New Scoliosis Orthosis

For the past several decades, there has been general acceptance of the value of the Boston style TLSOs and the Milwaukee style CTLSOs as the predominant orthoses for the management of idiopathic scoliosis. The effectiveness of the Milwaukee CTLSO for higher curves and the equivalency of the Boston concept for mid-thoracic and lower curves are now well documented by convincing long-term studies. If you are an Academy Member you can read an excellent editorial on this topic recently published in the JPO.

The controlled prospective study of electrical stimulation for scoliosis treatment was terminated some years ago due to dismal interim results, and the review by the group at Texas Scottish Rite Hospital suggests that nocturnal orthoses such as the Charleston Bending Brace are suitable only for smaller, more flexible curves. So, it is interesting to see that radically new concepts in the treatment of IS with body jackets continue to emerge despite the proven efficacy of the Boston/Milwaukee protocols.

At the BAPO meeting a couple of months ago, I had the first chance to look closely at the Spine-COR system of elastic webbing that purports to dynamically correct smaller curves than are usually treated with the more rigid spinal orthoses. I have been told that the promulgators are recruiting collaborators for a controlled, prospective study, so we may have some data on the effectiveness of this device within a few years.

I spotted a new limited-contact scoliosis orthosis at the REHA meeting that has been designed by a group at the Groningen University Hospital in the Netherlands. The TriaC is custom-fitted from a kit of prefabricated bars and straps, and is also intended to treat only milder, more flexible curves. Their advertising reports that "initial research results have shown that the TriaC exhibits results comparable to existing braces" but no data or citations were given to document this claim.

This seems intuitively more plausible to me than the flexible strapping of the Spine COR concept because the TriaC is based on a series of three-point pressure systems that correspond to those exerted by the Boston/Milwaukee orthoses. This orthosis also seems easy to don and doff and less constricting than most body jacket styles.

Of course, even if it proves effective biomechanically over time, there is no guarantee that a prefabricated kit approach will succeed commercially, as the demise of the Scolioisis Orthosis System [SOS] some years ago illustrates. Additional information on this new orthosis should be available at www.scoliosis.nl by the time this report is posted.