The Bracing Debate

[mamamax]

I found a very interesting article written by Robert B Winter, MD. It's about the Milwaukee brace and its history.

http://www.acpoc.org/library/1992_01_016.asp

The Milwaukee kind of looks like it was effective when: it was used in conjunction with a good patient care program accompanied by physiologic and psychologic support systems. And was not effective when applied too late, worn too little & removed too soon.

Poor results apparently attributed to half-assed programs leading to half-assed results.

Good results = Good treatment protocols.

Good article which I think pretty much sums up most bracing methods - and explains both the current and past bracing controversies in general.



Robert B. Winter, MD, is one of the founders of the Twin Cities Spine Center, and currently serves as a research consultant there. He is a clinical professor in the University of Minnesota Department of Orthopaedic Surgery.

[txmarinemom]

I found a very interesting article written by Robert B Winter, MD. It's about the Milwaukee brace and its history.

http://www.acpoc.org/library/1992_01_016.asp

The Milwaukee kind of looks like it was effective when: it was used in conjunction with a good patient care program accompanied by physiologic and psychologic support systems. And was not effective when applied too late, worn too little & removed too soon.

Poor results apparently attributed to half-assed programs leading to half-assed results.

Good results = Good treatment protocols.

Good article which I think pretty much sums up most bracing methods - and explains both the current and past bracing controversies in general.



Robert B. Winter, MD, is one of the founders of the Twin Cities Spine Center, and currently serves as a research consultant there. He is a clinical professor in the University of Minnesota Department of Orthopaedic Surgery.

Interesting as you may find this 18 year old article, Maxene, I respectfully suggest your summary is quite possibly the most liberal over-simplification I may have ever read.

Pam

[mamamax]

Interesting as you may find this 18 year old article, Maxene, I respectfully suggest your summary is quite possibly the most liberal over-simplification I may have ever read.

Pam

The respectful suggestion duly noted ;-)

The article in question, while written some time ago (by a well respected surgeon), I suggest - is just as true today (regarding patient care programs and support systems), as it was then. Perhaps Dr. Winter also liberally oversimplified the situation - then again - maybe he knew what he was talking about. His discussion on the subject, certainly worth more than one read.

[Pooka1]

Folks, including researchers, can't just know bracing works. They have to show it.

The world is still waiting.

[mamamax]

Dr. Winter points to two independent studies showing excellent results with the Milwaukee - proper patient care programs and support systems in place: (1) Lonstein & Winter (1988) 1030 patients (2) Andrew & MacEwen 1989. May prove an interesting read. His article also covers - scientific evidence. One illustration (attached) for sake of discussion.

Referenced article: http://www.acpoc.org/library/1992_01_016.asp

[Pooka1]

Studies, whether they show excellent results or otherwise, will always be limited by their design. If they are poorly designed, anyone using the results is just fooling them self. There is a reason you can't publish an uncontrolled study in all other fields of science. And that reason doesn't include a magic exemption for medical research just because adequately controlled studies are difficult to do.

And I'd like to hear from the people here who wore their Milwaukee brace and still required fusion. I think a case can be made that bracing often just delays fusion as opposed to avoiding it. Someone should study that.

[txmarinemom]

I got busy with school and forgot about this thread ...

Maxene, look up the study Lori Dolan was involved with in 1996.

*One* key finding:

"The findings of this study do not agree with previously reported favorable results with bracing and raise questions about whether the natural history of progressive idiopathic scoliosis is truly altered by use of the Milwaukee brace."

(speaking of the 1992 study)

Personally, I couldn't care less about the *history* of the Milwaukee. It's barely relevant (if at all) to anything modern (except maybe itself - and typically only for high thoracic curves).

As a braced adult, you may *think* you understand JIS/AIS bracing ... but you don't (and you can't). FYI, I disagree with the past AND current bracing protocols (AS a braced child), and *I* sit on my fingers more often than you when it comes to this topic. Some of the stuff you post is really insulting.

If you're a pinkie swear kind of girl, I'll zip it if you will. Exceptions may only be granted by a consensus - and only on FIRST HAND experience.

Do we have a deal?

