Issuu on Google+

T r e a t me n t fo r A do l es c en t S c o l i o s i s


Contents Information on Scoliosis .......................................................... page 3 The SpineCor Dynamic Corrective Brace ............................... page 4 SpineCor Treatment Information ............................................. page 5 Useful Information for Parents ................................................. page 10 Patient Stories........................................................................... page 12 Case Studies ............................................................................. page 14 SpineCor Treatment Results .................................................... page 16 Treatment Cost Information ...................................................... page 18

2


Spinal Correction Clinics

Specialists in spinal correction, stabilisation and pain relief

Healthcare UK Limited has been providing clinical services since 1999. Healthcare UK Limited's Spinal Correction Clinics have been established to provide optimal treatment to patients with spinal deformity. Our multidisciplinary teams have extensive experience in the treatment and management of spinal deformities in both adults and children. Patients are fully assessed and only offered appropriate treatment with clearly advised objectives and prognoses.

What is Scoliosis? Scoliosis is the most common spinal deformity in children. It is a sideways (lateral) curvature of the spine. The spinal column curves and twists, causing problems which can also affect the ribs and pelvis. For the majority of children this is very mild and needs no treatment. However, for the small minority of children that need treatment, early diagnosis is important to prevent any further problems from developing. Scoliosis is best treated whilst the patient is young as the body responds better to treatment when the spine is still flexible and still growing.

What Causes Scoliosis? •

80% of cases are “idiopathic”, which in the past meant its cause was unknown. Today we know that such cases are triggered by a genetic fault causing unbalanced growth.

• Abnormal development of the bones in the spine which is present at birth (congenital). • Many conditions affecting the nerves and muscles (neuromuscular system) can cause scoliosis. There is no way of preventing scoliosis from occurring and, when it does occur, it is nobody’s fault.

Signs of Scoliosis • One shoulder may be higher and more prominent than the other. • One hip may be more prominent than the other. • Clothes may not hang properly.

3


SpineCor® Healthcare UK Ltd offers SpineCor® treatment consisting of a custom-fitted brace system which requires regular review appointments to ensure maximum effectiveness of the treatment.

SpineCor® Dynamic Corrective Brace •

The SpineCor® Dynamic Corrective Brace is the first and only truly dynamic brace, which can provide stabilisation or even correction of Idiopathic Scoliosis from a 15° Cobb angle and above.

Allows normal body movement and growth and permits normal activities of your child’s daily living.

Is worn easily and comfortably under clothing.

Increases children’s treatment acceptance, leading to better compliance.

4


SpineCor® Brace Components

Bolero (4) Corrective Bands (5) Pelvic Base (1) Crotch Bands (2) Thigh Bands (3)

The SpineCor® brace is made up of two sections: The first section consists of the pelvic base (1), the crotch bands (2) and the thigh bands (3). Its role is to act as an anchoring point and support for actions applied to the child’s trunk by the elastic corrective bands. The second section consists of the bolero (4) and the corrective bands (5). This is the part designed to correct the scoliosis curve. The fitting of the corrective bands is specific for each child and depends on their type of curve.

®

It is advised that children wear a bodysuit under the SpineCor brace: •

To keep the brace cleaner for longer

To add comfort by providing a barrier between the brace and the child’s body, reducing the likelihood of the brace rubbing.

To facilitate going to the toilet by detaching the bodysuit’s fastening.

5


SpineCor Treatment Information SpineCor Assessment Appointment An initial assessment appointment is required to confirm your child's suitability for SpineCor treatment. A detailed assessment will be made of your child’s medical history. Their x-rays will be reviewed and clinical examinations will be undertaken. Recent x-rays of the spine are necessary to determine the treatment suitability. If recent x-rays are unavailable, then x-rays can be arranged to be taken at the time of the assessment appointment if required. A letter of referral from your child's GP or Spinal Consultant will be required prior to this appointment to confirm whether your child will be suitable to proceed with treatment.

