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Thread: Why is SpineCor not an accepted means of treatment among Orthopedists' in the USA?

  1. #1
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    Why is SpineCor not an accepted means of treatment among Orthopedists' in the USA?

    It is used worldwide with proven data of success, so why are Pediatric Ortho's in the States reluctant to prescribe it? Which physician/clinic do you see, and why? Cannot seem to find one in the Southwest (USA). Saw one mention of a specialist in Studio City (CA), but when I "googled" him, all I seemed to find was info about the coffe shop he and his wife own. I looked at the website of the specialist in Sugarland TX, his site has a picture of the SpineCor dancer, but no mention of the product or the type of individual he works with. My daughter is 7 with lumbar 20, thoracic 12.

  2. #2
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    Hi ccgonzalesnm,

    I see Dr. Rivard and Dr. Coillard in Montreal, Canada. I'm not sure why its not widely offered, but I have a hunch that it has to do with insurance issues more than anything else. Most parents would rather choose a brace that is guaranteed to be re-imbursed by insurance companies. For the record, our insurance company paid for the brace but it was pretty iffy in the beginning.

  3. #3
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    I believe that part of the reason it has not been accepted among the orthos is that doctors generally are going to go with what they know. Most of them don't even believe that bracing works. So they figure that the curves are going to go up regardless, and then they will perform surgery. I think it would be difficult for them to start recommending a brace that is relatively new when so many people have not been trained to fit this brace. The brace is only as good as the person who is fitting you for it. It takes a lot of time and money to train a lot of people. This is just my humble opinion. The hard brace has been around for a very long time. It is just easier to say "Wear the Boston, and if your curves get too high, I will operate."
    Chiros are always trying to avoid surgery so they are more open to prescribing exercises and alternative treatments.
    One ortho I spoke with told me he doesn't know enough about Spinecor to prescribe it. Another told me he believes a soft brace will not hold a large curve like a hard brace does. This makes no sense. The Spinecor is not trying to hold the spine in one place the way the hard brace does. The philosophy is completely different. I am sorry for going on and on. Anyway, we as Parents have to look at our child and decide what we think is best.
    I would strongly recommend looking into the Spinecor while your child is so young and her curve is still small.
    God Bless.
    Melissa

  4. #4
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    Hi Celia,
    Just curious, is your daughter one of the youngest children wearing Spinecor?

    Melissa

  5. #5
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    Hi Melissa,

    Happy belated Birthday ! Dr. Rivard told me that the youngest patient he has fitted with the Spinecor brace is a four year old from Maine. Deirdre had just turned 5 when she got her brace.

  6. #6
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    I agree with Melissa, I've been told by docs that the SpineCor takes a lot of time training and monitoring and they're just not ready to do it yet. John Hopkins in Maryland, Shriners in Erie, PA is now offering it. It's starting to prove itself. I just hope people keep asking about it with their "traditional" ortho docs.

  7. #7
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    Celia,
    You are actually early in your birthday greetings. It was my husband's birthday on March 2nd. Thanks anyway. My birthday is May 28.
    Your daughter is definitely one of the youngest. That is great!!! She is a real cutie. Thanks for sharing your pictures.

    Melissa

  8. #8
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    There was something that I read reently that touched on this subject, and I think it also had to do with one of the studies as well. That was that there is a great deal of training involved for the pros, as well as the patients and their families. It's relatively new therapy and like everything else, it's slow to catch on. There was also some question as to the reliability of the study results as the numbers in the studies were relatively small. Alond with that, the main study results come from the manufacturer, rather than objective parties.

  9. #9
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    Hi...

    I think most scoliosis specialists are reluctant to move to new technology until not only are there short-term studies published (and results recreated by a non-related center), but long-term studies that show the results are as good or better than current treatment options. I personally think this is the responsible way to practice medicine. If the Spinecor long-term results turn out to be worse than currently accepted braces, we'd end up with a lot of kids needing surgery who might have been saved from it.

    When the Spinecor brace was first available to the U.S. market, there were quite a few U.S. specialists who agreed to try them on some of their patients. Most of those doctors did not continue using the brace after the trial period. Why that happened is anyone's guess, but I'm thinking that Melissa's idea of insurance issues and a long learning curve are probably correct.

    Regards,
    Linda

  10. #10
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    All really excellent points ! However, what really clinched it for me was the study conducted by Dr. Rivard who I have enormous faith and trust in. I don't think he skewed the results in his favour, he is a member of the SRS and a scientist. I don't have the time to wait another 20 years before a final conclusive study showing the merits of the spinecor brace comes out - by that time my daughter will be 25 years old If her curve progresses, I know where to find a rigid brace. The thought of having her wear one of those things for the next 10 - 12 years (23/7) was just too much for me and I honestly think I would have lost my mind - that's if I haven't already lost it

    Melisssa, wish Ed a very HAPPY belated birthday for me I saw the name Majesnic on the spinekids wish list the other day.

  11. #11
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    I asked Dr. Rivard why he thought doctors in the states were not prescribing this brace. He said he thought it was the time involved. This brace takes more of their time than traditional treatments. I'm sure insurance and the status quo influence decisions also.

