In brace correction radiographs

[Pooka1]

I thought I would post this to show a 32* T curve reduced to 10* in a Charleston bending brace. I am not sure which way they usually use to calculate the percent reduction but I would guess it's the difference over the original times 100 so it is almost a 70% reduction. My kid wore it for a year at night.

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[TAMZTOM]

I thought I would post this to show a 32* T curve reduced to 10* in a Charleston bending brace. I am not sure which way they usually use to calculate the percent reduction but I would guess it's the difference over the original times 100 so it is almost a 70% reduction. My kid wore it for a year at night.
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Interesting Sharon. I've attached a copy of Tamzin's "Charleston" night-time bending brace, which she wore for two nights until I torched it. Not because they're no good, just that the orthotist who measured Tamzin for this one should be jailed.

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I spent two months informing the spine surgeon and orthotist that Tamzin was not 'configured' the way the 07/07 manipulated x-ray suggests (radiographer pulled and yanked her all the over the place). I told them that with a horizontal pelvic, her LC was significantly improved, but because it crossed the midline, would require a King 1 configuration to safeguard the LC. King 1 classifications have a 4 point pressure system: opposite hip to LC convexity is stabilized; LC has corrective force; TC apex has corrective lateral pressure; high rib have bending pressure. The eedjit made a King 3 classified brace for a ghost then fitted it to Tamzin. It increased her LC by approx 8 degrees, tilted her horizontal pelvis and crushed her sternum. Acting like the jaws of a vice crushing a skull to straighten a bent nose, it achieved an 11 degree correction on Tamzin's TC. They agreed that I'd been correct anticipating a dangerous piece of equipment.

I can't tell for certain, but it looks as if your kid also has a King 2 or 3 configuration. Minimal LC out of brace, good correction on TC, but whoa, looks what they've done to her lumbar spine!

Am I missing something here Sharon?

[Pooka1]

Am I missing something here Sharon?

I have no idea how these things are supposed to fit. I have no idea what you are referring to with King type curves. They map to Lenke type curves but I haven't studied it. I think the Charleston braces are most effective for lumbar, not thoracic curves but I don't know that.

Tamzin's in-brace radiograph does not appear to be with a bending brace to my eye if my kid's radigraph is typical. I don't blame you for tossing that brace.

[TAMZTOM]

I have no idea how these things are supposed to fit. I have no idea what you are referring to with King type curves. They map to Lenke type curves but I haven't studied it. I think the Charleston braces are most effective for lumbar, not thoracic curves but I don't know that.

I'll send you the orthotist's and orthopaedist's guide to measuring and fitting a Charleston Brace. It goes through all the King classifications. (It's too big to attach in here.)


Tamzin's in-brace radiograph does not appear to be with a bending brace to my eye if my kid's radigraph is typical. I don't blame you for tossing that brace.
They 'sold' it as a Charleston bending brace, looks like a clone rip-off to me. And this is the top scoliosis hospital in Wales; they deal with 1500 patients. All those kids tortured in contraptions like they tried to pan off on Tamzin...

Be calm Tom, patience...

[TAMZTOM]

I have no idea what you are referring to with King type curves.
I've sent you the classification system Sharon. Orthotists guide.


They map to Lenke type curves but I haven't studied it.
Mapping to Lenke type curves is another matter. King classifications are used to fit the brace.


I think the Charleston braces are most effective for lumbar, not thoracic curves but I don't know that.
I seem to vaguely recall that it was the other way around, good for TC, not for LC, in general. Really can't vouch for that though.


Tamzin's in-brace radiograph does not appear to be with a bending brace to my eye if my kid's radigraph is typical. I don't blame you for tossing that brace.
As you know, Sharon, I am taking this matter further. What do you see on Tamzin's x-ray that suggests it wasn't a bending brace?

On your kid's radiographs, it looks (to me) as if the brace did a good job on the TC, but made the LC much worse. Is that your interpretation too?

[Pooka1]

I've sent you the classification system Sharon. Orthotists guide.

Okay thanks.


Mapping to Lenke type curves is another matter. King classifications are used to fit the brace.

Okay but I had my hands full trying to understand the Lenke classification. :-)


I seem to vaguely recall that it was the other way around, good for TC, not for LC, in general. Really can't vouch for that though.

Well, I thought I read somewhere that it was more effect for lumbar but that was a long time ago and I may have gotten that wrong. I did mention this in passing to our surgeon and he disagreed so I think you are probably right.


As you know, Sharon, I am taking this matter further. What do you see on Tamzin's x-ray that suggests it wasn't a bending brace?

The spine isn't bent over one way like in my kid's radiograph. My kid looks windswept off to the left in the film. I don't see that in Tamzin's film but I am not an orthotist so I can't say.

I never had much chance to talk with the surgeon about the brace. I was picking up the first kid from the hospital after her fusion and my husband took the other kid to the orthotist to get the brace and then raced over to the surgeon to have the radiographs done and so the surgeon could see if he liked how the brace was fitted. SO we were both at the hospital/clinic but in different areas that day. Per my husband, the surgeon okayed the brace and said there was a large correction in it. That's what I know. I never got too involved in the brace because I was starting to read the bracing literature at that point and progressively lost interest. At some point, I read the article with the declarative statement about bracing not working in Marfans patients and that's when I completely jumped ship mentally on the brace. There are very few declarative statements of the type "surgeons should know" that bracing will not work in these cases etc. etc. etc. in these research articles so when you see one and it seems to apply to your kid, you take notice.


On your kid's radiographs, it looks (to me) as if the brace did a good job on the TC, but made the LC much worse. Is that your interpretation too?

Since the curves go in opposite directions, any brace with one bend has to make one curve better and the other curve worse it seems. If the TC got better then the LC had to get worse because of the geometry. I am guessing they didn't think that was significant because the LC was not structural. They were only trying to hit the structural TC. Who knows.

[TAMZTOM]

The spine isn't bent over one way like in my kid's radiograph. My kid looks windswept off to the left in the film. I don't see that in Tamzin's film but I am not an orthotist so I can't say.
The thing took "windswept" and then achieved a MANGLE.


I was picking up the first kid from the hospital after her fusion and my husband took the other kid to the orthotist to get the brace and then raced over to the surgeon to have the radiographsdone and so the surgeon could see if he liked how the brace was fitted.
Bloody hell, Sharon! My guts would've been mince going through that with both your kids. Well done.


Since the curves go in opposite directions, any brace with one bend has to make one curve better and the other curve worse it seems. If the TC got better then the LC had to get worse because of the geometry.
That is precisely why there is a "King 1 classification" for fitting Charleston braces, viz., to ensure the LC does not get worse.
Thanks again for the radiograph, it's the only other radiograph I've seen of a 'real live kid' in a Charleston!