Are improvements from bracing permanent?

[roscateri]

Hi, all. I posted a while back. My almost 13 YO DD has a 30 degree thoracic curve diagnosed about a month ago. We go to Shriners in a couple of weeks to be evaluated. If she is put in a brace and her curve improves, will it be permanent? I am just trying to think long term. Of course, we don't want surgery. But I am concerned about how to tell her that her back will never look any better than it does now. Her shoulders and hips are very obviously unbalanced, and at her age (and upcoming age) this is a big deal. I know that this pales in comparison to alot of things that could be going on, but I just want to be prepared for dealing with it. And, I know I am probably jumping the gun until we hear from the doctor. There are just a million things going through my head right now.

Oh, and one more question. From your experiences, will we know something from Shriners that day? And if it is determined she needs bracing, will they go ahead and cast her? Shriners is about a 5 hour drive for us, so we are trying to anticipate what will happen when we get there and how long we'll stay. Also, we are thinking if it is a definitive brace situation, we might get it done closer to home. We have a second appointment with a great doctor in Memphis-a little over a couple of hours away. Thanks to everyone for all the info thus far!

Susie

[LindaRacine]

Hi Susie...

The improvement is almost always temporary. The goal is to hold the curves during growth so that they stay small. And, while success is nowhere near 100%, most brace patients avoid surgery in the long term.

The makers of the Spinecor brace are stating that they're finding the improvement is permanent, but that remains to be proven.

Regards,
Linda

[roscateri]

Thanks, Linda. I thought I had read that-just trying to get a handle on all this info!

[amandap]

Hi Susie,

I responded to your post on Spine Kids but like Linda said the brace does not provide permanent correction.

The goal is simply to prevent the curve from progessing.

Amanda

[ecnw]

My son has been braced now going on almost four years. There has been improvement, but we will need to see as growth spurts continue. We'll just be happy as long as surgery is avoided.
As long as your doctor approves, I wouldn't see a problem with getting it done closer to home. Especially if any readjustments are needed, it saves a drive.
Emily

[orthoman]

a brace is an instrument made to stop progresion of the curve, if you have a curve that gets smaller than that is a nice side effect. The first goal is stopping the curve , and yes if you wear it in the picture you will see a smaller curve, but that is deu to the brace. after you are fully grown it is always waiting for what will happen to your back.
hopefully you have some use for this information

stan orthopedic instrument maker
Netherlands ,Europe

[gerbo]

I have gathered, and have been told, that the most succesful braces are those which are worn consitently (over 20-22 hrs/day) and which give the highest initial correction, over 50% inital correction seems to be the gold standard, giving a reasonable chance of stabilisation or even some improvement

I do not know till what extend "orthopedic instrument makers" are actively trying to achieve as much correction as possible on initial fitting and whether there are proven methods to achieve that, or whether it is a question of "making it up as you go along", and every instrument maker just doing whatever they think is best.

I worry that low expectations could lead to not trying hard enough to get as much out of bracing as possible and lead to a self fullfilling prophecy of low succes rates......

[The Slice]

What others have said is correct, bracing is not a cure, nor will it correct the curve. The hope is that it will stop, or slow the curve's progression until the child has finished growing, at which time, the spine is usually considered stable. Curves over 50 degrees are suspect after growth has completed and are often times monitored for several years if surgery is not done. It seems that curves even worse than that have a higher risk of increasing even further later on. (Not positive about this.) Aside from the changes in body image, are other possible complications such as compression of the heart and lungs, nerve, and spinal cord damage. The problem is that in kids that are still growing, curves can very easily progress well beyond the 50 degree mark before they get to the point where their growth is considered finished or stable. Apparently some have curves that level off at points anywhere up to the 50 degree mark without treatment, and since there is no way of predicting where someone's curve will level off, many kids who are caught early in their growth spurt are braced to help assure that it hopefully won't go to a severity that causes other problems. The other element in this is that often times the smaller the curve, the better the correction results are. However there are other factors involved there as well. Often times curves that are closer to 50 degrees have a good chance of an almost straight correction, whereas curves that are say, over 120 degrees have a chance of only being partially straightened. With all of that said, I am not speaking as an expert, but one who has seen alot of info on the subject. The catch here is that there are many differing opinions between the experts, so it's hard to know who IS correct, but that's like all of medicine. It's up to the patients/parents to do the research into who they are going to get the treatment from.

