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Dingo
04-24-2009, 12:29 AM
From what I read online many doctors won't brace a Juvenile curve until it reaches 25 degrees. However research has shown (http://journals.lww.com/spinejournal/Abstract/2006/08010/Progression_Risk_of_Idiopathic_Juvenile_Scoliosis. 10.aspx) that curves less than 20 degrees at puberty are associated with a very low risk of fusion.

From the study link
Curves less than 20 degrees at puberty progressed to fusion in 15% of cases.
Curves that measured 21 to 30 degrees were fused in 75% of cases.
Curves over 30 degrees were fused in 100% of cases.

Why are doctors waiting to brace until after a curve is 25 degrees and has a 75% chance of fusion?

In addition take a look at how a brace is constructed (http://www.srs.org/professionals/bracing_manuals/section8.pdf).

Scroll to page 16 for a great photo. Every brace is different but they all operate on force. The larger the curve is the more the brace has to push to achieve correction. Wouldn't you guess that a brace designed for a 15 degree curve would be several times more comfortable than a brace designed for a 25 degree curve? No brace is particularly comfortable but a smaller curve requires less force to correct and is probably more pleasant to sleep in.

And finally Some research (http://www.spinaltech.com/newsGoodNight.html) and plenty of anecdotal stories on this board suggest that bracing a Juvenile can permanently improve a curve.


Another positive aspect of nighttime bracing involves an aesthetic consideration: because the patient does not need to wear the brace during the daytime, it has less of an impact on his or her everyday life. Feeling less constrained and inconvenienced by their treatment than he or she might with a full-time brace, the patient may be more likely to achieve a higher degree of compliance. This, in turn, helps boost the chances of success.

In the case of juvenile scoliosis, orthotists can take advantage of the tendency of younger children to sleep more hours than their teenaged counterparts. An ongoing study involving 60 patients with juvenile scoliosis (aged 3.5 years to 9.5 years) indicates an average in-brace correction of 101% for major curves, and 96% for compensatory curves. The average curve improved by five degrees in all treated patients.

This study also revealed that more than one third of the participants improved to the point that they were able to spend time (up to a couple of years) out of the brace.

hope404
04-24-2009, 12:54 AM
Dingo, Amen to that...

Always wondered, once my daughter was diagnosed, what the heck we were told to wait for????

Once the feed forward mechanism of scoliosis kicks into gear, good luck stopping it.

Hmmm... massive rotation..lateral flexion..compression..sound like smart things to wait for.:(

hope404
04-24-2009, 01:37 AM
But, to brace a child for years ..until all growth has stopped UGH !!!

unfortunately, to me, waiting or bracing, NEITHER are great options:(

Pooka1
04-24-2009, 07:14 AM
From what I read online many doctors won't brace a Juvenile curve until it reaches 25 degrees.

There is a good reason for that. Do you know why they do this?


However research has shown (http://journals.lww.com/spinejournal/Abstract/2006/08010/Progression_Risk_of_Idiopathic_Juvenile_Scoliosis. 10.aspx) that curves less than 20 degrees at puberty are associated with a very low risk of fusion.

From the study link
Curves less than 20 degrees at puberty progressed to fusion in 15% of cases.
Curves that measured 21 to 30 degrees were fused in 75% of cases.
Curves over 30 degrees were fused in 100% of cases.

Why are doctors waiting to brace until after a curve is 25 degrees and has a 75% chance of fusion?

Because there is no good evidence that the curves that didn't progress were stopped by bracing and that the curves that did progress were halted by bracing. FULL STOP


In addition take a look at how a brace is constructed (http://www.srs.org/professionals/bracing_manuals/section8.pdf).

Scroll to page 16 for a great photo. Every brace is different but they all operate on force. The larger the curve is the more the brace has to push to achieve correction. Wouldn't you guess that a brace designed for a 15 degree curve would be several times more comfortable than a brace designed for a 25 degree curve? No brace is particularly comfortable but a smaller curve requires less force to correct and is probably more pleasant to sleep in.

Some large percentage of 15* curves won't progress anyway. Why make a kid wear a brace if the curve is not likely to progress?


And finally Some research (http://www.spinaltech.com/newsGoodNight.html) and plenty of anecdotal stories on this board suggest that bracing a Juvenile can permanently improve a curve.

Why the doubt among the experts then?

