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.
The dynamic corrective brace is made up of two components:
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.
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.
1st Visit (within 1 month after the recruitment/prescription visit)
- Regular clinical exam (as detailed in the SpineCor Assistant Software)
- SAS computer classification, to be validated by the Doctor, Orthotist or Therapist.
- The SpineCor Dynamic Corrective Brace will be set-up on the patient and a PA X- ray in brace will be taken immediately to control the brace actions
- If the brace set-up and the immediate result are satisfactory training will be given to the parent/child on how to put on and take off the brace. Each of the following visits will include a control of the brace set-up.
- The brace will be worn 20 hours per day. (Four hours break time from wearing permitted each day. The four hours however must not be taken in one period, at least two breaks must be taken each day ideally of equal duration.)
2nd Visit (4 weeks after initial fitting)
- Regular clinical exam (as detailed in the SpineCor Assistant Software)
- The brace will be adjusted based on the Doctors, Orthotists or Therapists evaluation before x-ray control
3rd Visit (3 months after initial fitting)
- Regular clinical exam
- The brace MUST FIRST be adjusted and then the result controlled with a PA X- ray in brace, which must show a reduction or stabilisation of the original Cobb angle(s).
4th Visit (6 months after initial fitting)
- Regular clinical exam (as detailed in the SpineCor Assistant Software).
- The brace will be adjusted based on the Doctors, Orthotists or Therapists evaluation this MUST BE done prior to in brace x-ray.
- PA x-ray in brace and shoe lift if prescribed.
5th Visit (9 months after initial fitting)
- Regular clinical exam (as detailed in the SpineCor Assistant Software).
- The brace will be adjusted based on the Doctors, Orthotists or Therapists evaluation.
6th Visit (12 months after initial fitting)
- The brace will be adjusted based on the Doctors, Orthotists or Therapists evaluation this MUST BE done prior to in brace x-rays.
- PA X-ray in brace and shoe lift if prescribed.
Following Visits (every 3 months*)
- Regular clinical exam (as detailed in the SpineCor Assistant Software)
- The brace will be adjusted based on the Doctors, Orthotists or Therapists evaluation this MUST BE done prior to in brace x-ray.
- PA X-ray in brace and shoe lift if prescribed each 6 months from initial brace fitting.
- When patient is ready for weaning evaluation (not normally less than 18 – 24 months from start of treatment) the brace should be removed 72 hours prior to visit for PA x-ray out of brace.
* Follow-up visits after the first 3-4 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 risk of progression is low. Extended review periods are not advised without great experience of SpineCor treatment.
The conventional classification of idiopathic scoliosis is based on a radiological evaluation in the P/A view and different types are identified according to the position of the apex without any consideration of the sagittal view. This classification provides only partial information even though scoliosis is known as a three-dimensional deformation of the spine associated with postural disorganization. When comparing x-rays among patients classified as the same, several differences in the morphological aspect of the curvature and other characteristics may be noted. Clinically, the differences in posture for these patients are obvious enough to reconsider if they are indeed of the same type of scoliosis. This has lead to the development of subclasses of the conventional classification of scoliosis patients. A classification that reflects the three-dimensional deformation of the spine and the associated postural disorganization is therefore essential.
Observation of specific parameters, by combining frontal and sagittal x-rays, in order to get the maximum 3D information is involved.
- Tilt / rotation / version for each vertebra
- Tilt / rotation / version for the shoulder girdle / thorax / pelvic girdle
- P/A and lateral shift
- Modifications in the sagittal plane of the thoracic, thoracolumbar and lumbar segment
- Anteversion / retroversion / antepulsion / retropulsion
Scoliosis is a deformation of the spine which affects more than 5,7 million children around the world. Although to date there is no consensus on the etiology of Idiopathic Scoliosis, which accounts for 80% of cases, enough is known to allow better non-surgical treatments today.
Using modern knowledge along with that of years gone by, and safe, up-to-date technology, a multi-disciplinary team from Hospital Sainte-Justine in Montreal has been addressing this problem. The team is led by Dr. Charles Hilaire Rivard, who is a paediatric orthopaedic surgeon, professor, and head of the Department of Surgery at the Université de Montréal. He, and Dr. Christine Coillard, a paediatric orthopaedic surgeon and Clinical Assistant Professor in the Department of Surgery at the Université de Montréal, have dedicated the last 12 years to the improvement of a non-rigid brace. Working in conjunction with The SpineCorporation to supply this unique brace world-wide, the team has developed a new, innovative treatment for scoliotic patients: the SpineCor System.
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.
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.
