Further Responses to my Scoliosis Orthosis Query

Further Responses to my Scoliosis Orthosis Query

Harry Phillips

10/12/2010

To the List,

            Some additional responses to my original question arrived
after I posted the initial digest of replies. My original question is
followed by the new responses separated by dotted lines.

 

            I finished the day yesterday with a lengthy telephone
conversation with the mother of a 14 year old girl who was just
diagnosed with a rapidly progressing 37 degree lumbothoracic curve and
prescribed a TLSO. The child is devastated at the thought have being
forced to wear a rigid brace according to Mom. Consequently Mom hit
the internet and feels that the Spinecore system would be less
restrictive and noticeable and might perhaps be the better option for
her daughter. I do not use the Spinecore system for a variety of
reasons not the least of which is the fact that I have no experience
fitting the system and no access to a colleague who has experience to
coach me. I was quite forthcoming about this in my conversation and
explained that I relied on the Boston system because I have had a lot of
experience and using it and have achieved reasonably good results. I
also feel the Boston system is the most thoroughly researched device and
that the efficacy of the system is born out by that research.

All of which proceeded the following question: Have I heard of anyone
who has fit patients with the Spinecor system for daytime wear and a
rigid TLSO for night time use? I told her I had not (and observed the
it was unlikely that there would b third party funding for such a
procedure), but said I would pose this question to the listserv to see
if anyone has tried a tension based Scoliosis orthosis during the day
and a more rigid TLSO (either Boston or Bending Brace) for night time
wear. I will post responses to this question (if there are any) as well
as comments in favor or opposed to Spinecor, Boston, or nocturnal
bending brace approaches to Scoliosis management.

Thanks for your help

 

 

 

Thought I would throw in my perspective as well. I have over 40 years in
orthotics and during the last 20 years I pretty much specialized in
Scoliosis bracing. To have a young person present that is devastated
by the thought of wearing any orthosis, especially during the day is so
QUITE common. My experience, having been accumulated after fitting
hundreds of Boston Braces and many Charleston Bending Braces was, night
time verses no time proved to be a better option than throwing in the
towel. Towards the latter years I along with my primary per scribing
physician leaned towards the Charleston Bending Brace. I understand the
other manufactures of night time bending braces are putting together
good results as well. If the patients insurance company or the parents
willingness to contribute out of pocket expenses warranted such, we
would often try to make a deal with the young person to wear a Boston
type day time brace during the week days or week ends when she or he was
not going to be going out in public. Bottom line: the more hours per
week you can treat the progression of the curve(s) the better the
chances of offsetting it or them. Compromise is better than the
alternative however, MAKE SURE the patient along with the parents
understand that this compromise is not the best alternative only better
than doing nothing relative to orthotics at all.

 

Im always shocked at young Moms their daughters who both sometimes come
in with Braces on their teeth?Boy are we doing a bad job of marketing!
Use a nite time brace, So they can both wear there Britney Spears low
slung hipsters and can be COOL. Just let her wait it out and figure out
which low back formal she wears to hide Rodding scar!

 

Here is another component to the spinecor brace. It can only be provided
by Chiropractors. There are no Orthotists that are certified to provide
this treatment (this is according to Dr. Tom Pappas who is the clinical
specialist for spinecor in the Midwest/east coast). They feel only the
Chiropractic profession can meet the immediate needs of this population.
The spinecor brace requires X-ray, fit, x-ray, adjust, x-ray again until
optimal correction is achieved. They feel it would not be timely in an
orthopedic setting and referring to an Orthotist (Again words from Dr
Pappas). Just something to think about when dealing with Mom.

I'm fascinated by the responses you received. Can you believe doctors in
Charleston are ordering the Providence?

 

I was not going to reply at all because my exposure to Spinecor has been
brief, while I'm sure there are those in the O&P field with far more
experience. Apparently, there are a number of our colleagues who have
never used the Spinecor system or taken the time to learn about the
differences between that and more 'traditional' bracing systems but are
quick to say that it wouldn't work.

 

Did you know the synthesis of the Spinecor system came from a 20 Million
dollar grant in Canada? Their initial goal was not to develop a device
to treat scoliosis but to understand scoliosis better. The brace was a
natural progression out of their studies.

 

There was a long terms outcome article published that indicated at 2
year follow-up on these patients that showed they were maintaining the
curve corrections. Where the traditional brace studies would say if the
curve returned to before bracing treatment after 2 years that would be
still successful. (Coillard et al, J Pediatr Orthop; 2007;27:375-379)

 

It originally was not sold to Chiropractors, but when the O&P world
wouldn't except it they were the only ones still interested. So until
people in the O&P field are willing to fit these patients and do it
better we will not hold the corner on this. Is it not also a problem
that a device was developed with good research and rather than attempt
the use of it our field will reject it because of its differences from
what we are familiar with.

 

All that being said anything we do to treat these patients has to be
done because the patient is indicated for the treatment and we as
clinicians have to develop tools by which those discernments are made.
Ultimately there will be patients that are more appropriate for Boston
bracing, night bracing (some Charleston and some Providence),
Assymetrical TLSO designs, and yes Spinecor. Personally I think it's
best to be prepared to have all of the tools in your belt. How effective
is a rigid device that is never worn?

Making these decisions aren't easy, but I believe there is a danger when
anyone has convinced themselves there is only one best way. I would
fear the day where my only tool is a hammer, because everything might
start looking like a nail.

 

At this point I don't really feel that we have significant enough
information about your patient to really make an informed decision on
which course of action to take. Which may be true for you as well
because the patient hasn't physically come into your office.

Thanks again for the thoughtful responses

 

 

Harry Phillips, CPO

Triangle Orthopaedic Associates, P.A.

Orthotics and Prosthetics Department

120 William Penn Plaza

Durham, NC 27704

(919) 281-1814

Fax: (919) 281-1877

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