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flerc
05-28-2010, 11:08 AM
I talked several times about this old technique.
http://www.tesisenxarxa.net/TESIS_UB...TESISILVIA.pdf
http://cat.inist.fr/?aModele=afficheN&cpsidt=15144900
Itís a simple idea, stretch the spine and keep that stretching, as surgery does, but with a brace. I know it is used again in some countries only with a non surgical purpose.
I think that in fact a necessary condition for reduce degrees and probably for avoid progression too, is to given the discs the chance to regain some of her lost height in the concave side (always talking about great curves, so near or after skeletal maturity).

I think that EDF give this chance. I think that discs are the reason because sometimes braces work during growth, and sometimes not. If the external force leads the spine to growth more straight, the decompression is reached, so the discs could be saved. But not always this occurs, and maybe it would not be enough , I donít know.

Probably a rigid braces lead muscles to some kind of atrophy and even with health discs, the spine begin to collapse again when the brace is removed. This could be the reason because EDF was not effective 100%.
So I thought in a dynamic brace http://www.scoliosis.org/forum/showthread.php?t=10276
But it seems to be absolutely impossible for me to find someone in the world telling me if Spinecor could keep the spine straight as EDF technique requires.
So I think now in some semi rigid brace. I think a great flexibility should be required to keep the spine straight if a brace do not do all the work, but I think my daughter is enough flexible. In those days it seems that only Cotrel machine could be used to reach flexibility, but now so many therapies exists.

It would be also possible to combine EDF with exercise that requires the muscles to fight against the gravity force to keep the spine straight, when some weight is put in the shoulders and a walk is performed with the spine straight (some therapy as Clear do the same?). I think that in this way muscles not only would not be suffering atrophy, but can do an exercise demanding so much the muscles that hold the vertical.
I realized time ago that an amazing force is developed doing some activity, but only for that activity, when I practiced Jiu jitsu and I had to fight with an Olympic weightlifter. I was really afraid, looking her amazing torso, arms, back, but in the floor he had not much force, even I beated him. So I can not imagine other exercise more specific to strength those specific muscles. I think that as jiu jitsu people has an amazing force to fight, weightlifters to lifting weights, swimmers to swim.. people doing these exercise should has an amazing force to keep her back straight.


I think that EDF also lead the neuromuscular (and balance?) system to Ďseeí that new posture as the correct, the ligaments to regain her functionality because the great tension is stopped, the muscles to works in the right way with the right length in both sides, the rib cage to adapt a new shape before the definitive ossification of the sternum, (internal organs adapted to the right position?).. all that I supposed occurs after surgery.
Iím sure if we used to walk across the ceiling upside down all the day, instead of walking across the floor, scoliosis would be reversed, at least it could not evolve.
I think EDF is as close to that. If in fact some degrees could be reduced, the scoliosis vicious circle would be transformed in a virtuous circle.

Someone knows about a reason why it could not work? We could be sure about some kind of irreversible damage as a terrific vertebral wedge (I suppose it not exists)? Muscles or ligaments could not be restored any more?
I donít know how much time need discs to reaches a significant regeneration. That could be a reason if so many years are necessary, or if it is impossible. Who could know that? Rheumatoid or osteology doctors? It could be seen in some kind of study?
I know ABR people thinks that without improving pressure and volume of internal organs, nothing could works, the pneumatic skeleton remains collapsed for ever and the spine too. I donít know if it could be good for organs, fascias.. and the pneumatic skeleton could improve in some way too.. surely they donít think that..
I think regeneration discs could be helped with some alternative procedure that probably can works while the great pressure in the concave side, leading to degeneration is stopped (otherwise I donít imagine how could it be done).

The most important of all for me is to know about risks. Could be progression triggered because EDF when the brace is removed? May be that a worse state in some sense would be reached for using a brace in that way? Muscles or ligaments could be weaker?
I know that probably nobody in the world could be sure about all those questions, but Iíll really appreciate all opinions.

flerc
05-29-2010, 09:47 AM
Yesterday I realized that surely that was the thought of the genious Cotrel (not mine of course, I just agree with him)
Is really shameful my medical ignorance yet, but I believe that many years ago a orthopedic surgeon said to me about why they used casts for fractures. I remember he said something like they don't make nothing in fact, nature does everything, they only give it the chance to do all the job. In this case seems to be a fact that tissues could not be regenerated without keeping the correct 'posture' of the bone.
Then I think that 'Nature doing the job', is not only a mystic, religious or eastern belief.
Yes, the spine is not an only bone, but anyway, is logic to think that the spine and all tissues related, need to be in the right posture so nature could works.
So, why not to give nature a chance in that way if it seems to be be the only one? Someone knows?

flerc
05-30-2010, 12:39 AM
I should have used another term instead of nature, such as intelligence or Self Heal power of the body.. like the 5ļ Osteopathy law.

mamamax
05-30-2010, 07:30 AM
What is the 5ļ Osteopathy law?

flerc
05-30-2010, 09:59 AM
'The law of self-healing of the body: the body has all the necessary mechanisms for self-healing, you just have to help restore normal function.' http://es.wikipedia.org/wiki/Andrew_Taylor_Still
What kind of help are we giving the body to do their job if we leave discs compressed during all day?. What could make this "intelligence" under these conditions? Surely the same like with a broken bone without cast.
I thinh EDF is the only therapy of scoliosis that gives the body the chance for self-healing
Other as Rpg, Schroth, Fed.. getting a great flexibility, but without keeping that stretch during the day, give a partial chance. The only way could consists in doing those exercises and sleeping or swimming all the day , never stand up or sit down or walk.
Someone agree or disagree?

