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concerned dad
03-20-2009, 05:08 PM
I dont suppose anyone has references about the effectivness of night braces. Sharon, I know you said your daughter is using one. The reason I ask is because, well, after careful thought we have decided to abandon the SpineCor. I am not ready to get into details but I have lost faith in the brace and the claims made by the inventors in the technical literature.

momw/scoli
03-20-2009, 06:06 PM
I was told by my Daughters Dr. they work best on single curves. My daughter has an S curve and we tried it anyway. It didn't work, and a year later she wore a Boston. I wish you the best of luck.
Becky

daniel s.
03-20-2009, 06:10 PM
i wore the charelston night time bending brace as a teenager about 20 years ago. it was fairly new then. i think there have been some questions raised about their effectiveness. i can tell you that at that time i had 32/28 degree curves. now 20 years later i am 62/45. i was not as diligent as i should have been in wearing it, i starting wearing it a little later than ideal, and i was lazy and in denial and did not follow up with xrays annually as i should have. so, i cant say if i continued to progress during the time i was in the brace or after i stopped wearing it... it was extremely uncomfortable and actual somewhat painful at times. mostly when removing it when everything inside me kind of shifted back into place it knocked the wind out of me... but, i think many kids with parents help may be more likely to wear this in lieu of wearing other braces they would have to wear to school etc... but again, i would investigate its effectiveness. i cant say either way... hope this helps!

daniel

mamandcrm
03-20-2009, 07:06 PM
Hi CD, sorry things are not working out as you hoped. I'm sure you've already done this as you seem very adept at research but I recall from when I researched the Providence brace (my daughter wore one for 5 months) that there were a 2-3 studies found through a simple net search that were helpful. They all involved AIS and seemed clear on what their parameters were.

Just FYI, my daughter had no problem wearing the Providence. My 14 year old niece also has one and has done fine with it, no compliance problems.

Good luck,

Pooka1
03-21-2009, 02:10 AM
CD, hang in there.

I don't have the literature at hand but here is what I was told, what I understand to be the case, and what our experience has been...

1. Our surgeon specifically told me that before the recent literature on the Charleston, he never (or rarely) braced. So as I understand it, this is the only brace he uses and has used it only recently. Essentially, it pulled him out of watching and waiting camp as I understand his comments to me.

2. As I understand it, it seems to be more promising for the lumbar curves. My daughter has a thoracic curve so I think it was not expected to be as effective. (Moreover, there is evidence in hand that no brace can hold certain curves associated with connective tissue disorders like I think my daughters have. So there's that in looking at her experience.)

3. I found one article on its use in the JIS crowd but I didn't critique the analysis.

4. As I have written, my daughter's curve movement does not appear to be a function of brace wear; it was stable for periods without it and the curve increased ~8* with it though was stable in the next 6 months in the brace. But again, I don't think her case applies to the AIS cases.

5. About half the kids find it very comfortable and are uncomfortable not wearing it for a night. My daughter is in this group.

Good luck.

concerned dad
03-21-2009, 11:27 AM
Charleston vs Providence?

I think we will only (easily) have access to the Providence Brace. I dont really see yet what the difference is.

txmarinemom
03-21-2009, 12:44 PM
Charleston vs Providence?

I think we will only (easily) have access to the Providence Brace. I dont really see yet what the difference is.

I know you've seen this literature before, CD, but I've included the links for anyone who hasn't and would care to review.

It seems the main difference between the Providence (http://www.srs.org/professionals/bracing_manuals/section8.pdf) and the Charleston (http://www.srs.org/professionals/bracing_manuals/section7.pdf) is that the Charleston uses applies opposite bending force to overcorrect the curve.

The Providence seems to take more of 3 dimensional approach, and does not attempt to mimic opposite bending. Instead, it relies on counter forces applied against the lateral and rotational aspects of the curvature. I find it interesting the thoracic and lumbar sections are modeled separately and then rejoined to form the brace vs. a one piece construction like the Charleston and TLSO's like the Boston. Conceptually, that makes sense to me.

I've made my views on bracing fairly clear, but I've also said if bracing is destined to work it is a LOT more likely to work if the patient wears it. Anything that achieves effective compliance is better than nothing, and I really wish either option for night time bracing had been available for me. I suspect it could have changed how I view the concept of bracing trauma as a whole.

Best of luck to you, CD. I can only imagine how tough it is to head one direction and switch midstream. No matter what the eventual outcome, you've done the best you can to find the best solution for your daughter. That's a tough task in a scenario without absolutes - and riddled with anomalies.

Hang in there.

