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Have any adults used the spinecore brace?

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  • #16
    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...abilities.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
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

    Comment


    • #17
      Originally posted by 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:

      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
      Last edited by Celia; 07-24-2005, 03:20 PM.

      Canadian eh
      Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

      Comment


      • #18
        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
        Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
        ---------------------------------------------------------------------------------------------------------------------------------------------------
        Surgery 2/10/93 A/P fusion T4-L3
        Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

        Comment


        • #19
          bracing curves early

          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.

          Comment


          • #20
            for orthotist

            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/q...051&query_hl=1

            http://www.ncbi.nlm.nih.gov/entrez/q...080&query_hl=7

            Karen
            Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
            Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

            Comment


            • #21
              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.

              Comment


              • #22
                adult

                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.

                Comment


                • #23
                  Originally posted by orthotist

                  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

                  Canadian eh
                  Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

                  Comment


                  • #24
                    Schroth method

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

                    Comment


                    • #25
                      concern with article

                      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.

                      Comment


                      • #26
                        linda

                        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.

                        Comment


                        • #27
                          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

                          Canadian eh
                          Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

                          Comment


                          • #28
                            happy to contribute

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

                            Comment


                            • #29
                              Here's the latest outcome study to include Spinecor:

                              http://www.ncbi.nlm.nih.gov/entrez/q...554&query_hl=2
                              Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                              ---------------------------------------------------------------------------------------------------------------------------------------------------
                              Surgery 2/10/93 A/P fusion T4-L3
                              Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                              Comment


                              • #30
                                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

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