The London Orthotic Consultancy launched its own Cheneau-Gensingen derivative scoliosis brace in January 2022, the LOC Scoliosis Brace. Our brace has been fine-tuned according to feedback from our scoliosis patients and from referring spinal consultants. This is to ensure we are achieving as much skeletal correction as possible in-brace for each individual user, whilst also making our brace as comfortable as possible.
The London Orthotic Consultancy has been providing bracing treatment for scoliosis since it opened in 2005. Between 2016 and 2021, LOC prescribed and fitted derivatives of the Cheneau-Gensingen brace for its scoliosis patients where active intervention was indicated.
Dr Jaques Cheneau developed this first brace in 1979. His brace design acknowledged that scoliosis is a three-dimensional condition and focuses on the three-dimensional correction of the spine in the coronal (front), transverse (rotational) and sagittal (side) planes. Goals for brace wearers are stabilization at a minimum, but LOC has witnessed first-hand significant spinal corrections in our patients, particularly juveniles and early adolescents.
Since its initial development, Cheneau bracing has been intertwined with the Schroth concept for scoliosis. Dr Cheneau visited Katherina Schroth and Christa Lehnert-Schroth at their renowned clinic in Germany. He immediately understood the efficacy of the Schroth breathing concept and incorporated this into his brace designs using the augmented Lehnert-Schroth curve-pattern classifications, which for decades have been the basis of Schroth scoliosis treatment.
We now have almost a year’s quantitative data on the in-brace curve correction we are achieving with the LOC Scoliosis brace – it’s just over 86%. This compares with Boston braces which achieve 50% and other asymmetric braces that are available in the UK that achieve between 50-65%.
In-brace correction is of paramount importance and is one of the major contributors to achieving a reduction of true skeletal alignment (Cobb angle).
For adolescents with idiopathic scoliosis, time is of the essence when considering treatment options. At a time of rapid skeletal growth, the chances of existing curves getting worse are high.
Because of this, we have introduced a same-day service where our scoliosis patients can be assessed in the morning and have their bespoke brace fitted in the afternoon.
LOC can provide this service because of the combined expertise of our scoliosis team that can assess, model and manufacture our brace in-house without requiring any outside input. The benefits of this service are being increasingly recognised by spinal consultants in London who understand the time sensitivity of providing corrective treatment for scoliosis if surgery is going to be avoided.
The general protocol in the UK on the NHS is, if the Cobb angle is less than 20°, the client is to be monitored. If the Cobb angle measures between 20° and 40°, then typically a patient will be referred to an orthotic service for a Boston or a TLSO brace to delay the progression of the curve.
According to NHS guidelines, if a curve exceeds 40° then the patient would be advised to have surgery. To slow the progression of the curve during growth spurts, the Boston and the TLSO brace are prescribed by the NHS.
In contrast, LOC uses a published risk of progression formulae – which considers the patient’s age, skeletal age (Risser sign) and the size of the presenting curve. If it is agreed that a LOC Scoliosis Brace is required, we can actively reduce the curvature by loading the spinal bones 3 dimensionally to change their shape (thereby reducing the Cobb angle) whilst growth is completed.
The LOC Scoliosis Brace also:
The LOC Scoliosis Brace is a much more tailored brace with bespoke 3-point pressure systems. This means that we can keep plastic down to an absolute minimum, making them smaller and more comfortable than traditional NHS Braces.
Left: Adolescent male patient wearing a traditional Boston brace. Right: a bespoke LOC Scoliosis Brace on the same patient.
The general protocol in the UK is that if an x-ray is taken in-brace, a ‘good’ brace should aim to reduce the original curve by 50%.
At LOC, we often refer patients for a rapid low-dose scan to confirm the efficiency of our braces following the fitting. This scan is typically performed at the 2-month mark in other braces, and changes are then made to improve the fit of the brace and the correction in the brace. We have found that a rapid scan gives the clinician a very clear indication as to the correction that will be achieved, whilst ensuring no time is wasted (and therefore correction lost) while waiting for this scan.
While it varies from patient to patient, the LOC Scoliosis Brace offers more than 50% skeletal correction. To the extreme, we have seen corrections exceeding 100% (as below) in the LOC Scoliosis Brace, which is why these braces can be termed ‘over-corrective’.
