Bracing FAQ

 The Chêneau-Gensingen® FAQ

Why is scoliosis bracing so important?

Bracing is recommended for children and adolescents with idiopathic scoliosis (AIS) with progressive curves and remaining growth, usually with Cobb angles over 20º to 25º.  Research has shown that when an adolescent reaches skeletal maturity with Cobb angles at 30º or less, progression into adulthood is less likely (1).  Controlling scoliosis during the adolescent years is essential. Time is of the essence when it comes to scoliosis.

For years, bracing was a controversial topic amid scoliosis physicians but the publication of the BrAIST has quieted that debate. Released in 2013, the conclusions of the study were that bracing for scoliosis is an effective conservative management tool.

When should a child be braced for scoliosis? 

The recommendation for bracing for scoliosis is dependent upon one or a combination of factors including age, Risser sign, Cobb angle(s) and estimation of progression. Timely brace treatment should occur when curves approach 25º, or for curves of 20º or greater prior to the primary growth spurt. Timing depends on estimation of the stage of growth.  A dramatic increase in a curvature can occur in only a few weeks time during a growth spurt. At Scoliosis 3DC we’ve treated one patient whose scoliosis increased by 13º in only 26 days. The increase was documented by x-ray of the weeks just prior to her arrival to our facility.

Is wearing a scoliosis brace painful?

It shouldn’t be physically painful to wear a scoliosis brace. If it is, a brace adjustment may be necessary. A good brace corrects the scoliosis, in-the-brace, to the best possible extent without causing pain.

Why the Chêneau-Gensingen®?

Dr. Moramarco believes that if a child must wear a brace for scoliosis it should be the most effective brace available. This belief is the result of his experience as a parent of a child who wore a scoliosis brace (SpineCor, 2001) but still progressed significantly, and his professional experiences over the last decade as a conservative scoliosis treatment specialist.

During his many visits to Germany to work with Dr. Weiss, Dr. Marc witnessed consistently impressive – 30% to 50% – in-brace corrections for patients wearing the Gensingen Brace®. Particularly impressed with the high rate of patient satisfaction and postural improvements he observed, he was anxious to introduce the brace in the U.S.

Both men share the same treatment philosophy: that striving to halt scoliosis progression is not enough when the potential exists for improving trunk asymmetry and reducing Cobb angle.

Dr. Weiss’s experience in bracing dates back to the early 1990s and the Gensingen Brace® is the evolution of his vast experience. It is, by far, a scoliosis brace of the highest caliber in terms of design, performance and comfort.

It’s been three years since we began fitting patients in the Chêneau-Gensingen Brace®. With time, Dr. Moramarco has become even more excited about the prospects of this brace for kids, and now for adults, too as we have witnessed patients achieve some very impressive results.

How does the Chêneau-Gensingen® differ from other braces? 

The Chêneau-Gensingen® differs from other braces in a number of ways. See our brace features page for specifics. It is important to note that to attempt to correct a scoliosis or counteract curve progression there are a number of factors that play a role. With a 3-dimensional brace, there must be room for corrective movement, in-brace, for the opportunity for a successful outcome at skeletal maturity. This is not achieved by applying compressive forces. The brace also aims for overcorrection/correction whenever possible. Patients with immature curves that achieve overcorrection are achieving tremendous results which is why waiting too long to brace and using the wrong brace could be a mistake.

The Gensingen also offers a bracing opportunity for kids that are nearer to skeletal maturity and/or kids that have more mature spines. If your doctor told you “it’s too late to brace,” then the Gensingen Brace may just be what your child needs.

What is in-brace correction and what factors affect in-brace correction?

In-brace correction is the amount (either in Cobb angles degrees or as a percentage) that the Cobb angle(s) decrease, as demonstrated by x-ray, while the patient is wearing their brace. This will depend upon several factors, most notably: age, curve pattern, spinal stiffness, trunk shift, and brace fit.

What is over-correction and why do strive for it?

Over-correction refers to when a scoliosis treatment (whether it scoliosis-specific exercise or Cheneau bracing) brings the scoliotic curve past the midline of the back into the opposite direction of the curve. Overcorrection is good because it can potentially halt scoliosis curve progression and increase the likelihood of reduction of the curve.

What type of results can be expected when wearing the Gensingen Brace?

Scoliosis is an unpredictable condition. Factors such as age, stage pf development, gender, spinal flexibility and others play a role in determining end-result. Attempting to predict the result of brace wear is not prudent. With that said, patients wearing the Gensingen Brace® in North America, in Europe and in Asia consistently demonstrate halted progression with the added benefit of demonstrated postural improvement, at minimum, with some patients experiencing Cobb angle reduction.

How long will my child have to wear their scoliosis brace?

This is another difficult question to answer since each case of scoliosis is different. Length of wear is a function of skeletal maturity. In our office, we recommend kids continue to wear their braces right through skeletal maturity and then begin the “weaning off” process for best results. Dr. Moramarco is the Gensingen Brace® expert in the United States. He will advise you on the proper course of action.

