Still,
today, 80% of the scoliosis cases are known as idiopathic.
Since the true cause is unknown, the treatment can only
be based on the symptoms. Until now, only two types of
treatment have been known to be efficient: the first
is the treatment using an orthopaedic rigid brace,
and the second one is surgery with a spinal system.
In both cases, the
therapeutic benefits can unfortunately be associated
with non-negligible drawbacks that limit
their uses. Because of a better understanding
of the risk associated and of the disease evolution,
we have seen a shift towards earlier treatment.
The correlation between
growth potential of the child, and, more specifically,
of
the adolescent, and the
evolution of the scoliosis has been clearly established.
It was demonstrated by Duval-Beaupère,
Perdriolle, William P. Bunnell, Furster,
Risser and many others. This means that
the earlier the scoliosis appears, the greater the
risks of evolution. Lonstein & Carlson analysed
the natural evolution of scoliosis in a population
of 729 adolescents. They concluded that a child with
an angle between 20° and 29° and a Risser of
0,1 or 2, will see his/her scoliosis evolve in 68%
of the cases. Stagnara and Clarisse and other
authors have named the 30° limit "the
critical limit" because, beyond this point, during
high velocity growth periods, evolution of the disease
is guaranteed.
Finally, the fact that
the Cobb angle remained stable after maturity had been
reached
was challenged by Duriez, Ponsetti and, in 1980,
Guillaumat shed some light on this: scoliosis
with greater risk of
evolution are the lumbar and thoraco-lumbar that have
reached 30° or more at bone maturity. The thoracic
and double scoliosis will evolve only if they have
reached 60° at maturity. It does not mean that
they are well accepted below 60°, especially from
a cosmetic and sociological point of view. With this,
it seems illogical to pretend that any 30° curve
will remain stable after bone maturity is reached.
It has been established
by Styblo, Lonstein & Winter, Durand & Salanova
that we can get much better results while treating
small curves between
20° and 29°, compared with curves of 30° to
39°. A growing number of physicians have started
treating scoliosis with an angle below 30º, hoping
to get better results but also to break the evolution
of the disease before it gets over 30º and becomes
much more difficult to treat.
Despite some effectiveness, currently available braces,
because of their rigidity, are damaging to a certain
degree to the normal development of the neuro-musculo-skeletal
system .
- Muscles are barely active and can only be maintained
through a heavy physiotherapeutic treatment.
- Because
of the pseudo-atrophy of the spine's muscular system,
it is not possible to guarantee that the
correction obtained by the brace will be permanent.
- Finally the aesthetical results
are generally poorly acceptable. In most cases,
the adolescent prefers
the cosmetic results following surgery in spite
of the
scars.
At the time period when orthopaedic
treatment would have the best efficiency (i.e.idiopathic
scoliosis of less then 30° for pre-adolescents),
the drawbacks are major considering the consequences
on an immature,
evolving body. It is important to note
that the existing brace's main objective is
to stop the disease's progression.
There are two reasons for this: first,
there is no efficient corrective treatment
that exists to this
date; and second, it becomes more and
more obvious today that it is extremely difficult
to get a real
correction, even partial, for a deformation
beyond 30° since permanent vertebral deformations
appear. We can assume that early treatment
can provide a better correction in a brace and that
we can hope that this
correction will be permanent. We believe that if one
has efficient means to correct with none or limited
drawbacks, the assumption of a true permanent correction
would justify earlier therapeutic treatment with a
minimum risk of over treating. The expected benefits
justify a more aggressive therapeutic approach for
curves smaller then 30°.
It is obvious to us that this means must be a dynamic
one as we now better understand the relationship between
the neurological, muscular and skeletal systems. It
is also clear that not only must we not harm the neurological
and muscular systems, but we need to use them to stabilize
the spinal system. The spine curvature correction goal
must not interfere with the goal of maintaining structural
mobility and neuro-muscular control of the posture
and movements.
In order to have better results
in idiopathic scoliosis, early treatment while reducing
or eliminating any drawbacks
as well as using the neuro-muscular corrective potential,
we have developed a new therapeutic tool based on an
innovative approach. SpineCor the Dynamic Corrective
Brace is the first and non-rigid brace which aimed
at correcting scoliotic deformation through self-maintained
correction of the neuro-musculo-skeletal system. SpineCor
full potential is achieved with skeletally immature
pre-adolescents with progressive idiopathic scoliosis
of less than 30°.
SpineCor changes the dynamic of the trunk while harmonizing
the posture. It is a therapeutic means with less mechanical
constraints and an acceptable comfort level that preserves
and enhances movements with a double therapeutic action:
- Neuro-muscular stimulation and correction.
The design of SpineCor
happened through a scientific process based on decades
of knowledge
on scoliosis and its treatment. Therefore, we
can
be optimistic
about its efficiency. To demonstrate
and establish the real efficiency of this treatment
about
encouraging preliminary results, we are
taking two different
approaches. We are comparing it to the
natural evolution of the disease
and to the existing braces.
This is exactly what we have been doing since
1995.
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