Thursday, May 19, 2022

Scoliosis Orthoses question: Responses

Harry Phillips

Here is my original question followed by the responses that did not
request not to be posted. My thanks to the list for the thoughtful
responses.
Original (long-winded) question:

To the List,
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

*****************************************
I have not used the SpineCore system, but if you do proceed with that
during the day I would recommend that you go with a bending brace at
night (Charleston, Providence, or similar) as you will get more
night-time correction with those than with the BostonBrace.

******************************************
Try and get a hold of J R Brandt, has years of experience in Boston
Brace and other
scoliosis Bracing
worked at Shriners Sacramento ;
He is now consulting.

********************************************

I have no experience with the SpineCor device but I’d say stick with the
rigid braces if you can. I would suggest a Providence nocturnal brace
for night-time use. See if the curve improves in the followup x-rays. If
it does, then keep patient in providence. If no luck, go with Boston
type during the day with providence at night.

You might have a better case for the second “day” brace in this case in
reimbursement as the second brace would be for day bracing as an adjunct
treatment for the curve.

As a side note: I have fit Boston Brace’s Dynamic Movement Orthosis
(soft bracing system) system for neuromuscular curves with good results
anecdotally. But these were kids that had multiple disabilities and not
idiopathic scoliosis.

******************************

Over the past 2 yrs. our local physicans in Charlotte treating
idiopathic scoliosis have been Rx’ing the Providence system. I have had
good to excellent results with the system.

****************************************************

I had the same conversation this past Friday with a family. It appears
that the Chiropractic Profession has embraced the Spinecor system and it
is being better advertised to the public.
What I told my parents is why would you take a chance on a product that
has not been proven to be effective on such large curves. Imagine how
devastated they will be if they need surgery.
In rapid progressing scoliosis, she needs to be in a rigid orthosis. As
a parent with the knowledge that I have, I would insist on a Boston
“Style” Orthosis or something similar.
If the insurance gods would allow, I have had great success with the one
two punch. An over correction brace at night and a stabilizing orthosis
during the day. In this case, I could possibly see using the Spinecor
for the daytime portion of brace wear.
Best of luck
**********************************8
Once again, thanks for your help

Harry Phillips, CPO

Triangle Orthopaedic Associates, P.A.

Orthotics and Prosthetics Department

120 William Penn Plaza

Durham, NC 27710

(919) 281-1814

Fax (919) 281-1877

[email protected]

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