Scoliosis Clinical Research

Clinical research

Since commencing its scoliosis treatment, the London Orthotic Consultancy has established itself as a clinic at the very forefront of scoliosis brace design. As such, we are now in a position with the LOC Scoliosis brace where our work is being internationally recognised as pioneering in terms of brace design, development and the levels of correction we can achieve.

Since we launched the LOC Scoliosis Brace in 2022, we have been collecting continuous data from all our scoliosis patients who consent to participate and we have conducted this research alongside St George’s University Hospital London.

As a result, we have been invited to present our research and clinical findings at several leading conferences worldwide, aimed at conservative as well as surgical treatment of scoliosis. The most eminent of which has been The Scoliosis Research Society, the leading international body dedicated to scoliosis research.

Below you can find a detailed list of the conferences where we have presented our clinical findings.

Jack Choong presents scoliosis clinical research findings from the London Orthotic Consultancy at Spine Week 2023 Conference in Melbourne, May 2023

Senior orthotist Jack Choong presents scoliosis clinical research findings from the London Orthotic Consultancy at Spine Week 2023 Conference in Melbourne, May 2023

Anna Courtney, Lead scoliosis clinician at the London Orthotic Consultancy fitting a LOC Scoliosis Brace

Anna Courtney, Clinical Lead Consultant & Senior Orthotist fitting a LOC Scoliosis Brace

Participation in NHS BASIS study (Bracing Adolescent Idiopathic Scoliosis Study)

In 2023, The London Orthotic Consultancy was invited to participate in the NHS BASIS study (Bracing Adolescent Idiopathic Scoliosis Study).

This long-term study is currently scheduled to continue until 2031. It has been designed by surgeons, scoliosis patient representatives and researchers to try to further the evidence surrounding scoliosis bracing.

More than twenty hospitals across the UK are involved and young people aged 10-15 years old with a diagnosis of scoliosis are being asked to participate in this randomised controlled trial.

The objective of the study is to compare two different types of back brace, one which is worn most of the day and one which is worn only at night time. A version of the LOC Scoliosis Brace will be prescribed and fitted to the night-time group.

Read more about LOC’s involvement in the study

 

OUR CLINICAL RESEARCH

Upcoming: Global Spine Congress, Bangkok, May 2024. Abstract tbc. The London Orthotic Consultancy’s Scoliosis team will travel to Bangkok in May 2024 to begin the next round of education and discussions at the leading world-class spine congress which gathers thousands of worldwide spinal surgeons.

 

Scoliosis Research Society, Seattle, September 2023. Can an immediate increase of standing height, when wearing a corrective scoliosis brace, be predictive of in-brace skeletal correction? Courtney A, Walmsley S, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

View abstract

 

The British Scoliosis Society, Liverpool, November 2023Assessing the presentation of adolescents seeking bracing treatment in the UK, using SRS bracing guidelines. Courtney A, Walmsley S, Choong J, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

 

The British Scoliosis Society, Liverpool, November 2023On-site clinician-led bracing algorithm with short clinical feedback loops lead to significant improvements in bracing outcomes. Courtney A, Walmsley S, Choong J, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

 

The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, Spine Week, Melbourne, May 2023. Can an immediate increase of standing height, when wearing a corrective scoliosis brace, be predictive of in-brace skeletal correction? Courtney A, Walmsley S, Choong J, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

View abstract

The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, Spine Week, Melbourne, May 2023. Assessing the presentation of adolescents seeking bracing treatment in the UK, using SRS bracing guidelines. Courtney A, Walmsley S, Choong J, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

 

The International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, Spine Week, Melbourne, May 2023. On-site clinician-led bracing algorithm with short clinical feedback loops lead to significant improvements in bracing outcomes. Courtney A, Walmsley S, Choong J, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

 

The British Scoliosis Society, Edinburgh, November 2022Can an immediate increase of standing height, when wearing a corrective scoliosis brace, be predictive of in-brace skeletal correction? Courtney A, Walmsley S, Lui D, Bishop T, Bernard J. The London Orthotic Consultancy, Kingston Upon Thames, United Kingdom; Trauma and Orthopaedics, St. George’s University Hospital, London, United Kingdom.

