© 2011 The SpineCorporation Limited Pediatric Treatment Goal SpineCor Custom Scoliosis Brace The SpineCor ® Dynamic Corrective 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 SpineCor © 2011 The SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Paediatric SpineCor Brace

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

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

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

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

1. Lateral Wedging 2. Anterior/Posterior Wedging 3. Rotational Deformity © 2011 The SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Localised 3D Vertebral Deformity

Rib Deformity Decreased distance between the ribs in concave side Highlights the lateral wedging of the vertebrae © 2011 The SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Evidence of Lateral Wedging

Modification of the sagittal profile Hypokyphosis Hypolordosis Flat back © 2011 The SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Evidence of Anterior/Posterior Wedging

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 SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Evidence of Rotational Deformity

INITIAL LOCALISED 3D 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 SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Localised 3D Vertebral Deformity

The other vertebras are disoriented but not deformed! © 2011 The SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Localised 3D Vertebral Deformity

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

Consequence of the initial 3D 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 SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Destablisation of the Spine

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

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

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

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

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

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

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

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 SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Asymmetrical Loading of the Spine

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 SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Hueter-Volkmann Principle

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, 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, Static versus dynamic loading in the mechanical modulation of vertebral growth. Akyuz E et al, Biological response of the intervertebral disc to dynamic loading. Walsh AJ et al, The transformation of spinal curvature into spinal deformity: pathological processes and implications for treatment. Hawes MC et al, 2006 © 2011 The SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Bone Growth Stimulation

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 SpineCorporation Limited The SpineCor ® Dynamic Corrective Brace Catch up of the Vertebral Side Deficient in Growth