mamamax
05-30-2010, 11:20 AM
Yes, such philosophies have been around for a long time. while I believe that intuition is a factor to pay attention to in treatment choices ... we have no studies relating to it :-)

The ancient practice of Qigong http://www.healingcancernaturally.com/free-qigong-walk-practicevideo.html comes to mind relative to this posting. Len Walker, a holistic healer, in the UK, claims to have managed his scoliosis in this manner. http://www.healingcancernaturally.com/visualization-intention-saliva.html

No studies relating to this either. As is said of many such things: initial reports appear promising - more study is needed.

rohrer01
05-30-2010, 12:21 PM
What is EDF?

flerc
05-30-2010, 02:57 PM
What is EDF?
this link must to works:
http://www.tesisenxarxa.net/TESIS_UB/AVAILABLE/TDX-0609104-113152//TESISILVIA.pdf
It's the invention of a genious, but it is an incredible simple an obvious concept: stretch and keep this stretching

flerc
05-30-2010, 06:35 PM
The same can be done with adolescents or adults:
http://www.youtube.com/watch?v=kFHAED_BHVk

mamamax
05-30-2010, 08:11 PM
flerc - is the same thing being done for adolescents and adults somewhere?

Pooka1
05-30-2010, 09:18 PM
The same can be done with adolescents or adults:
http://www.youtube.com/watch?v=kFHAED_BHVk

Holy crap. Innocent baby kid. Totally fed up with divine claims. They are intellectually insulting.

hdugger
05-30-2010, 09:44 PM
You might try posting over at scoliosis support, or flagging down Toni over here. I'm pretty sure she had serial casting as an infant.

rohrer01
05-30-2010, 09:49 PM
Ouch! It looks painful. It would be worth it if you KNEW the correction would hold. I'll bet that cast would be painful to wear, though.

flerc
05-30-2010, 10:38 PM
A mother from Spain, told me that her daughter had 30ļ and after one hour of stretching was 15 ļ and then they put her immediately a plaster brace, to be replaced after three months for another kind of brace. Mamamax, do you think that it could be replaced by a Spinecor?, could it be so strong to keep the stretch?
I think that the younger, the easier to cut as many degrees in less time.
In an adult, I think that first, flexibility should be obtained with some therapy, I donīt think that Cotrel machine should to be used now.

flerc
05-31-2010, 12:02 AM
I thought I was not clear enough explaining what is EDF, so I thought that a video might be the only way, and sorely I only could found this. I agree it is really ugly. I showed it to my wife and now she donīt want to hear nothing about EDF.
I'm sure Edf has nothing of painful. In any case the pain could be for the plaster over the skin, but nothing terrible. Look what Maty, the mother of a 13 years old girl says here http://escoliosis.org/escoforo/index.php?topic=865.msg6529#msg6529
and what she said recently: http://escoliosis.org/escoforo/index.php?topic=979.msg7901#msg7901
She said Cotrel, refering to EDF. She did not used Cotrel machine but Fed machine (it is beeing now used in adults too). In only one hour the curve was reduced from 30ļ to 15ļ.
Please let me know if I'm not being clear enough. It is really a very simple concept and really I don't know what to do, I'm think that probably it is the only chance, but I'm afraid.

Pooka1
05-31-2010, 12:15 AM
No creo lo hacen con pareja espinas. ŅCuŠnto tiempo serŪa usado? La ķnica manera que valdrŪa la pena es si la correcciůn era permanente tras el elenco estaba despegado. No creo casting puede corregir una pareja columna o que lo harŪa rutinaria.

rohrer01
05-31-2010, 12:35 AM
Well, at least I learned how to use the google translator!:) Is the girl's correction holding? Like I think Pooka1 asked, correct me if I'm wrong, if it works why aren't they using this technique all of the time? It seems simple, like you said, but there have to be drawbacks. I would find out what they are before I proceeded. It seems too big of a procedure to take any risks. Could there be dislocations of the vertebrae? If so, this could cause excruciating pain. My suggestion would be to find someone whom this didn't work for and see what they have to say.

tonibunny
05-31-2010, 03:00 AM
If it's of any interest to you, for the first 10 years of my life (1976-1986) I wore EDF plaster casts and Milwaukee braces that were created using plaster moulds taken whilst on the EDF frame.

I think they did a wonderful job in preventing me from progressing too quickly. The goal was to get me to the age of 10 before I had my first fusion surgery, and I made it, though around the age of 5 my notes stated that I'd probably need fusion at 8 or 9.