Pam

[RitaR]

Can I see your surgery photos? But it says password required.
Thanks.

[leahdragonfly]

Mamamax,

I'm not sure why you dug up such an old article. The Milwaukee brace has been pretty much abandoned by modern orthopedists and orthotists alike. They realize, apparently more than you, what an incredible burden the Milwaukee brace is. Especially given that there are PLENTY of other, more palatable options, including the boston and the providence.

I wore a boston brace for about 2 years. Can I tell you how much I hated it?? There is no support or psychological care I could have received that would have made it any better, and I truly can not imagine how I would have coped with being made to wear a Milwaukee. My dear daughter hates her boston brace tremendously, but for now, she must endure it. But I would NEVER make her wear a Milwaukee, for any reason.

I was psychologically scarred by bracing. I still, nearly 30 years later, clearly remember the utter anguish I felt when I got my brace and had to wear it to school. You can not imagine what that is like if you never wore a brace as a child.

And BTW, the brace did contain my curves (32T/33L before bracing), but I now have major degenerative changes, arthritis, spinal stenosis, and pan-lumbar disc disease in my early 40's. This is all attributed to the uneven loading from the scoliosis. And my lumbar curve is just a hair under 40 degrees now, still being watched because it is slowly creeping up. Is this really a bracing success--I don't know. I have already been recommended to have the rest of my lumbar fused to treat my myriad problems there.

So please, if you want to make a point about bracing, please make it on a credible study on a modern brace, and please, don't try to downplay the psychological burden of brace-wearing on children.

Regards,

[mamamax]

Gayle (and anyone else I may have offended) - you have my apologies, please know offense was not my intent. And Gayle, thank you for your candid (and yet gentle) comments on this.

I dug up this old article while researching late into the night and thought there were some significant things in it from a historical point of view. Dr. Winter had pointed out that this brace required some strict attention to detail - namely frequent medical observation along with a patient care program which included both physiologic and psychologic support systems. Interestingly enough, the only study showing an impressive outcome is one in which Dr. Winter himself was involved in (from 1988 involving 1,030 patients). From that study it was discovered that the most ideal candidate for Milwaukee brace treatment was a Risser 0, girl with a documented progressive right thoracic idiopathic scoliosis of 20° to 29. This study was duplicated (using the same protocols) by Andrew and MacEwen in 1989 (with the same results). The article briefly touches on the historical modifications of this brace - due to reduction in vital capacity. Dr. Winter implies that poor results were obtained when the strict treatment protocols (of the original designers) were not followed to the letter. I find that noteworthy and perhaps an implication that crosses into all bracing treatments. I have not been able to find a patient follow up for those who were in the two referenced studies ... but I'll keep looking.

Why would anyone care about all this? Because while not a popular brace, it is still being used today (chiefly for very high thoracic curves): http://www.cincinnatichildrens.org/health/info/orthopaedics/home/milwaukee.htm

I have no experience with this brace personally. The closest I maybe came was at a time when I wore something similar (from pictures and descriptions I have found). Following hospital treatment for a fractured neck (using chin strap traction), I as sent home in a neck brace made of leather which had metal posts around the neck, with the head supported by a chin pad. I only wore this for a week (24 hours a day) prior to an appointment with a neurosurgeon which resulted in emergency treatment in ICU. It was most unpleasant and I have a difficult time imagining a young child dealing with such a cumbersome orthotic as the Milwaukee brace.

I do not pretend to know all about bracing across the wide spectrum of its use for juveniles and adults. And I know even less about infantile scoliosis outside of some articles I have researched which are showing some very promising results with serial casting. My personal experience is limited to simply surviving juvenile scoliosis into adulthood and bracing at the age of 59. I'm not a parent of a child with scoliosis - at the age of 29, my daughter seems to have escaped my fate (a simple prayer so far answered). In the future, I could be the grandparent of a child with scoliosis - and that alone finds me researching late into the night. And that is why I posted this information - for others like myself, with an eye into the future. In hindsight - posting in the research section would have been a better choice. My sincere apologies for any upset this may have caused anyone. Hope I will be forgiven.

