General
Information
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
[2-4-7-8-19-21-22-23-31-32-33-35-36-42-46],
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 [1-3-5-10-28-29]. 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
[13-14-15-16-17], Perdriolle [37],
William P. Bunnell [6], Furster
[24], Risser [40] and many others
[inc. 34]. This means that the earlier the
scoliosis appears, the greater the risks of evolution.
Lonstein & Carlson [30] 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 [9-44] and other authors
[4-11-26-30-31] 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
[12], Ponsetti [38] and, in 1980,
Guillaumat [26] 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 [45], Lonstein &
Winter [31], Durand & Salanova
[11] 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
.
- Bone
structures, especially the rib cage, have to stand
significant mechanical constraints that can affect the
harmonious growth process leading to some malformation
and atrophy of mobile structures.
- 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:
- Progressive correction of the spine deformation
up to the limit imposed by the pre-existing bone
deformation.
- 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 can
take two different approaches. We can compare it to the
natural evolution of the disease or compare it to the
existing braces. This is exactly what we have been doing
since
1995.
General Information
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 [2-4-7-8-19-21-22-23-31-32-33-35-36-42-46], 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 [1-3-5-10-28-29]. 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 [13-14-15-16-17], Perdriolle [37], William P. Bunnell [6], Furster [24], Risser [40] and many others [inc. 34]. This means that the earlier the scoliosis appears, the greater the risks of evolution. Lonstein & Carlson [30] 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 [9-44] and other authors [4-11-26-30-31] 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 [12], Ponsetti [38] and, in 1980, Guillaumat [26] 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 [45], Lonstein & Winter [31], Durand & Salanova [11] 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 .
- Bone structures, especially the rib cage, have to stand significant mechanical constraints that can affect the harmonious growth process leading to some malformation and atrophy of mobile structures.
- 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:
- Progressive correction of the spine deformation up to the limit imposed by the pre-existing bone deformation.
- 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 can take two different approaches. We can compare it to the natural evolution of the disease or compare it to the existing braces. This is exactly what we have been doing since 1995.