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GHD1959
08-06-2004, 01:15 AM
I AM 44 YEARS OLD AND MY CURVE IS AT 60 DEGREES, GOING TO PT, USING A INVERSION TABLE AND HAVE A PRESCRIPTION THAT IS FULLY COVERED FOR A BOSTON BRACE LIKE I WORE AS A TEEN. I HAVE BEEN TOLD NOT TO GET IT AS IT WILL NOT HELP STRENGHTEN THE MUSCLES I AM TRYING TO STRENGHTEN. I WOULD LIKE TO RELIEVE PAIN WITH IT. DOES ANY ADULTS USE A BRACE LIKE THIS FOR PAIN RELIEF?? WHAT ARE YOUR THOUGHTS????

lindabar
08-07-2004, 06:16 PM
I was told that no bracing would help me with pain or correction when I saw a surgeon in Tucson in the early nineties. He would not do surgery, nor give me any pain relievers except for naproxen. I had a job at that time that required prolonged standing and I had to quit that job and get a desk job. I had just come from Philadelphia (where I had Blue cross, not HMO) where I could have surgery if I wished. PT in Tucson was not as good as in Phila.Ended up travelling to Phoenix to find a decent orthopedic physician. What city do you live in? You may want to find a physician in the nearest large city.

GHD1959
08-07-2004, 09:13 PM
I AM FROM TUCSON AND LIVE IN PHOENIX NOW AND HAVE BEEN TO A COUPLE OF DOCTORS, ONE WHO LOVES TO DO SURGERY AND SAID COME BACK IN A YEAR AND RECHECK MY CURVE. PT HAS NOT REALLY DONE MUCH EITHER, ESPECIALLY WITH THE ARTHRITIS AT MY LOWER BACK AREA....

lindabar
08-17-2004, 10:58 PM
When I was in Phila PT included passive therapy, like heat and ultrasound. In Tucson all I got was PT aides trying to make me do sit ups, which I refused to do.
I asked them to do put some heat packs on my pack for a couple of visits, but they said that it wouldn't help me. They didn't want to take the time or expense of doing something like that. Maybe you can talk the therapist into some heat therapy or massage, which will probably make you feel better, if only temporarily. I saw Dr Maric in Phoenix. He told me to come back every year and said he would do surgery but did not push it too much. If you don't want surgery, all the surgeons do is make sure you haven't had a big change in the curves since the last time you were there. I did go to a pain clinic and Tucson and that was some help.

KaTy
08-18-2004, 02:36 AM
Hello GHD1959,

I am 43 years-old, have a 80 degree progressing curve which is
inoperable because of a rare congenital respiratory anomaly.

I got a Boston brace last year, just like the one I used to wear when I
was a teenager. I know that my curve will not be corrected or my
progression will be
halted by a Boston brace but I wanted to try it as a pain relief measure.
The doctors were all raising eyebrows but I was so desparate.
They gave in though cautioned me not to wear it for long hours as it
will deteriorate my muscles and told me to do lots of exercises.

But the brace DOES help a bit in easing my pain.
I get severe pain especially in my rib hump and lower back areas when I sit or stand for some hours. But with the Brace on, I get less pain, particularly in my rib hump. I think it's because the pad on the brace gives a nice press to my rib hump.

However, I can only wear the Brace for an hour or so. After that, I
start having dizziness and nausea. The corset maker told me that it is probably because my spine, though it still has some flexibility, is not so flexible as teenagers.

I also have a soft corset which I wear when I go out.

So now, I wear a Boston brace or a soft corset when I sit or stand for long hours and I do abdominal exercises everyday, which altogether releives my pain and enables me to function.

However, I would NOT recommend other adults to get a Boston brace.
I think the merits are slim compared to its cumbersomeness.

That's my two cents.

I hope you can find pain relief measures that suits you.

KaTy

Celia
08-18-2004, 08:30 AM
My husband has minor scoliosis which still causes him quite a bit of discomfort. I have often said that he should look into the SpineCor brace which is quite flexible (straps) and works with the muscles. It can't hurt to give it a try.





Celia ;)

LindaRacine
08-18-2004, 11:13 AM
Hi Celia...

Actually, I think it could hurt. A brace will almost certainly cause muscles to atrophy over time. Kids bodies have the ability to recover from that. In adults, a brace would almost certainly have to be permanent. That's probably OK in older adults.

--Linda

Celia
08-19-2004, 08:54 AM
Linda,

Is that why adults are not prescribed braces by their doctors ? It seems as though more should be done in treating adults than just allowing curves to progress to the point when fusion is necessary. My husband has suffered from back pain for a number of years only to realize after my daughter was diagnosed with scoliosis that he too, had it.