[mariaf]

Just wanted to add a few thoughts.

First, Mamamax - apology accepted. Some of us who have either been braced, or have a child who has been braced, feel strongly that sometimes folks minimize the challenges of brace wearing. I'm not directing this at you personally so please don't feel I am attacking you as I assure you my post is not meant that way :)

That said, a lot of us still cringe thinking of how well-meaning family and friends would say (about brace wearing) things like "oh, it's not that bad", to which a friend of mine gave me a good reply - she suggested I respond "no, it's not, unless it's YOUR kid".

With regard to the Milwaukee brace in particular, I second Gayle's sentiment that I would NEVER make my child wear a Milwaukee for ANY reason. Period.

To give some idea of the emotional impact on a child who feels they are being perceived as different in ANY way, when my daughter who was 13 at the time, was about to graduate from 8th grade and begin high school she was distraught because the braces on her teeth still weren't off. All I heard the entire summer was things like "can't they take them off", "most kids get them off by 6th or 7th grade and I have to start high school with them on - I feel like a freak" - maybe that's not verbatim but you get the idea. Luckily, for her (and me - LOL!) they came off midway through her freshman year.

I don't think I have to point out to anyone the difference between braces on one's teeth (which lots of kids have) and walking into any school with a Milwaukee brace!

As for Cincinnati Children's Hospital, I have to wonder - even though the Milwaukee is listed on their website, how many children, if any, do they actually prescribe it for these days?

One last point - it was stated above that the ideal candidate for a Milwaukee brace is a Risser 0 girl with a curve between 20 and 29 degrees. That same girl would also be an excellent candidate for VBS. The success rate for curves under 30 degrees is extremely high. In fact, I know one girl who was a Risser 0 with a high thoracic curve who was stapled at 42 degrees (nearly 4 years ago before they changed the criteria) and I would definitely consider her a success so far with a curve that continues to hold in the mid 20's, and she "could" gain additional correction as she grows. This same girl (who is now around 9 or 10) HATED bracing when it was tried for a short time prior to her having VBS. Again, her curve started above 40 degrees! Many curves that are stapled in the 20's are reduced into the single digits, something no brace can do. My point is - if I had a daughter who fit this criteria, it wouldn't even be a consideration to put her in a Milwaukee for several years when she could probably get better results (and no emotional scars) by having VBS.

Again, just my two cents.

[txmarinemom]

Like Gayle and Maria - who are both, admittedly, more tactful than I hope to be in this lifetime - I'd NEVER put my child in a Milwaukee.

There are really only a few circumstances where I'd even place my kid in a Boston ... and it would *still* kill me to buckle the straps. If there's anyone I've related with around here or VBS, it's Gayle. Leah's time "in-brace" hasn't been the solution (on its own), as far as I know. With her, it's been the stop gap to halt progression - and rally other options.

Unfortunately, some doctors *do* still prescribe Milwaukees (or Bostons with superstructures) as THE treatment: The ones that do, aren't familiar with the current protocols. My curve apex was T9 (T9 and above is what split out the Milwaukee vs. Boston candidates back in the day), and as Gayle said, I don't know how I would have stood a Milwaukee. Like Gayle, I will ALWAYS wear the mental scars of a Boston ...

While I'm a huge proponent of VBS, I DO understand parents who seek the non-invasive options. I just wish people would consider the long-term results ... mental and physical ... and not wait until the timeframe (to consider all options) has passed. If it sounds too good to be real, don't look at 18 year old articles: LOOK at those of us who went that route ... and where we are now.

Think about it ... a Boston is *still* the same damn Boston for which I was fit in 1979.

Is it any easier to "save" your 10 year old from surgery (which could be as minor as VBS) - only to watch them go on to have full fusion (with other spine issues from years of abuse) at 30-40+?

I haven't seen ANY positive data on bracing that matches VBS. My opinion, sure ... but it's also based on scientific data that isn't 18 years old.

The results I've seen are significant enough to me, I nagged my surgeon to become the first one in the 4th largest US city to start performing it. I'm grateful the option is now available here. At the risk of getting blasted again (I said this *before* I had fusion, and still mean it), I wish the option had been available for me - and my eligible ±35° curve - 31 years ago ...