SpineCor Treatment Appointment During the treatment appointment, we will carry out more detailed evaluations before fitting the SpineCor brace: Clinical evaluation: to evaluate your child’s growth and the pattern of any postural abnormalities. X-ray evaluation: to evaluate your child's type of curve and its potential for progression. Postural Evaluation: to evaluate your child’s postural abnormalities by visual evaluation of their spine and simple measurements being taken, using a laser plumbline, scoliometer, protractor and ruler. SpineCor® Assistant Software: a computer will record data from all our evaluations and calculate your child’s specific curve classification. The software will also specify the exact brace fitting details for your child.

6


Once the brace is fitted we will evaluate the changes to your child’s spine and posture. A new x-ray of your child wearing the brace will then be required to confirm the results. At the end of the visit we will explain how to fit and take off the brace (don’t worry, it is very easy!). Your child will need to make further visits to our clinic for regular readjustments to the brace for the duration of their treatment.

SpineCor Physiotherapy Programme To further enhance and improve the treatment, we may recommend that your child undergoes a physiotherapy programme. To optimise the dynamic effect of the brace, we would encourage your child to perform any type of sport WEARING the brace (except for swimming). The SpineCor Physiotherapy Programme has been designed to complement the effects of the brace and reinforce the treatment. Your child will be prescribed precise exercises for their specific type of curve. Your child should only carry out these exercises to avoid interfering with the action of the brace. The physiotherapy programme, in conjunction with the brace, will provide optimal treatment for your child.

7


Frequently Asked Questions Does my child need a referral? Yes, a referral from a GP or SpinalConsultant is essential before an assessment appointment can be made. Will my child be suitable for SpineCor treatment? This can only be determined after an assessment appointment when your child's case can be evaluated.

Does my child need an assessment prior to SpineCor treatment? Yes. An assessment is essential to ascertain your child's suitability for SpineCor treatment. Full information regarding treatment aims and prognosis will be given at all times. Will my child be offered SpineCor treatment? Your child will only be offered SpineCor treatment if this is deemed an appropriate treatment for them during their assessment appointment. If SpineCor treatment is not recommended then we will advise you to seek further advice from a Spinal Consultant.

Will my child need x-rays during his/her assessment/treatment? Yes. Unless you already have relevant recent x-rays that you are able to bring with you to your assessment. A further in-brace x-ray will be required at the treatment appointment and then every six months during treatment. What are the indications for SpineCor treatment in children? The SpineCor system was designed for the treatment of Adolescent Idiopathic Scoliosis (from 15° Cobb angle and above). Today SpineCor® is also used frequently to treat Juvenile Idiopathic Scoliosis and some selective syndrome and neuromuscular related curves.

How long does it take to establish if my child is suitable for SpineCor® treatment? Assessment visits usually take around 45 minutes.

8


How long does it take to fit the SpineCor® brace? This depends upon the complexity of the case but anything from one and half hours to three hours. How long does my child need to wear a SpineCor® brace for? Usually the SpineCor® brace is worn for 20 hours per day. The four hour out of brace period should be taken on two or more intervals during the least active part of your child’s day. The brace must be worn whilst sleeping. How long will the SpineCor® treatment last? The length of treatment will depend on your child’s age when treatment is started and the severity of their curve. It is always a minimum of 18 months. Adolescents typically wear braces for an average of 26 months. Juveniles may require brace treatment for many years. How often will my child need follow-up appointments? An initial follow-up appointment is generally held between 4-6 weeks after the brace fitting. Following this, three monthly reviews are held to monitor your child’s progress and adjust the brace if necessary. These reviews take around 45 minutes. Is Physiotherapy treatment essential with SpineCor® treatment? No. SpineCor® treatment may in itself be considered a physical therapy which in many cases is sufficient. However, additional physiotherapy may be considered beneficial to your child, in which case it will be prescribed. How do I make an appointment? Contact one of our Clinic Co-ordinators on 01246 454682 who will assist you in making a convenient appointment to see one of our Clinical Specialists.