I started off with Infantile Idiopathic curves of 62 and 40 degrees at the age of 6 months. EDF casts, as you'll know, can actually correct curves in infants due to the fact they have such soft bones they are able to be "moulded" into place. Sadly this did not work for me; it does not work for eveyone who starts off with a curve of this size, and double curves seem harder to treat than single ones.

flerc
05-31-2010, 09:09 AM
Thanks Toni, all kind of information is useful for me. If you know about more people that have used Edf (especially teenagers) please let me know.
Sorry Sharon, Iím not sure if I understand what you said me, please say me in English too.
rohrer01, as you suggested, Iím thinking in risks. I donít know if it could be possible what you said about dislocations. Edf is not being used in my country; I donít know how to contact other people using it.
In fact I want to do a mix of different solution. I donít want to use EDF exactly as Cotrel said to use it. I think a rigid brace could be bad. It seems it would be a mystery for ever (at least for me) if Spinecor could be used when the plaster brace is removed.. is so difficult for me to get information..

Pooka1
05-31-2010, 09:21 AM
Sorry, Fer. It was a machine translation.

I don't think anyone will put a plaster cast on a mature spine. If this worked, nobody would ever need a fusion. But people still get fusions.

How could it work? Maybe holding the spine in a straighter position for the months/years needed to re-shape the vertebra? But even if that happened the spine might curve again due to the primary reason it curved in the first place.

Can you ask your surgeon why they don't cast mature spines.

hdugger
05-31-2010, 10:37 AM
Sorry, Fer. It was a machine translation.

When I translate it back with a machine translation, I get this:

"I think they do not even thorns. How much time would be used? The only way it would be worth it if the correction was permanent after the cast was off. I do not think you can correct a couple casting column or would routine."

Pooka1
05-31-2010, 10:40 AM
When I translate it back with a machine translation, I get this:

"I think they do not even thorns. How much time would be used? The only way it would be worth it if the correction was permanent after the cast was off. I do not think you can correct a couple casting column or would routine."

LOL. The second sentence, though, is exactly right.

flerc
05-31-2010, 10:55 AM
I used a translator too, but it not seemed so clear for me as what Sharon now said me. I think translators are great, pero a veces demuestran que son solo mŠquinas y (todavŪa?) no piensan.
Sharon, Itís true what you say about a historical cause that could be working still now, but is not possible to be sure a priori. I could understand some causes during growth and I can imagine others, but no one except gravity force and vicious cycle after growth.
I think that vertebras are not the problem in my daughter. I think discs could be the problem, so stopping the degeneration process because the compression, should to help.
If discs could regain some of their height in the concave side, the curve should to be reduced. Or not? I donít believe that her spine would remains absolutely straight when the brace will be removed. I think that probably 10į could be reduced. This means a great difference for me.

Of course we could do the same question about any other non surgical treatment. If it works, why surgeons donít use it? I think surgeons are so sure that is so impossible to reduce degrees after skeletical maturity as living for ever, and anyway they could do a surgery, so why to waste the time thinking about something else?
The surgeon said me time ago he donít know if it could works, he never heard about something like that before. But in fact I asked him to use a dynamic brace instead of a rigid brace to keep the stretching. This was my original idea, but I cannot know if a Spinecor could be used for this purpose and it seems that Iíll never know it.

hdugger
05-31-2010, 11:11 AM
I think that orthopedic surgeons think they *have* a cure - i.e., something which they can do (surgery) which straightens the spine. Since it's unlikely that the field of orthopedic surgery is going to produce a procedures which creates a normal (unfused and uncurved) spine), fusion is probably the best solution they're going to get.

That's not to say that, looking into the future, fusion will always be the best possible solution for a curved spine, but I suspect it will always be the best *surgical* solution for a curved spine.

So, spinal surgeons don't have any reason to continue looking. They have largely hit the pinnacle of the kind of solution they can offer. They can improve the way they do fusion, but fusion is likely to remain their solution.

It's doctors in *other* specialties who might be looking for a more elegant cure.

Pooka1
05-31-2010, 11:14 AM
Of course we could do the same question about any other non surgical treatment. If it works, why surgeons donít use it? I think surgeons are so sure that is so impossible to reduce degrees after skeletical maturity as living for ever, and anyway they could do a surgery, so why to waste the time thinking about something else?
The surgeon said me time ago he donít know if it could works, he never heard about something like that before. But in fact I asked him to use a dynamic brace instead of a rigid brace to keep the stretching. This was my original idea, but I cannot know if a Spinecor could be used for this purpose and it seems that Iíll never know it.

There is no evidence Spinecor can permanently reduce a mature curve. In fact they don't even try to claim this. What the brace does is take over for muscle to improve the posture which in some not all adults will lessen pain. But the curve and pain will likely return after they come out of brace because the muscles are weakened from a few years of letting the brace hole the torso up. "Dynamic" just means "looser" and that may explain the lack of efficacy of Spinecor in AIS. Spinecor does not admit any of this but I would be interested in hearing from McIntire on this point.

If Spinecor worked in mature spines, every surgeon would be prescribing it. The reason they don't is because there is no evidence it can do that.

flerc
05-31-2010, 11:22 AM
I think that orthopedic surgeons think they *have* a cure - i.e., something which they can do (surgery) which straightens the spine. Since it's unlikely that the field of orthopedic surgery is going to produce a procedures which creates a normal (unfused and uncurved) spine), fusion is probably the best solution they're going to get.

That's not to say that, looking into the future, fusion will always be the best possible solution for a curved spine, but I suspect it will always be the best *surgical* solution for a curved spine.

So, spinal surgeons don't have any reason to continue looking. They have largely hit the pinnacle of the kind of solution they can offer. They can improve the way they do fusion, but fusion is likely to remain their solution.