Regards,
Pam

[mariaf]

There are really only a few circumstances where I'd even place my kid in a Boston ... and it would *still* kill me to buckle the straps.

I think any parent who has ever "buckled the straps" was probably nearly brought to tears by that line.

I know I was.

[txmarinemom]

I think any parent who has ever "buckled the straps" was probably nearly brought to tears by that line.

I know I was.

Maria, I was crying when I typed it ... and crying again when I read what you wrote.

I know everyone in my house was in tears at brace-time.

[LindaRacine]

Unfortunately, some doctors *do* still prescribe Milwaukees (or Bostons with superstructures) as THE treatment: The ones that do, aren't familiar with the current protocols.
Hi...

I don't think that's correct. I don't know for certain, but I asked maybe 8-10 surgeons at the last SRS meeting, about whether they were still bracing. These weren't surgeons from Podunk, they were pretty much the movers and shakers of the industry. Their answers were pretty much all along the line of "yes, we haven't proved that bracing is effective, but we also haven't proved it isn't."

I think if you surveyed kids, they'd opt for no brace. But, most parents want to do something. Check out all of the posts on this forum, where you have parents of kids with curves well under 25 degrees, but who don't want to "wait and see." If you were to tell those parents that their only option was to wait until the curves hit 50 degrees, I think their heads would explode. (I know Dingo's would at least ;-)

If I had a child with a 25-30 degree curve, I'd try to convince her (or him) that the brace might help them avoid surgery. However, if I got a lot of push back, I wouldn't force the issue. While surgery has gotten a lot better, it's still imperfect, and will always come with some pretty significant risks. If my child was one of the small number of kids who has surgery and ends up with a major complication, I would certainly be kicking myself that she didn't at least try bracing.

I'm not insensitive to those of you who were braced and who had to have surgery anyway. That really sucks. But, I know there are huge numbers of kids who haven't progressed, and who hopefully won't progress when they're much older. It's possible that those kids have curves that wouldn't have progressed anyway. But, it's also possible that their curves would have progressed. Until we know more, I think it's best to err on the side of the more conservative treatment.

This debate may be meaningless in the not-too-distant future, as we're moving rapidly toward a society where only proven effective treatments are paid for by insurance companies (or the government).

--Linda

[txmarinemom]

I don't think that's correct. I don't know for certain, but I asked maybe 8-10 surgeons at the last SRS meeting, about whether they were still bracing. These weren't surgeons from Podunk, they were pretty much the movers and shakers of the industry. Their answers were pretty much all along the line of "yes, we haven't proved that bracing is effective, but we also haven't proved it isn't."


Linda, I wasn't specifically arguing against bracing (at least not in this instance) ... only that the emotional impact of bracing isn't something to be minimized. That's the way I perceived the original post ... and yes, I'm in the group that's probably what can be grossly understated as "a little touchy" in that regard.

You clipped out the part of my post that referred to Milwaukees and Bostons with superstructures: I'm not sure that I understand what you meant by "... don't think that's correct", and/or I was what I was saying was clear. I didn't mean they weren't bracing, period - only that those two particular (Milwaukees and BwSS) aren't commonly used these days.

They are - or were as recently as 3-4 years ago (if that), however - still used in some circumstances. A friend's daughter was stapled for a high thoracic curve (up to T2, I think). Prior to that, I'm almost sure she was wearing a Milwaukee because of the extremely high apex.

Mariaf, am I remembering incorrectly, or didn't Lorena have one?

Pam

[Snoopy]

I'd NEVER put my child in a Milwaukee.

There are really only a few circumstances where I'd even place my kid in a Boston ... and it would *still* kill me to buckle the straps. Regards, Pam



When my daughter was first diagnosed, I did like most moms do and I researched and educated myself (and Jamie) as much as possible. We realized that Scoliosis wasn't the end of the world. We knew that together, we could deal wtih Scoliosis.......as long as they didn't prescribe a Milwaukee brace. To both of us, that was, at the time, our worst fear. At 12 y.o. there was NO WAY Jamie was going to wear that thing!