9


Information for Parents So, your child has been referred for the SpineCor brace? Both you and your child will be feeling a mixture of emotions - apprehensive, confused, scared, all of which are quite normal to feel. The purpose of this booklet is to give you an idea of what to expect and what lies ahead for your child, you and your family as a whole. Every family is different and will have its own way of dealing with things, but you might benefit from the experiences of other families and staff who have worked with them. At times it may well seem that your whole life revolves around the treatment and may place quite a lot of strain on your family. We are here to inform you and try and prepare you and your child for the treatment - if it is the treatment you decide on. Not all children and families will decide that this treatment IS for them. What have we learned from other families? We know that children/adolescents who have been through bracing can find difficulty with: • The sheer length of time the brace has to be worn, not just the number of hours each day but that it can be worn for several years (depending on the age at onset). • Boredom and frustration having to wear the brace. • Rubbing/pressure from the brace. • Peer pressure/feelings of being different. • Other peoples' reaction to the brace. • Not always being able to wear exactly what you want. • Effect on schooling (missing school, extra time for toileting ). • Uncertainty of the outcome - will wearing the brace REALLY help. For the parents, they can be worried by: • The length of the treatment. • The commitment for all the family. • Seeing their child stressed/upset and angry at having to wear the brace. • Seeing their child upset/stressed at having scoliosis and how this can/might affect them in the future. • Worried about the pressure/tightness of the brace and if it is affecting their child. • Having to take time off work for hospital visits. • The time their child has to take out of school.

10


So what's the best way to try and cope? We know that families seem to cope better when: • They have a clear and realistic picture of what the treatment involves. • They take things one at a time over the treatment period rather than building up high hopes that the progress will be quick, smooth and trouble free. • They understand that the brace, although ‘flexible’ is still a brace and is NOT the same as wearing NO brace. • They keep a normal life, where possible, during treatment for the child and the rest of the family. • The whole family share their feelings openly over the course of the treatment. Some families have found that contact with other families who have gone/are going through the same treatment is very valuable (although some prefer not to do this. You might find it useful, before the treatment, to sit down and make a list of things that you, as a family, can rely on to help you cope. This could be: • A good sense of humour. • Talking things through. • Taking one day at a time. • Ensuring that, as a parent, you lead the process, and that your child needs your guidance and support. You may then want to make a list of things that might hinder you. These could be: • You don’t talk worries over. • You don’t work together as a team. • You find it difficult to accept things when they don’t turn out exactly as you would wish. • You don’t like to ask for help. If you identify anything that may hinder the treatment and ability to cope with it, can you do anything about it? Preparation for the brace Before starting treatment the family should carefully consider what it will involve. It is a big commitment, not only for the child but the family too, with the brace being worn for at least 18 months. It might be useful to sit down and make a list of things, as a family, you want to know about the treatment and how it might affect you all. Talking through what is expected of your child and you as a family, prior to bracing, can help you decide if the treatment is right for you as a family; we would therefore advise you to talk to the team before any appointment to fit the brace is made if you have any concerns/questions. Open discussion about the brace, how it will affect you and your family, is essential if the treatment is to be effective. If the brace is to work, it needs to be worn!

