The Spine Cor Dynamic Corrective Brace Pediatric Treatment

The Spine. Cor® Dynamic Corrective Brace Paediatric Spine. Cor Brace • Research in 1992 at Ste-Justine Hospital, Montreal, Canada. • Professor Charles H Rivard MD; Christine Coillard MD. • Canadian Government Research Project. • 12 million dollars. • 65 researchers • Orthobiom • Blood Test • Spine. Cor © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Circle of Idiopathic Scoliosis Genetic Fault Temporary asymmetric delay in ossification (growth) of the posterolateral segment of vertebra Growth Modulation Asymmetric Biomechanical Growth Plate Loading Idiopathic Scoliosis Localised 3 D Vertebral Deformity Destabilisation of the Spine Neuro-musculoskeletal Dysfunction Postural Disorganisation © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Origin of the Localised 3 D Deformity Genetic temporary fault Delayed ossification in the postero-lateral part of the vertebra Initial deformity © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Localised 3 D Vertebral Deformity NEURO-CENTRAL CARTILAGES Growth plates involved in the 3 D development of part of the vertebral body, transverse and articular processes and laminae. © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Circle of Idiopathic Scoliosis Genetic Fault Temporary asymmetric delay in ossification (growth) of the posterolateral segment of vertebra Growth Modulation Asymmetric Biomechanical Growth Plate Loading Neuro-musculo- Idiopathic Scoliosis skeletal Dysfunction Localised 3 D Vertebral Deformity Destabilisation of the Spine Postural Disorganisation © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Localised 3 D Vertebral Deformity 1. Lateral Wedging

The Spine. Cor® Dynamic Corrective Brace Evidence of Lateral Wedging Rib Deformity • Decreased distance between the ribs in concave side • Highlights the lateral wedging of the vertebrae © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Evidence of Anterior/Posterior Wedging Modification of the sagittal

The Spine. Cor® Dynamic Corrective Brace Evidence of Rotational Deformity Arc from spinous process through the vertebral body • Rotation in the rest of the spine is a disorientation as a result of this © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Localised 3 D Vertebral Deformity INITIAL LOCALISED 3 D VERTEBRAL DEFORMITY PATTERN • Specifically confined to one vertebra + half of the vertebra above + half of the vertebra below • At or around the apex of the major structural curve © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Localised 3 D Vertebral Deformity • The other

The Spine. Cor® Dynamic Corrective Brace Circle of Idiopathic Scoliosis Genetic Fault Temporary asymmetric delay in ossification (growth) of the posterolateral segment of vertebra Growth Modulation Asymmetric Biomechanical Growth Plate Loading Idiopathic Scoliosis Localised 3 D Vertebral Deformity Destabilisation of the Spine Neuro-musculoskeletal Dysfunction Postural Disorganisation © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Destablisation of the Spine • Consequence of the initial 3 D vertebral deformity. • May result in 1 or more curves: • Primary structural curve contains the deformed vertebrae and has greatest potential to progress • Secondary compensatory curve has limited potential to progress © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Circle of Idiopathic Scoliosis Genetic Fault Temporary asymmetric delay in ossification (growth) of the posterolateral segment of vertebra Growth Modulation Asymmetric Biomechanical Growth Plate Loading Idiopathic Scoliosis Localised 3 D Vertebral Deformity Destabilisation of the Spine Neuro-musculoskeletal Dysfunction Postural Disorganisation © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Postural Disorganisation • Postural disorganization is closely related to the type of curve. • It permits to get an indirect 3 D evaluation of the scoliosis curve. • The postural disorganization contributes to the aggravation of the curve. © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Circle of Idiopathic Scoliosis Genetic Fault Temporary asymmetric delay in ossification (growth) of the posterolateral segment of vertebra Growth Modulation Asymmetric Biomechanical Growth Plate Loading Idiopathic Scoliosis Localised 3 D Vertebral Deformity Destabilisation of the Spine Neuro-musculoskeletal Dysfunction Postural Disorganisation © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Neuro-Musculo-Skeletal Dysfunction Postural disorganization affects the orientation of the whole skeleton: • Shoulder girdle • Rib cage • Pelvic girdle • Lower limbs • Gait is also affected! DREIDIMENSIONALE SKOLIOSE BEHANDLUNG CHRISTA LEHNERT-SCHROTH © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Neuro-Musculo-Skeletal Dysfunction Muscular dysfunction • Length, strength and direction altered • Shorter – concave side • Longer – convex side Muscles can not actively work to correct the progressing deformity DREIDIMENSIONALE SKOLIOSE BEHANDLUNG CHRISTA LEHNERT-SCHROTH 1998 © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Neuro-Musculo-Skeletal Dysfunction NEUROLOGICAL DYSFUNCTION SPINAL SYSTEM MOTOR CONTROL CENTER GROWTH MATURATION Abnormal Movement PERIPHERAL RECEPTORS Ligament / muscle / joint capsule FEED BACK © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Circle of Idiopathic Scoliosis Genetic Fault Temporary asymmetric delay in ossification (growth) of the posterolateral segment of vertebra Growth Modulation Stokes IA Asymmetric Biomechanical Growth Plate Loading Idiopathic Scoliosis Localised 3 D Vertebral Deformity Destabilisation of the Spine Neuro-musculoskeletal Dysfunction Postural Disorganisation © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Asymmetrical Loading of the Spine Once the scoliosis is established, the asymmetrical loading of the growth plates, due to the biomechanical forces action, results in an asymmetrical vertebral growth which increases the vertebral wedging increasing the spinal curvature. Stokes IA © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Hueter-Volkmann Principle • Compressive forces tend to inhibit skeletal growth. • Distractive forces tend to accelerate skeletal growth. • Scoliosis deformity holds pressure on the vertebrae which does not allow the bones of the spine to grow properly, basically stunting growth. • Repetitive dynamic loads placed on bone trigger remodelling; static loads do not. • The fundamental research proved that the bone growth is stimulated by the alternation of compression and decompression. © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Bone Growth Stimulation • Research has proven that bone growth is stimulated by the alternation of compression and decompression. • Static distraction does not stimulate the bone growth. - Modulation of vertebral and tibial growth by compression loading: diurnal versus full-time loading. Stokes IA et al, 2005 - Biomechanical spinal growth modulation and progressive adolescent scoliosis - a test of the 'vicious cycle' pathogenetic hypothesis: Summary of an electronic focus group debate of the IBSE. Stokes et al, 2006 - Static versus dynamic loading in the mechanical modulation of vertebral growth. Akyuz E et al, 2006 - Biological response of the intervertebral disc to dynamic loading. Walsh AJ et al, 2004 - The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. Hawes MC et al, 2006 © 2011 The Spine. Corporation Limited

The Spine. Cor® Dynamic Corrective Brace Catch up of the Vertebral Side Deficient in Growth • Curve opening needs to be focussed at the level of the initiating deformity. • Vertebral growth plate dynamic loading is essential to get a true correction. • Static opening merely stops progression and does not facilitate true correction. © 2011 The Spine. Corporation Limited