Dingo
04-24-2009, 08:55 AM
Pooka1

I agree that bracing for years sounds dreadful. But if a small curve is progressing I believe doctors should brace long before it hits 25 degrees.

If bracing isn't effective why prescribe it at 25 degrees?

Dingo
04-24-2009, 08:59 AM
hope404

But, to brace a child for years ..until all growth has stopped UGH !!!

unfortunately, to me, waiting or bracing, NEITHER are great options

I agree.

But 10 years of night bracing is a lot better than being self conscious and living through 50 years of back pain.

Of course this assumes that bracing works. But if it doesn't work why do doctors prescribe it at all?

Pooka1
04-24-2009, 09:00 AM
Pooka1

If bracing isn't effective why prescribe it at 25 degrees?

Because the only alternative presently is experimental non-fusion surgery for the JIS crowd and some folks want to do something short of experimental surgery and hope it works.

If I had a JIS kid, I would go with the experimental surgery over years of bracing (no question in my mind whatsoever) but that's just me.

Pooka1
04-24-2009, 09:06 AM
Of course this assumes that bracing works. But if it doesn't work why do doctors prescribe it at all?

I'm guessing they are hopeful there is some subset of kids for which it will work.

Again, we don't know that bracing doesn't work. It certainly might work for some kids. Unfortunately, if that's the case, nobody has yet shown it rigorously. And bracing is too extreme compared to surgery in my opinion. Even if it can be shown to work in some cases, I would still consider surgery over even effective bracing if it is likely to produce a more definitive treatment and a less uncertain future.

My fused daughter is done with scoliosis. My braced daughter has a very uncertain future even if the brace "works." Night and day.

leahdragonfly
04-24-2009, 02:03 PM
Hi Dingo,

I'm not sure where you got your data about most orthos waiting to brace JIS kids until their curves are over 25 degrees. If you read the SRS Bracing Manual and SRS Guidelines, they clearly say that children who are Risser 0-1 with curves equal to/greater than 20 degrees are recommended for bracing. Further, the guidelines go on to say that juveniles with curves of 15 degrees or greater that have shown progression are recommended for bracing.

Also, there are published studies that show about 70% of JIS cases progress, and 30% don't. I really doubt orthos have any nefarious motives for waiting to brace a young child until such point that it becomes clearly needed. I have read at least one published study where the data suggests that a staggering 70% of children braced for scoliosis wouldn't have progressed anyway. As an adult who wore a Boston brace for two years as an adolescent, this bothers me terribly! Unless you have personally worn a brace, it is impossible to truly understand what it is like. This is just one reason some of us are looking for alternatives to upwards of 9-10 years of bracing for our young JIS children.

p.s. I guess my spine never read the study that showed 100% of children with curves over 30 degrees at adolescence would go on to fusion surgery! I was diagnosed with AIS and had a double curve of 33L/32T. I avoided fusion for scoliosis, but now have a 36-degree lumbar curve and very significant degenerative arthritis in my spine. If I had been able to choose bracing or fusion as a child, I wouldn't have chosen bracing.

Take care,

Pooka1
04-24-2009, 04:03 PM
Hi Dingo,

I'm not sure where you got your data about most orthos waiting to brace JIS kids until their curves are over 25 degrees. If you read the SRS Bracing Manual and SRS Guidelines, they clearly say that children who are Risser 0-1 with curves equal to/greater than 20 degrees are recommended for bracing. Further, the guidelines go on to say that juveniles with curves of 15 degrees or greater that have shown progression are recommended for bracing.

Also, there are published studies that show about 70% of JIS cases progress, and 30% don't. I really doubt orthos have any nefarious motives for waiting to brace a young child until such point that it becomes clearly needed. I have read at least one published study where the data suggests that a staggering 70% of children braced for scoliosis wouldn't have progressed anyway. As an adult who wore a Boston brace for two years as an adolescent, this bothers me terribly! Unless you have personally worn a brace, it is impossible to truly understand what it is like. This is just one reason some of us are looking for alternatives to upwards of 9-10 years of bracing for our young JIS children.

p.s. I guess my spine never read the study that showed 100% of children with curves over 30 degrees at adolescence would go on to fusion surgery! I was diagnosed with AIS and had a double curve of 33L/32T. I avoided fusion for scoliosis, but now have a 36-degree lumbar curve and very significant degenerative arthritis in my spine. If I had been able to choose bracing or fusion as a child, I wouldn't have chosen bracing.

Take care,

Excellent post, Gayle.