Regards,
Pam

mamandcrm
03-21-2009, 02:11 PM
It was my understanding from our ortho that the Providence "overcorrects" as well...and I could see that in my daughter when she was upright in it, walking to the bathroom or something before bed. Definitely tilted, much different than a "standing" brace. But from the pictures I've seen of the Charleston, which looks very bending (much moreso than the Providence), it is not as obvious in the Providence I think because the Providence has a straighter look to it from the outside...the foam padding on the inside is fairly thick in places and more molded...

mamandcrm
03-21-2009, 02:55 PM
Hi CD,

I was reading over another post of yours and noticed that your daughter's curve is 38 (not sure where it's located). If I recall correctly, I think the success of night-time bracing goes down significantly where the curve is over 35 degrees...and that lumbar curves fare better than thoracic...just some things to think about...

mariaf
03-22-2009, 08:16 AM
Hi CD,

I'm not sure where you live, but just this morning I came across this post on the VBS site and thought you might be interested:

Someone posted the following:

"I have seen a few comments about the Providence brace being uncomfortable for some children to wear. Dr. Betz was so impressed by my daughter's orthotist that he asked for his card. She has curves of T2-T-10 35degrees and T-11 - L2 25 degrees. She corrected to ZERO in brace. Brace fits really well and there is some discomfort, but minimal. Here is the name and info. of the orthotist. He is in Spring Valley, NY which is about 45 minutes from New York City in Rockland County.

Kenneth Lynch Co.
Phone: 845-356-9357
AMKEN Orthopedics
9A Perlman Drive
Spring Valley, NY 10977"

Good luck to you and your daughter.

momw/scoli
03-22-2009, 11:01 PM
It looks like the Providence works with double curves. Does it depend what part of the country you live in to get the Providence? If my younger daughter ever develops scoli that looks very promising. Compliance is a big issue and nighttime braces are easier to tolerate. For the life of me, I couldn't keep my daughter in her Boston except at night! She wore the Charleston faithfully every night, it just didn't work on her curve types.
Becky

concerned dad
03-23-2009, 11:11 AM
Hi CD,

I was reading over another post of yours and noticed that your daughter's curve is 38 (not sure where it's located). If I recall correctly, I think the success of night-time bracing goes down significantly where the curve is over 35 degrees...and that lumbar curves fare better than thoracic...just some things to think about...

Yes, the 35 degree cut off looks pretty troubling.

This is from the 2007 Janecki Paper we discussed before (the paper that came out simultaneous with Coillard). This is what they observed for a subset of patients between 35 and 40 degrees. Emphasis added is mine.

There was no difference in the progression of curve magnitude or the rate of surgery between the 14 patients in the TLSO group and the 11 patients in the Providence group whose initial curves were between 36 and 40 degrees. Only 2 patients in the TLSO group (14%) and 1 patient in the Providence group (9%) did not progress. The curves of all 12 remaining patients in the TLSO group progressed beyond 45 degrees and required surgery. In the Providence group, the curves of 8 of 10 patients progressed beyond 45 degrees, but all 10 required surgery.

Granted it seems they pull the trigger on surgery pretty quick (even below 45 in some cases) but wow, this is a bummer.

mamandcrm
03-23-2009, 11:38 AM
It is a bummer. I am so sorry you got the rug pulled out from under you on the spinecor. It's hard to start over from scratch again.

Pooka1
03-23-2009, 03:19 PM
Granted it seems they pull the trigger on surgery pretty quick (even below 45 in some cases) but wow, this is a bummer.

It's a bummer, CD. Sorry.

In re pulling the trigger, my daughter was at 48* when we scheduled surgery. She was 58* on the table.

Maybe they schedule the cases that they know are moving fast because the fast moving ones are known not to stop. Who knows. My daughter's curve averaged about 5*/month in the two months before her surgery but even the slower progression just prior to scheduling her was enough to trigger the call. And it was a perfect call on the surgeon's part I might add. These guys are amazing.

concerned dad
03-23-2009, 03:42 PM
Any idea just exactly what they are trying to say here?

We wish to again emphasize the differences between the Charleston Bending Brace and the Providence brace, both of which are recommended for nighttime use. The Charleston brace works by bending the spine. When a double curve is treated, the forces unbending one of the curves in a double curve pattern can worsen a curve with an apex in the opposite direction. Indeed, this was observed in 11 of 24 double curves in the first report published on the Charleston Bending Brace. The Providence brace works by the application of opposing forces and does not bend the spine; rather, it pushes the curve apexes to the midline. We did not experience permanent worsening of secondary curves at the final follow-up.

Not bend the spine? Push the apex? How can you push the apex without bending the spine?

This is from:
Nighttime Bracing With the Providence Brace in Adolescent Girls With Idiopathic Scoliosis
Charles Roland d’Amato, MD, FRCS(C), Sean Griggs, MD, and Barry McCoy, MEd, CPO
SPINE 2001 Volume 26, Number 18, pp 2006–2012

concerned dad
03-23-2009, 03:47 PM
Here is the name and info. of the orthotist. He is in Spring Valley, NY which is about 45 minutes from New York City in Rockland County.


