Scoliosis Braces

There are many types of scoliosis braces available. Braces are either hard plastic braces such as the ScoliBrace, Boston, Cheneau and Sforzesco braces, or they are soft and dynamic such as the SpineCor scoliosis brace or second skin pressure garment. The type of brace recommended to a scoliosis patient may depend on the type of scoliosis they have, or the access and understanding the health professional has about particular braces.

TLSO

The most commonly prescribed and used brace in Australia is the TLSO. TLSO stands for Thoraco-Lumbar-Sacral-Orthosis and is the generic descriptive name for the common thermoplastic hard braces used in the treatment of scoliosis. There are many of variations of TLSO braces available. The most commonly known version is the Boston brace. This version was one of the original TLSO braces invented in the early 1970’s. Its modular assembly made it popular, however cost and the ability to customise the brace have meant that most hospitals and clinics in Australia use a custom TLSO that is not a specific brand.

All TLSO type braces primarily rely on a 3 point of pressure principle to apply force to the spine in an attempt to make correction. This approach usually involves taking a plaster cast of the patient to create a mould for the brace and then at specific points within the brace pads are added to create points of pressure and holes or voids are cut to release pressure. Although some consideration is given to body shape this approach is largely 2 dimensional and the treatment is mainly based on the standing x-ray.

Each centre using TLSO bracing will have slightly different approaches and will use different variations of a TLSO. The success of the TLSO can vary greatly and the skill of the individual orthotist will often be a crucial factor in the ability of the brace to make correction. This variability in brace design and application has made comparison of results difficult  and the effectiveness of this approach has been questioned by many surgeons. In some centres TLSO bracing is no longer recommended, instead the advise given is to “wait and see” if surgery is necessary.

European style TLSO braces

In Europe, the effectiveness of rigid bracing approaches is reported as being much higher than traditional Boston braces. The braces themselves may seem to look very similar to those used in the rest of the world, however they employ corrective principles that are different to the tradition 3 point pressure system. For example, the Cheneau brace focuses on creating de-rotation of the spine and rib cage and allows rib cage movement within the plastic brace. There are variations of Cheneau bracing, including the Rigo Style Cheneau (RSC) scoliosis brace.

Hard Bracing and Rehab approaches

Hard bracing is almost always prescribed in conjunction with scoliosis specific rehabilitation/physical therapy exercise. It is known that hard bracing can stiffen the spine and weaken the muscles and as a result most of the correction seen on x-ray is lost after weaning. It is theorised that by using intensive exercise therapies that are tailored to the individual’s curve that spinal mobility and muscle strength can be maintained and that as a result correction seen in the brace is better maintained and progression is better controlled.

Since the early 70’s technology has developed to help in hard brace design and manufacture. Computer assisted design and manufacture (CAD CAM) is now used in some hard bracing approaches. Once such approach is the ScoliBrace system.

ScoliBrace

The ScoliBrace was developed after years of research into the effect of Mirror Image rehabilitation procedures on scoliosis. This approach takes into consideration the postural alignment of the patient and the scoliosis deformity in 3 dimensions. Based on this 3 dimensional assessment  computer assisted design and manufacture are used to produce a brace that attempts to correct the patients postural and spinal deformity in all 3 planes.

The ScoliBrace can be used for infantile, Juvenile and adolescent idiopathic scoliosis treatment. In some cases it can be used in non-idiopathic cases such as congenital and neuromuscular curves. The ScoliBrace can be used as a treatment in its own right, with physical therapy or as a initial treatment for larger or stiff curves that are not manageable with SpineCor bracing.

For more information on the ScoliBrace system of treatment in Australia you can visit the Sydney Scoliosis Clinic website click here.

The SpineCor System

The SpineCor brace is a unique treatment that utilises a dynamic brace as part of an overall treatment approach.

The Canadian government commissioned a research project  into the cause and treatment of scoliosis. The project employed over 165 researchers at it peak and had a budget of over 12 million Canadian dollars. From the research a better understand of the scoliosis particularly the genetic trigger and the effect of spinal growth on progression were developed. In 1992 as a result of these breakthroughs a new treatment approach was developed.

The SpineCor system of treatment is based on the fact that when a scoliosis develops it does so in a particular pattern and this pattern has a 3 dimensional effect on the body shape and posture. By reversing the abnormal posture and body shape into their opposite position the body and posture correct the abnormal alignment of the spine. This concept is know as spinal coupling. i.e. if I bend my torso to the right my spine will also bend to the right. So if I have a lower back scoliosis to the right and I bend my torso to the left I can correct some of the scoliosis.

The Montreal team discovered that to have the best chance of stopping progression and even making correction that this concept of over correction is crucial because of the the effect it has in balancing back up the growth of the bones of the spine. Another important factor they found was that achieving this over correction dynamically i.e. by using movement rather than forcing the position in a hard brace gave better results. This is because repetitive movement trains the posture and spine to make correction, meaning that this approach treats the muscles rather than weakening them, keeps the spine flexible rather than stiffening it and help to reprogram the neurological control over the muscles, spine and posture.

For each type of scoliosis a specific corrective movement of the body shape and posture is used. This corrective movement is achieved by using the SpineCor brace. The brace uses a series of 4 elastic bands attached in different positions at different tensions to a pelvic harnes and vest like jacket. The bands can be positioned in many different configurations and unlike traditional TLSO’s which have difficulty treating high thoracic curves SpineCor can influence the shoulders and cervical spine making the range of curves it can treat equivalent to a CTLSO.  Over time the tension in the appropriate bands is increased to gradually improve the corrected position.

As SpineCor requires the child to have a relatively normal neuromuscular system to be effective, it is generally not used in neuromuscular scoliosis. The primary uses for SpineCor are in Juvenile and Adolescent idiopathic scoliosis and adult scoliosis.

SpineCor has been used through the world on ten’s of thousands of patients. It has been shown to be an effective treatment for slowing and stopping progression of juvenile and adolescent curves  and surgery can be avoided in over 75% of cases where the curve is between 20 and 45 degrees and the patient is still relatively young.

Research comparing the the dynamic SpineCor brace to the standard TLSO brace and found that when correctly applied, the SpineCor scoliosis brace is 4 times more effective in stopping progression to surgery.

Research from most centres thought the world replicate the results found at the Montreal clinic. In clinics where the brace has been used without thorough training such as in Hong Kong or the brace has been used inappropriately  as has been the case in Germany the result reported are not as favourable.