11


Patient Stories Andrea's Story When I was 12 years old, my mum coincidentally felt my back and noticed that the left side of my spine was slightly raised. I went to see my GP and he sent me for an x-ray. The x-ray clearly showed I had scoliosis and had a lumbar curve measuring about 24 degrees and a small thoracic curve. It was suggested to do physiotherapy, which unfortunately did nothing. I was then referred to an orthopaedic surgeon who confirmed the fact that I had scoliosis but told me I should wait without a brace for 3 months to see how aggressive my curves would be and how they would behave during this period. When after three months I had another x-ray and saw my consultant for my results, he told me that my curve unfortunately had increased by 12 degrees and it was measuring about 36 degrees and my spine started to rotate as well. This is where I was told I needed to get into a brace as soon as possible to avoid further progression and the possibility of an operation. The first brace that I was told about was the Boston brace, however after a lot of research from my family and myself and after recommendation from our family abroad who already had experience with the spinecor brace, we came to the conclusion that boston brace was not for me and that’s when we looked into this and decided to go with the spinecor brace. I chose spinecor for two reasons. Firstly because it is the only brace that is flexible and that meant that I could do nearly all the things I used to do before and my movement wouldn’t get restricted and I wouldn’t be in pain while wearing it. Secondly I was worried if people could see it at school however you can’t see it at all, it’s like I’ve never worn a brace. Even when I wore it in the summer I never let it show through my clothes and I was never uncomfortable either! My first appointment was two years ago, during which I had the brace fitted. They checked my height, my balance; they measured the rotation of my spine and did other related tests that I had to do every three months to keep a record of how I was progressing. In general I was quite stable during my follow up appointments in my brace; however when I grew a little, it had a minor effect on my balance and rotation at times. The brace felt quite tight for the first few weeks and some parts of my body felt a bit sore at the beginning, however I still managed to wear my brace for the full 22 hours a day and sometimes more because I was very determined to do anything to help myself and avoid surgery. Every 6 months I had an x-ray which in general they showed that I was considerably stable; I only ever went up to 39 degrees after I had taken the brace off for 3 days for the first time after I had worn it for about 18 months. My most recent x-ray (after 24 months of treatment), showed unexpectedly amazing results. I had taken my brace off for 3 days and my results showed that my biggest curve, previously 39 degrees, went down by 10 degrees to 29 degrees! These results came as a complete surprise, because I had finished my growing so even if I stayed at 39 degrees I would have been okay, as we would have managed to keep it stable, however my brace helped me avoid surgery and I feel very grateful for that. Overall my experience with my brace has been much better than expected. I started, not knowing anything and being quite scared for the unknown, however spinecor brace and most importantly the very helpful, warm and supportive orthotists I used to see at my appointments during my treatment,has proved to me that they can help you get over any problems you might face and it is not impossible to have a positive result after all.

12


Laura's Story Hi, my name is Laura and I’m 16 years old. I was diagnosed with scoliosis at the age of 15 and put on the SpineCor treatment process two months later. I found the brace hard to adjust to at the start as many of my clothes didn’t disguise the brace or wouldn’t fit over it. I also found it quite painful as the brace rubbed on my thighs and under my arms. Other problems that I faced: •

I found it hard to sleep,

I couldn’t eat as much,

I felt uncomfortable and self-conscious

These have all improved as time has gone on and after 3 months of wearing the brace my sleeping pattern and appetite returned to how it had been before and I didn’t feel uncomfortable anymore. However, I still felt a bit self-conscious as I was unsure about how people would react to me having a brace. At the beginning I only told my best friends and told them not to tell anybody else but 15 months later I don’t care what people think about my brace as it is helping me. To start with I found it difficult to wear the bodies that came with the brace so I had to find an alternative to wear underneath it. I found that the stretchy t-shirts that you can get from shops like Primark worked really well as they came in a range of colours so they could go under different tops. The only problem that I found with this is that the brace rubbed a lot on my thighs but this was only for the first few weeks I found it extremely difficult last summer to adapt to my brace as we went to Spain on holiday. It was very hot, to help me enjoy my holiday we decided that I could take my brace off more than 2 x 2hours a day, this enabled me to play in the pool and sunbathe for some time on the morning and afternoon. I would make sure that I wore by brace on the evening and during the night, this made the holiday bearable so I could still have a great time. I just started my GCSE PE course when I was diagnosed with scoliosis. I was worried about how I was going to continue with it, but my teachers were supportive and didn’t draw any attention to me when I found it difficult to do a sport at the level that I would normally do it at. Once I got used to wearing my brace, I would sometimes take my brace off for my PE lessons, as part of my four hour allowance, to allow me to perform at a higher level. A year after wearing my brace, I told some classmates about it, they were surprised as they hadn’t noticed during PE and any other lessons that I had with them. So far, my experience in my brace has been ok, I have had some moments when its been uncomfortable but overall it has been a lot better than I thought. I have always tried to wear the brace 20 hours a day, and by doing this my back has greatly improved, it has been worth it.

