The name of an orthosis design is not a standard. In practice, it can be observed again and again that functionally deficient orthosis constructions are given to patients under known names and paid for by the insurer without sufficient control.
Scoliosis progression in the RSC® Brace: The clinical and radiographic correction is convincing.
Despite extensive informational opportunities, many patients and their relatives are left alone with both diagnosis and choice of therapy as well as therapy. The importance of adequate education and a compact treatment concept for scoliosis therapy is widespread.
The number of sufferers who have to face the end of growth with major cosmetic and psychological problems due to the large curvatures and all the resulting pathomechanisms, could be significantly lower with a correct and, above all timely, diagnosis and comprehensive care of all involved professional groups.
What resources are there for non-specialist doctors, therapists and orthopedic technicians to make a difference?
What opportunities would arise if the professionals involved in the therapy would specialize more and use holistic, proven care systems?
For patients, the RSC® scoliosis delivery system guarantees safety, since only trained professionals familiar with the supply are treating.
The RSC® scoliosis delivery system
The RSC® restoration system is a patented procedure that uses computer technology to generate standardized and at the same time individual trunk orthoses for scoliosis patients. The system ensures the exact CAD / CAM based reproduction of an original corset to Rigo based on patient measurements. The biomechanical design of each curvature-specific model remains intact.
For this purpose, the original self-modeled corset positive models are digitized in a special procedure for the Ortholutions model database. For the production of a corset, specific patient measurements and photographs are required, which ensure the individual production of the orthoses for each patient.
For scoliosis therapy experts, the learning of the care philosophy as well as the theoretical and practical knowledge for the determination of the specific data and the expert adaptation of the orthoses in a multi-day Ortholutions Original RSC® workshop are taught in detail.
The patient data is uploaded digitally to a secure database. Each treatment team has its own secure account. The database is the central communication platform for the scoliosis experts. This will also ensure that each patient receiving an Original RSC® Brace will receive an individual diagnosis from Dr. Rigo is asked. The diagnosis includes the model determination (Rigo curvature classification) required for the patient’s individual curvature types.
The brace modules prepared for fitting will be sent to the RSC® Competence Centers and adapted on-site by the appropriately trained teams. Proofing, dispensing and follow-up checks are continuously documented by photo and saved in the database.
In addition, complex questions and complications can be discussed and clarified at any time with the Ortholutions specialist team. Information and problem solutions are transmitted directly and quickly. The system ensures maximum security of supply via the communication platform, the trained teams, and through constant further development of know-how.
The complete RSC® package guarantees safety, since only trained professionals familiar with the supply engineering and supply philosophy are required to do so. The trunk orthoses are only delivered to certified competence centers or adapted by the manufacturer itself.
The corset care system is integrated into an internationally established physiotherapy program – the BSRS Barcelona Scoliosis Rehabilitation School Concept – which was developed by Dr. Rigo is based on the teachings of Katharina Schroth and Christa Lehnert-Schroth. The method also involves modifications of the French school (6).
Case example of a course of treatment
– in a period of 32 months
Generally, at least four digital photographs (4 clinical views) are required for the clinical documentation (procedure, fitting, control appointments). These are carried out on the LASAR posture (manufacturer: Otto Bock).
The LASAR posture uses pressure measuring plates to determine the exact center of gravity and project the actual line of floor reaction force onto the patient using a red laser beam. The important tool thus allows to draw accurate conclusions about the actual static starting situation.
Figure 1: Patient with a 3-bend, group A2 Rigo classification. The Cobb angle of the thoracolumbar major curvature is 49°.
Clinically, the asymmetry of the trunk due to the collapse into the concave side of the thoracic curvature as well as the rib hump are clearly visible.
The left shoulder has fallen along with it caudally.
From the CSL (Central Sacral Line – vertical line from the center of the sacrum), the overhang to the right or the prominence of the basin can be seen on the left.
In the corset the concave collapse is corrected. To achieve this, a three-point system is required in the frontal plane which produces the so-called mirror effect.
The patient is overcorrected by the orthosis and brought to plumb, the rib hump is reduced.
In order to open the collapsed thoracic concave side and to ensure the three-dimensional correction mechanisms, the corset construction must lift the shoulder of the thoracic concave side in curves of type A2 (3-bog). The main thoracic curvature is corrected in the corset to 24° Cobb. The X-ray in the corset shows that the ribs of the thoracic concave side are clearly spread apart, the CSL shows that the overhang to the right has been removed in the corset.
Figure 2: Clinical picture of the patient after 8 months: the trunk symmetry is markedly improved.
Along with this, the collapse of the thoracic concave side is significantly reduced and the shoulder position is balanced.
The bending angle according to Cobb is 35° without corset. Radiographically, the improved and thus corrected position of the ribs of the concave area of the thoracic curvature can be seen.
The curvature pattern has changed, which is why Ortholutions Original RSC® module for the curvature type C1 according to Rigo continues to be treated orthetically.
Due to the changed situation, the correction principles do not require any displacement of the pelvis, but rather, as can be seen, a central stabilization.
The left shoulder is raised less cranial compared to the previous A2 corset module.
When viewing the plumb line, also radiographically, a slight decompensation to the left can be seen, which is caused by the different stiffness of the bends and the correction pressures of the orthosis. The main curvature is corrected to 18° Cobb in the Ortholutions Original RSC® Brace.
Figure 3: The clinical appearance and the findings that can be derived from the X-ray show after 7 more months to a stable state.
The body statics is almost balanced. The angle of curvature according to Cobb is 37° without orthosis. The patient is treated with a corset module of type C1.
As can be seen on the representation in the corset, the left axillary attachment was again increased slightly to deflect the thoracic curvature more.
It can be clearly seen how in the orthosis the rib hump is reduced on the basis of the three-point system in the frontal plane (axillary pad, thoracic pad and lumbar pad) and the resulting overcorrecting postural deflection is generated.
Figure 4: 12 months later clinically a slightly worse situation. The pelvis is noticeably prominent on the left, and the collapse of the thoracic concave side is also more pronounced.
When looking at the shoulder, it can be seen that the left shoulder has dropped slightly in comparison with FIG. The x-ray confirms the new situation.
With unchanged thoracic Cobb angle the curvature pattern corresponds again to the state (three-way / type A2 to Rigo) of the beginning of treatment.
For the orthotic follow-up treatment, an RSC® module of type A2 is produced according to the curvature pattern.
Pelvic translation to the right and thorax segment deflection produce the required postural overcorrection (mirror effect). At the beginning of treatment, the pronounced deformities of the vertebral bodies and ribs are easily detectable by radiography. The progression of structural deformation of the ribs and vertebrae of the thoracic curve has been corrected.
The orthotic modules have lifted the unequal axial loads on the vertebral bodies, allowing for more even growth of the bony structures.
Corrected scoliosis in Ortholutions Original RSC® Corset
Figures 5/6: Overview of the X-ray images within the illustrated period of 32 months. The correction of the ribs and vertebrae is stable in the growth phase.
The lower wedge shape of the vortices involved in the curvature, especially the vertex vertebra, is characterized by lines parallel to the cover plates.