While every scoliosis curve seems to differ in its presentation, we believe scoliosis curves do form into predictable patterns. Classification systems attempt to find patterns and group curves into these patterns (classes). Several classes have been described in the literature, however, we believe that the king classification is best suited for developing appropriate brace corrective force applications. The King classification was developed to assist with surgical correction and described classes as King 1, King 2, King 3, King 4 and King 5. We have modified the king classification to specifically address brace force corrections. We call the classification system the "Brace Class", and classify scoliosis patterns as follows:
A: 4-curve -Lumbar, Thoraco-Lumbar
B: 4-curve -King 1 Lumbar Double
BC: 4-curve -King 1/2 Double Major
C: 4-curve -King 2 Thoracic Double
D: 4-curve -King 3 Thoracic Major, Lumbar Minor
E: 4-curve -King 3 Thoracic Major Lumbar Neutral
EF: 3-curve -King 3/4 Thoracic Major Lumbar Neutral
F: 3-curve -King 4 Single Thoracic Curve
G: Decompensation curve
H: King 5 Double Thoracic
The King 5 curve pattern (Double Thoracic) does not have an associated "Brace Class" as the high thoracic curve has usually too high an apex to be significantly impacted with bracing. We therefore use a King 3 or King 4 pattern brace for these (King 5) curve types. We find this curve type does not respond as well to conservative treatment and has a higher probability of progression. It is therefore better to treat earlier with bracing and use in combination with aggressive postural corrections (e.g. Schroth).
How does The L.A. Brace TM work?
The L.A. Brace TM is a unique new concept in scoliosis bracing. It has been said in the past that all scoliosis braces are "a rigid structure to which correction pads are applied". These typical rigid scoliosis braces are symmetrical structures that have thick liners and work by applying thick correction pads to key areas of the brace to create an asymmetrical interior surface. The system relies on a very experienced orthotist been able to very accurately position the pads and then modify the thickness and positioning of these pads as directed by the ensuing "in-brace" x-ray. The resulting brace is typically 9-25mm thick.
The L.A. Brace TM, like most European Cheneau type braces, differs from this mentality. The L.A. Brace TM is an asymmetrical brace specifically and mathematically designed to incorporate the necessary corrections and voids. The resulting brace is typically 2-3mm thick.
A limiting factor in scoliosis bracing is the data acquisition system. Generating accurate information of the patients size and shape is critical to creating an effective brace. The L.A. Brace TM uses a unique, proprietary system called A.G.P. that accurately predicts the patients data set, ensuring an accurate model irrespective of the skill or experience of the orthotist.
How does the AGP data acquisition system differ from other systems?
There are essentially 5 techniques for acquiring pt size and shape information.
This is theoretically the least accurate method. It has however become the standard for post-op bracing that are of a symmetrical design, have gradual changes in brace contours and are usually minimally impacted by inaccuracies in measurements. Conversely asymmetrical scoliosis braces have acute changes in brace contour and are significantly affected by inaccurate measurements. Changes to the measurements produce changes in the position and direction of the force applications, rendering the brace ineffective.
2. Digital Photography and Measurements
Still predominantly relies on measurements, resulting in inaccuracies and inconsistency.
Although at first impression this may seem an accurate system, it is very much prone to inconsistency in the quality and accuracy of the cast. In addition it is very time intensive and variation occurs in how well molded the cast is and whether pressure is exerted that could minimize or exacerbate a curve. It also can be an uncomfortable procedure and sometimes embarrassing for female patients.
4. Non-Contact Systems
Imaging and Scanning non-contact systems now exist that potentially provide the most accurate patient shape information. Precise shape information is essential for other applications, such as below knee socket design, however, for scoliosis bracing, the patients' pre-brace shape bears minimal relevance to the shape of the scoliosis brace that is designed to modify the alignment of all the segments of the torso and thereby produce changes to the shape of the patient.
5. Algorithm Generated Predictions (AGP) Represents a major advancement in data acquisition technology. Through the analysis of hundreds of patients' size and shape data, relationships were found to exist between certain key variables. Complex algorithms were then developed that can accurately estimate the various dimensions of the patient based on these certain key pieces of information. The resulting AGP system is less subject to the inaccuracies of other methods and is the only system that accounts for "brace re-modeling".
