� 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