Luke Stikeleather, COScoliosis Solutions

SOSORT  2014Educational Course

May 6, 2014

SRS Manual of Brace Treatment

Published in 1998 by SRS and edited by Dale E. Rowe, MD, et al.

Presented at the 33rd SRS conference in New York City, 1998

At the time of publication, was the most comprehensive compilation of AIS brace-related information

SRS Online Manual of Brace Treatment Same content as original publication, with minor updates in

2003 and 2009

“A History of Bracing for IS in North America”

Comprehensive history of bracing options and commonly used braces up to 2009

However, newer designs focus on three-dimensional correction

Fayssoux, R, Cho, R, Herman, M. A History of Bracing for Idiopathic Scoliosis in North America. Clin Orthop Relat Res. 2010 March; 468(3): 654-664. doi: 10.1007/s11999-009-0888-5.

BrAIST Study Bracing in Adolescent Idiopathic Scoliosis Trial University of Iowa, NIH Funded, 2007 - 2013

Principle Investigator: Stuart Weinstein, MD Study Director: Lori Dolan, PhD

Purpose: “To compare the risk of curve progression in

adolescents with AIS who wear a brace versus those who do not and to determine whether there are reliable factors that can predict the usefulness of bracing for a particular individual with AIS.”

BrAIST: Preliminary Findings

Bracing is effective in stopping or slowing the progression of curves

Correlation between bracing outcome and orthotist skill and competence

Highlights need for advancement in research, orthotist training, and brace design

BrAIST: Brace Types 365 total braces reviewed in case reports:

• 208 Boston (+46 “Boston-like” braces)

• 26 Wilmington (+13 “Modified Wilmington” braces)

• 22 Rosenberger

• 26 Hospital For Sick Children design (Cheneau variation)

• 8 Minnesota

• 4 Mortensen technique design

• 1 LA Brace

• 11 unspecified designs

Asymmetrical

MilwaukeeCheneau / Rigo-Cheneau

RosenbergerGomez

LA BraceMortensenMinnesota

Strap-Based

SpineCor

Symmetrical

WilmingtonBoston

Lyon-like

Types of OrthosesGroupings based on design

NocturnalCharlestonProvidence

Milwaukee CTLSO Walter Blount, MD & Albert Schmidt, MD Milwaukee, Wisconsin, 1945 Anterior & posterior metal bars Pads & straps on bars direct pressure Form-fitting leather girdle Plastic neck ring 1975: Added thermoplastic LSO base Still used today for kyphosis and high

thoracic curves

Wilmington TLSO Dean MacEwen, MD A.I. DuPont Hospital for

Children, Wilmington, Delaware, 1969

Symmetrical, total contact, anterior-opening

Initially molded directly to patient; currently custom from cast or measurements

Boston Brace John Hall, MD & William Miller, CO Boston Children’s Hospital,

Boston, Massachusetts, 1972 Symmetrical, prefabricated

modules or custom fabricated Posterior opening, total contact Most commonly used and copied

scoliosis brace in North America Approx. 4,000 (made by Boston

Brace, Inc) fit annually in North America

Charleston Bending Brace Frederick Reed, MD and Ralph

Hooper, CPO Charleston, South Carolina, 1979 Over-correction through side-

bending Anterior-opening First nocturnal bracing system Introduced as alternative design

for non-compliant patients Approx. 1,400 fit annually in

North America

Providence TLSO Charles d’Amato, MD, and Barry

McCoy, CO Children’s Hospital of Rhode

Island, Providence, RI, 1992 Nocturnal brace system Anterior-opening Custom-made from measurements

or cast Patented process provided

exclusively by Spinal Technologies

Christine Colliard, MD and Charles Rivard, MD St. Justine Hospital, Montreal, Canada, 1998 “Results are achieved not so much by the brace but by the

interaction of the brace with the patients Corrective Movement” Corrective principles significantly different from traditional

thermoplastic TLSOs More commonly fit in the Chiropractic community in North America

SpineCor Brace

Rosenberger TLSO Richard Rosenberger, CO University of Virginia,

Charlottesville, Virginia, 1983 Popularized in Chicago by Wilton

Bunch, MD and Tom Gavin, CO Curve reduced externally during

casting Asymmetrical, anterior-opening Utilizes adjustable sling and three-

point pressure system, with expansion areas

Lyon Brace Created by Pierre Stagnara, MD Lyon, France, 1947 Metal and plexidur plastic design Symmetrical, anterior-opening “Lyon-like Brace”: Limited use in Chicago

since 1990 with adaptations using thermoplastic

L.A. Brace Gez Bowman, CO Los Angeles, California, 2007 Measurement-based, centrally-

fabricated Asymmetrical, anterior-opening Emphasis on three-dimensional

correction Rigid polypropylene construction Limitedly used and available through

LA Brace certified orthotists

Gomez Orthotic Spine System (GOSS) Miguel Gomez, MD Houston, Texas, 2009 Adapted from Rosenberger TLSO Asymmetrical, anterior-opening Emphasis on three-dimensional

correction Custom to measurements Central fabrication through

Friddle’s O&P

Chêneau Brace Jacques Chêneau, MD initially

designs brace in 1960s and 1970s in France

1979: Dr. Chêneau publishes successes with novel brace design incorporating 3-D correction and regional derotation

1985 & 2004: Long-term follow up studies published demonstrating stable curve patterns

Many design variations exist internationally; rarely used in North America

Rigo-Chêneau Brace Manuel Rigo, MD Barcelona, Spain, 1990s Elaborated on regional

derotation concepts with expansion spaces and true three-dimensional correction principles

Asymmetrical, anterior-opening Growing use by Rigo-educated

orthotists in North America since 2004

Current State of Scoliosis Bracing in North America The Boston style posterior-opening brace continues to

be the most commonly prescribed brace

Newer designs like the Rigo-Cheneau, GOSS, and others, which more effectively address three-dimensional correction, are gaining acceptance

Ultimately, the success of any bracing regimen depends on competence of the orthotist, construction of the brace, and compliance of the wearer

Objectives for the Future Greater emphasis on training competent and

proficient orthotists

Sustained financial support for research and development of biomechanically-sound brace designs

Intentional international collaboration between SOSORT, SRS, ISPO, and others

Thank you!