View abstract

FURTHER RESEARCH

 

 

Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST)

 

LOC has found the prognostic model validated by this study of immense benefit when evaluating new adolescent idiopathic scoliosis patients:

  • ‘Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST): Development and Validation of a Prognostic Model in Untreated Adolescent Idiopathic Scoliosis using the Simplified Skeletal Maturity System’

Lori A. Dolan, Stuart L. Weinstein, Mark F. Abel, Patrick P. Bosch, Matthew B. Dobbs, Tyler O. Farber, Matthew F. Halsey, M. Timothy Hresko, Walter F. Krengel, Charles T. Mehlman, James O. Sanders, Richard M. Schwend, Suken A. Shah and Kushagra Verma. Spine Deform. 2019 Nov; 7(6): 890–898.e4.

This study aims to fill the gap in prognostic models for untreated Adolescent Idiopathic Scoliosis (AIS). It successfully develops and validates a model using the Simplified Skeletal Maturity System, offering reliable risk estimates for curve progression. This has significant implications for comparative studies and assists clinicians and families in making informed treatment decisions.

View paper

 

 

 

 

 

Senior Orthotist and Lead Scoliosis Consultant Anna Courtney at the Scoliosis Research Society Conference in Seattle, Washington in September 2023, alongside Orthopaedic Consultants at St George's University Hospitals NHS Foundation Trust.

Senior Orthotist and Lead Scoliosis Consultant Anna Courtney at the Scoliosis Research Society Conference in Seattle, Washington in September 2023, alongside Orthopaedic Consultants at St George's University Hospitals NHS Foundation Trust.

 

 

There is an increasing body of evidence detailing the enormous benefits that 3-dimensional bracing (based on Cheneau principles) in tandem with Schroth-based therapy offers in the treatment of scoliosis.

Below you can find links to a series of research papers that discuss the efficacy of this approach in treating scoliosis and avoiding spinal surgery.

 

  • 'Management of Spinal Deformities and Evidence of Treatment Effectiveness

Bettany-Saltikov J, Turnbull, D, Ng, SY, Webb, R. Open Orthop J. 2017 Dec 29;11:1521-1547. eCollection 2017.

The review evaluates the up-to-date evidence for the treatment of spinal deformities, including scoliosis and hyperkyphosis in adolescents and adults.

Excerpt from conclusion: "There is at present high-quality evidence in support of the conservative treatment of AIS. The current evidence supports the use of PSSE, especially those using PSSR, together with bracing in the treatment of AIS. In view of the lack of medical consequences in adults with AIS, conservative treatment should be considered for curves exceeding the formerly assumed range of conservative indications."

View paper

 

  • ‘Bracing scoliosis: the evolution to CAD/CAM for improved in-brace corrections’

Weiss HR, Seibel S, Moromarco M, Kleban A. Hard Tissue 2013 Nov 25;2{5}:43

This study of 21 patients proves that asymmetric braces allow better in-brace correction than symmetric braces and that in turn results in optimal improvements to curvatures, even in curves exceeding 45 degrees.

View paper

 

  • Remodelling of trunk and back shape deformities in patients with scoliosis using standardised asymmetric computer-aided design/computer-aided manufacturing braces.’

Weiss HR & Monomarco M. Hard Tissue 2013 Feb 26;2{2}:14

This paper compares the case studies of three patients with curvatures exceeding 45 degrees with a plethora of literature on the subject which had shown limited evidence of improvements via bracing.The case studies indicate that trunk and back shape can be improved by bracing, even in patients with curvatures exceeding 45 degrees. For the majority of scoliosis patients with curvatures exceeding 45 degrees, surgery should not be indicated, considering that a large percentage of long-term effects are detrimental, as shown in the literature.