In re your last line, I think the time is drawing to a close when it was a rational decision not to be fused. I think it was rational to avoid fusion with the pre-modern hardware. With the new hardware, and what may or may not be the case about surgery down the line even if bracing works, I suspect bracing will decrease and most kids will be fused when they become eligible.

I don't know why our surgeon seems to think my fused daughter is back in the general population for back issues but he must have some reason to suspect it. I think it maps to the new hardware and her being done at the earliest possible time. I'll ask him this fall when I see him again.

jillw
04-24-2009, 05:26 PM
Gayle, just to clarify, the study dingo was referring to pertained to JIS not AIS. They looked at children who were diagnosed with JIS and then looked at the size of the curve, not at diagnosis, but as they were entering their peak velocity growth. The stats in that study shows what ultimately happened. With AIS, it is generally the onset of peak velocity growth that brings on the scoliotic curve - in other words with AIS the kids are entering peak velocity growth without a curve - so AIS children are entering peak velocity growth in the below 20 degree curve category-technically below 10 degrees. (for the most part. as discussed elsewhere there is always the chance that a curve might have been undiagnosed and an AIS child might technically have JIS-for example Pam and her doctor have come to the conclusion that she probably had JIS)

jillw
04-24-2009, 05:34 PM
Sharon, I like to hear what your surgeon says regarding your daughter being back in the general population. I would like to think that is true and that newer instrumentation provides better results than what they were using several decades ago. However, I haven't been able to find any scientific evidence or studies for this - could you point me in the right direction?

And a general question for anyone out there who knows: I have frequently read in these boards about how much better instrumentation is today compared to days of old (Harrington rods? other rods also?). How long have these "newer" instrumentation options been around? Have the early recipients of it had it for a couple decades or more yet so we can see the long term results?

Just curious - I haven't researched fusion a whole lot yet (we're so early in this scoliosis journey), so I'd love to learn from those of you who have.

Pooka1
04-24-2009, 05:54 PM
Sharon, I like to hear what your surgeon says regarding your daughter being back in the general population. I would like to think that is true and that newer instrumentation provides better results than what they were using several decades ago. However, I haven't been able to find any scientific evidence or studies for this - could you point me in the right direction?

All I have at present is his comment. It came up when I asked if she will need surgery in the future to extend or revise the fusion and he said she will not (assuming a good fusion) and used the phrase "one-stop shopping" for surgery for her. He went on to say that she was not predisposed to back issues over and above an unfused person.

Here's what I wrote right after the 7.5 month visit... this will be more correct than anything I write now if it differs...

http://www.scoliosis.org/forum/showthread.php?t=8002

Note that that means she has an 85% chance of having back problems like the rest of us per that reference Linda posted. I don't have scoliosis and have had back problems including a naturally-fused level in my lumbar which is very likely a riding injury (repetitive, not catastrophic). And there are days when it feels like it is propagating elsewhere in my lumber. :eek:


And a general question for anyone out there who knows: I have frequently read in these boards about how much better instrumentation is today compared to days of old (Harrington rods? other rods also?). How long have these "newer" instrumentation options been around? Have the early recipients of it had it for a couple decades or more yet so we can see the long term results?

It's a good question.

I am guessing that since a certain percentage of Harrington rod patients have no problems, they are extrapolating from that to what is the likely average scenario given the better hardware. I really don't know but got the distinct impression he feels if the fusion ends at L1 or above, he really really REALLY doesn't expect the kid to ever need an extension or revision. Like the bottom of the fusion is some type of master variable/predictor for future surgery. I would like to see the evidence for it though despite his certainty.


Just curious - I haven't researched fusion a whole lot yet (we're so early in this scoliosis journey), so I'd love to learn from those of you who have.

I would also.

Pooka1
04-24-2009, 06:44 PM
p.s. I guess my spine never read the study that showed 100% of children with curves over 30 degrees at adolescence would go on to fusion surgery!

Do you mean at maturity? If so, can you please give me that citation? I want to show it to our surgeon. He claims few people with a curve <50% at maturity will ever progress in their lifetime.

Based on the testimonials here, I think at least some or at least more than a few progress despite being <50* at maturity.

Thanks in advance.

mmm2001
04-24-2009, 08:29 PM
I think that the data from the JIS article is interesting but there is info missing and results can be interpreted in different ways...

1. The institution had 444 cases of JIS, only half were used. it was unclear to me why the other half were excluded. I assume missing data?