It's doctors in *other* specialties who might be looking for a more elegant cure.


Fortunately I knows some exceptions, but at least in my country, if I visit a doctor of other speciality, they says mm.. scoliosis, well you need to see a surgeon, and refuse to say any more.

Pooka1
05-31-2010, 11:28 AM
So, spinal surgeons don't have any reason to continue looking. They have largely hit the pinnacle of the kind of solution they can offer. They can improve the way they do fusion, but fusion is likely to remain their solution.


No I think it is likely that a surgical solution that preserves motion will occur before they solve the etiology and develop a preventative cure. Maybe Linda knows.

Pooka1
05-31-2010, 11:30 AM
Fortunately I knows some exceptions, but at least in my country, if I visit a doctor of other speciality, they says mm.. scoliosis, well you need to see a surgeon, and refuse to say any more.

Orthopedic surgeons are the only game in town. They are the only people trained to treat scoliosis in both conservative and surgical approaches.

Many people on this forum don't like this fact but that doesn't change anything.

flerc
05-31-2010, 11:32 AM
There is no evidence Spinecor can permanently reduce a mature curve. In fact they don't even try to claim this. What the brace does is take over for muscle to improve the posture which in some not all adults will lessen pain. But the curve and pain will likely return after they come out of brace because the muscles are weakened from a few years of letting the brace hole the torso up. "Dynamic" just means "looser" and that may explain the lack of efficacy of Spinecor in AIS. Spinecor does not admit any of this but I would be interested in hearing from McIntire on this point.

If Spinecor worked in mature spines, every surgeon would be prescribing it. The reason they don't is because there is no evidence it can do that.

I think Spinecor people falls in the same error: adjusting the spine to a wrong posture. It could works sometimes during growth, of course.

Pooka1
05-31-2010, 11:39 AM
I think Spinecor people falls in the same error: adjusting the spine to a wrong posture. It could works sometimes during growth, of course.

If there was evidence for that then every surgeon would be prescribing it. But we don't see that.

Rather than acknowledge the obvious, this is what drives normally rational people to suggest either that surgeons are evil and want to do surgery for the money or that they are incompetent and just too dumb to recognize a cure right in front of them.

Sadly and shamefully, we have seen both these arguments on this forum either stated as such or necessarily implied. Scoliosis makes people lose their mind at times.

flerc
05-31-2010, 11:41 AM
Orthopedic surgeons are the only game in town. They are the only people trained to treat scoliosis in both conservative and surgical approaches.

Many people on this forum don't like this fact but that doesn't change anything.

May be in EEUU is different but in my experience, they donīt help very much in conservatives approches, simply because they think it would be impossible.

Pooka1
05-31-2010, 11:44 AM
May be in EEUU is different but in my experience, they donīt help very much in conservatives approches, simply because they think it would be impossible.

Surgeons prescribe braces in many JIS and AIS cases. Our surgeon prescribed a brace for one of my daughters. They also prescribe PT for pain as far as I know.

Braces and PT are conservative approaches.

I think you are talking about "alternative" approaches which are outside of medicine and science. These are approaches that don't have a rational physiological basis. Praying is one of these for example. Homeopathy is another example.

flerc
05-31-2010, 11:50 AM
If there was evidence for that then every surgeon would be prescribing it. But we don't see that.

Rather than acknowledge the obvious, this is what drives normally rational people to suggest either that surgeons are evil and want to do surgery for the money or that they are incompetent and just too dumb to recognize a cure right in front of them.

Sadly and shamefully, we have seen both these arguments on this forum either stated as such or necessarily implied. Scoliosis makes people lose their mind at times.

Sharon, what happens? Iím not saying surgeons would be idiots or bad people. In fact I feel a really great respect for our surgeon. I simply not agree with him and others surgeons in the point of irreversibility. Whatís the matter? Why could not they be wrong in this point?
Also EDF was the idea of a great surgeon, not mine.

Pooka1
05-31-2010, 11:56 AM
Sharon, what happens? Iím not saying surgeons would be idiots or bad people. In fact I feel a really great respect for our surgeon. I simply not agree with him and others surgeons in the point of irreversibility. Whatís the matter? Why could not they be wrong in this point?
Also EDF was the idea of a great surgeon, not mine.

NO! I was not talking about you. But others have said and implied these things.

I think you are careful to say you are thinking about these things and you know when there is no evidence. Others are not so careful and that is what I am talking about. Others here do seem think that surgeons are either idiots or evil. Maybe both. They are letting their emotions take over for their mind.

Casting is a legitimate conservative approach in certain patients. It is not an "alternative" approach because there is some scientific basis and indeed some evidence for casting.

When "alternative" approaches show any evidence that they work then they move into the "conservative" column.

You are trying to research this irreversibility issue and are being honest. I always read your posts because you are honest and a great father. :)

flerc
05-31-2010, 12:22 PM
Ok Sharon. I think all we are here trying to solve a great problem or to help others. We never should to loose this from mind. This is a great Forum, the best I know.
I think you are extremly scientist, and it's really great! I like to talk with you, because you have a great knowledge, a logic mind and also you are a very good mother.
You could help me to do a good decision. What do you think about risks?

Pooka1
05-31-2010, 12:33 PM
You could help me to do a good decision. What do you think about risks?

What do I think about risks of casting a mature spine? Only a surgeon could guess.

