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FFECTING 7 MILLION AMERICANS of all
PHOTO: Keith M. Smith, CO, LO, FAAOP, Orthotic & Prosthetic Lab Inc.
ages, scoliosis remains a bit of a “mystery” condition, with a full 85 percent of cases defined as idiopathic. Scoliosis is most commonly diagnosed between the ages of 10 and 15, with females being eight times more likely than males to have a curve progress to a stage that requires treatment. Each year, 30,000 children are fitted for a brace for scoliosis, and 38,000 people with scoliosis diagnoses under spinal fusion surgery. Curvatures of the spine are traditionally measured by Keith M. Smith, CO, LO, FAAOP (left) works with Laura Hartung, CO, and Glenn Schmidt, CO, the “Cobb method” and diagto mold for an asymmetrical TLSO for a right thoracic left lumbar curve on the Risser table. nosed in terms of severity by the number of degrees. Studies have indicated that braces, when used Evolving Diagnostic Tools structures actuwith full compliance, may successScoliosis is typically confirmed ally are in space,” through a physical examination, an says Tom Gavin, fully stop curve progression in about X-ray, spinal radiograph, CT scan, or CO, LO, national 80 percent of children with scoliosis. MRI. But as new technologies come orthotic specialist For optimal effectiveness, the brace to market, the tools available to assess at Hanger Clinic’s should be checked regularly to ensure new cases of scoliosis are expanding, National Orthotic a proper fit, and in many cases may and clinicians have more options than Program. “In the need to be worn 16 to 23 hours every Tom Gavin, CO, LO operating room, ever at their disposal when making day until growth stops. their evaluations and treatment they look very Effectiveness of orthotic intervenrecommendations. “The means of different.” Gavin designed the tion was demonstrated in a widely capturing images have changed, with Rosenberger thoracolumbosacral read study published an October 2013 CAD systems, scanning equipment, orthosis (TLSO) in 1983 to apply issue of the New England Journal of and digital X-rays allowing for 3-D Milwaukee brace forces without a Medicine. Titled “Effects of Bracing in metal superstructure and neck ring, Adolescents With Idiopathic Scoliosis,” imaging,” says Debra Auten, CPO, LPO, who works at Cook Children’s Hospital and has updated that design to be the research concluded that “bracing in Fort Worth, Texas. CAD-based, now called the ProSpine significantly decreased the progression Using advanced CAD/CAM and scoliosis orthosis. When training of high-risk curves to the threshold computer technologies allows for more orthotists, Gavin makes sure that all for surgery in patients with adolescent specific placement of pads, for “more residents he works with observe and idiopathic scoliosis. Longer hours intense pressure in braces that aren’t report on at least one spinal fusion, of brace wear were associated with symmetrical,” says C. Ralph Hooper Jr., for a fuller understanding of the greater benefit.” CPO, president of Carolina Orthotics & human spine. While these findings are important, Prosthetics. Gavin advocates for a studied some of today’s orthotists are delving Today’s orthotists are learning to approach to scoliosis patient care: “I deeper into bracing protocols for look beyond the X-ray to formulate can help many more people with an patients, looking beyond the coronal the ideal treatment plan for each orthosis by being meticulous with the plane and assessing patients’ flexibility individual scoliosis patient. “X-rays application of biomechanical princito determine optimal orthotic interare our current, most precise way to vention on a case-by-case basis. These ples of treatment, combined with a document curve severity, pattern, clinicians, while sometimes differing kind clinical approach,” he says. “Most and progression, and to diagnose any in their approaches to treatment, all importantly, I believe in what we do, co-morbidities, but are a poor depicemphasize the importance of treating and I believe that patients and families the patient, and not just the X-ray. can sense if you believe in your work.” tion of what these three-dimensional O&P ALMANAC | DECEMBER 2016
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