2. They braced kids >20 (not >25)... so the 75% progression in the 21-30 degree group was in spite of bracing. The 15% progression in the <20 degree group was in spite of NOT bracing. Personally, if someone told me my child had only a 15% risk of progression, I would not put them in an orthotic for 6-9 years to avoid something that would not occur 85% of the time anyway.

3. When you do an OVID search of juvenile scoliosis, only 39 articles are returned, many of which are case reports or only tangentially related to JIS, not very impressive numbers on the research front.

4. Imagine how many kids out there have curves (especially under 20 degrees or so), that are simply unrecognized and never go on to progress. Not all kids go to docs, and not all docs check for scoli in 7 year olds. Of course some of the AIS is JIS unrecognized as well. The point is, we don't know for sure what to make of very small curves in young children, and the treatment is not exactly benign.

Just some thoughts.

Lisa

macky
04-24-2009, 09:31 PM
Hi Guys,
Well for 34 years I was definately part of the general population. I had my surgery and that was it, on with life. Never had a problem, never even thought about it, never had to until 1997, but even now I am still part of the crowd, albeit hobbling a bit.:)

Macky xx

Dingo
04-24-2009, 11:31 PM
leahdragonfly

I've read loads of threads about young children with progressive curves that doctors don't want to brace until the mid 20s. To me that is crazy. I'm glad that's not the official policy but sadly it happens all the time.

The thought of bracing my son breaks my heart. If my son's case is progressive I hope that night bracing is all that he will need. I live in the sunbelt and so 23/7 bracing isn't really an option except for short periods. If night bracing won't correct or hold my son's curve I hope that at the very least it dramatically slows progression. Bracing is the only therapy available that buys him time. Hopefully his curve won't exceed 35 degrees which would allow us to do VBS when he is 10 or 11. That's 4 or 5 years off for us.

Obviously my dream scenario is that his curve corrects or holds without any treatment or at worst night bracing for a few years. His curve is somewhere between 10 and 15 degrees so there is still a small chance of that.

jillw
04-25-2009, 03:10 PM
Sharon, I see in your prevous post, I asked the same question. oops. If he tells you the research/evidence he has read to come to his conclusion in future visits, would you mind letting me know? I'm very interested in reading it. .

Pooka1
04-25-2009, 05:58 PM
Sharon, I see in your prevous post, I asked the same question. oops. If he tells you the research/evidence he has read to come to his conclusion in future visits, would you mind letting me know? I'm very interested in reading it. .

Yes of course. I won't see him until September, though.

Rosebud9
04-28-2009, 08:41 PM
Actually at Shriners Hospital for Children they start bracing at 20 degrees. And they are very nice and good there!

S4Sarah
05-24-2009, 09:33 AM
Personally I think it is really silly to wait until they are exactly at 25 degrees. Even if they may not really need it it is better to treat early then wait until it gets to the surgery point. A 22 degree curve is a lot easier to deal with and fix with a brace than a 40 degree curve. Some doctors believe that and will even start bracing at 15 degrees (anywhere below 10 is considered normal)
Plus if you have a 20 degree curve and you have a lot of growing to do it is most likely going to get worse, why wait that extra 5 degrees? Maybe bracing at 20 will prevent it from even getting there.

Pooka1
05-24-2009, 09:37 AM
Personally I think it is really silly to wait until they are exactly at 25 degrees. Even if they may not really need it it is better to treat early then wait until it gets to the surgery point. A 22 degree curve is a lot easier to deal with and fix with a brace than a 40 degree curve. Some doctors believe that and will even start bracing at 15 degrees (anywhere below 10 is considered normal)
Plus if you have a 20 degree curve and you have a lot of growing to do it is most likely going to get worse, why wait that extra 5 degrees? Maybe bracing at 20 will prevent it from even getting there.

Would you be willing to wear a brace if 70% (or more) of kids who were braced shouldn't have been either because the curve progressed anyway or their curve would not have progressed anyway? That is the state of affairs as far as we can tell at this point.

What about if it is 80%? What about 90%?

leahdragonfly
05-24-2009, 04:15 PM
Thank you Sharon, for pointing that out. That has been my position as well all along--is it right to inflict bracing on children knowing that 70% of them or more are being treated unnecessarily??