13


Case Studies Patient 1

Pre-bracing 2012

Post-bracing 2014

This patient was treated in the brace from February 2012 to the 30th October 2014. She was at a Risser value of 2+, had a curve from T9 to L3 with an apex at T12 and a Cobb angle of 24째, and, even more importantly, had a shift to the left at T12 measuring 37mm. End of treatment (Risser4+) her Cobb angle measured less than 10째 (7째) and the shift left of T12 measured 7mm (this is the x-ray above). Overall Outcome: Correction

14


Patient 2

Initial Pre-treatment X-ray 2012

End of Treatment X-ray 2014

The patient was treated with the brace from December 2012 to December 2014. At the start of treatment the upper curve (from T6 to T11 with apex T9) measured 23째 and the lower curve (from T11 to L3 with apex L1/2 disc) measured 36째. The Coronal Balance (shift of the spine) at T12 measured 9mm left. At the end of treatment the upper curve measured 29째, the lower curve measured 26째 and the Coronal Balance at T12 measured 5mm left. A key factor in the good outcome was the compliance of the patient, ensuring she wore the brace its full 20 hours a day.

Overall Outcome: Stabilisation

15


Coillard et al. Scoliosis 2013, 8(Suppl 1):O47 http://www.scoliosisjournal.com/content/8/S1/O47

ORAL PRESENTATION

Open Access

A prospective interventional cohort study of 175 patients treated by the SpineCor orthosis, following the Scoliosis Research Society Criteria C Coillard*, A Circo, CH Rivard From 9th International Conference on Conservative Management of Spinal Deformities - SOSORT 2012 Annual Meeting Milan, Italy. 10-12 May 2012 Background The mainstay of the conservative treatment still remains the orthosis, which was demonstrated to provide a reduction of curve progression, possibly a decrease in the need for surgery, and sometimes a correction of the existing deformity. The effectiveness of the SpineCor orthosis compared with the natural history of the disease has already been shown for milder and moderate curves[1].

the percentage of patients who subsequently underwent surgery.

Results At two years post skeletal maturity, successful treatment (correction >5 degree or stabilization ±5 degree) was achieved in 100 patients of the 175 patients (57.2%) from the time of the fitting of the SpineCor orthosis to the 2 years follow-up point. 41 immature patients (23.4 %) required surgical fusion.(34 while receiving treatment and 5 in the follow-up period).

Aim To provide confirmation on the demonstrated effectiveness of the Dynamic SpineCor orthosis for adolescent idiopathic scoliosis, following the standardized criteria proposed by the SRS Committee on Bracing and Nonoperative Management[2], and to confirm the stability of the results two years after the end of the treatment.

Conclusions The SpineCor orthosis is effective for the treatment of adolescent idiopathic scoliosis. Positive outcomes are maintained after the weaning of the orthosis, since 86.1% of the patients stabilized or corrected their Cobb angle. Moreover, out of the 86.1%, 11.7 % of the patients still had correction of their Cobb angle 2 years after the end of the treatment.

Method From 1993 to 2011, 390 patients treated using the SpineCor orthosis respected the criteria for inclusion recommended by the SRS committee. 198 have a definitive outcome, and 175 have at least 2 years of follow-up. Assessment of brace effectiveness included; 1) percentage of patients who have 5 degree or less curve progression, and the percentage of patients who have 6 degree or more progression at skeletal maturity, 2) percentage of patients who have had surgery recommended/undergone before skeletal maturity, 3) percentage of patients with curves exceeding 45 degree at maturity (end of treatment) and 4) 2-years follow-up beyond maturity to determine

