Idiopathic Scoliosis is principally a sideways (lateral) curvature, combined with (rotation) a corkscrew like twisting effect of the spine. The progression of curves is dependent on several factors but is mainly influenced by age (growth speed/ potential) and flexibility of the spine. Idiopathic scoliosis has been conventionally treated with hard braces such as the Boston brace and Milwaukee brace. With new developments, KK Women’s & Children’s Hospital is introducing a new scoliosis bracing program, the SpineCor System. SpineCor system is based on the concept that the cause of idiopathic scoliosis is genetic and the pathogenesis involves a three dimensional deformation of the spine: postural disorganization, unsynchronized growth. The Spinecor dynamic brace is the first and only truly dynamic brace, which provides a progressive correction of idiopathic scoliosis. Compared with the conventional braces, SpineCor brace is lighter, more comfortable to wear, and allows movement of the spine in order to achieve true reduction of deformities of the scoliosis curve. It treats the pathology of the spine deformation which results in permanent change of the curve. Upon the diagnosis of scoliosis, the patient will be evaluated for the suitability of using SpineCor dynamic brace. The indications for SpineCor brace are:

1)  Confirmed diagnosis of idiopathic scoliosis;
2)  Boys or girls 5 years of age +;
3)  Initial Cobb angle equal or above 15 degrees if there is a first degree family history of Scoliosis or proven progression > 5 degrees in last 6 months;
4)  Initial Cobb angle equal or below 50 degrees;
5)  Risser 0, 1, 2, 3 or pre-menarchial;
6)  Curve type: all classes including curves that are inverse to normal patterns (e.g. Left Thoracic, Right lumbar).

Some contraindications for SpineCor treatment are:
1)  Cerebral palsy;
2)  Traumatic paraplegia or quadriplegia;
3)  Spinal muscular atrophy;
4)  Friedreich’s ataxia;
5)  Familial dysautonomia;
6)  Peroneal muscular atrophy;
7)  Duchenne MD;
8)  Myopathy.

SPINECOR DYNAMIC BRACE COMPONENTS

The SpineCor dynamic brace consists of a pelvic base and corrective bands attached to a bolero.

SPINECOR FITTING AND FOLLOW UPS

Before fitting of the brace, the patient would need to have recent X-rays (both AP & lateral view) taken within a month. Clinical evaluation will be performed, and corrective movements will be taught to the patients based on the classification of the curve. The tension of the corrective bands is then set with the patient’s spine in the corrective position. A shoe lift may be prescribed if indicated. An AP spine X-ray will be taken to assess the degree of immediate curve reduction. If the reduction is satisfactory (usually at least 5 to 10%), the patient / parents will then be educated on the fitting of the brace before home.

Follow-ups of the brace are done at 1, 3, 6, 9, 12 months after initial fitting, and every 3 months after the 12 month visit. Regular clinical exam will be carried out and band tension adjusted at each visit. Spine X-rays are taken at 3, 6, and 12 month visits to assess the progress of the curve. Weaning of the brace usually starts after 18 to 24 months in brace. Patients must fulfill all of the three criteria before commencing weaning:

1)  Full Risser 4 or more;
2)  2 years post-menarche or after voice change;
3)  Minimum 18 months in brace.

The patient removes the brace 3 days prior to the weaning evaluation visit. An out of brace AP X-ray will be carried out on the day of visit. The Cobb’s angle will be compared with the last in-brace X-ray taken when they first satisfy the weaning criteria. If the two X-rays show similar angles (less than 5 degrees), the brace can be completely discontinued. If the difference is more than 5 degrees, full-day brace wearing needs to be continued (20 hours per day) for a period of another 6 months with compliance emphasized. The patient will be reviewed again in 6 months for weaning evaluation.

SPINECOR PHYSIOTHERAPY PROGRAM

Though the SpineCor system itself may be considered as a physiotherapy program 20 hours up to 24 hours a day, a physiotherapy program may be recommended when:

1) A faster consolidation of the reduction of the curve is desired;
2) To complement the action of the brace in very rigid curves or for patients with a major postural disorganization;
3) During the weaning period. The physiotherapy program is carried out in-brace at the beginning of the treatment, and is done out of brace for patients in the weaning period.

Recommended frequency of physiotherapy session is 1 per week at the beginning, and can be decreased progressively depending on patients’ response. In order to guarantee results, the treatment length is recommended to be minimally one year. The SpineCor physiotherapy program is based on the corrective movement principle; it focuses on postural re-education, muscular balance, neuro-muscular integration, and respiratory exercises.

Contribution from:
Tian Li Feng
Senior Physiotherapist
Rehabilitation Department
KK Women's & Children's Hospital

(Source: The Singapore Physiotherapy Association)