What is SpineCor?
The SpineCor Scoliosis System is a treatment approach not just a brace. It was developed by a team of researchers from the St. Justine Hospital in Montreal Canada. In the early 90's the Canadian government gave a grant of over 12 million dollars to a group of research scientists who were looking at the cause of scoliosis, why it progresses and how best to treat it. This research team at its height included over 165 researchers and the world renowned orthopedic surgeons, Dr. Charles Rivard and Dr. Christine Colliard.
From this research the team developed a better understand of the genetic and hormonal influences triggering scoliosis, the most important factors leading to progression of scoliosis and they developed new concepts in the treatment of scoliosis.
How does it work?
One of the key discoveries to improving scoliosis treatment was a better understanding of the difference between treating scoliosis with dynamic rather than static forces. In this context dynamic forces mean forces applied to the spine using movement and allowing the spine to move while being corrected but only in certain directions. Static forces are where the spine is held in a certain position and not allow to move.
What they found was that dynamic forces had a greater positive effect on the bones of the spine than static forces. Using dynamic forces also meant that the muscles of the the spine are not weakened because they continue to work during the treatment process also the spine did not become stiffer over time as it does when static forces are used.
As a result of this research the SpineCor brace was developed as a way to position the spine using dynamic forces, with the goal of achieving, a gradual correction of the scoliosis over time and overall better results compare to hard bracing.
Is it effective?
Since 1992 there has been much research published supporting the SpineCor approach to scoliosis treatment. In 2005 the Scoliosis Research Society Committee on Bracing and Non-Operative Management published Standardization of Criteria for Adolescent Idiopathic Scoliosis Brace Studies1. The point of these guidelines was for the first time to be able to make meaningful comparisons between studies of the effectiveness of different types of bracing.
In June 2007 two studies were published in the Journal of Paediatric Orthopaedics. One study looked at the SpineCor brace2, the other look at traditional hard bracing3 including the most commonly used brace, the TLSO/Boston brace. Both studies followed the new Scoliosis Research Society criteria and each study was carried out by clinicians that were experienced in the type of bracing they were studying.
The results from the hard bracing study showed that in the traditional TLSO/Boston brace group, correction or stabilisation was only achieved in 15% of patients and 79% of patients went on to have surgery. Therefore the TLSO brace was only effective in stopping 21% of scoliosis patients from having surgery. In the SpineCor brace group correction or stabilisation was achieved 59% of patients and of those that did progress only 23% went on to have surgery. The SpineCor brace was effective in avoiding surgery 77% of cases.
As both studies were conducted using the SRS criteria it is possible to compare the results. SpineCor was 3.9 times more effective in achieving correction or stabilisation (59% vs 15%) and 3.7 times more effective in stopping scoliosis progression to surgery than the TLSO/Boston brace (77% vs 21%).
Several other studies have been published since 2005. In general when the study has been undertaken by clinicians that have formal training and are experienced in fitting the SpineCor brace, they obtain good results that are close to those reported by the Montreal group. Positive results have been published from groups in the UK4, Poland5,6, Spain7 and Greece8.
There are two confounding studies, one from Hong Kong9 and one from Germany10, which reported negative results. However on closer examination it is found that the clinicians involved in these studies lacked the required formal training and were inexperienced with the SpineCor brace11.
In a more recent study was published in the Journal of Paediatric Orthopaedics by a clinical group in the United States12. They achieved comparably favourable results for both the SpineCor and TLSO brace.
The most recent published results from the Montreal group13, with a larger group of patients (576) and up to 5 years of follow up showed, 67.6% correction or stabilisation with only 16.1% of the patients being recommended for surgery
The research to date supports the SpineCor brace as being an effective treatment for adolescent idiopathic scoliosis. In the hands of well-trained, experienced clinicians it has shown at best to be 4 times more successful than the TLSO brace, and at the least to be just as effective.
References
1) Standardization of Criteria for Adolescent Idiopathic Scoliosis Brace Studies: SRS Committee on Bracing and Nonoperative Management. Richards, B Stephens MD; Bernstein, Robert M. MD; D’Amato, Charles R. MD; Thompson, George H. MD. Spine: 15 September 2005 - Volume 30 - Issue 18 - pp 2068-2075
2) Effectiveness of the SpineCor Brace Based on the New Standardized Criteria Proposed by the Scoliosis Research Society for Adolescent Idiopathic Scoliosis Coillard C, Vachon V, Circo AB, Beausejour M, Rivard CH. J Pediatr Orthop. 2007 Jun; 27(4):375-379.
3) A comparison of the Thoracolumbosacral Orthosis and Providence Orthosis in the Treatment of Adolescent Idiopathic Scoliosis: Results using the New SRS Inclusion and Assessment Criteria for Bracing Studies. * Janicki J A, Poe-Kochert C, Armstrong DG, Thompson GH. J Pediatr Orthop. 2007 Jun; 27(4):369-374.
4) “A Retrospective Analysis Of The Spinecor Brace Treatment At The Sheffield Children’s Hospital (S.C.H.), United Kingdom.” K. Hassan, Journal Of Bone And Joint Surgery - British Volume, Vol 90-B, Issue SUPP_III, 477. 2006.
5) The Early Results of The Treatment Of Idiopathic Scoliosis Using The Dynamic Spinecor Brace, Tomasz Potaczek et. al. Medical Rehabilitation 2008, 12 (2), 1-6
6) Preliminary Results of Use of Spinecor Brace In Katowice (Poland), Ann. Acad. Med. Siles. 61,1. Jacek Durmała et al. 2007.
7) Initial Results Of Spinecor Treatment Of Adolescent Idiopathic Scoliosis In Seville. Vera Miller A. (ESP) , 6th International Conference On Conservative Management Of Spinal Defomites , 2009.
8) The Use Of The Spinecor Dynamic Corrective Brace In Greece: A Preliminary Report, Irini Tsakiri1, Scoliosis 2009, 4(suppl 1):O35
9) The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with Adolescent Idiopathic Scoliosis. Wong et al. Spine 2008;33:12:1360–1365
10) Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): A prospective trail comparing two different concepts. Weiss HR, Weiss GM. Pediatr Rehabil 2005;8:199–206
11) Letter to the Editor. Rivard, Charles H. MD.Spine: 1 December 2008 - Volume 33 - Issue 25 - p 2837.
12) A Comparison of Thoracolumbosacral Orthoses and SpineCor Treatment of Adolescent Idiopathic Scoliosis Patients Using the Scoliosis Research Society Standardized Criteria. Gammon, Steven R. MD; Mehlman, Charles T. DO, MPH; Chan, Winston BS*; Heifetz, Jonathan CPO; Durrett, Gregory LO; Wall, Eric J. MD. Journal of Pediatric Orthopaedics: September 2010 - Volume 30 - Issue 6 - p 531–538
13) SpineCore treatment for idiopathic scoliosis:updates and follow-up results.Christine Coillard, Alin B Circo, Charles-Hilaire Rivard. From 7th International Conference on Conservative Management of Spinal Deformities. Scoliosis 2010, 5(Suppl 1):O56