So we go for her first appointment with the orthopedic surgeon, he x-rays her entire back and tells us that not only does Jamie have a high thoracic Scoliosis curve, but she also has Kyphosis. Never heard that word before, so he explained it to us and showed it to us on the x-ray. He then proceeds to tell us that he'd like to put Jamie in a brace. Okay, we can handle this because we knew going into the appointment that this is what was most likely to happen. Then he tells us he wants her in a modified Milwaukee brace!:eek: We lost it! I don't know how either of us kept the tears and emotions inside, but we did.

We took the script and went downstairs to make the appointment for her fitting.....and coudln't do it. We left. We cried, we fought and finally my husband and I told Jamie she had to try the brace. Her doctor said this was the best option for her and we had agreed beforehand that we'd try what the doctor recommended.

Fast forward......we got the brace. She refused to wear it to school (8th grade at the time). She'd wear it a few hours at home. We fought, we cried, we bribed her to wear it.....to no avail. Went back to the doctor two weeks later for repeated x-rays to see if the brace was working. Had to fight with the nurse when she wanted to do x-rays when I knew Jamie hadn't worn the brace long enough to make a difference, so why put her through x-rays? Saw the doctor and he basically said that we didn't have any other options beside surgery in the future.

Went for a second opinion and she said the Boston brace woudl be best for Jamie. I asked, what about the Kyphosis? How will that be addressed? She said we could add a piece to the front of the brace, to address that and was given a script for a Boston brace with an added section to the front. Long story, short, Jamie woudl not wear this brace either. Why? Was it because she had already experienced the Milwaukee brace? Was it because the front piece of the Boston brace pushed out and showed through her clothing? I don't know.

All I know is "I buckled the straps." I decided after a few tries at getting her to wear her brace, that it wasn't worth it. I explained to Jamie again that by not wearing the brace, it most likely would mean surgery (her Scoliosis was 36* at the time of diagnosis and stilll progressing) and she was okay with that. I proceeded to take Jamie to three other doctors until we found the perfect match for us.

One year and two months from her original diagnosis, she had surgery. Her main Scoliosis curve went from 36* to 46* and was still progressing even though she was done growing long before this. Do we regret having surgery? No. Neither of us have ever regretted that decision. Do I regret trying the braces? Not really. At the time, I was pretty uneducated and trusted what the doctor said. Am I glad that I was strong enough to trust my instincts and keep looking for another doctor? Absolutely! Would I ever put my other daughter in a hard brace for Scoliosis? NO.

Sorry this is so long. For those of you who've read this far, thanks.

Mary Lou

[txmarinemom]

This debate may be meaningless in the not-too-distant future, as we're moving rapidly toward a society where only proven effective treatments are paid for by insurance companies (or the government).

And that, in itself, is REALLY scary. The biggest question is what treatment(s) will be deemed effective, by whom, and by what methods?

Ack.

Even scarier is if surgery (VBS and/or fusion) IS included, who will "they" deem capable of performing it?

Double ACK.

[Pooka1]

Hi...

I don't think that's correct. I don't know for certain, but I asked maybe 8-10 surgeons at the last SRS meeting, about whether they were still bracing. These weren't surgeons from Podunk, they were pretty much the movers and shakers of the industry. Their answers were pretty much all along the line of "yes, we haven't proved that bracing is effective, but we also haven't proved it isn't."

You don't need to be an orthopedic surgeon to conclude this. Everyone is stuck with the same literature, such that it is.

For AIS (not JIS or IIS), before the pedicle screw era for all curves and before the Harrington rod era for T curves, it might have been worth a try with hard braces. As the surgeons said, nobody showed it never works. But now, having booted myself up on the bracing literature, I would never consider a 23 hour/day brace, hard or soft for a kid of mine.

Life is short. And JIS kids need to go to the head of the VBS line in my opinion... they have no other choice.

[LindaRacine]

I think that Boston braces are still the "gold standard" for most curves.

Sharon, it's interesting that you're on the VBS bandwagon, considering they don't have any RCTs. :) (I'm definitely not anti-VBS. I'm just pointing out that that method will have to go through the same trials that bracing is having to go through, before the mainstream surgeons hop on board.)

