What Types of Spinal Curves Do We Treat?
We treat patients with mild, moderate, and severe scoliosis of varying curve patterns. Dr. Moramarco and the Scoliosis 3DC team have treated patients with scoliosis Cobb angle(s) starting at 10° and up to 120°. Our patients with kyphosis typically have thoracic Cobb angles ranging from 50°-85° (as measured on a lateral spinal x-ray). We take a proactive approach to treatment while others are ‘watching and waiting.’ That said, it’s never too late to improve quality of life, help with pain management, and halt the prospect of further progression.
Who is a Candidate for Our Schroth Method Treatment?
Adolescents, adults, and some juveniles with idiopathic, congenital and/or neuromuscular scoliosis may all benefit from our Schroth method program. We also treat patients with kyphosis (with or without scoliosis), Scheuermann’s disease, and post-surgical scoliosis patients (1-year post-operation or with written consent from their surgeon). Scoliosis is not one-size-fits-all, so Dr. Moramarco will recommend the best program for you, your child or loved one.
Why would a post-surgical patient want Schroth Therapy?
Post-surgical scoliosis patients choose to treat with us when there is pain, they are seeking postural improvement post-surgery, and/or when the spine begins to collapse above and below the spinal fusion(s). Our Schroth therapists can address all three and help improve the quality of life after scoliosis surgery.
Who is a Candidate for our Chêneau Bracing System?
Most small children, adolescents and adults with scoliosis are candidates for the Chêneau-Gensingen brace. Our 3D asymmetric CAD/CAM designed braces are Schroth method compatible. Each scoliosis brace is custom-designed based on an individual’s curve pattern and it addresses severe curves that are otherwise recommended for surgery at other facilities that specialize in scoliosis. Part-time bracing for adults may help with stabilization, improved posture, and pain reduction (on a case-by-case basis). Learn why we think our bracing system is the best brace for scoliosis management,
Who is a Candidate for the Kyphologic ® Brace?
Growing children, adolescents and adults with kyphosis, including thoracic kyphosis (kyphosis, kyphoscoliosis, Scheuermann’s disease) are candidates for the Kyphologic® brace. In the case of kyphoscoliosis, Dr. Marc will recommend the most appropriate brace style depending on the severity of the accompanying scoliosis. For adults with kyphosis, part-time bracing with the Kyphologic® brace may be appropriate to help with posture and back pain (on a case-by-case basis).
Who is a Candidate for the Physiologic ® Brace?
The Physiologic® brace is designed to address chronic low back pain in adults with thoracolumbar or lumbar kyphosis. Thoracolumbar/lumbar kyphosis presents as a ‘flattening’ of the normal arch in the low back.
How Long Does Treatment at Scoliosis 3DC Take?
Our intensive Schroth program consists of 12 or 17 hours of 1-on-1 treatment according to an individual’s Schroth method curve classification of one’s unique spine. Dr. Moramarco usually recommends shorter programs (typically 12 hours or less) when curves are less severe. This is typical for post-surgical patients, patients with juvenile scoliosis (under the age of 10), and patients with kyphosis without scoliosis. To learn more, please call and us and once we learn more about the individual case we can make our recommendations for treatment.
An intensive 17-hour program can be completed in just 4-5 days for long-distance patients (3-4 hours of daily scoliosis exercise instruction). For Boston area scoliosis patients, treatment can be spread out a bit but we always recommend a condensed, intensive Schroth program for optimal learning and efficiency. Scoliosis and kyphosis patients come to see us from all over the United States, Canada and beyond. In fact, we’ve treated patients with scoliosis from all over the world.
In addition to scoliosis exercise rehabilitation treatment we offer bracing options to be used alone or in conjunction with our Schroth method program. When opting for bracing alone, the process takes 4 days, minimum with advance scheduling. When Schroth therapy and bracing are done concurrently, brace measurement and fittings can be completed in the same time frame as the Schroth program. While we do not require that patients utilize both treatment options, we find that those who combine bracing and our specialized approach to Schroth therapy ultimately do have the best outcomes.
Scoliosis Bracing Questions Answered
Why is scoliosis bracing important?
First and foremost, bracing is recommended to reduce the asymmetric load on the spine–an important contributing factor of scoliosis curve progression. During the growth phase, it’s critical to have the best 3D spinal brace–one that attempts correction rather than just trying to stop progression.
Bracing is recommended for children and adolescents with idiopathic scoliosis with progressive curves and remaining growth. Research has shown that when an adolescent reaches skeletal maturity with Cobb angles at 30º or less, progression into adulthood is less likely (1). This is why controlling scoliosis progression during the adolescent years is essential. Time is truly of the essence when it comes to treating scoliosis.
For years, bracing had been a controversial topic amid scoliosis professionals, and to a certain extent still is; however, publication of BrAIST has quieted that debate and professionals who tell you bracing isn’t necessary for progressive curves should be called into question. BrAIST, released in 2013, studied the Boston Brace, primarily. Fortunately, now state-of-the-art 3D bracing for scoliosis offers patients an even better opportunity for an improved outcome at the conclusion of brace treatment.
