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.  

INDICATIONS 

The SpineCor System was designed, developed, and tested for the    treatment of idiopathic scoliosis.  Its efficacy for treating neuromuscular, neurological and other types of scoliosis has not been evaluation and is generally contraindicated. 

CONCEPT 

The therapeutic approach is based on the etiology and pathogenesis of idiopathic scoliosis and uses a new treatment concept.  It is a pathology of the neuro-musculoskeletal system in growth and maturation.  The cause is genetic, and the pathogenesis involves a three-dimensional deformation of   the spine, postural disorganization, unsynchronized growth and particular movement pattern of the body.  

DIAGNOSIS

In order to obtain an accurate diagnosis, that would specify a particular    class and subclass for the patient, the evaluation combines a clinical exam, radiological and postural evaluation.  

TREATMENT  

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.    

PROGNOSIS  

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.

Treatment Approach

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 Hôpital 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.

THE CONCEPT

Scoliosis is not only a deformation of the spinal column, it is also a disease    of the neuro-musculo-skeletal system. If it progresses, it can have serious consequences for the patient. This complex system's unstable balance    during growth may, perhaps, be governed by the theory of chaos.

Scoliosis is more than a 3D deformation of the spine. It also involves     postural disorganization, neuro-musculoskeletal dysfunction and unsynchronized growth patterns all evolving with time. Using these four defining criteria, we can adopt a more specific approach to the static and dynamic properties of scoliosis that evolve over a period of time. Scoliosis      is a four-dimensional deformation! Even though the etiology of scoliosis  remains unknown in 80% of cases, technological progress and the creation    of multi-disciplinary teams mean that, in addition to the spinal deformation,     a child's or adolescent's morphological and postural abnormalities can be recognized, together with their dysfunction, growth and maturation    problems. The therapeutic concept of the SpineCor System is closely     related to the etiopathogenic concept. In keeping with this therapeutic concept, the design of this Dynamic Corrective Brace incorporates various independent, yet related, components.

It provides dynamic control of the shoulders and pelvic girdles and thorax, controls movement, and modifies the three-dimensional postural geometry. This allows us to correct the three-dimensional deformation while    harmonizing the function and maintaining it over time. More harmonious  growth patterns can thus be achieved. The SpineCor Dynamic Corrective  Brace is prescribed by orthopaedists, who also monitor the treatment. It is suitable for all pre-adolescent or skeletally immature adolescents with early progressive idiopathic scoliosis, or in cases where the risk of progression is considered high. Early idiopathic scoliosis treatment will increase the      chance of total correction and, therefore, reduce the bracing period. It can also be used as other braces with patients showing scoliosis with a Cobb  angle between 31º and 50º with the objective of stabilization of the curve.

Radiological Classification

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