We braced our daughter at age 6 for 5 months and fortunately her very pliable curve reduced enough for her to try being brace free for a while. She has been holding stable at about 20 degrees now for 8 months without bracing, and can continue to be brace-free as long as the trend continues. She will be rechecked in September, so that will be a year out of brace. Our family is absolutely thrilled that she has had (at least) one year of a normal childhood without a brace, as well as normal development of her trunk muscles and ribs.

My point is, some people feel you should start bracing at well under 20 degrees, and maybe in some cases it is warranted, I don't know, but it seems like a good idea to see if the curve is of the progressive type before bracing. Because if the curve is non-progressive, that means it will maintain itself without a brace. And isn't that great!

BTW S4Sara, a brace will never correct a curve, so to say "it's easier to fix a 22 degree curve than a 40 degree curve" with a brace is incorrect. A brace is meant to control progression.

mamandcrm
05-24-2009, 05:16 PM
What is the difference between reducing a curve and correcting it? Maybe it's just semantics but I do not understand (genuinely, I'm not trying to pick a fight here) the absolute statement I often read (not just Gayle's) that a brace will never correct a curve. I agree that it won't correct it 100% but I view a meaningful reduction that lasts through growth as correction. Is it that you view correction as meaning only complete correction?

emarismom
05-24-2009, 06:05 PM
How to handle the issue of "to brace or not to brace" is really a personal issue for the parent when it comes to JIS. I weigh the pros and cons of bracing my daughter every single day. I realize it may or may not be keeping her stable. The truth be told I know she was not progressing when I braced her. Does that mean that she won't progress, no. Should I have waited until she DID progress to do something about it, what if she had a rapid progression in a 6 month period, then factor in the time it takes to get a brace. Instead of looking at a 24 degree curve,I could have been facing 30, or 32, or 35.

In my case I KNOW that no brace will control her curve if it does start to progress. I hope that by bracing her I am buying her time to grow. In many ways I do agree with Sharon that maybe in the long run, surgery is the best option. However, my daughter has already been through one surgery and is terrified at the possibilty of going through another one. (The first one is a piece of cake compared to fusion).

There are a great many issues to consider when it comes to JIS. It really depends on how much risk we as parents are willing to face. At this point in time there is no right or wrong answer.

Pooka1
05-24-2009, 06:33 PM
Thank you Sharon, for pointing that out. That has been my position as well all along--is it right to inflict bracing on children knowing that 70% of them or more are being treated unnecessarily?

I have never worn a brace but I can read testimonials that have broken my heart and haunted me. Being cavalier is not appropriate when discussing bracing kids. Suggesting bracing smaller curves which are known to be LESS likely to progress is very cavalier in my mind. In this group especially, it could very well be the case that 90% or more will not progress even if you do nothing. Yet bracing kids with smaller curves that don't progress will always be chalked up to brace success. That is simply not scientific.


We braced our daughter at age 6 for 5 months and fortunately her very pliable curve reduced enough for her to try being brace free for a while. She has been holding stable at about 20 degrees now for 8 months without bracing, and can continue to be brace-free as long as the trend continues. She will be rechecked in September, so that will be a year out of brace. Our family is absolutely thrilled that she has had (at least) one year of a normal childhood without a brace, as well as normal development of her trunk muscles and ribs.

I think you have the right perspective on the situation. I think you are a textbook case of how to make an informed decision and continue to do so going forward.


My point is, some people feel you should start bracing at well under 20 degrees, and maybe in some cases it is warranted, I don't know, but it seems like a good idea to see if the curve is of the progressive type before bracing. Because if the curve is non-progressive, that means it will maintain itself without a brace. And isn't that great!

It's that cavalier attitude. And nothing like setting the bar low (bracing curves that most likely will not progress) to get the results you wanted ahead of time.


BTW S4Sara, a brace will never correct a curve, so to say "it's easier to fix a 22 degree curve than a 40 degree curve" with a brace is incorrect. A brace is meant to control progression.

Yes. There is an ocean of misunderstanding on this point. Underlying most of these comments is the ASSUMPTION that bracing works. That may not be a good assumption.

Pooka1
05-24-2009, 06:38 PM
What is the difference between reducing a curve and correcting it?

Not sure but I would say:

reducing = lowering the angle

correcting = getting the angle below 10*


Maybe it's just semantics but I do not understand (genuinely, I'm not trying to pick a fight here) the absolute statement I often read (not just Gayle's) that a brace will never correct a curve. I agree that it won't correct it 100% but I view a meaningful reduction that lasts through growth as correction. Is it that you view correction as meaning only complete correction?