Why the Chêneau-Gensingen ®?
Dr. Moramarco believes that if a child must wear a brace, it should be the most effective scoliosis brace available, and attempt correction. This belief is the result of his experience as the father of a daughter who was braced and progressed significantly (SpineCor, 2001). His professional experiences as the nation’s most experienced Schroth method provider and instructor inspired him to introduce the Gensingen brace ® in the US and Canada. Being in the unique position of having treated kids from all over the US, many who have presented with nearly every other scoliosis brace available–including the Boston Brace, the Charleston Brace, the Providence Brace, SpineCor, Scolibrace, and other Chêneau-style braces, he understands the importance of asymmetric, 3D bracing, either independently or in conjunction with the Schroth method.
The Gensingen Brace® is superior because it consistently offers patients 30% to 50% in-brace corrections– sometimes better. It offers a high rate of patient satisfaction (and we don’t need to tell you that when patients are happy, their parents are happy). It also helps improve and re-balance posture and offers the potential to reduce Cobb angle because of its in-brace correction effect.
Each brace is custom-designed according to a patient’s curve pattern and is a Schroth Method Compatible Brace. In fact, it’s Dr. Moramarco’s relationship with the brace developer, Dr. Hans-Rudolf Weiss, third-generation Schroth family member, that allowed the brace to be introduced here in the US.
Dr. Weiss and Dr. Moramarco share the same philosophy: Striving to halt scoliosis progression is not enough when the potential exists for improving trunk asymmetry and reducing the Cobb angle.
The Gensingen Brace® is the evolution of Dr. Weiss’s vast experience with scoliosis bracing. Results have shown that is is, by far, a scoliosis brace of the highest caliber in terms of design, performance, and comfort.
We began fitting Scoliosis 3DC® patients with the Chêneau-Gensingen Brace® in 2013. Over time, Dr. Moramarco has become even more excited about the improved prospects for kids with scoliosis as a result of wearing the Gensingen brace ®. Many of our patients have achieved some very impressive results, results in the medical establishment claim are unattainable with bracing.
How does the Chêneau-Gensingen ® differ from other braces?
The Chêneau-Gensingen ® differs from other braces in a number of ways. What you should know is that when attempting to correct the spine with bracing, or at least counteracting 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-the-brace, for the opportunity for a successful outcome at skeletal maturity. This is not achieved by applying compressive forces. 3D bracing accomplishes this by aiming for overcorrection or correction, whenever possible. (Overcorrection is more likely to occur for patients with mild curves. Moderate and severe curves will most likely achieve in-brace correction, but not necessarily to the extent of overcorrection).
The Gensingen also offers a bracing opportunity for kids that are closer to skeletal maturity–Risser 2,3, and 4. If your doctor told you “it’s too late to brace,” then the Gensingen Brace is the brace that could make a critical difference for your child, maybe even improve the spine enough to prevent surgery.
What is an in-brace correction and what factors affect in-brace correction?
In-brace correction is the amount (either in Cobb angle 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: spinal flexibility/stiffness, age, curve pattern, trunk shift, and brace fit.
What is over-correction and why do we strive for it?
Over-correction refers to instances during scoliosis treatment (whether it is curve-pattern specific scoliosis exercise, or Chêneau bracing) when the scoliotic curve returns to the center of the back then into the opposite direction of the curve. We strive for overcorrection during our treatments because it helps the patient attempting to halt curve progression and increases the likelihood of improving the curves. It can also help improve the postural symmetry so the patient appears more balanced.
What type of results can be expected when wearing the Gensingen Brace?
Scoliosis is an unpredictable condition. Factors such as age, stage of development, gender, spinal flexibility/stiffness, and various other conditions will play a role in determining the outcome at skeletal maturity. 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 are consistently demonstrating spinal improvements. At a minimum, we aim for halted progression, but always want more for your child.
When should a child be braced for scoliosis?
This is a topic of debate among professionals. Our contention is that patients with immature spines who are braced earlier will attain a better outcome. As stated above, when a patient can achieve overcorrection the potential for excellent results increases dramatically. This is why we think that waiting too long to brace and using the wrong brace could be a mistake.
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 and occurred in the weeks just prior to her arrival for treatment at 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 scoliosis, in-the-brace, to the best possible extent without causing pain.
How long will my child have to wear their scoliosis brace?
This is another difficult question since each case of scoliosis is different. Length of wear is a function of skeletal maturity and curve severity. In our office, we recommend kids continue to wear their braces right through skeletal maturity and then begin the “weaning off” process for the 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 is 10-years-old and is a Risser 0, the answer is most likely 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 (we don’t advocate watch and wait) 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. Managing scoliosis is a process.
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, she puts on her brace and feels relief and support almost immediately.
Other than bracing, what else can be done for AIS?
In addition to bracing, our intensive Schroth-based pattern-specific-scoliosis 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 during daily activities. 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 exercises. 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 will most likely depend upon the amount of growth remaining at the time bracing commences, in-brace-correction, and patient compliance. When bracing takes place in a skeletally immature patient, as early as possible in the growth process, the prognosis is often 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. 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. Please feel free to call us with additional questions.