How much correction can I expect?
Studies have usually suggested that generally about 50% "in-brace correction" is needed from bracing to be effective. More recently, Clir et. al. (Correlation between Immediate In-Brace Correction and Biomechanical Effectiveness of Brace Treatment in Adolescent Idiopathic Scoliosis - Spine 2010; 55: 1706-1713) demonstrated scientifically that a 48% value should be used for flexible curves and 27% for stiff curves. However these numbers, while being a great start point, should not be used to critique each individual brace. "In-brace correction" is affected by other factors including sex, age, size and classification. Patients typically exhibit very good initial correction with The L.A. BraceTM then correction is maximized within a short period. Studies show that correction usually has a gradual reduction in effect over time. However The L.A. BraceTM appears to do a better job of minimizing this loss effect over other rigid bracing systems, particularly when combined with Schroth therapy.
"Most curves show best correction at the initial application or a few months thereafter, and correction tends to have a gradual loss of effect after this initial period." Renshaw TS. Orthotic treatment of idiopathic scoliosis and kyphosis. AAOS Instructional course Lecturers 1985;38:110-118
"Mean correction in-orthosis fell from 50 percent initially to 23 percent at the stage for weaning to begin" Emans JB, Kaelin A,Bancel P,et al. The Boston bracing system for idiopathic scoliosis: follow up results in 295 patients. Spine 1986;11:792-801
"...after 6 months, the force values remained unchanged but the mean correction of the curves had dropped from 37 percent to only 14 percent" Chase AP,Bader DL, Houghton GR. The biomechanical effectiveness of the Boston brace in the management of adolescent idiopathic scoliosis. Spine 1989;14:636-641
We have found that the A.G.P. software can fairly accurately estimate the expected in-brace correction with The L.A. Brace TM. This information helps us to understand if there is a problem with the brace and helps to give us a prediction on the eventual outcome.
Click here to go to the correction prediction calculator page.
Why is my patient's correction less than expected?
Several factors can cause The L.A. BraceTM to be less effective than predicted. These include but are not limited too:
1. The brace is not worn tight enough
2. The brace is not worn for enough hours daily
3. The wrong classification was used to design the brace
4. The brace was trimmed down too much by the orthotist
5. The patient is less flexible than first estimated
The curve(s) have increased during brace treatment - why?
Several factors could be in play if a curve increases rapidly while wearing the brace theses include but are not limited to:
1. Curve is a King class 5 (these curves are generally not correctable with a brace and will typically progress regardless of the brace)
2. Brace is not being worn tight enough. Patient may have lost weight or became more flexible
3. Brace is not being worn for enough hours daily
4. Brace is now too small and force corrections are no longer in the correct place
5. Patient is overweight
How long will The LA BraceTM last?
Our prior experiences have found that symmetrical compression braces such as the Boston brace typically last between 6 and 12 months. The L.A. Brace TM appears to last a little longer than most other bracing methods. As the brace is designed to have many void areas, there are places for the body to "grow into", hence more growth is accommodated by the brace. For most adolescent children the brace will therefore last between 8 and 20 months.
What are the advantages of The L.A. BraceTM ?
The advantages of The L.A. Brace TM can be summarized as follows:
1. Unique and accurate data acquisition system
2. 3D tri-planar correction
3. More consistent correction
4. Good correction even with minimal orthotist modifications
5. Lower profile design
6. Thinner and cooler than other designs
7. Lasts longer
8. Less correction loss
9. sufficient voids to be compliant with Schroth treatment
How can I start using The L.A. BraceTM ?
The L.A. Brace TM can only be provided by orthotists trained and certified to use The LA BraceTM.
Physicians - Please review the list of approved orthotists. If there is no orthotist in your area, you have the following options:
1. arrange for your patient to travel to the nearest facility
2. contact us to request and arrange for a certified LA Brace orthotist to do a biweekly bracing clinic in your area.
3. Have your local scoliosis specializing orthotist contact us to arrange for training and certification.
Orthotists - You must be currently specializing in scoliosis to be eligible to be trained and certified to use The LA BraceTM. Contact us for training and certification information.
The LA Brace Company
16430 Ventura Blvd Suite 304
Encino, CA 91436
Click here to open your email client and send us an email or you can visit our Contact Us page