No the comment that braces never correct a curve refers to the fact that they have never been shown to permanently reduce a curve. That is, no matter what your in-brace correction, you are expected to return to the out-of-brace angle after removing the brace. At present, the only credible claim made for braces is that they might prevent a worsening. There is no evidence of a permanent reduction from bracing nor is it the claim.

Pooka1
05-24-2009, 06:39 PM
There are a great many issues to consider when it comes to JIS. It really depends on how much risk we as parents are willing to face. At this point in time there is no right or wrong answer.

Totally agree when it comes to JIS! Well stated. Truly.

mamandcrm
05-24-2009, 08:36 PM
There is no evidence of a permanent reduction from bracing nor is it the claim.

By "no evidence" do you mean no studies (agree) or that no child anywhere at any time has ever experienced a reduction in their curve that has lasted through growth and not increased after brace wear ceased?

Pooka1
05-24-2009, 09:05 PM
By "no evidence" do you mean no studies (agree) or that no child anywhere at any time has ever experienced a reduction in their curve that has lasted through growth and not increased after brace wear ceased?

In re the latter, if there are kids like that who are wearing a brace, we can't assume the brace is what held the curve rather than the child having a non-progressive curve.

concerned dad
05-24-2009, 10:13 PM
There is no evidence of a permanent reduction from bracing nor is it the claim.

Oh boy, here we go again
:eek:

Presents under my tree is evidence for Santa Clause. It is not proof of Santa.

There is evidence for a permanent reduction from bracing. That evidence falls (well) short of proof.

I know you're going to say "what evidence".

I'd point to the 20 year data in the 2008 Daniellson paper and to the plethora of SpineCor papers. We may not like or believe the evidence, but it is evidence that people can and should weigh.

Heck, if one person posts here that they obtained a permanent reduction, then that IS evidence. (It is not proof.)

Since this thread is regarding JIS, I would say that a parent has to weigh the cost to the child against the potential benefit. A tough personal decision no doubt. Even tougher since there is no proof.

mamandcrm
05-25-2009, 09:11 AM
In re the latter, if there are kids like that who are wearing a brace, we can't assume the brace is what held the curve rather than the child having a non-progressive curve.

No, but if that child (JIS) started out with a mild/moderate curve, progressed rapidly into the mid-thirties (the point at which the specialists say I believe that the curve will progress without question), then started reducing when she started wearing a full-time brace, I'd say that was a heck of a coincidence :)

Pooka1
05-25-2009, 09:21 AM
Perhaps I'm not following along here but doesn't everyone's curve reduce, sometimes 100%, in brace?

mamandcrm
05-25-2009, 09:35 AM
Oh boy, here we go again
:eek:

Since this thread is regarding JIS, I would say that a parent has to weigh the cost to the child against the potential benefit. A tough personal decision no doubt. Even tougher since there is no proof.

Personally speaking only, I don't worry about the absence of proof (studies) for curve reduction using the device we are using. I don't think there are any JIS-specific studies and I just don't have time to wait for one. So I make my decisions based on the evidence I see in my daughter and in others in the practice where she is seen. I have no intention of keeping her in a full-time brace for 8 years. If and when the evidence shows me that she is not going to be where she needs to be in within the time frame we have set, then it's off to VBS;)

mamandcrm
05-25-2009, 09:36 AM
Perhaps I'm not following along here but doesn't everyone's curve reduce, sometimes 100%, in brace?

I'm not talking about in-brace. I am talking about out of brace.

Pooka1
05-25-2009, 09:40 AM
I'm not talking about in-brace. I am talking about out of brace.

Are you saying braces can permanently reduce a curve? I don't think they even claim that.

mamandcrm
05-25-2009, 09:58 AM
Are you saying braces can permanently reduce a curve? I don't think they even claim that.

I think we've come full circle:) Back to my previous post "are you saying that no child anywhere at any time has ever experienced a reduction, etc., etc." No brace manufacturer makes that claim, and they shouldn't. But, yes, I believe that there are some kids out there who have attained some post-growth reduction from there original measurement after brace wear.

There are also intermediate non-permanent levels of success. Enough temporary reduction to reduce brace time to a more liveable level until growth is completed (to some extent this is what VBS offers to many as well), or at least until the child is old enough to have fusion.