I do not think you will find a surgeon who will cast a mature spine so we will never know.

In general though, just like with braces, when you restrict motion the muscles will deteriorate. When the patient comes out of a cast, to the extent the muscles were holding the curve, that will be much less and the curve might progress even quicker than before the cast. That is my guess.

It could be the muscles are doing nothing to hold the curve in which case the casting will not adversely affect progression. That is my guess also.

flerc
05-31-2010, 01:13 PM
It could be the muscles are doing nothing to hold the curve in which case the casting will not adversely affect progression. That is my guess also.

Sharon, is really great to talk with you. That is exactly my suspect. I ever say that the back not collapse in a dead.

flerc
06-03-2010, 10:02 AM
I ever say that the back not collapse in a dead.

I was meaning that the spine would never bend to one side, as occurs with scoliosis, in a normal back. In the film ĎBe Coolí (J. Travolta) a dead remains sit down in a chair. Itís only a film, but common sense tells me this is true. I think that muscles donít avoid the spine to get a frontal curve shape. Vertebras and discs are the responsible, as once some surgeon said me. May be muscles work against, they could do worst, increasing the curve with an excessive tone or short length, but normal muscles could not reduce degrees by itself. They only could help to decompress discs doing some kinds of exercises.
Iím right?

flerc
06-04-2010, 02:59 PM
I was meaning that the spine would never bend to one side, as occurs with scoliosis, in a normal back. In the film ĎBe Coolí (J. Travolta) a dead remains sit down in a chair. Itís only a film, but common sense tells me this is true.
Iím right?

In fact is much more than a fact!! I was doing some experiments and it is absolutely impossible to get a frontal curve in my spine. No matter if Iím sleeping, unconsciousness or dead. The only way might be compressing my spine and pulling one side with a devastating force, like in the second picture http://www.sastre-roca.com/metodofed.html
Which could be the source of such terrific resistance? The lack of this is the current cause of scoliosis without any doubt.

flerc
06-04-2010, 11:18 PM
Which could be the source of such terrific resistance?

The answer to this question should to be the same to this I asked to a neurology surgeon time ago: Which is the source of the resistance of a spine (with scoliosis) to be stretched? He said me he was present in hundreds of surgeries and he knew without any doubt it's because the rigidity of the sternum.

Then I felt back pain, but when I was trying to make a curve in my spine, I didn't feel nothing in my muscles, ligaments, vertebras, joints.. but I felt something in my thorax..

skevimc
06-08-2010, 02:59 PM
Are there any x-rays of these patients while in the cast? I'd want to know for sure the spine is actually being flexed, elongated and derotated.

I would have concern with stretching the ligaments/muscles/fascia too much or too quickly.

After removal of the cast the muscles will be EXTREMELY weak.

Depending on how long the cast is being worn, there will be a lot of bone, muscle, tendon, fascia remodeling after the cast is removed. Our tissues are shaped and formed the way they are due to, genetics of course, but also their function. That is, ligaments are oriented in the direction of the force they resist. This is done with collagen fibers. Ligaments and tendons are all aligned in the same direction but the collagen in skin is aligned in every direction because it resists forces in a variety of directions. As tissues heal/repair/form, collagen is laid down almost randomly. Once the body begins to use that tissue the body senses the force being applied and triggers the collagen to line up appropriately. If the concept is to unload the concave side so that vertebral and disc growth is symmetrical, I'm not sure how structurally sound that 'new' tissue would actually be.

Astronauts lose bone and muscle mass because of zero gravity and this can happen relatively quickly. If no force is applied to the concave side, that side of the vertebrae could be less dense. Of course I'm making some very basic assumptions.

You may have answered these questions already, but how old is your daughter?

How do they determine how long to put the cast on?

Do they take x-rays once the cast is on? and.. are there any pictures of this anywhere?

What is the strategy for removing the cast?

I like your basic idea of applying weights while in the cast in order to activate the muscles. It's a good idea to at least have some type of muscle activity during this period.

flerc
06-09-2010, 11:36 AM
Thank you so much for your help!. Is nothing usual to me that a doctor answer my questions.
First of all Iíll say you I start from the premise that reducing a significant number of degrees in a non surgical way at (or so close) the end of growth is not quite impossible. May be because my medical ignorance and because I have never heard an explanation that seems to me unquestionable such as that relating to why we can not move any more certain body parts if certain muscles were cut. May be becouse doctors in my country do not like to explain.
All I heard gives me the pattern that is very difficult to achieve but not impossible, as I think is reasonable to say it would be with a terrible vertebral wedge, which I think is not the case of my daughter.
She has 16 years, Riser 4 menarche at 12. Doctors said that her growth is at least almost finished. I understand it and I agree too.
I'm not looking for reducing all the 56į of her torax lumbar curve, I also agree may be effectively impossible. Iím sure that 10ļ degrees would be a significant difference and I think is possible to be done, as seemed to occur some months ago, I donít know (x-rays said this).