Published: 3 June 2013 References 1. Coillard C, Vachon V, Circo AB, Beausejour M, Rivard CH: Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the scoliosis research society for adolescent idiopathic scoliosis. J Pediatr Orthop 2007, 27(4):375-379. 2. Richards BS, Bernstein RM, D’Amato CR, Thompson GH: Standardization of criteria for adolescent idiopathic scoliosis brace studies: SRS Committee on Bracing and Nonoperative Management. Spine 2005, 30(18):2068-2075, discussion 2076-2067. doi:10.1186/1748-7161-8-S1-O47 Cite this article as: Coillard et al.: A prospective interventional cohort study of 175 patients treated by the SpineCor orthosis, following the Scoliosis Research Society Criteria. Scoliosis 2013 8(Suppl 1):O47.

Ste-Justine Hospital, Montreal, Canada

© 2013 Coillard et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

16


Coillard et al. Scoliosis 2012, 7(Suppl 1):O24 http://www.scoliosisjournal.com/content/7/S1/O24

ORAL PRESENTATION

Open Access

A prospective randomized study of the natural history of idiopathic scoliosis versus treatment with the SpineCor brace C Coillard*, A Circo, C Rivard From 8th International Conference on Conservative Management of Spinal Deformities and SOSORT 2011 Annual Meeting Barcelona, Spain. 19-21 May 2011 Background The purpose of this randomized study was to evaluate the effectiveness of the Dynamic SpineCor brace [1,2] for early adolescent idiopathic scoliosis (15°-30°) compared to the natural evolution of the disease. 47 patients participated in this study (26 treated and 21 controls). Material and methods The inclusion criteria where: 1) High risk of evolution: family history and/or proven progressive 2) No significant pathological malformation of the spine; 3) Girl or boy; 4) Initial Cobb angle between 15° and 30°; 5) Risser 0, 1 or 2. Assessment of brace effectiveness included; 1) percentage of patients who have 5° or less curve progression and the percentage of patients who have 6° or more progression at skeletal maturity, 2) percentage of patients who have had surgery recommendation/undergone before skeletal maturity.

Conclusions The SpineCor brace is effective for the treatment of early adolescent idiopathic scoliosis comparing with its natural history. Moreover, the positive outcome appears to be maintained in the long term. Published: 27 January 2012 References 1. Coillard C, Circo A, Rivard CH: A new concept for the non-invasive treatment of adolescent idiopathic scoliosis: the corrective movement principle integrated in the SpineCor system. Disabil Rehabil Assist Technol 2008, 3(3):112-9. 2. Coillard C, Circo AB, Rivard CH: SpineCor treatment for juvenile idiopathic scoliosis: SOSORT award 2010 winner. Scoliosis 2010, 5:25. doi:10.1186/1748-7161-7-S1-O24 Cite this article as: Coillard et al.: A prospective randomized study of the natural history of idiopathic scoliosis versus treatment with the SpineCor brace. Scoliosis 2012 7(Suppl 1):O24.

Results At three years follow up a correction was achieved in 50% of treated patient and only in 9.5% of controls, stabilization in 23.1% treated and 33.4% in controls and progression in 26.9 % for the treated group and 59.1% for controls. Three immature patients required surgical fusion while receiving treatment (11.5%) as well as 3 control patients (14.3%). For the control patients we considered as a failure if the Cobb angle worsened by more then 5° from the original angle and the patient then received treatment.

Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

Sainte-Justine Hospital, Montreal, Canada © 2012 Coillard et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

17


Treatment Cost Information How Much Does it Cost? A new simplified transparent pricing policy has been introduced, together with a staged payment plan to make SpineCor treatment more accessible to patients without insurance. Treatment for both adults and children is now charged at the same simple all inclusive price covering 12 months of treatment, regardless of complexity, number of follow up visits required or replacement parts required due to either growth or reasonable wear and tear.

