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Thread: Rehabilitation of adolescent patients with scoliosis—what do we know?

  1. #91
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    Hi Mamamax,

    I doubt anyone has much extra time to do a literature search for the type of articles you are interested in. But you can search to your heart's content on PubMed, and I bet you will find all sorts of interesting articles.

    Your surgeons also might be able to point you towards some articles. Also most hopsitals have a friendly medical librarian who could help you find articles.

    I wouldn't hold your breath for other forum participants to produce the articles you desire.

    Regards,
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  2. #92
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    Here you are, Mamamax

    Radiologic Findings and Curve Progression 22 years after Treatment for Adolescent Idiopathic Scoliosis: a Comparison of Brace and Surgical Treatment with Matching Control Group of Straight Individuals
    J. Danielsson, Aina MD, PhD; L. Nachemson, and Alf MD, PhD

    in Spine, March 1st 2001, Vol 26 Issue 5 pp 516-525


    Study Design. This study is a follow-up investigation for a consecutive series of patients with adolescent idiopathic scoliosis treated between 1968 and 1977. In this series, 156 patients underwent surgery with distraction and fusion using Harrington rods, and 127 were treated with brace.

    Objectives. To determine the long-term outcome in terms of radiologic findings and curve progression at least 20 years after completion of the treatment.

    Summary of Background Data. Radiologic appearance is important in comparing the outcome of different treatment options and in evaluating clinical results. Earlier studies have shown a slight increase of the Cobb angle in brace-treated patients with time, but not in fused patients.


    [.....]

    Results. The mean follow-up times were 23 years for surgically treated group and 22 years for brace-treated group. The deterioration of the curves was 3.5° for all the surgically treated curves and 7.9° for all the brace-treated curves (P < 0.001) [.....]

    Conclusions. Although more than 20 years had passed since completion of the treatment, most of the curves did not increase. The surgical complication rate was low. Degenerative disc changes were more common in both patient groups than in the control group.



    It is always expected that there will be a little bit of "settling" following surgery before the fusion has taken, usually of under 5 degrees, so a deterioration of 3.5 degrees is considered perfectly normal (any surgeon will tell you this before you have the surgery, you might like to ask your surgeon contacts about it). This study shows that after 22 years, the operated curves were basically stable.

  3. #93
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    You are a wonderful person tonibunny! The scoli world is fortunate to have you around!

  4. #94
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    [QUOTE=mamamax; If Gore can win one - hey, there's hope :-) [/QUOTE]

    Too funny. Don’t forget BO’s peace prize. That one beats Al Gore’s for lunacy.

  5. #95
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    even with my scoliosis, i cannot stoop low enough for that kind of name calling!
    nice language...lovely respect for the office!

    this is why some folks dont come on forum...or are on less and less!

    J.
    Last edited by jrnyc; 08-04-2010 at 07:06 PM.

  6. #96
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    Surgery/Bracing Comparison 22yrs Post Treatment (2001)

    Quote Originally Posted by tonibunny View Post
    Here you are, Mamamax

    Radiologic Findings and Curve Progression 22 years after Treatment for Adolescent Idiopathic Scoliosis: a Comparison of Brace and Surgical Treatment with Matching Control Group of Straight Individuals
    J. Danielsson, Aina MD, PhD; L. Nachemson, and Alf MD, PhD
    in Spine, March 1st 2001, Vol 26 Issue 5 pp 516-525

    Study Design. This study is a follow-up investigation for a consecutive series of patients with adolescent idiopathic scoliosis treated between 1968 and 1977. In this series, 156 patients underwent surgery with distraction and fusion using Harrington rods, and 127 were treated with brace.

    Objectives. To determine the long-term outcome in terms of radiologic findings and curve progression at least 20 years after completion of the treatment.

    Summary of Background Data. Radiologic appearance is important in comparing the outcome of different treatment options and in evaluating clinical results. Earlier studies have shown a slight increase of the Cobb angle in brace-treated patients with time, but not in fused patients.
    [.....]
    Results. The mean follow-up times were 23 years for surgically treated group and 22 years for brace-treated group. The deterioration of the curves was 3.5° for all the surgically treated curves and 7.9° for all the brace-treated curves (P < 0.001) [.....]

    Conclusions. Although more than 20 years had passed since completion of the treatment, most of the curves did not increase. The surgical complication rate was low. Degenerative disc changes were more common in both patient groups than in the control group.

