This is similar to a thread I just started in Adolescent category regarding holding a juvenile curve reduction through the adolescent years. However, this one is more focused on the treatment options we have with our JIS children who have already reached 30+ deg (or others who are less than 30+ deg but showing significant curve progression). These options are primarily focused on bracing and VBS (vs other alternative/non-surgical methods).
My daughter is 8 diagnosed Feb 2009 when she was 7 with a 23 deg curve. Then Oct 09 she was 36 deg. And at this point we started bracing and some other treatments. As of Mar 2010 her 36 deg (T4-T12) curve is reduced to about 24 deg but within the T4-T12, the T5-T10 curve measurement is about 28-30. It has remained consistent but I expect it to be less at our next x-ray.
I have also seen several threads/posts of JIS children who were in there mid 30s and had their curves reduced to low teens. These were results with different braces (SpineCor, Rigo-Cheneau, and Boston). In each case there was significant in-brace correction.
So, what are the options for all of us with our JIS children who have already reached mid 30s (or in 20s showing significant curve progression), which puts them at high risk of ongoing curve progression?
Here are my thoughts:
1. Do nothing (would not be my recommendation). But some doctors make this recommendation with the assumption that bracing has no impact on a curve that is high risk of progression.
2. Brace full-time or part-time to hold it or reduce it. This would be bracing until maturity, maybe 6-8 years. That is a long time.
3. Brace full-time or part-time to hold it until older, maybe 11-12 (maybe before significant growth spurt) then do VBS.
4. Do VBS now as a juvenile and do no bracing (unless part-time bracing was required to help after VBS).
And VBS is done for curves up to 35 deg and VBS/Hybrid Rod is done for curves up to 45 deg (generally speaking for thoracic curve). So, this is a decision we need to make while the curve is 25-30, or 25-35 deg. So we have to make it quickly if there is curve progression. However, successful bracing can give us some time to make that decision.
One of the questions or concerns I have is that there are studies that show a curve can continue to progress up to 3 deg per year between the ages of 16-20 and up to 1 deg per year beyond the age of 20. So, a curve that is held in the low teens or 20s could continue to progress to the 30s and beyond over the years after maturity.
So, if we assume no bracing after maturity (maybe age 15-16 for girls, 17-18/19 for boys) what solution is best right now for a JIS child who has already demonstrated to be a high risk for curve progression (i.e. mid 30s curve).
Would VBS as a JIS or AIS (before growth spurt) be better in reducing the curve progression beyond maturity or would it have no impact?
If it would impact the curve progression beyond maturity then VBS might be recommended for a JIS or AIS child, even if the child is willing to wear a brace to maturity.
What is the best solution to control the curve progression after maturity? Has anyone seen any recommendations, studies, or have any experience? I assume with VBS we have very few children who have reached maturity and beyond to let us know whether VBS has impacted any curve progression beyond maturity.
It would be unfortunate for a child to wear the brace until maturity (6-8 years) only to see the curve progress back to the mid 30s or higher when the brace was removed. I have read some threads/posts recently that this is exactly what happened to some people after wearing a brace for many years until maturity. Over time it eventually progressed back to the mid 30s and in some cases into the 40s and 50s and now they are considering spinal surgery (or maybe some type of adult bracing) to help with some pain and/or stop the continued curve progression.
I am interested in any experience or studies around this subject for JIS children. I assume many parents are faced with this question of bracing, part-time or full-time (and which brace) but now also the question of VBS and when should it be done, especially if you are getting great results (significant curve reduction) with bracing.
It would probably be best if the replies to this stayed focused on Bracing vs VBS and not other JIS alternative methods (which I do support, but would prefer to keep this focused on bracing and VBS).
Thank You
Michael
My daughter is 8 diagnosed Feb 2009 when she was 7 with a 23 deg curve. Then Oct 09 she was 36 deg. And at this point we started bracing and some other treatments. As of Mar 2010 her 36 deg (T4-T12) curve is reduced to about 24 deg but within the T4-T12, the T5-T10 curve measurement is about 28-30. It has remained consistent but I expect it to be less at our next x-ray.
I have also seen several threads/posts of JIS children who were in there mid 30s and had their curves reduced to low teens. These were results with different braces (SpineCor, Rigo-Cheneau, and Boston). In each case there was significant in-brace correction.
So, what are the options for all of us with our JIS children who have already reached mid 30s (or in 20s showing significant curve progression), which puts them at high risk of ongoing curve progression?
Here are my thoughts:
1. Do nothing (would not be my recommendation). But some doctors make this recommendation with the assumption that bracing has no impact on a curve that is high risk of progression.
2. Brace full-time or part-time to hold it or reduce it. This would be bracing until maturity, maybe 6-8 years. That is a long time.
3. Brace full-time or part-time to hold it until older, maybe 11-12 (maybe before significant growth spurt) then do VBS.
4. Do VBS now as a juvenile and do no bracing (unless part-time bracing was required to help after VBS).
And VBS is done for curves up to 35 deg and VBS/Hybrid Rod is done for curves up to 45 deg (generally speaking for thoracic curve). So, this is a decision we need to make while the curve is 25-30, or 25-35 deg. So we have to make it quickly if there is curve progression. However, successful bracing can give us some time to make that decision.
One of the questions or concerns I have is that there are studies that show a curve can continue to progress up to 3 deg per year between the ages of 16-20 and up to 1 deg per year beyond the age of 20. So, a curve that is held in the low teens or 20s could continue to progress to the 30s and beyond over the years after maturity.
So, if we assume no bracing after maturity (maybe age 15-16 for girls, 17-18/19 for boys) what solution is best right now for a JIS child who has already demonstrated to be a high risk for curve progression (i.e. mid 30s curve).
Would VBS as a JIS or AIS (before growth spurt) be better in reducing the curve progression beyond maturity or would it have no impact?
If it would impact the curve progression beyond maturity then VBS might be recommended for a JIS or AIS child, even if the child is willing to wear a brace to maturity.
What is the best solution to control the curve progression after maturity? Has anyone seen any recommendations, studies, or have any experience? I assume with VBS we have very few children who have reached maturity and beyond to let us know whether VBS has impacted any curve progression beyond maturity.
It would be unfortunate for a child to wear the brace until maturity (6-8 years) only to see the curve progress back to the mid 30s or higher when the brace was removed. I have read some threads/posts recently that this is exactly what happened to some people after wearing a brace for many years until maturity. Over time it eventually progressed back to the mid 30s and in some cases into the 40s and 50s and now they are considering spinal surgery (or maybe some type of adult bracing) to help with some pain and/or stop the continued curve progression.
I am interested in any experience or studies around this subject for JIS children. I assume many parents are faced with this question of bracing, part-time or full-time (and which brace) but now also the question of VBS and when should it be done, especially if you are getting great results (significant curve reduction) with bracing.
It would probably be best if the replies to this stayed focused on Bracing vs VBS and not other JIS alternative methods (which I do support, but would prefer to keep this focused on bracing and VBS).
Thank You
Michael
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