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Thread: spine-cor vs. Boston brace

  1. #151
    Join Date
    Feb 2007

    SRS indications for treatment

    Since adolescent idiopathic scoliosis progresses most often in patients who are
    growing and have curves which are above 20 degrees, this is the time to use a brace
    modality. Studies have shown that curves greater than 40 degrees are unlikely to respond
    to bracing. Treatment protocols may vary

  2. #152
    Join Date
    Feb 2007

    Are Braces Really A Viable Option

    In 1993 Goldberg reviewed patients in Dublin who did not wear braces 31. She
    discovered that their clinic had the same number of surgeries for scoliosis when patients
    did not wear braces as they had while the authors were using the brace regimens. About
    the same time, series of patients treated with external electrical stimulators seemed to
    indicate that these patients had the same progression as might be expected from the
    natural history studies indicated 9,20,29,62. To answer these challenges, the Scoliosis
    Research Society commissioned a prospective, non-randomized, multi-center study to
    evaluate the effect of bracing and electrical stimulation on the natural history ofscoliosis57. Researchers were given freedom to treat patients as they felt appropriate; that
    is to say they braced with their favorite brace or treated their patients with observation if
    they did not believe that bracing was effective. The overall results indicated that bracing
    did keep curves from getting larger compared to no treatment or treatment with lateral
    trunk electrical stimulation.
    In 1995, the SRS Natural History and Prevalence Committee carried out a metaanalysis
    in order to determine from the English literature whether braces did keep
    idiopathic scoliosis from progressing 64. The committee also wanted to try to determine
    whether part-time bracing had the same effect as full- time bracing. A total of twenty
    studies were included in the meta-analysis studying 1,910 patients who had completed
    treatment. 1,459 had been braced, while 322 were treated with lateral electric stimulation
    (LESS) and 129 were treated by observation only 1-4, 7-13, 18, 20-23, 25, 26, 28, 29, 30, 32, 33-39, 40, 43,
    44, 46, 47, 49-54, 57-60, 68-72, 74-78, 79, 80-82.
    The untreated patients did not progress (successful treatment) in forty-nine
    percent of the cases. Those treated with the LESS were successful thirty nine percent and
    braced patients did not progress in ninety-two per cent of the cases. The braced patients
    responded favorably significantly more than other forms of treatments reviewed.
    The very young patients, especially juveniles, did not respond as well as adolescents and,
    of course, more mature patients who had little growth remaining. The reason for this is
    not clear from the meta-analysis, however literature since its publication has added
    precautions to the treatment of juvenile patients and boys. Karol 40 has shown that boys
    only respond in twenty- five percent of the cases treated. Goldberg, et al,32 and Dobbs, et
    al,19 have shown that boys with scoliosis have a higher incidence of neuro-axis defects
    than the girls with adolescent idiopathic scoliosis. All children under the age of ten have
    been found to have an increased incidence of neuro-axis deformities. These findings may
    explain why braces are less effective in girls that are in the adolescent period.
    Especially interesting, was the finding that there seemed to be a “dose response
    curve” related to the amount of time the braces were worn each day. While there was a
    trend that the patients prescribed part-time brace wear preformed better than observation,
    full-time bracing was significantly better (p=0.001). Furthermore, the Charleston brace
    which is worn eight hours was not statistically different then the TLSO’s worn for twelve
    hours, and both were not as successful as those braces worn full-time. The TLSO type of
    brace was not statistically different from the Milwaukee brace if both were worn fulltime.
    These data were based on the length of time braces were prescribed to be worn.
    No timed data was available to confirm that patients were compliant with their
    Literature since the meta-analysis has confirmed these findings.6,27,48,73,81. Katz
    and Durrani42 have also shown that a dose response curve exists for the length of time
    braces are worn daily and the control of curve progression. They did demonstrate that
    this time effect was more important for curves greater than 35 degrees. This makes
    treatment of smaller curves with part-time braces seem possible, further refining the
    treatment modalities the physician can offer patients and their families.

  3. #153
    Join Date
    Feb 2007

    Other Types Of Braces

    There are several types of commonly used scoliosis braces:

    1. Thoraco-Lumbo-Sacral-Orthosis (TLSO)
    The most common form of a TLSO brace is called the “Boston brace”, and it may be referred to as an “underarm” brace. This brace is fitted to the child’s body and custom molded from plastic. It works by applying three-point pressure to the curvature to prevent its progression. (See Figure 1.)

    It can be worn under clothing and is typically not noticeable. The TLSO brace is usually worn 23 hours a day, and it can be taken off to swim, play sports or participate in gym class during the day.

    This type of brace is usually prescribed for curves in the lumbar or thoraco-lumbar part of the spine

    2. Cervico-Thoraco-Lumbo-Sacral-Orthosis (known as a Milwaukee brace)
    The Milwaukee brace is similar to the TLSO described above, but also includes a neck ring held in place by vertical bars attached to the body of the brace.

    It is usually worn 23 hours a day, and can be taken off to swim, play sports or participate in gym class during the day.

    This type of brace is often prescribed for curves in the thoracic spine.

    3. Charleston Bending Brace
    This type of brace is also called a “nighttime” brace because it is only worn while sleeping. A Charleston back brace is molded to the patient while they are bent to the side, and thus applies more pressure and bends the child against the curve. This pressure improves the corrective action of the brace. (See Figure 2, 3)

    This type of brace is worn only at night while the child is asleep. Patients can go to school and participate in sports normally without their friends even knowing they have scoliosis and wear a brace, avoiding any potential negative stigma.