I donít know very much about EDF. I read that was used with teenagers up to 17 years. I have never seen x-rays or something else. I know the spine can be kept with a great reduction for about 4 months with the cast and then it is replaced (I donít know how it is removed) by a rigid brace. Long time ago a Cotrel machine was used during 2 weeks to reduce the curve. I have heard now is doing in an hour with the Fed machine http://www.sastre-roca.com/metodofed.html
But EDF is for me just only the concept of stretching the spine and keeping this stretch. I think that only a mix of methods can reduce degrees.
She is being treated with Rpg and she has a great flexibility. I think that a dynamic brace should to be best than a rigid one for EDF technique, but I donít know if Spinecore could be used at this purpose (could it be?)
So Iím thinking in a semi rigid brace allowing doing those kinds of exercises with a weight over the shoulders.

I donít know how itís possible, but I see her spine straight when she is lying down http://www.scoliosis.org/forum/showthread.php?t=10546 so I suppose her spine not need to be stretched with a sudden procedure and also I suppose it is deroteted too when it is stretched. Of course I should to be absolutely sure of these before adapting the brace to her straight spine. I think that having the spine straight, at least might help to disc recovery and structuring the rib cage in a best way (when does it reaches its full solidification the sternum?) leading to some reduction, but of course if something else turn worst, maybe not only not to reach some reduction but even to trigger progression. Iím really afraid of risks. I think you told me something about this.



Astronauts lose bone and muscle mass because of zero gravity and this can happen relatively quickly. If no force is applied to the concave side, that side of the vertebrae could be less dense. Of course I'm making some very basic assumptions.


I think it would be possible with a cast, but the brace Iím thinking in, I believe that just only not allows a lateral displacement, so the spine could not be curved again. Do you think that anyway the vertebras will not support weight?


Depending on how long the cast is being worn, there will be a lot of bone, muscle, tendon, fascia remodeling after the cast is removed. Our tissues are shaped and formed the way they are due to, genetics of course, but also their function. That is, ligaments are oriented in the direction of the force they resist. This is done with collagen fibers. Ligaments and tendons are all aligned in the same direction but the collagen in skin is aligned in every direction because it resists forces in a variety of directions. As tissues heal/repair/form, collagen is laid down almost randomly. Once the body begins to use that tissue the body senses the force being applied and triggers the collagen to line up appropriately. If the concept is to unload the concave side so that vertebral and disc growth is symmetrical, I'm not sure how structurally sound that 'new' tissue would actually be.


Iím not sure if I understand right, but it seems a risk. Do you say that when the brace is removed, a new and randomize alignment would be triggered? There would not be any remodeling of tissues while the stretch is kept?
Do you think that during growth, it would be less risk adapting a brace to the curve like in the traditional way, than stretching the spine before as in EDF?
I think that something as removing the brace occurs when she wake up and get out of bed. Do you think that could be harmful or it need more time stretched to be risky?

Thanks again and forgive me for so many questions!

livingtwisted
03-05-2011, 04:27 PM
No I think it is likely that a surgical solution that preserves motion will occur before they solve the etiology and develop a preventative cure. Maybe Linda knows.

I am just now reading this thread for the first time and was thinking something similar recently. I've been rethinking the entire treatment approach, which in its current state has some obvious flaws, hence all the debate. I hope minds much more equipped to answer this have already considered it and dismissed it, but bear with me for a moment...

It seems that some of the conservative therapies have actually had some mildly positive results in adults, but are often futile attempts against a child's rapidly progressing curve. The scolioscore work seems to support the theory that a curve is going to do what its going to do no matter what. I have a separate theory that even surgery doesn't hold up against your destiny and would be really curious if there is a way to see data showing the relationship between a scolioscore-like test (if it went higher than just reaching surgical range) and revision surgeries, but that's a separate point. Regardless, we try to address it at the youngest age possible because children are much more flexible and don't yet have any permanent damage, which might be what prevents adults from seeing any dramatic improvements.

So what I'm suggesting is this... what if we could just let kids be kids and not try to change the direction of a speeding train. I realize it seems really risky (and for a small percentage of extreme curves just not an option), but for most is there really a difference between fusing at age 14 and let's say age 20? So when things have clearly stabilized, at whatever curve that might be, I am wondering if some smaller surgeries could be done to reform any wedged vertebrae without losing flexibility so that at least the foundation is normal. And then begin a longer journey of PT (borrowing from Schroth, CLEAR, SEAS) to work to reduce the curve.

I'm sure there are big flaws in this theory, but I do think it's about time for some advancements. I just have never fully understood the status quo of treatment protocols, and am discovering that that is because they don't really make all that much sense. I also never really understood the electoral college when it was taught in school, and it turns out I was right about that too. There, now I've given everyone plenty of things to challenge, including politics. Woohoo!

P.S. Casting an adolescent or adult seems a bit extreme and would surely lead to muscle atrophy, no?

hdugger
03-05-2011, 05:08 PM
I'm unfortunately not going to remember the article, but I read a review recently that was primarily about vetrebral stapling but also mentioned some work being done to reshape wedged vertebrae. You'd have to somehow address whatever it is that's making people rotate, because that seems to be tied to progression. But, no, I don't think that's unreasonable. Making a spine not-a-spine is clearly not the most elegant surgical solution, and I'm sure there's a better way of addressing the problem.

hdugger
03-05-2011, 05:11 PM
Maybe something like this: http://www.spine-health.com/video/kyphoplasty-osteoporosis-fracture-treatment-video

hdugger
03-05-2011, 06:12 PM
Here's the article I was trying to recall:

http://www.spineuniverse.com/conditions/scoliosis/new-surgical-treatments-scoliosis-vertebral-body

