cases where there is slight risk, but a risk nonetheless, of progression.

Enough for now. hope this helps.

[Karen Ocker]

I love your posts!

I thought the Schroth method involved some type of casting/bracing along with the other modalities?

Although I haven't done a thorough search I only I was under the impression most of the patients were adolescent.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15456051&query_hl=1

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12607080&query_hl=7

Karen

[orthotist]

In response to

"Conventional rigid braces leave much to be desired, often resulting in abdominal atrophy, rib cage compression and many times the best that can be hoped for is a pre-brace curve at the end of many years of bracing ! So why not embrace new methods if old methods are obviously inadequate ? Why is it taking so long to conduct independent control studies on the effectiveness of the SpineCor brace ? If there are failed studies, why isn't anyone letting us know ? Is there a brace out there that you really believe in - that makes your heart skip a beat"

Celia,
Yes, I am all for improving brace design. But here are some things to think about:

A child comes in for brace treatment double curve, 27 degrees each curve, history of progression, family history, skeletally immature (i.e. risky patient for progression). He or more likely she, wears a conventional brace, and upon completion of treatment at maturity, has the exact same curve, and will not have to worry about that curve worsening for the rest of his life and avoids an expensive and somewhat riskier procedure (surgery). I wouldn't call that inadequate.

It used to be common to prescribe physical therapy specific to scoliosis in conjunction with scoliosis treatment with a brace. Kids learn to actively treat their backs. Unfortunately, managed care has cut back on this over the years. Still, I recommend it as much as possible. Programs that emphasize this could help address the atrophy issue, but I am not sold that muscle atrophy is a proven concern.
Vital capacity issues can be avoided with proper design. I prefer custom design of braces with relief areas that encourage breathing vs. total contact designs.

There is not one brace that makes me skip a beat. To me, there are two keys to successful treatment. First, The child-she or he has to wear the brace and wear it properly for the prescribed time. The child has to buy into the treatment-otherwise. Second, the team treating the child - they should have experience and desire to help kids with scoliosis. The family is part of this team and their support helps improve outcomes. With these two keys, most brace designs have a better chance of succeeding.

[orthotist]

Karen
Hi

Interestingly, Schroth method is employed in the adult population too. Albeit the literature is focused on adolescents. Adults typically do not constitute the best brace wearing population and we cannot achieve correction like we do in the adolescent population. Usually Pain control is the goal with the adult population. There is a clinic at the University of Wisconsin in Stevens Point that where they are beginning to treat adult scoli patients employing the Schroth method, and, anecdotally, are having good results. Note many patients aren't good operative candidates or don't want more surgery, so what can they do? IMO, this form of exercise program specific to scoliosis has little risk to it and potential positive upsides (better health, less pain, regular exercise regimen, etc.). They've been doing it for years in Europe, but hasn't gone mainstream here in US yet.

[Celia Vogel]

It used to be common to prescribe physical therapy specific to scoliosis in conjunction with scoliosis treatment with a brace. Kids learn to actively treat their backs. Unfortunately, managed care has cut back on this over the years. Still, I recommend it as much as possible. Programs that emphasize this could help address the atrophy issue, but I am not sold that muscle atrophy is a proven concern.
.


Patrick,

A few months ago, I came across an article which kind of got me worried. Here is an excerpt from that article:

Rigid orthoses such as the Milwaukee, Boston, Atlantic Rim, Charleston and Providence, Wilmington, and Rosenberger have been the accepted protocols for idiopathic scoliosis over the years. Orthotic intervention with these orthoses begins at 20° curves and ends at the skeletal maturity of the spine or if the curve progresses to being a surgical candidate.10 Rowe and colleagues11 found that a 23-hour regimen is more successful than the 8-and 16-hour protocols. Although correction is usually obtained while in the orthosis, statistically the majority of patients regress back to their original curve magnitude after weaning from the orthosis at skeletal maturity.9,12 Carr and colleagues12 proved that patients progressed back to their original degree value in a long-term study of patients who were thought to be corrected permanently by the Milwaukee orthosis. Each of these orthoses relies on intra-abdominal pressure to decrease the axillary load on the spinal column, thereby causing the abdominal muscles to atrophy. Bunnel et al.10 suggested doing pelvic-tilt and sit-up exercises to avoid this paraspinal and abdominal atrophy from the total contact orthoses. Watts et al.13 also recognized the importance of an exercise program out of brace to maintain muscle tone. Lam and Mehdian14 have reported the importance of spine stability coming from the ability of the abdominal muscles to maintain intra-abdominal pressure. They proposed by looking at prune-belly syndrome (absence of abdominal musculature) that hypokyphosis results from the inability of the spine to remain stable and hyperactivity of lumbar musculature as a result of this lack of intra-abdominal pressure. It leads one to ask the question if intra-abdominal pressure is necessary in the treatment of adolescent idiopathic scoliosis, and further does it actually increase the instability of the spine further?





