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Dynamic Corrective Brace


Current results of the effectiveness SpineCor dynamic brace vs. Rigid bracing systems based on the new SRS inclusion criteria for bracing studies.
Jeb McAviney* BSc, MChiro, MPainMed. Andrew Mills** MBAPO
*The Ulster Spine Centre, Belfast, UK. **Sheffield Childrens Hospital, UK.

Introduction: Adolescent Idiopathic Scoliosis is a serious condition affecting millions of children worldwide. Traditionally, rigid bracing techniques such as casting and TSLO (Boston) and providence braces have been used to try to stop the progression of scoliosis to surgery. The effectiveness of orthotic management has been questioned and many surgeons no longer use bracing, preferring a wait and see approach. As a result of this and in a quest to determine the actual effectiveness of bracing on those cases most at risk of progression in 2005 the scoliosis research society published guidelines for the reporting of results from bracing studies. This reporting is designed to allow comparison between cohorts and give a true indication of the effectiveness of each intervention. Paper compares the result of the two papers currently pushed using these guidelines. The criteria were established by the SRS Brace Committee to standardize future studies and reporting on the non operative management of adolescent idiopathic scoliosis. They recommend inclusion criteria for future adolescent idiopathic scoliosis brace studies to include: age of 10 years or older when brace is prescribed, Risser 0-2, primary curve angles 25 degrees -40 degrees, no prior treatment, and, if female, either premenarchal or less than 1 year postmenarchal. Assessment of effectiveness should include the percentage of patients with 6 degrees or greater progression at maturity, the percentage of patiet5ns with curves that exceed 45 degrees at maturity and those that have surgery or surgery is recommended, and a 2 year follow-up after maturity. Research: The June 2007 issue of Journal of Paediatric Orthopaedics published two papers on different bracing methods following the new SOSOC guidelines. The Thompson et al. paper studied the TSLO and Providence braces and the Coillard et al. paper studied the SpineCor brace. Methods: The rigid bracing paper was a retrospective comparative cohort study, SpineCor paper a prospective cohort study. Both studies followed standard treatment protocols for treatment of prescribed deceive, TSLO 22 hours, Providence 8-10 hours and SpineCor 20 hours of wear. The rigid bracing paper had 83 subjects in which there were 48 patients in the TLSO group and 35 in the Providence group. There were 170 patients in the SpineCor group.

Results: There were no significant differences in age at brace initiation or initial primary curve magnitude. There were slight differences in sex, with the percentage of girls treated in the SpineCor group was 92.7% vs TSLO 80% and Providence 84% . Initial Risser were very similar with the exception of riser 0 in the providence group. However in the results presented for the providence group there was 11% unknown. It is possible that this group could be riser 0 which would make sense given the difficulty in establishing riser value prom pelvic x-ray and the fact that the average age for the providence group was 12.8 it is unlikely the riser value is at the upper end of the scale. All of the 170 patients in the SpineCor group met the inclusion criteria and had results from beginning to end of bracing. As the SpineCor group is an active treatment group in a prospective study, 47 of 170 had two year follow up results post bracing. However unlike the trend seen in rigid bracing where the majority of patients regress to their initial cob magnitudes and often progress (as shown in the Thompson paper) the results of the SpineCor group were extremely stable with 95.7% maintaining or improving their correction two years after the end of bracing. Since the publication of these results in JPO it has been confirmed that these stable results are seen across the whole cohort making a comparison between the rigid bracing study and the SpineCor study possible. Comparing results of SpineCor to TSLO shows that SpineCor was 4 times more effective than TSLO (the main bracing treatment currently used across the world) in stopping progression of the scoliotic curve. When success is measured in avoiding surgery, SpineCor was 76.5% effective, and TSLO was 21% effective. The SpineCor was 71% more effective in stopping the progression to surgery compared to TSLO. Although 40.6% of patients in the SpineCor paper did show some progression of the scoliotic curve, only 1.2% progressed to a curve greater than 45 and most of these did not require surgery (unlike the TSLO group). Comparing the Initial Cobb angle with the one at end of bracing TLSO SPINECOR SCOLIOSIS CURVE Correction/Stabilisation 15% 59.4% Progression over 6 85% 40.6% Progression over 45 56% 1.2% Progression to Surgery 79% 23.5% Conclusion: SpineCor is a more effective treatment than TSLO (Boston) bracing. Given that it can be provided to the patient at similar cost, with the same amount of radiological intervention, and it is not associated with the multiple side effects seen in rigid bracing, surgeons currently not recommending bracing or using a rigid brace should consider using the SpineCor brace for the benefit of their patients.

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