You are right, it would be a permanent solution and the muscles could atrophy over the long term. Have you seen the SpineCor brace ? Do you think it could lead to muscle atrophy ? I'm just looking for ways right now to help my husband with his pain. I don't want to see his curve progress over the long term. It's such a dilemma.

I just had a thought, wouldn't it be great if they had something similar to the titanium rib for adults ? Granted there would be no expansions every six months but it would work as an internal brace...think about it, no fusion.

Celia :)

KaTy
08-26-2004, 02:58 AM
I always wonder whether the medical community ever care for scoliosis patients who have big curves but unable to undergo fusion surgery due to heart, respiratory or other problems.

Ms. Schommer writes in her book "Stopping Scoliosis" that "proper
patient selection" is important for adult surgeries. (pg 100)

So, what about people who fall from that "selection" ?

All scoliosis text, at least that I have read, never mention what
happens to these group of people.

If braces aren't for them and exercises won't help, what's the message?
Just sit back, relax and enjoy your curve progress, your rib hump grow and your lung function deteriorate?

I know people who fall into this group are very few, minority among the minority, so exceptional enough to be ignorable.
I feel discarded, cut off and left out from treatment. And it's sad.
Sometimes I get depressed just by reading surgery success stories.

Now, please don't recommend me any alternative treatments.
That's not my point here.

I just hope the scoliosis medical community would start exploring ways to help patients who fall from the current fusion-surgery-only option.

KaTy

LindaRacine
08-26-2004, 11:26 AM
Hi Katy....

I'm so sorry to hear that you fall within that group. It must be a "tough pill to swallow."

Since orthopaedists are surgeons, It may be asking too much to expect them to have solutions for people who aren't candidates for surgery. A good scoliosis specialist should, however, have some solutions for pain reduction. In addition to seeing a pain management doctor, you might want to look at these braces:
http://www.corflex.com/cerv-spine-products/unloader-body-frame.html
http://www.treatmyback.com/orthoflash.htm

While bracing won't permanently reduce curves in a skeletally mature patient, it can help reduce pain (especially lower back pain).

Regards,
Linda

LindaRacine
08-26-2004, 09:24 PM
Hi Katy...

I just happened to come across the following abstract today and thought you might be interersted:

Br J Dis Chest. 1986 Oct;80(4):360-9. Related Articles, Links

Cardiorespiratory consequences of unfused idiopathic scoliosis.

Branthwaite MA.

A retrospective survey was carried out on approximately 800 scoliotic subjects attending a chest clinic over 25 years. One hundred thirty-one patients with unfused idiopathic scoliosis were identified and further consideration was restricted to 54 who were assessed at 30 years of age or older. Sex, age of onset of curvature, severity at the time of presentation, degree of dyspnoea, presence of independent cardiac or pulmonary disease and smoking habit were recorded. Measurements of lung function were compared with predicted figures calculated according to span, age and sex. Disabling dyspnoea or cardiorespiratory failure were associated with either scoliosis of early onset (curve first noticed before 5 years) or with independent cardiac or pulmonary disease. Only one of 28 patients with unfused idiopathic scoliosis of adolescent onset developed disabling dyspnoea in later life attributable solely to spinal deformity. A similar conclusion was drawn from a separate survey of mortality in 86 patients, 19 of whom suffered from idiopathic scoliosis. Cardiorespiratory failure attributable to the scoliosis was the cause of death of 11 patients, in 10 of whom the curve had first been noticed at less than 5 years of age whereas the onset was during early adolescence (11 years) in only one.

Regards,
Linda

Karen Ocker
08-27-2004, 05:01 PM
Linda:

Is there anything more recent? That study was done 18 years ago; not considered recent in the scientific community.
Karen

LindaRacine
08-27-2004, 11:46 PM
Karen...

I don't know, and don't really have time to look. If you want to search, here's the link:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

I found that article while doing a search for something else, and thought it might be of interest to Katy, since she had talked about the issue.

--Linda

Celia
08-28-2004, 05:42 AM
Hi Linda,

You ARE such a great source of information, people just take it for granted that you have all this at your fingertips ! I saw one of your posts somewhere about Risser 0 1, 2, 3, 4 ( is there a 5 ? - I thought it was in this thread ) and I've been looking everywhere for information on the average age of patients as they attain these different levels. I know if I keep my - soon to be - four year old below 20 degrees that there won't be much risk of progression once she hits Risser 3 and 4 level. I think right now she is a Risser 0. Sorry guys for going OFF TOPIC :D





Celia

LindaRacine
08-28-2004, 05:20 PM
Hi Celia...