Celia

[lindabar]

Orthotist:
Obviously the Schroth method can not correct curves adults. But can it halt progression?

[orthotist]

Well, that article is not entirely true. Again, a bad case of lumping things together.... For example, the Charleston and providence brace use overcorrection, sidebending, and elongation as the primary mechanism of action in their designs. Furthermore, they are only night time braces and are worn only when supine when the spine is not subject to the weight of the torso or axial load. not sure how these braces might effect musculature, esp. given the kids are out of them during the day. Also, no one expects permanent correction, at least anymore.

IMO, abdominal pressure should not one of the primary means of action for a brace. For a total contact brace, it's difficult to avoid compressing the abdomen, and exercise is that much more important. A brace can be designed, non total contact, where transverse forces are the primary means of correction and space is created in the brace for patients to move,even minutely, and breathe properly.

Agreed, lumbar musculature is important to the stability of the spine. But a combination of exercise with brace treatment, as U referenced by Bunnel, could address the potential for atrophy.

And the article potrays regression of the curves to original magnitude as something bad, as per your interpretation. Once again, a 30 degree curve treated with a brace that goes to 15 degrees, and then after brace treatment, returns close to 30 degrees is a successful outcome- no surgery and no likelihood that it will get worse over time. Maybe scoliosis exercise could play a role in maintaining that curve correction achieved in brace? No one knows.

Regardless, I'm a big proponent of concommitant exercise program during brace treatment. What's interesting, is that a decent amount of our patients are athletes and well conditioned - still have scoli.

[orthotist]

halt progression,
in the adult? Don't know. open to the possibilty, but I do suspect that if schroth exercise has any chance, the patient has to perform it regularly. That is a challenge in itself.

[Celia Vogel]

Patrick,

Thanks so much for giving us your views on that article ! It's great having a resident "pro". Hey, I'm all for avoiding surgery. ;)








Celia

[orthotist]

happy to contribute, but far from a "pro"! just a keen interest in scoli, spine deformity.

[LindaRacine]

Here's the latest outcome study to include Spinecor:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16087554&query_hl=2

[gerbo]

of course, the company behind spinecor might argue that orthotists in this sample had not been properly trained in the use of the spinecor, which by the looks of it is fairly complicated, whilst at the same time experience with the cheneau brace in germany is extensive, hence bound to have better results. Also study group was very small

why does it all have to be so complicated?

I have to say that the studies on the spinecor webside go in much more detail with regards to initial correction achieved and progression over a longer timespan and eventual "endresult" the what i have seen in any study with regards to hard bracing. Either these results must be seen as "encouraging" or otherwise they are "scientific fraud", is the latter likely??

gerbo

[gerbo]

happy to contribute, but far from a "pro"! just a keen interest in scoli, spine deformity.

however are you actively working as an orthotist, and in bracing for scoliosis?

gerbo

[orthotist]

Research is a funny thing. Tough to find truly unbiased research, and there are interests or motives oftne behind studies. That being said, at least someone is making an effort... True, maybe practitioners were not trained properly in spinecor - be interesting to see if they highlighted who fit the patients in the study - have not read it yet. small study, But good to see a comparison.

[orthotist]

yes to your questions.
To clarify, "far from pro" meaning that despite actively practicing in the area, I still have much to learn.

[gerbo]

yes to your questions.
To clarify, "far from pro" meaning that despite actively practicing in the area, I still have much to learn.

that is a useful insight, which many professionals sadly are lacking.

[gerbo]

To "orthotist":under parents and family> idiopatic scoliosis>adolescent I posted a question re "initial correction" of braces. do you feel able to comment? Also; have you come across the german bracers and their extraordinary (???) claims of succes, at least with regards to initial correction?

best wishes

gerbo

[Rilla4Ever]

"orthotist" - Can you tell me where you heard about the Schroth treatment at the University of Wisconsin? As I am very interested in getting in touch with them, because I receive on average 3 to 4 people a week from my website (The Scoliosis Tree www.erikamaude.com) wanting to get this treatment in the USA and up until now I had no idea that such a place existed. Do you have any contact details for them?

Thanks,

Erika

[orthotist]

Hello - I have visited your website often and think it's great.

There is a group of physical therapists out of the University of Wisconsin at Steven's Point who are initiating training in this method with Dr. Rigo out of Spain - he's actually coming in September to provide more training-2 week course. One of the physical therapist's children had scoliosis, and she went to Europe for treatment and became very interested and intrigued, so much so that she coordinated a conference in Wisconsin with Dr. Rigo last year - was there and it was intriguing. Her goal is to offer the Schroth method and get as much training as possible.

It is in its infancy, but the group is very committed and dedicated to learning. I would ask that you contact her for more information from Beth (P.T.) about their program given it is still developing before publicizing anything. her email is nhiw@wi-net.com.

Hope this helps.
Pat

[Rilla4Ever]

Thanks for that!!! :)

Erika