Thanks Maria, That's a bit of a drive for us. But I'll keep that name in mind should we not like the fellow around here.

Pooka1
03-23-2009, 04:14 PM
Hey I am not sure but I think the difference is that the Providence aims to straighten but not over-straighten (counter-bend) the spine whereas the Charleston aims to over-correct (counter-bend) as much as possible.

Now in practice, I don't think they really ever over-correct but do come near to straight like with my daughter at first.

I don't "get" how the Charleston can possibly work with an S-curve (because it has only one bend) but what the hell do I know??

Ballet Mom
04-22-2009, 04:21 PM
Actually, my daughter has been in a Charleston Bending Brace for fourteen months now. She had a greater than 100% correction in brace on her major curve, the in-brace Cobb angle was measured at -4 degrees (negative four degrees). Her compensatory lower curve was able to achieve a 50% in-brace correction. She has had great success with this brace even though the doctor said she was likely to progress to surgery. I am curious where you come up with the conclusion that the Charleston brace doesn't typically over-correct the curve, as that is the whole point of the brace as I understand it.

Pooka1
04-22-2009, 04:40 PM
Well two things...

First, -4* is not distinguishable from straight (0*) considering the precision (+/- 5*).

Second, there is some limit on how much they are going to bend these kids. I assume they bent my daughter the maximum (why wouldn't they?) and she was about straight in brace. If it was possible and advantageous to bend them much farther then I wonder why they didn't do that with my daughter?

So I guess I don't know that most other kids are not extremely overcorrected but then I have a few questions for my surgeon.

I was not able to be at the initial brace appointment but was told the surgeon was very pleased after seeing her correct to near straight in brace... so pleased he revised his guess about her needing surgery from 80% likely (based mainly on her ID twin's case) to 60% unlikely.

ETA:
I would think that if she should have been over-corrected more, he would not have been so pleased nor have revised his surgery prediction estimate so high. But again, I don't *know* any of that as such.

If I ever intended to see the orthotist again I would ask. I don't intend to see him again. I will be buttonholing the surgeon ion this point if I remember.

Dingo
04-22-2009, 05:12 PM
Concerned Dad

I'm not an expert but to me it looks like the Providence brace is the one to go with. It works for pretty much every type of curve except a high thoracic curve. If anybody knows better and I'm wrong please correct me on that.

Take a look at how they build one of these (http://www.srs.org/professionals/bracing_manuals/section8.pdf).

Scroll to page 16 for a great photo. The back is pushed until the curve is 0 degrees or as close as they can get to 0. The brace is molded off of those measurements.

The bigger the curve the more the brace is forced to push.

All braces are uncomfortable but it seems to me that a brace designed to correct a 15 degree curve will be two or three times as comfortable as a brace designed to correct a 25 degree curve. That doesn't even count the fact that bracing is less effective in larger curves. Why doctors wait to brace, I dunno. If it's going to work at all it's right at the beginning.

(still crossing my fingers that my son won't need a brace for as long as possible)

Ballet Mom
04-22-2009, 06:21 PM
Pooka1,

Actually, the negative curve is quite noticeable in the x-ray. It certainly is easily distinguishable.

I've attached a web address of an othotist's manual which shows what the orthotist is aiming for when fitting the Charleston Bending Brace. Starting on page 12, it shows the different curve types and the "Correct Positioning" pictures to show the way they want the spine to look in this brace. Obviously, there will be variance due to spinal flexibility and skill of the orthotist, but it is the point of the Charleston Bending Brace to overcorrect the spine. I just thought you had actual info to back up your statement and was curious what that was.

http://www.srs.org/professionals/bracing_manuals/section7.pdf

Pooka1
04-22-2009, 06:37 PM
My daughter has a T curve and the manual says to correct those 100% (not to over correct them). So I guess the orthotist fit the brace correctly to my daughter when he achieved a near straight spine.

If I understand the figures, most curves are not over-corrected but few are.

Dingo
04-22-2009, 07:05 PM
Pooka1

What is a T curve?

My son has an S curve, sometimes called a double curve.

Pooka1
04-22-2009, 07:35 PM
Pooka1,

Actually, the negative curve is quite noticeable in the x-ray. It certainly is easily distinguishable.


By the way, you have a better eye than I do. When I first saw my daughter's fused radiograph, it looked straight to my eye. But the surgeon said it was 5*.

Clearly, I would not be able to eyeball a 4* as different from straight but I haven't looked at a million of these radiographs.

Pooka1
04-22-2009, 07:38 PM
Pooka1

What is a T curve?

My son has an S curve, sometimes called a double curve.

Thoracic

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