Will my child need more than one brace? 

Growth in children is unpredictable, so the answer to this question is dependent upon a variety of factors. If your child 10-years-old and is a Risser 0, the answer is probably yes. If your child is fit in the brace at a Risser stage 3 or 4, then perhaps one brace will be all that is necessary, but maybe not. As we all know, during puberty, kids tend to grow taller, and often wider. Growth can come early for some kids and later for others.

Be aware that throughout the scoliosis management process, the most important thing is that the Gensingen brace fits optimally and is adjusted for the maximum correction effect. Once a brace no longer allows room for growth, but the child is still not fully grown, the brace should be replaced. When a brace doesn’t fit properly it can’t work optimally.

When initial wear begins at the appropriate time (don’t watch and wait around to see what happens–be proactive with bracing), the potential for out-of-brace improvement increases. This means that any successive braces may help kids achieve additional correction (if correction was achieved with the first brace, and even if it wasn’t it is possible that some correction could still occur). This is how the Gensingen system can help kids achieve correction.

Is the Gensingen scoliosis brace suitable for adults?

Yes. Absolutely. While it is not realistic for adults with scoliosis to expect that brace wear will result in Cobb angle reduction (although one of our patients claims that she has) adults who currently wear the Gensingen Brace report improvement from a variety of symptoms of scoliosis. These include pain relief or reduction, postural improvements and spinal support. We have one adult patient who calls her Gensingen Brace “the magic brace.”  This is because after years of experiencing mid-day spinal collapse and fatigue when she puts on her brace she feels better almost immediately.

Other than bracing, what else can be done for AIS?

In addition to bracing, our intensive Schroth-based scoliosis-specific exercise program is designed to educate and empower the patient while providing the skills and tools needed to manage scoliosis, for life. We teach patients Schroth Best Practice® principles and how to incorporate those principles into daily activities. It is our goal to make fighting curve progression  second nature. This is the unique benefit of the advancements to the Schroth method known as Schroth Best Practice®.

Our patients re-learn sitting, standing, lying, and other positions used in daily. Instruction is always according to individual curvature. We also teach patients how to modify postural habits such as carrying, walking and more. Our Schroth Best Practice® back school addresses scoliosis from the sagittal plane, too. We incorporate spinal mobilizations and include 3-D Made Easy® exercises, in addition to more traditional Schroth exercise. It’s comprehensive!

Our goal is to educate and empower patients and show them how to avoid feeding into curve progression as per the Vicious Cycle (2). Our two-pronged approach (scoliosis bracing and Schroth scoliosis-specific exercise, at one facility, offers patients, both adolescents and adults, the best chance for successful scoliosis management in the long-term.

What constitutes successful brace treatment?

When the Cobb angle of a high risk curve is stabilized within the limits of the accepted margin of error (+/-5°) through skeletal maturity, this is generally regarded as successful brace treatment by most of the medical establishment. With the Chêneau-Gensingen® brace, we strive for more! We attempt to improve curvature (to some degree) as well as postural appearance. Success is most likely to depend upon the amount of growth remaining at the time bracing commences and patient compliance. When bracing takes place in a skeletally immature patient  as early as possible in the growth process the prognosis is excellent. Some degree of curve correction is even possible when the brace is worn full time during residual growth. These statements are made based on results of patients previously braced in the Chêneau-Gensingen® (see trunk remodeling paper below and link to the fine art of bracing scoliosis by Dr. Weiss. Please consider that each individual is different and bracing success is dependent upon timing and compliance, among other factors.

Is the Cheneau-Gensingen® brace covered by insurance?

Check with your individual insurance company. The Chêneau-Gensingen® is a fairly new innovation in bracing, especially in the United States. Insurance companies and plans vary.

Some patients have been successful in attaining coverage, either full or partial. One particularly persistent mom told us her company wanted to deny coverage. She stressed to them that the Gensingen brace is unlike the one prescribed by her doctor since it allows her daughter  greater independence at school (the Gensingen brace closes in the front, not the back). They then agreed and paid her claim. Like other effective scoliosis braces, the Gensingen Brace is a TLSO. It incorporates Chêneau principles, used successfully in Europe for years.

We are happy to guide you in your conversations with your insurer and to provide you with any necessary paperwork to file for brace reimbursement.

It is always our goal to offer patients the absolute best in conservative management for scoliosis.

(1) http://www.ncbi.nlm.nih.gov/pubmed/12578488

(2) http://www.ncbi.nlm.nih.gov/pubmed/8727190?dopt=Abstract&holding=f1000,f1000m,isrctn

________________________________________________________________

For additional information about the newest Chêneau brace for scoliosis, read the following:

Weiss HR, Moramarco M. Remodeling of trunk and backshape deformities in patients with scoliosis using standardized asymmetric CAD / CAM braces. Hard Tissue 2013 Feb 26;2(2):14.

 

 

 

 

Leave a Reply

Your email address will not be published. Required fields are marked *

Time limit is exhausted. Please reload CAPTCHA.