View paper

 

  • Standardising the treatment with Cheneau braces via CAD: Prospects and risks’

Weiss HR. OA Musculoskeletal Medicine 2014 May 03;2{1}:10

This is a review of the literature with respect to the outcome of Cheneau brace treatment. The end results of the latest two independent trials indicate a success rate of over 95%

View paper

 

  • ‘The Treatment of Adolescent Idiopathic Scoliosis (AIS) according to the present evidence. A systematic review’

Weiss HR. & Goodall. D. European Journal of Physical Rehabilitation and Medicine 2008, 44:177-93

This review provides a synopsis of all treatment options for idiopathic scoliosis, including a review of short-term studies which support outpatient physiotherapy. No controlled study was found to support surgical intervention as a treatment for idiopathic scoliosis and cites the unknown long-term effects of surgery as a factor.

View paper

 

  • ‘Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature’

Weiss HR & Goodall, D. Scoliosis 2008, 3:9.

This paper looks at the limitations of spinal fusion surgery in preventing progression, restoring ‘acceptability’ of the deformity and reducing curvature. This paper concludes that scoliosis surgery has a varying but generally high rate of complications, though long-term risks have not yet been reported on and further research is needed.

View paper

 

  • ‘Improving excellence in scoliosis rehabilitation: A controlled study of matched pairs.’

Weiss HR & R. Klein. Pediatric Rehabilitation, July 2006; 9(3): 190–200.

This paper tests the hypothesis that physio-logic® exercises improve the outcome of Scoliosis Intensive Rehabilitation (SIR) by correcting the deformity in the sagittal plane.

View paper

 

  • 'Specialized physical therapy helps teens with scoliosis get ahead of the curve'

University of Alberta. ScienceDaily. ScienceDaily, 25 January 2017. 

A new study shows specialized physical therapy exercises can improve the curve of the spine, muscle endurance and quality of life, as researchers advocate for conservative management to be added to the standard of care for patients in Canada.

Scoliosis Journal, 2016 “Among all PSSE approaches, Schroth [14] is among the most studied and widely used specific exercise approaches for scoliosis.”

Scoliosis FAQs:

The LOC Scoliosis Brace is a 3D, hypercorrective, Cheneau-Gensingen derivative brace, known as one of the most corrective and modern scoliosis braces available in the UK. It is designed to: 

  • correct and reduce the Cobb angle of a curve(s) 
  • correct both simple and complex curves 
  • reduce the need for surgery later in life 
  • help with pain management 
  • improve posture 
  • enhance the cosmetic appearance of scoliosis 
  • slow the progression of a curve before spinal surgery (See our Delayed surgery brace) 

The brace is entirely unique and tailored to the patient’s spinal curve pattern, ensuring optimal skeletal correction while prioritising comfort. 

Unlike traditional braces, it opens from the front for easier self-application and maintains a low profile under clothing. 

The LOC Scoliosis Brace is worn 22 hours a day (including nighttime) and works in conjunction with Schroth-based therapy for maximum results. 

As adults have reached skeletal maturity and the vertebrae are no longer malleable, an orthotic brace is unlikely to be able to correct the existing Cobb angle of the patient. However, LOC prescribes bespoke back braces to reduce posture-related pain and improve appearance and posture.

The operation used to treat severe scoliosis curves is typically spinal fusion surgery; a major procedure that involves moving muscles and realigning the skeleton into place. The curved, deformed vertebrae are fused together into a single bone, putting metal screws and rods into the spine to help straighten it. Surgery typically lasts between 4 and 8 hours depending on the severity of the curve. Bone graft is then taken from other parts of the body and used to cover the implants.

Following the operation, it is necessary to spend around a week in intensive care before returning home and the first few days are often uncomfortable. Most adolescents can expect to return to school from 2-4 weeks following surgery, but pain medication may be required up to 6 weeks following. A full recovery from the procedure can take up to a year, as it can take that long for the spine to heal fully.

Spinal fusion surgery causes the fused portion of the back to become permanently stiff, as a result, returning to sports that require large amounts of flexibility (ballet, yoga, gymnastics, dance) or contact (rugby, football, karate, hockey) may take longer.

Risks of spinal fusion surgery are like that of any other major procedure and include infection, blood clots and anaesthesia complications. The added risks include permanent nerve damage to the spine and paralysis.

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