--Linda

[Pooka1]

Sharon, it's interesting that you're on the VBS bandwagon, considering they don't have any RCTs. :) (I'm definitely not anti-VBS. I'm just pointing out that that method will have to go through the same trials that bracing is having to go through, before the mainstream surgeons hop on board.)

Well it is my understanding that VBS is leaving the "experimental surgery" category and getting into whatever category the "gold standard of surgery is (posterior spinal fusion). That's mainly why I said that.

Also, based on that recent talk at the POSNA meeting, it seems like it is at least safe; The question did arise as to whether the results are better than watching waiting. That is, it tends to work better on L curves which have a lower progression potential than T curves. Things like that.

Last, VBS surgery is much less of a burden than bracing. So considering everything, it is a better deal.

[LindaRacine]

Well it is my understanding that VBS is leaving the "experimental surgery" category and getting into whatever category the "gold standard of surgery is (posterior spinal fusion). That's mainly why I said that.

Also, based on that recent talk at the POSNA meeting, it seems like it is at least safe; The question did arise as to whether the results are better than watching waiting. That is, it tends to work better on L curves which have a lower progression potential than T curves. Things like that.

Last, VBS surgery is much less of a burden than bracing. So considering everything, it is a better deal.

Hi...

I'm really surprised that you don't see that arguing for VBS is the same as someone else arguing for bracing. Neither has proved any effectiveness using your own stringent standards. Why aren't you giving parents like Maria the same scrutiny as you're giving those parents who have opted for bracing?

Again, I'm not at all anti-VBS. If my child was a candidate, I'd probably chose it over bracing. However, you should admit there's zero proof that the VBS treated kids won't go on to have their curves progress later in life. Yes, VBS feels less intrusive, but it comes with a lot more risks than bracing. I don't think you can die, get an infection, or become paralyzed from bracing. ;-)

You can't have it both ways.

--Linda

[Pooka1]

Hi...

I'm really surprised that you don't see that arguing for VBS is the same as someone else arguing for bracing. Neither has proved any effectiveness using your own stringent standards. Why aren't you giving parents like Maria the same scrutiny as you're giving those parents who have opted for bracing?

No I think there is more definitive data (yes it "worked" which includes cases that would not have progressed versus no it didn't work) for VBS than for bracing. By far. And that is amazing considering teh length of time each has been under study. Also, VBS has no worse a record than bracing and is far less burdensome.


Again, I'm not at all anti-VBS. If my child was a candidate, I'd probably chose it over bracing. However, you should admit there's zero proof that the VBS treated kids won't go on to have their curves progress later in life. Yes, VBS feels less intrusive, but it comes with a lot more risks than bracing. I don't think you can die, get an infection, or become paralyzed from bracing. ;-)

While it is true that there are few kids out of the growth period who were stapled, if most of those had gone on to fusion we probably would have heard it by now. Thus I think they avoid fusion at least to this point.

I think the risk situation surrounding VBS is small enough such that it still is better overall than wearing a brace for a few years. Just my opinion.


You can't have it both ways.

Not trying to. The situation with VBS, as a surgery with a defined outcome in something close to real time is distinguishable (and superior) to that for bracing as far as I can tell. Surgery will always have that advantage over things like PT and bracing. I may be missing some info though. In fact I certainly don't have all the relevant info.

[mariaf]

I think that Boston braces are still the "gold standard" for most curves.

Sharon, it's interesting that you're on the VBS bandwagon, considering they don't have any RCTs. :) (I'm definitely not anti-VBS. I'm just pointing out that that method will have to go through the same trials that bracing is having to go through, before the mainstream surgeons hop on board.)

--Linda

Hi Linda,

I just wanted to share the information that a lot of the top names in the field ARE on board - it may not be common knowledge because some have come on board in the past year or two. But in addition to Dr. Betz and the team at Shriners Philadelphia, these include Drs. Luhmann, Sturm, Oswald, Skaggs, Vitale, Hresko, Hanson, Diab - and hospitals like Childrens Hospital of Boston, Childrens Hospital of Los Angeles, etc.