Scoliosis Assessment * - £150 Detailed review of the patient’s medical history, x-rays and clinical examinations is necessary to determine suitability for SpineCor treatment. Most patients seeking treatment will have already have been seen by a consultant spinal surgeon and have had their diagnosis confirmed, however this does not absolutely confirm suitability for treatment. Patients who have not recently seen a consultant spinal surgeon should obtain a referral letter from their GP providing relevant medical information to scoliosis clinician prior to assessment. Recent spinal x-rays of the patient’s spine are necessary for determination of treatment suitability; if recent x-rays are unavailable then further x-rays will need to be taken prior the assessment appointment. The cost of assessment is £150 (payable in advance of the appointment).

12 Month SpineCor Treatment Plan * - £150 deposit plus 12 x £150 During your initial bracing appointment further detailed clinical measurements will be taken to establish baseline readings for optimising brace adjustment and future ongoing progress monitoring. The Brace will be fitted and adjusted according to clinical measurements prior to adjusted x-ray confirmation of efficient brace fitting. For children x-ray confirmation is always carried out on the day of brace fitting for adult patients x-rays are usually taken once the treatment has had time make some changes. Brace training is carried out to ensure the user and parent or carer fully understands the wearing program and how to fit the brace correctly. The cost of this treatment session including 12 months ongoing treatment follow-up for essential routine brace adjustments, maintenance and replacement parts is in total £1950, with two payment options; 1. £150 deposit (paid in advance of 1st appointment) plus 12 further monthly payments of £150 = £1950 2. £150 deposit (paid in advance of 1st appointment) plus balance of £1800 = £1950 (payable on commencement of treatment) In exceptional circumstances it may be necessary to combine the assessment and brace fitting appointments. A £300 deposit must be paid in advance of the appointment. Combination of scoliosis assessment and treatment appointments is only advised where there is reasonable certainty of treatment suitability.

* A Scoliosis Assessment is essential before treatment is commenced to establish suitability of treatment and the patients curve specific treatment plan.

18


What is included? Scoliosis assessment, clinical base line measures, brace fitting, user brace education, routine brace follow-up appointments according to our protocols and complete brace including two body suits and all replacement brace components necessary due to growth or wear and tear.

What is excluded? a) Inclusive treatment costs cover your SpineCor Clinical Specialist only. Should referral need to be made to consultant surgeon or other specialist, then their charges will be billed separately. b) The number of review appointments shall normally follow treatment protocol guidelines, in exceptional circumstances and at the sole discretion of your SpineCor Clinical Specialist, additional reviews may be provided free of charge. Patient demands for additional reviews outside of protocol may still be charged. c) Replacement brace components shall be provided at the sole discretion of your SpineCor Clinical Specialist when judged necessary due to growth or wear and tear affecting the performance of the brace. Body suits are not included in the free replacement policy due to wear and tear. Brace components shall not be replaced purely for aesthetic reasons. d) The cost of x-rays and any other imaging or diagnostic procedure are excluded from this plan all such charges will be billed to the patients directly by the hospital or imaging centre providing the service.

How much will x-rays cost? X-Ray fees range from ÂŁ120 to ÂŁ225, depending on the number of films required. These fees are set by the radiology company and are payable to their own offices.

How much will a Consultant Spinal Surgeon charge? Fees for a Spinal Consultations are approximately ÂŁ200 and are payable to the Consultant's own offices.

19


Spinal Correction Clinics

Specialists in spinal correction, stabilisation and pain relief

London, Sheffield, Cambridge Head Office Millennium House, Peak Business Park, Foxwood Road, Chesterfield S41 9RF Tel No: 01246 454682 Email: info@healthcare.uk.net Web: www.healthcare.uk.net

Manufactured in the UK

Healthcare Š 2010 Healthcare UK Limited All rights reserved. No part of the contents of this manual or any images therein may be reproduced or transmitted in any other form or by any means without the written permission of Healthcare UK Limited. ™SpineCor is a registered trademark of The SpineCorporation Limited


Healthcare Paediatric Brochure