So, Betz is actually doing work in this area, although Lenke is concerned about the feasibility of such a treatment.

hdugger
03-05-2011, 06:23 PM
And here are some additional articles:

http://www.spineuniverse.com/professional/research/srs/2005/fusionless-surgery-scoliosis-2-15-year

So, no, you're not crazy at all to consider this.

livingtwisted
03-05-2011, 06:28 PM
Wow, thanks for posting. Here I thought it was just my own crazy invention. This gives me a lot of hope for the future. I really hope fusionless surgery proves to be safe and effective and becomes the norm.

flerc
03-05-2011, 06:33 PM
I am just now reading this thread for the first time and was thinking something similar recently. I've been rethinking the entire treatment approach, which in its current state has some obvious flaws, hence all the debate. I hope minds much more equipped to answer this have already considered it and dismissed it, but bear with me for a moment...

It seems that some of the conservative therapies have actually had some mildly positive results in adults, but are often futile attempts against a child's rapidly progressing curve. The scolioscore work seems to support the theory that a curve is going to do what its going to do no matter what. I have a separate theory that even surgery doesn't hold up against your destiny and would be really curious if there is a way to see data showing the relationship between a scolioscore-like test (if it went higher than just reaching surgical range) and revision surgeries, but that's a separate point. Regardless, we try to address it at the youngest age possible because children are much more flexible and don't yet have any permanent damage, which might be what prevents adults from seeing any dramatic improvements.

So what I'm suggesting is this... what if we could just let kids be kids and not try to change the direction of a speeding train. I realize it seems really risky (and for a small percentage of extreme curves just not an option), but for most is there really a difference between fusing at age 14 and let's say age 20? So when things have clearly stabilized, at whatever curve that might be, I am wondering if some smaller surgeries could be done to reform any wedged vertebrae without losing flexibility so that at least the foundation is normal. And then begin a longer journey of PT (borrowing from Schroth, CLEAR, SEAS) to work to reduce the curve.

I'm sure there are big flaws in this theory, but I do think it's about time for some advancements. I just have never fully understood the status quo of treatment protocols, and am discovering that that is because they don't really make all that much sense. I also never really understood the electoral college when it was taught in school, and it turns out I was right about that too. There, now I've given everyone plenty of things to challenge, including politics. Woohoo!

In some way our thoughts are similars. But I'm really so frustrated because I failed to find out two years before how the Spinecor work , when my daughter was still growing and with a Risser something lesser. I asked here and in other forums, I talked with many doctors and people wearing the Spinecor, but it was not just some months before, that I know that a dynamic brace may do the same that a gypsum one.



P.S. Casting an adolescent or adult seems a bit extreme and would surely lead to muscle atrophy, no?

A rigid brace.. who knows, but it's difficult to imagine this with a dynamic one.

livingtwisted
03-05-2011, 06:38 PM
Flerc, sorry you are frustrated and I also don't mean to commandeer your thread. I think the Spinecor has proven affective for some, but certainly isn't the most aggressive at holding/reducing curves. It's flexiblity means less muscle atrophy, but it also means it can't hold up to all curves.

hdugger
03-05-2011, 06:44 PM
Wow, thanks for posting. Here I thought it was just my own crazy invention. This gives me a lot of hope for the future. I really hope fusionless surgery proves to be safe and effective and becomes the norm.

Betz seems like he's way out in the forefront of the fusionless treatment research. Hopefully he'll spark some interest in adult orthopedic surgeons.

Karen Ocker
03-05-2011, 07:10 PM
In 1956 The usual treatment, which I experienced, was in a very large cast: neck to one knee.

It was called a "turnbuckle jacket". There was a hinge in the major curve side, the cast was split in the middle and on the concave side was a turnbuckle. Every day the doctor came in and turned the turnbuckle to straighten the spine until the maximum correction was obtained. Then an uninstrumented fusion was performed through a large hole in the back of the cast.
I then went home for 6 months for the fusion to heal__unable to walk the whole time(year). In 6 months the cast was changed and made a little lighter and shorter. Back home for 4 more months--still unable to walk. After about a total year I got a "walking cast" which could be removed for showering. I had to learn to walk again.

I spent a total year in a corrected state in a cast--not walking! I was 13 and finished the treatment at 14.

By the way I was considered to have stopped growing.


The rest is in my signature.

flerc
03-05-2011, 07:59 PM
Flerc, sorry you are frustrated and I also don't mean to commandeer your thread. I think the Spinecor has proven affective for some, but certainly isn't the most aggressive at holding/reducing curves. It's flexiblity means less muscle atrophy, but it also means it can't hold up to all curves.

I also have heard that it cannot hold up curves > 50ļ or Risser > 2 or not so far from the end of growth, but if the spine is enough flexible and vertebras are not very much deformed.. why not?
As I investigated, Spinecor may hold the spine in the best posture that current structure allow. Rotation is what not allow vertebral bodies to remains aligned, and it seems that the bands may hold the derotation. I know about a girl close to 16 years with 52ļ but holded in 33ļ with the Spinecor.

flerc
03-06-2011, 09:32 AM
Mehera, why are you using a rigid brace if it not hold some reduction of the curve? You was in pain?

livingtwisted
03-06-2011, 10:52 AM
Mehera, why are you using a rigid brace if it not hold some reduction of the curve? You was in pain?