Gotta go

S4Sarah
05-25-2009, 09:59 AM
Would you be willing to wear a brace if 70% (or more) of kids who were braced shouldn't have been either because the curve progressed anyway or their curve would not have progressed anyway? That is the state of affairs as far as we can tell at this point.

What about if it is 80%? What about 90%?

Well only if the doctor is sure they need it. If you have like a 8 degree curve at age 15 most likely you'll be fine. But if you are like 9 and have a 20 curve it is probably best to do something before it gets worse. Oh and I'm not talking about the hard plastic braces. We have come a far way in Scoliosis treatments, to new surgical technologies to new therapies to new braces. There is now The Spinecor, the TriaC, and many others.

Pooka1
05-25-2009, 10:11 AM
I think we've come full circle:) Back to my previous post "are you saying that no child anywhere at any time has ever experienced a reduction, etc., etc." No brace manufacturer makes that claim, and they shouldn't. But, yes, I believe that there are some kids out there who have attained some post-growth reduction from there original measurement after brace wear.

There are also intermediate non-permanent levels of success. Enough temporary reduction to reduce brace time to a more liveable level until growth is completed (to some extent this is what VBS offers to many as well), or at least until the child is old enough to have fusion.

Gotta go

I think there is so little known about JIS as you say that anything is possible. That is, I would not be as surprised to hear certain things in JIS as I would be with AIS because we do have at least some amount of research, such that it is, with AIS.

mishwz
05-26-2009, 10:52 AM
Hi There,

My daughter was diagnosed in 2006 with 15* since then has progressed to 36* at T6 & T11 now there saying she has Thoracolumbar scoliosis and T12 L4 angle is 26* but yet no one is doing a thing except wait and see in 6ths...she is in alot of pain, but according to them scoliosis does not cause. Oh by the way although I was told she was done growing in Sept.08 she progressed 11*. Very fustrated can anyone offer suggestions.

Thanks,
Michelle

mamandcrm
05-26-2009, 10:57 AM
Hi Michelle,

I would suggest you start a new thread with your post about your daughter as this particular one is relating to JIS (you might not get the readers you are looking for). I wish I had some advice to offer you but, other than seeking another opinion, I don't really.

concerned dad
05-26-2009, 11:04 AM
Hi Michelle,
I'm sorry, but I am confused. It looks like her curve reduced from 36* to 26*. But you say she has since increased 11*. Maybe you could clarify that for us and also tell us how old she is.
I am sorry to hear she is experiencing pain. Have you sought a second opinion? Does your orthopedic doctor specialize in scoliosis? Is he a member of the SRS (scoliosis research society) - it doesnt guarantee competance but many think it increases your odds of getting someone who specializes in scoliosis as opposed to possibly a different focus of expertise.
I see MAMANDCRM just replied (and I'm too lazy to type this in response to your new thread :D), so go ahead and start a new thread with the details and probably someone here can point you in the right direction.

Pooka1
05-26-2009, 01:54 PM
Hopefully this post and any answers will be moved out of this thread on JIS and into the AIS section...



Hi There,

My daughter was diagnosed in 2006 with 15* since then has progressed to 36* at T6 & T11 now there saying she has Thoracolumbar scoliosis and T12 L4 angle is 26* but yet no one is doing a thing except wait and see in 6ths...

Are you saying she had a single curve in the thorax area that moved from 15* to 36* in the last three years and now there is a second curve in the thoracolumbar region that measures 26*?

If so, I think that is pretty common with the main structural curve getting worse that induces a compensatory curve lower down. You should ask if the second curve is structural or compensatory. If compensatory, it will disappear on its own if the structural curve is corrected.

How old is your daughter if I might ask?


she is in a lot of pain, but according to them scoliosis does not cause.

Our surgeon said the same thing. What I think your surgeon means is that because there are large curves that are painless, the curve alone is not causing the pain. That is, there is something else going on that may or may not be related or caused by the scoliosis that is causing the pain.


Oh by the way although I was told she was done growing in Sept.08 she progressed 11*. Very frustrated can anyone offer suggestions.

All but the smallest curves are expected to keep progressing although at a lower rate for the smaller curves. But when you say she progressed 11* in the last 8 months, that is well being the progression rate of a 36* curve in a mature spine. I think it indicate that she wasn't done growing. The ways to tell if a child is growing or mature don't always agree. Your surgeon may have used a method that wasn't accurate with your daughter. That's my guess.

Good luck.