� Moe et al published first classic study on in-orthosis correction in CTLSO.

� Best was 55% for lumbar curves, 38% for Thoracic, and 17% for High Thoracic

� With patients that have apices above T10, a TLSO with superstructure is strongly recommended WATTS ET AL Clin Ortop Rel Res 1977.

� Biomechanically, there is no better three point pressure system than the Milwaukee, so why the change?

� Compliancy due to cosmesis

�Referral preference

ThoracicLumbar Thoracolumbar

� Lumbar pad is highest component

� For

� Lumbar Curves

� Thoraco-Lumbar curves where patient is decompensated to convex side

� Double curves with flexible thoracic curve

� Low thoracic pad is highest component

� For:

� Thoracolumbar curves where thoracic component flexible

� Lumbar curves where patient is decompensated to concave side

� Axillary extension is highest component

� For:

� Thoracic curves

� Double curves

� Thoracolumbar curves where thoracic component not flexible

� Increased comfort from total contact

� No ridges or sharp points of pressure

� Shifts with moderate three point pressure system

� Cast mold allows for shifting with total contact reducing pressure

� Allows for asymmetrical design.

� Use strap as central central sacral linesacral line

� Roll to allow time to shift mold while still wet

� Most patients balance well on table

� Identify waist grooves and pelvic girdle

� Help stabilize patient

� Use three point TOTAL CONTACT forces

� Or use SHIFTING SHIFTING techniques

� No pinpoint pressure on ribs or bony segments of hips

23

� Key is that it is assymetrical vs the traditional symmetrical designs.

� Can be made from mold (risser table, Scanned from mold)

� Can be made from measurements.

� Can be made from CAD

� Gluteus Push extremely important with End Point Control

24

� In past windows needed due to symmetrical designs.

25

Anterior Posterior

The dynamic connection between

these forces mean that they move

with every movement made by

the patient.

In every body position an equal corrective

force is exerted on the same place in the

body

After adjustments

After adjustments

INDICATIONS FOR TREATMENT

� Idiopathic Scoliosis

� Boys and Girls 5 Years +

� Initial Cobb angle equal or above 20o or proven progression > 5o in last 6/12 or strong family history

� Initial Cobb angle equal or below 50º

� Risser 0, 1, 2 or 3 or premenarchal

� Curve Type all classes

SpineCor Treatment Protocol

BRACE COMPONENTS

BOLERO

ELASTIC

CORRECTIVE BANDS

PELVIC

BASE

THIGH

BANDS

PERINEAL BANDS

SpineCor Treatment PrincipleSpineCor Treatment Principle

STEP 1 STEP 2 STEP 3

STEP 4 STEP 5

SpineCor Treatment PrincipleSpineCor Treatment Principle

A Clinical Case 2:

Left Thoraco-Lumbar Curve Type 2

The Treatment: SpineCor Brace for 24 months

The Outcome: Correction

Birth date: 1986-05-30

F- Age: 10-y, 9-m

Starting Date: 1997-03-10

STARTING POINT

1997-03-10

X-ray prior to the Brace

Risser: 0

16o

58o

24o

38o

Birth date: 1986-05-30

F- Age: 12-y, 2-m

Starting Date: 1997-03-10

STARTING POINT

1998-07-08

First X-ray with the Brace

Risser: 0

4o

12o

Birth date: 1986-05-30

F- Age: 14-y, 2-mStarting Date: 1997-03-10

WEANING POINT

1998-07-08To

2000-07-06

The Brace Treatment

Risser: 3

34o

52o

15o

11o

2 Years

Birth date: 1986-05-30

F- Age: 19-y, 2-m

Starting Date: 1997-03-10

FOLLOW-UP POINT

2000-07-06To

2005-07-20

Risser: 5

5 Years

24o

36o

8o

5o

5 Years Follow-up : Correction5 Years Follow-up : Correction

Beginning of the TreatmentDate : 1998-07-08, Age: 12-y, 2-m

Risser: 0

End of the Treatment and the Follow-up

Date : 2005-07-20, Age: 19-y, 2-mRisser: 5

1. Consider best available treatment evidence

2. Detailed clinical and biomechanical evaluation

3. Systematic segmental analysis in 3 planes

GOS Philosophy:GOS Philosophy:4. Document clinical, BM, & x-ray data

5. Generate orthotic CAD design based on flexibility / correctibility of deformity

GOS Philosophy:GOS Philosophy:

6. Sequential supine gravity-assisted donning

7. Prioritize 3D clinical improvement over 2D x-ray improvement

GOS Philosophy:GOS Philosophy:

Charleston Brace

• 30 CBB patients compared to TLSO

results

• “Nighttime bending brace was considered as effective as the Wilmington brace in

controlling adolescent idiopathic scoliosis”• Bowen, et.al.

• Orthopedics 24:967, 2001

Charleston Brace

• 85 CBB patients

• 27 TLSO patients

• “No significant differences in success rate was found between the two groups”

Gepstein, et.al.

JPO 22:84, 2002

Boston vs. Charleston

• “Both orthoses were comparably effective

in treating single thoracolumbar and single

lumbar curves.”

• Equally effective to 35 degrees

• Boston Brace more effective for larger curves

Katz, et al.

Spine 22:1302, 1997

To move the apices of

scoliosis curves to the

midline or beyond

the midline through the

application of controlled,

direct, lateral and

derotational forces on

the spine

• A recumbent brace worn only at night

• Overlapping 3–Point Pressure System with opposing void areas

• Segmental derotation at selected points

• CAD/CAM utilization from accurate measurements

�Correction Pads push apexes toward midline

••Lumbar

••Thoracic

�Stabilizing Pads hold patient on centerline

••Axilla

••Trochanter

A Measurement Board with Corrective Blocks & Bolsters 74%

Success rate for

compliant full-time TLSO patients

(Nachemson)

85%Success rate for

compliant night-time Providence patients

(McCoy and D’Amato)

The Providence

eliminates the

embarrassment of

being different at

just the time in a

child’s life when they

want most to fit in.

The Providence

increases compliance

and can be effective for obese,

juvenile and neuromuscular

scoliosis patients.

� CAD CAM DESIGN

� Assymetrical

� Algorithm

used to predict dimensions

and shape of the

Patient.

www.thelabrace.com

� www.grantwoodortho.com

� Also newer system called the Rigo-System Cheneau

� Takes into consideration the 3D aspects of scoliosis

www.grantwoodortho.com