The LA Brace was recommended to me to complement Schroth therapy. Both have a focus on derotation so the brace helps to replicate the movements learned in Schroth. The idea is to exercise in and out of the brace, but I was reluctant since I had always been told it was too late for a brace ever since I was diagnosed. In my new spirit of adults-are-free-to-be-guinea-pigs I decided to go for it. So far it has helped, combined with other things I am doing, to give me a good amount of flexibility and helped to train my muscles to move into a straighter position. It is also working as a sort of reset button for pain so that it doesn't build up -- I'm actually starting to look forward to putting it on at the end of the day when I'm feeling collapsed. But as far as I can tell so far I am not holding this correction throughout the day. I'm only using it part time so muscle atrophy isn't really an issue -- and I would even venture to say that my abs have never been simultaneously this long and strong at the same time. Maybe once I have my full Schroth routine over time that will help to train me to hold a straighter position, I don't know. My goals in all of this are pain management, flexibility, and a greater awareness and control over my posture in an effort to prevent progression. Basically if I can prevent my situation from ever getting worse than it is right now I will be a happy camper.

I don't completely understand what EDF is beyond the plaster casting, but it seems like that approach requires rigidity 24/7 which would worry me. I think it's more important to be able to be in control of your curve in daily life, than to just achieve straightness through immense force, but maybe I am misunderstanding.

flerc
03-06-2011, 05:09 PM
The LA Brace was recommended to me to complement Schroth therapy. Both have a focus on derotation so the brace helps to replicate the movements learned in Schroth. The idea is to exercise in and out of the brace, but I was reluctant since I had always been told it was too late for a brace ever since I was diagnosed. In my new spirit of adults-are-free-to-be-guinea-pigs I decided to go for it. So far it has helped, combined with other things I am doing, to give me a good amount of flexibility and helped to train my muscles to move into a straighter position. It is also working as a sort of reset button for pain so that it doesn't build up -- I'm actually starting to look forward to putting it on at the end of the day when I'm feeling collapsed. But as far as I can tell so far I am not holding this correction throughout the day. I'm only using it part time so muscle atrophy isn't really an issue -- and I would even venture to say that my abs have never been simultaneously this long and strong at the same time. Maybe once I have my full Schroth routine over time that will help to train me to hold a straighter position, I don't know. My goals in all of this are pain management, flexibility, and a greater awareness and control over my posture in an effort to prevent progression. Basically if I can prevent my situation from ever getting worse than it is right now I will be a happy camper.

I donīt understand how may the vertebra be derotated without being stretched the spine, but I suppose that some stretching should to ocurrs anyway when the brace is pulling.
I think you are in a right path and it seems that you may avoid surgery in the future.



I don't completely understand what EDF is beyond the plaster casting, but it seems like that approach requires rigidity 24/7 which would worry me. I think it's more important to be able to be in control of your curve in daily life, than to just achieve straightness through immense force, but maybe I am misunderstanding.

The great concept beyond EDF as I understand it, is extremly simple: Derotate and stretch the spine and then hold the stretching with a brace.
If the streching is achived through the Cotrel Machine (as in the original version) or the Fed machine or some PT methods as Rpg, Global Active Stretching, PNF..or the brace is made with gympsun or other material or requires 24 or 18/7.. I think they are only details.. variations of the original idea.
Of course, the greatest chances is during growth (but probably the great risks too), but maybe the brain after some time, accept that posture as the right posture and neuromuscular system try to adapt the new and best posture. May be a crazy idea, but why not the vertebra could be modified too? If could suffer modifications (wedge) to be worse, why not to be better?

livingtwisted
03-06-2011, 08:14 PM
I donīt understand how may the vertebra be derotated without being stretched the spine, but I suppose that some stretching should to ocurrs anyway when the brace is pulling.

There is definitely stretching/lengthening happening simultaneously. The way it fits, there is nowhere for the spine to go, but up. This is just my experience of what it feels like, I'm sure there's a more scientific explanation.

flerc
03-06-2011, 09:48 PM
There is definitely stretching/lengthening happening simultaneously. The way it fits, there is nowhere for the spine to go, but up. This is just my experience of what it feels like, I'm sure there's a more scientific explanation.

It seems to be a really good brace.

flerc
08-17-2011, 12:21 AM
It would be also possible to combine EDF with exercise that requires the muscles to fight against the gravity force to keep the spine straight, when some weight is put in the shoulders and a walk is performed with the spine straight (some therapy as Clear do the same?). I think that in this way muscles not only would not be suffering atrophy, but can do an exercise demanding so much the muscles that hold the vertical.
I realized time ago that an amazing force is developed doing some activity, but only for that activity, when I practiced Jiu jitsu and I had to fight with an Olympic weightlifter. I was really afraid, looking her amazing torso, arms, back, but in the floor he had not much force, even I beated him. So I can not imagine other exercise more specific to strength those specific muscles. I think that as jiu jitsu people has an amazing force to fight, weightlifters to lifting weights, swimmers to swim.. people doing these exercise should has an amazing force to keep her back straight.


A study proving that you can’t learn to play the piano by practicing on a banjo….
"There is no basis to expect training effects from one form of exercise to transfer to any other form of exercise. Training is absolutely specific."
www.cpdo.net/lecture_notes/cs_presentation.ppt