In these instances, it is possible to proceed with reduced brace wearing hours, or if full-time bracing is still indicated, the brace can be altered. This ‘over-correction’ gives the wearer the greatest chance at skeletal correction. If for any reason, our clinician is not fully satisfied with the skeletal in-brace correction after receiving the x-ray, the brace will be re-modelled and re-made (free of charge) as part of a multi-colleague meeting – this ensures all our patients are in gold standard braces, whilst not losing any possible corrective time in-brace.
Examples of correction that have been achieved in the LOC Scoliosis Brace:
Example 1: Over correction of a curve in a LOC Scoliosis Brace. This patient was then able to reduce the hours of brace wear.
Example 2: 80% in-brace skeletal correction in a LOC Scoliosis Brace.
Example 4: A 14-year-old patient with 54 degree Cobb angle prior to treatment. In-brace scan after 5 weeks shows the curve reduced to 14 degrees.
Example 3: Excellent in-brace correction in a LOC Scoliosis Brace.
Example 5: A 12-year-old patient with 26 degree Cobb angle prior to treatment. In-brace scan after 7 weeks shows the curve reduced to 5/6 degrees.
Due to the 3-dimensional focus built within the LOC Scoliosis Brace, we expect to see postural improvements within 2 months, which continue to improve with good brace compliance. This can also be true in adult scoliosis patients. This can be in the ‘rib hump’ measure (rotation from the scoliosis), but also in waistline symmetry, shift of the hips and general postural re-balance. If we are able to ensure the weight line coming down from the head is more centralized over the pelvis following treatment, the patient’s overall prognosis is much improved.
Example 1: Waistline and pelvic correction in an adolescent after only 4 weeks of wearing a LOC Scoliosis Brace. This will continue to improve throughout treatment.
Example 2: Almost perfect posture in young patient nearing the end of treatment which combined bracing with specialist physiotherapy.
We then plan for the in-brace x-ray and review the correction and adjust the brace as necessary.
Once this has taken place, we monitor each patient's progress with regular review appointments - typically every 2-3 months. We welcome communication from parents and patients throughout the treatment with our clinical team. We are then able to quickly respond to make brace adjustments as a patient grows.
Should you have any further questions, we would be delighted to offer a virtual free of charge phone call or assessment. Please drop an e-mail to [email protected] or complete a contact form.
Alex has been in full-time bracing, managing around 22 hours a day, due to the comfort of the brace. This has been combined with daily Scoliogold exercises provided by Scoliosis SOS, our partner in providing non-surgical treatment for scoliosis ... continue reading ...
We talk to the father of one of our scoliosis patients Ricarda, a thirteen-year-old horse rider and regional kickboxer, about her experience with adolescent idiopathic scoliosis and treatment with the Cheneau-Gensingen brace ... continue reading ...
In year three of school, Daisy’s mum, Sara, noticed something amiss with her posture. “I’m an orthopaedic physiotherapist, so I recognised that something was not quite right and suspected that we might be looking at scoliosis,” she explains ... continue reading ...
LOC recently heard from one of our young patients, Beau, who was diagnosed in 2020 with juvenile idiopathic scoliosis. Beau has embraced her treatment programme wholeheartedly. Her positive outlook and ‘can-do’ attitude are inspiring ... continue reading ...
It is fair to say that Venetia had been through the mill before she came to see us in March. It started about 3 years ago when Venetia kept getting bad cramps at night. Having rejected the quinine prescription suggested by her GP ... continue reading ...
Ariana was examined by LOC clinicians who checked for spinal rotation using a scoliometer device that measures how much a rib hump protrudes - known as ‘angle of trunk rotation’ (ATR) ... continue reading ...
LOC first met 11-year-old Yasmin after she found out she had adolescent idiopathic scoliosis quite by chance; an X-ray taken for a chest complaint revealed she had abnormal twisting and curvature of the spine ... continue reading ...
Motivated Angelina is a thirteen-year-old scoliosis patient currently going through scoliosis treatment, here her mother Paola talks to us about her scoliosis journey and her experience with the brace ... continue reading ...
Through bracing treatment with the dynamic chest compressor, Jack has achieved 90% correction in his pectus carinatum after only two months. Here, mum describes Jack's non-surgical treatment journey.
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