[orthoman]

I do not know till what extend "orthopedic instrument makers" are actively trying to achieve as much correction as possible on initial fitting and whether there are proven methods to achieve that, or whether it is a question of "making it up as you go along", and every instrument maker just doing whatever they think is best.

i don't know what the standart of education is in the U.S. concerning the beatiful profesion of orthotist ( a very personal rewarding profesion) but here i n holland whe go truogh a cuorse of 6 years of training before whe go into the fitting chambers , the boston is a extra specialisation with extra training skills every one in the netherlands who is making boston brace's has gone trough these classes, and yes whe try to get as musch result as possible, and i have to admit that sometimes it's a proces of making it up as we go along. but always by a few standart rules of brace making, its never just a make up story . there may be some individuals who don't compley to these rules , but for most of us i can say we do. we have to follow the curves of the patient, we can not just cut out a piece of plastic and see what happens.
if annything goes wrong or a patient still needs surgery i feel that i have failed, and that is not a nice feeling. so i do what i can to get the best results posible even if i know that for some patient's it just a matter of time before they get surgery ( the smaaler the curve the better results we get after surgery) . for me it's alway's a battle i have win with curve's in the opposite corner
stan

[gerbo]

When posting on a german forum, it was emphasised to me how important a well made brace was, also stating that IN THEIR EXPERIENCE, only a few orthotist in germany came up to high standards (of initial correction). Specifically they were raving about a mr rahmouni, making a modified version of the Cheneau brace, in their experience achieving often nearly 100% correction in brace (or even overcorrecting) and thereby achieving very high eventual succesrates. Never been sure whether this was fact or fiction, but considering this was based on personal experience of a large group of scoliosis patients and medically speaking it made sense, I have always felt that if only all "bracers" (be it doctors or othotists) would aim for that level of correction, overal results could be much better, and bracing might have not such a bad reputation. Ofcourse, chenau braces are not the same as boston braces, and whether a similar degree of aggressive correction would be possible with a boston, i don't know. what do ytou think, Stan??

[orthoman]

i have to agre with you gerbo that not all arthotist are going for the ultimate goal, unfortunatley , some think that they are teasing the kids who are wearing it for a long time and than still need or , i don't think so. the better the result the better the kids get.the cheneau brace is indeed not to be compared with a boston, they are both used for curves but both for diferent types of curves, the cheneau brace gives more presure than a boston but can only be worn in the night ( because of it's extreme curverture ) , i think that both brace's are good, but people have to think about the pro and con's of the diferent type of brace's. so yes i agree with you that results can be better,no matter what brace we choose, if everybody would go for the same goal, and that's the ultimate 100%.i can onley hope that more and more people will go for the best.

ps the succes rates are no fiction of this mr rahmouni. he indeed has very good succes rates with his way of bracing, what the story doesn't tel is that the patient's do have the right curve's for his type of bracing.

[gerbo]

interesting that you have heared about mr rahmouni, is he well known in the netherlands? in what context did you hear about him?

just to correct, i know for a fact that the cheneau brace as fitted by rahmouni needs to worn for 23 hours, is it the charlaston which is only worn at night??

i doubt whether the choice of brace in general particularly determined by the type of curve (apart from milwaukee) and that choice between boston, cheneau or custom made tlso or others is more based on geography and habit, then on science. Which is a shame really, because if one particularly brace is more succesful than others, the experience and knowledge of this should be shared and spread out.

out of interest, where do you work, Stan??

[orthoman]

i know mr rahmouni by searchon the internet to, he has a big practice in germany near stutgart ( http://www.rahmouni.de/ ) this is the site, only it´s in german i hope people can understand it a little bit ( i can read and write Englisch , german and my own langueges dutch ).and you are wright about the brace´s it was the charleston for the nighttime, i mixed them up .
and i do agree with you that everybody schould try out new bracing methods if someone make´s a good improvemnt on it and not stik to the old stuff they are used to.

i work in a city called Alkmaar its about 40 km above Amsterdam.i work with 8 orthopedic surgeons in a hospital, not just scoliosis but also lots of other bone or bone relatated problems, i always say i work from head to tow.

[~ScoliosisGirl~]

When i was diagnosed and started wearing my brace my curve was 50* and no, i did not have any problems.. It happened to me all of a sudden that i got scoliosis. The doctor told me it probobly happened to me all of a sudden because i grew all of a sudden like crazyy.. that year i got much taller and thats what affected the spine. I barely had any pain. I felt regular and just after i was diagnosed with it my dad looked much more into it and then we realized that how one hip of mine is straight and the other one is the opposite--- scoliosis. So now we are still watching it and we hope for the best... and in like 3 months im going to go back to my doctor in barcelona and to check my curves.

[ecnw]

Orthoman, thank you for bring another view to the site. My childrens' othrotist, like you, has always been very knowledgable on why braces are designed certain ways, how one must know how the body works to munipulate it to slow the progression of a curve. I don't think a lot of people understand that your profession requires a lot of training.
Emily