Good question. I looked through all of my scoliosis texts, and couldn't find anything showing average age correlated with Risser sign. I did find the statement that Risser 1 appears at an average of about 13-1/2 years in girls. And, if I'm not mistaken, most kids go from Risser 1 to Risser 4 in about a year.

And yes, there is a Risser 5.

Regards,
Linda

Celia
08-30-2004, 08:29 AM
Linda,


Thank-you so much !!! Although the information is quite sobering - quite depressing actually. I think I'll go shopping - that always cheers me up.






Celia

KaTy
09-14-2004, 02:57 AM
Thank you Linda, for the information, both on the lower back supportingbraces and the study.
Sorry for my slow reply.

Those back supporting braces might be helping though it seemed quite bulky. I recently saw a newspaper ad on a lower back brace with traction function. It was developed in South Korea. The price was fairly expensive which gave me second thoughts on purchase.

I will ask my doctor about pain management for scoliosis, but I doubt that there is any specific one for scoliosis in area.


As to the study, I did not know how I should react to it...

I wish a totally new fusion method will be developed soon so that more patients become eligible for surgery.

As my curve worsens, I am shrinking (I already lost about 2 inches since I was 15) and my rib hump is growing and there's less and less clothes that I can wear. I try to remain cheerful and optimistic, but sometimes I get so depressed that nothing can be done to stop my curve progression.

If there is anyone out there who have big progressive curves but is not eligible for fusion? What does your doctor say to you?

********

By the way, I found the following 2 studies on unfused scoliosis
patients. It might to be of interest to others though I thought the
follow-up years are too short.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3192566

J Bone Joint Surg Br. 1988 Nov;70(5):712-6.

Long-term follow-up of fused and unfused idiopathic scoliosis

Edgar MA, Mehta MH.
Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, Middlesex, England.

We reviewed 77 unfused and 91 fused patients with idiopathic scoliosis who first attended between 1949 and 1965. Both groups were re-examined at least 10 years after reaching skeletal maturity, with attention to progression of the Cobb angle, increased in vertebral rotation, back pain and psychosocial problems. We found that spinal fusion protects the scoliotic spine from further deterioration during adult life except for those with severe curves and marked rotation. Fusion also significantly reduced the incidence of severe pain and allowed patients to carry out heavy physical work, but did not confer complete immunity from backache. Surgery improved the appearance, but patients were not always completely satisfied with the cosmetic result.

PMID: 3192566 [PubMed - indexed for MEDLINE]


http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2956582
Orthopedics. 1987 Jun;10(6):931-9.

******

The natural history of unfused scoliosis.

Edgar MA.

Seventy-eight unfused patients with idiopathic scoliosis were followed from skeletal maturity over a mean period of 17 years (range 10 to 27 years) with a mean age at follow up of 33.7 years. The following aspects were investigated: curve deterioration, back pain incidence, and
psychosocial details. There was considerable variation in the
progression rate of similar deformities but on average significant
deterioration occurred when the Cobb angle was over 55 degrees with a maximum deterioration approaching 1.5 degrees per year in the thoracic curves between 90 degrees and 100 degrees mature Cobb angle.
Thoracolumbar and lumbar curves were slightly more benign with a maximum progression rate of about 1 degree when the mature angle was 80 degrees to 90 degrees. The thoracic component of double curves progressed least.
Rotation increased in proportion to the Cobb angle progression except in some lumbar curves where lateral subluxation occurred with a disproportionate amount of rotation. The incidence of back pain inrelation to pain in the general population and in fused patients remains uncertain. Eighty-two percent of patients had married and 87% had job satisfaction; 10% received treatment for depression.

PMID: 2956582 [PubMed - indexed for MEDLINE] totally new fusion method totally new fusion methos

LindaRacine
09-14-2004, 11:08 AM
Hi Katy...

Here's a more recent study:

AMA. 2003 Feb 5;289(5):559-67. Related Articles, Links

Comment in:

* J Fam Pract. 2003 Jun;52(6):451-2.
* JAMA. 2003 Feb 5;289(5):608-9.
* JAMA. 2003 May 28;289(20):2644; author reply 2644-5.


Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

Weinstein SL, Dolan LA, Spratt KF, Peterson KK, Spoonamore MJ, Ponseti IV.

Department of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA. stuart-weinstein@uiowa.edu

CONTEXT: Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. OBJECTIVE: To present the outcomes related to health and function in untreated patients with LIS. DESIGN, SETTING, AND PATIENTS: Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). MAIN OUTCOME MEASURES: Mortality, back pain, pulmonary symptoms, general function, depression, and body image. RESULTS: The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. CONCLUSIONS: Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

--Linda