I even spoke to one mom who took her child to Dr. Boachie and he said that since juvenile scoliosis cases don't make up a large part of his practice, he wasn't performing VBS but he recommended it as a good option for her daughter.

[mariaf]

Yes, VBS feels less intrusive, but it comes with a lot more risks than bracing. I don't think you can die, get an infection, or become paralyzed from bracing.

I realize the point you are trying to make about the risks of surgery vs. bracing, but I honestly feel that mentioning paralysis and death are a bit extreme - except to the extent that I guess one could say they could happen with any surgical procedure, no matter how minor - but how extremely remote is this possibility??

Luckily, with regard to VBS, there haven't been any serious complications that I'm aware of from among the many parents I've had contact with (probably a large percentage of the VBS patients out there), and from talking to some of the doctors performing it - and it is considered, as surgeries go, quite safe.

It's not that any of us WANT our kids to undergo any surgery, but like Sharon said sometimes there's no choice (if one is trying to avoid fusion, a more invasive surgery with arguably greater risks). I realize there is no guarantee that VBS means that a patient will avoid fusion - just like there's no guarantee that bracing will cause one to avoid fusion - but VBS is an "alternative to bracing" that many parents and a lot of the top orthos in the country feel is a good option for certain candidates.

[mariaf]

They are - or were as recently as 3-4 years ago (if that), however - still used in some circumstances. A friend's daughter was stapled for a high thoracic curve (up to T2, I think). Prior to that, I'm almost sure she was wearing a Milwaukee because of the extremely high apex.

Mariaf, am I remembering incorrectly, or didn't Lorena have one?

Pam

I recall that Lorena did have a Milwaukee brace, although it may have been a modified Milwaukee - I'm not sure.

[LindaRacine]

Hi Maria...

You're missing my point. I am not at all against VBS. I specifically said I'd chose it for my own child if it was appropriate. My point is that VBS is actually less proven than bracing, and no one should be dismissing one treatment (bracing) with the argument of no RCTs, unless they apply the same stringent measurement of success to the other treatment (VBS).

Just because doctors are jumping on board is not proof that a treatment is successful. Those same doctors are still prescribing braces for some patients, and I think we have all agreed that bracing has not yet been conclusively proven to be effective.

--Linda

[Pooka1]

Hi Maria...

My point is that VBS is actually less proven than bracing, and no one should be dismissing one treatment (bracing) with the argument of no RCTs, unless they apply the same stringent measurement of success to the other treatment (VBS).

Disagree.


Just because doctors are jumping on board is not proof that a treatment is successful.

Agree.


Those same doctors are still prescribing braces for some patients, and I think we have all agreed that bracing has not yet been conclusively proven to be effective.

VBS is easier to study than bracing.

[mariaf]

I'm just pointing out that that method will have to go through the same trials that bracing is having to go through, before the mainstream surgeons hop on board.)

--Linda

Hi Linda,

I didn't miss your point - and I hope you didn't interpret the tone of my post the wrong way - I do realize you aren't necessarily anti-VBS - I just wanted to share some information about the mainstream surgeons who HAVE already hopped on board. We keep a list on the VBS site, but I figured a lot of folks might not know that some of these mainstream surgeons are offering this option.

A lot of other surgeons don't perform VBS because it is still not "routinely" covered by insurance - however, I am happy to report that the reason several doctors outside of Shriners (Vitale, Oswald, etc.) have been able to perform VBS is that while many insurance companies will initially deny the claim, they have reversed that decision upon appeal from the patient's family and the surgeon, and paid for the procedure - if that were not the case, these doctors would not be able to perform the surgery.

Believe me, I realize that the jury is still out on whether or not VBS will guarantee that these kids can avoid fusion, but I honestly feel that not only is it, as Sharon said, less of a burden than years of bracing, but I feel it at least has the potential to permanently reduce the curve, unlike bracing. While many VBS patients have not reached skeletal maturity, several have either done so or at least gotten past their major growth spurt without requiring fusion.

I think we are all on the same page in hoping the alternatives like VBS are successful so that JIS kids, in particular, will have a brighter outlook :)