    I also have complete confidence in Dr. Rivard's integrity. His dedication and compassion are unquestionable, to me. This man cares about children. Like you, Celia, if Rachel's curve progresses in the Spinecor, we will change braces. I have a lot of confidence in this brace and Dr. Rivard, but these curves have a mind of their own.

    I also think that your brace is only as good as the person fitting it. This is true whether you use the Spinecor, TLSO, Milwaukee, etc. The skill of the orthotists is very important.

    Rachel's TLSO should have had a high underarm component(which it did not). Her apex is at T7. Out ortho did not specify the apex; she is missing a rib, and the orthotists counted her thoracic vertebrae wrong. He placed the apex at T8. A traditional TLSO can treat and apex of T8, but should not be used with an apex of T7. No one seemed to know or care(doctor or orthotists.) I did research on my own and stumbled across this information(too late). Obviously a lack of skill and caring led to the inefficacy of this brace for Rachel.

    One point I would like to make is that the hard braces weaken back muscles,restrict lung capacity, and restrict renal blood flow. Therefore they are not prescribed until curves reach 25 degrees, at least this is the criteria our ortho used. The Spinecor does not weaken the muscles of the back. The biomechanics of this brace are totally unique. It can be prescribed for smaller curves and correct problems at an earlier stage. I wonder how many surgeries could be prevented if more aggressive measures were taken against smaller curves. The Spinecor allows this option not previously avialable without adverse side effects. I wish I had known about it before Rachel's curves reached 38 degrees (she went from 24 to 38 degrees in 6 months).

    I have since read criteria that states that in premenstrual females with either rapidly advancing curves(5 degrees in 6 months) or curves 20 degrees or more, bracing is recommended. It is obviously up to the individual doctor which criteria he uses, but it pays to be informed of your options.

    Our ortho did not even know the Spinecor existed.

    Happy Birthday, Ed!
    Last edited by cherylplinder; 03-05-2006 at 08:00 PM.
    God has used scoliosis to strengthen and mold us. He's good all the time!On this forum these larger curves have not held forever in Spinecor,with an initial positive response followed by deterioration. With deterioration, change treatment.The first year she gained 4 or 5 inches and was stable at around 20/20 in brace, followed by rapid progression the next year.She is now 51/40 (Jan2008)out of brace (40/30 in Spinecor) and started at 38/27 out of brace(Jan2006.) Now in Cheneau.

  12. #12
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    Celia,
    Thanks for Ed's birthday wishes. I totally understand that you didn't want your daughter spending all of those years in a hard brace. Did you say that you live in Canada? How far do you travel to see Dr. Rivard? I would love to meet him one day. If this brace works, I am going to definitely meet with him personally.
    Change of subject -- I don't think Nicole's thigh bands have been completely dry when she has put her brace back on and now she has a bright red area on both thighs where the straps go. It is burning her. Is vaseline the best thing for that or does anyone know of something better. In additon, she was dancing and sweating a lot so it probably caused further irritation. If anyone has any immediate suggestions, please let me know. I know you have all mentioned moleskin, but I am talking specifically about what to put on the irritation.
    Thanks so much,
    Melissa

  13. #13
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    hello everyone =]

    these are all really good points to hit on spine cor

    MATJESNiC: im having the same problem as nikki. because the other day i was too lazy to dry my thigh bands and now my thighs are irritated and red. ive been using aquaphor. i also put it on my lower hip(quite odd) because my brace like irritates it and makes it bleed and get really dry and scratchy. so my mom put aquaphor on it too and it helped a lot. so i would try some aquaphor on it.

    i wanna meet Dr. Rivard too
    Diagnosed @ age 14 (now 15)

    i HAVE A LOVELY SPINECOR BRACE

    CUrVES* 14&&17 as of 4.22.06 (out of brace)

    ATLANTA, GEORGiA

  14. #14
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    Is vaseline the best thing for that or does anyone know of something better
    something with zinc in tends to be good for the skin, in the UK i would say "zinc and castor oil" as is used for irritated baby's bottoms. Don't know whether equavalent is available in USA

  15. #15
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    re brace studies

    I know there is only one proper spinecorstudy, (spine 2003) published, but it is so much more comprehensive than any study i have seen for hardbraces and therefor so much more informative. What I specially like is that the same group is followed for many years with clear indication what measurements they go through over time, i.e curve at diagnosis, initial correction, correction at 3 - 6 months etc, and even post traetment results. Now, either these results are doctored (adjusted to suit the researcher) or they are extremely convincing. Like celia says, we cannot afford to wait 25 years for the definite study to appear.

    Somehow, and i do not know why, despite all its failings and despite many, many stories of progression whilst wearing them, boston braces do not seem to attract similar scrutiny/ critisism.

    In our case the ortho paedic surgeon was quite happy for my daughter to have an unproven type of hardbrace, had no figures from his own hospital to indicate succesrates, wasn't bothered about how much correction was achieved (was happy with 25% correction in brace, whilst all studies for hardbracing suggest you need to aim for at least 50%), wasn't alarmed when it did not fir her properly anymore (we had to wait 2 months before we werew offered a better fitting one)! And this was a specialist scoliosis centre!!!!! In all fairness, i felt they were just not bothered

    life seems a bit better now, with clinicians which are interested, and take time and take care, now "just" some results to match!!!!

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