    Many studies have shown that the Charleston Night time brace is as effective as the above-described 23-hour-a-day brace wear.

    Curves must be in the 20 to 40 degree range and the apex of the curve needs to be below the level of the shoulder blade for the Charleston brace to be effective.

    Case Example
    As an example of bracing treatment that was effective for a young patient, please see the attached figures.

    The girl in the figures is 12 years old and athletically active in lacrosse, soccer, and basketball throughout the school year. She had a progressive 35-degree scoliosis King Type II curvature, apex toward the right side as measured from T5 to T12 (see Figure 4).

    The patient was pre-menarchal and therefore had a lot of spinal growth left. She was an ideal candidate for the Charleston Nighttime brace (see Figure 5) due to the position and degree of the curve in her spine and because the brace would not interfere with her athletic activities. (Note: the TLSO brace can also be removed during the day for athletic activities.)

    An X-ray should always be done after custom-making the brace. For this patient, while in the brace the curvature was reduced down to just 5 degrees, proving that it was a worthwhile treatment (see Figure 6).

    As a general rule, the Charleston brace will be worn every night for approximately 8 hours until the patient is one year after onset of menarche. The goal of wearing the brace is to prevent the scoliosis from progressing to over 40 degrees and prevent the need for surgery.
    Currently, the spine medical community advocates bracing as the only non-surgical treatment for idiopathic scoliosis. The objective of bracing treatment is to prevent the curve from progressing as the child grows, and studies have shown bracing is effective in stopping the progression of the majority of adolescent scoliotic curves.

    There are a number of bracing options, and the physician will recommend a particular back brace and bracing schedule based on factors such as the location of the child’s curve and degree of curvature. Compliance with wearing the back brace as prescribed is clearly vital to the success of bracing treatment.

    Unfortunately, even with appropriate bracing, some spinal curves will continue to progress. Early on it is very difficult to tell which curves will be aggressive and continue to progress, and which curves will not continue to progress.

    If the curve continues to progress to 40 - 45 degrees or more, then a spinal fusion surgery will usually be recommended. However, even if surgery eventually becomes necessary, the back brace can still be beneficial by helping delay the progression of the curvature and allowing the child to grow more before having a spinal fusion (which stops the growth of the spine).

    By: Paul C. McAfee, MD

  4. #154
    Join Date
    Feb 2007

    Previous Post

    The previous post do not include the spine-cor brace or thr triac-c brace by boston brace.I've posted the info on spine-cor and am looking for current info on the triac.
    Some key points are that some curves will progress no matter what bracing method is used.
    It is called idiopathic scoliosis because we really don't ave all the answers on etiology or really treatment for that matter.Each individual should be treated with the best method that suits there curve pattern.
    Wearing schedule is very important!!!!!Every study is based on compliant patients.So your best results are going to be for those patients that follow protocols and wearing schedules.
    This is all not to say that vitamins, e-stim or vestibular rehab cause harm but do they help?
    I have read recent studies that indicate that the best way to icrease Vitamin uptake is to get it in its natural form not a pill. the last study I saw implied that the pill form is often passed though the digestive system without fully being asborbed.
    E-tim has limited studies that suggest it could be a helpful adjunct treatment.
    Vestibular testing can be used as a predicter of Scoliosis.Unfortunaty when many practitioners suggested it we allready have a Diagnosis of Scoliosis.As far as rehalb, I have yet to read a study that suggest he vestibular rehab in and of itself improves Cobb angles. not to say that it can't help, but we will not know until relevant studies are published.
    As allways if anybody knows of any studies please let me know!

  5. #155
    Join Date
    Feb 2007
    is this info helpful to anyone?Should Iceast in posting this info??

  6. #156
    Join Date
    May 2005
    If I am totally honest; just "cold-posting" of this kind of overview will only be useful to a small minority of parents. Many parents coming to this forum will have spend many hours researching the issues concerning them on the internet and will have come across this type of info. Also, once posted, specific info gets soon moved nbackwards by newer posts and the info supplied will be less readily avail;able.

    As a rule it is more useful to respond to specific points or questions raised.

    Whilst we are on the subject of bracing, and i woulkd be interested in your opinion, I wonder whether we are seeing such a relatively poor results from hardbracing is because not enough attempts are made to improve the quality of bracing. what I mean by that is that longstanding methods and protocols are being used and little attempts seem to be made to try to understand what is required for a brace to work, and the little knowledge what is available is not consistently applied. Specifically, besides length of wearing, it is known that relative succes is very much dependent on initial correction provided by the brace (which makes sense, the straighter the spine in brace, the less the assymmetrical forces on the growth plates and more chance for some correction) Still, many places i know of (in the UK) will not xray after fitting and therefor will not know whether the "magicc 50%" is being achieved, and i have never heard of anybody having to come back for a further fitting "to see whether a bit more correction can be achieved".

    Pure anecdotically, on german forum i looked at, patients have raved about a orthotist , Rahmouni is his name, who makes a variation of the continental cheneau aiming for and achieving 100% correction or even overcorrection in brace. Inevitably (if true) his endresults are superior to anything else. (however there is no published study) It makes sense though, if you brace, you need to get the most out of it by trying to achieve maximum correction. i am not convinced aiming to achieve that is common practice.

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