    It is always expected that there will be a little bit of "settling" following surgery before the fusion has taken, usually of under 5 degrees, so a deterioration of 3.5 degrees is considered perfectly normal (any surgeon will tell you this before you have the surgery, you might like to ask your surgeon contacts about it). This study shows that after 22 years, the operated curves were basically stable.
    Hi Toni :-) I know you research like me, late into the night - thank you for sharing this one. While the number of patients studied is quite small, and the methods are outdated by today's standards - I have to say this one does hold some very interesting observations.

    Results. The mean follow-up times were 23 years for surgically treated group and 22 years for brace-treated group. The deterioration of the curves was 3.5° for all the surgically treated curves and 7.9° for all the brace-treated curves (PP < 0.001) [.....]

    What is astounding is that 22 years post treatment - curves did not progress significantly, in either group! Now that is almost a pro bracing study :-) and x-rays don't lie. The only thing missing is an understanding of this patient population in terms of their risk of progression, prior to treatment. that would also be interesting to know.

    This does demonstrate that curvature deterioration is near halted 22 years post operatively (using the old Harrington rod method), but does stop short of stating that the deterioration is unquestionably halted. I'm not sure how this is relevant to the newer instrumentation, other than that we would assume that newer instrumentation is better - we do not have the data on that yet - but certainly future data is forthcoming, hopefully in large study format.

    There is the case to be made that one might assume from this study, that at the 10 year mark deterioration was halted, but it can't be proven - and I presume that is why the verbiage is not present.

    What I'm looking for is something in the literature which states,literally, that surgery for scoliosis correction halts deterioration 10 years post operatively (not that the progression is minimal).

    I have found this to be an exhausting search with no results. I think it does not exist. I don't expect anyone to burn the midnight oil trying to find this for me, but if you do - please share.

    Thanks again Tonibunny, you do know how to find a good study and this one is quite unique in that it is rather positive from both surgical and non-surgical standpoints
    Last edited by mamamax; 08-04-2010 at 07:13 PM.

  7. #97
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    Well, it's down to semantics isn't it. You say you want to see the word "halt". The writers of this study haven't used that word, but they have shown that yes, the progression of scoliosis was stopped by fusion surgery and that surgery was more effective than bracing.

    Minimal "settling" of the fused spine is expected following a fusion surgery. Any surgeon will tell you this pre-operatively and one needs to be aware of this when considering these results. Besides, the "minimal progression" of 3.5 degrees over 23 years is well within the accepted +5/-5 degree margin of error when reading x-rays - in other words, it wouldn't usually even be considered to be progression! The bracing statistic, however, is larger than this and thus really does show that there's slight progression.

    You asked for something that showed that fusion prevents deterioration of spinal curvatures after 10 years, and this study shows that. In fact, it shows that deterioration of spinal curvatures has been halted for over twice that long This is for the "first generation" of spinal instrumentation, if you like -obviously more modern hardware systems have been developed, but it is still data that is relevant for instrumented spinal fusion, no matter what sort of metalwork is used.

    If you've decided, simply because this study doesn't use the word "halt", that this data is useless to you then that's up to you. It's your back! I do think you should have this discussion with a scoliosis surgeon, one who is a member of the SRS and thus has a lot of expertise; they will be able to tell you truthfully about how surgery can "halt" scoliosis. If you can't trust what they tell you then really surgery isn't for you anyway! To be honest, you seem happy to carry on with your nonsurgical treatments and I was surprised to hear you say you were considering surgery. Different things work for different people - just do what you're most comfortable with
    Last edited by tonibunny; 08-04-2010 at 07:47 PM.

  8. #98
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    If you need to hear the word "halt" then this may reassure you:

    Social acceptability of treatments for adolescent idiopathic scoliosis: a cross-sectional study
    by Stefano Negrini and Roberta Carabalona
    in Scoliosis [the official journal of SOSORT], 24th August 2006


    "....surgery halts progression, but fuses the spine"


    This is SOSORT (who I think you probably have a lot of respect for) and they didn't feel the need to qualify their statement by giving X amount of years. They've stated that surgery halts progression but fuses the spine, full stop (er, period )

  9. #99
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    Quote Originally Posted by tonibunny View Post
    Well, it's down to semantics isn't it. You say you want to see the word "halt". The writers of this study haven't used that word, but they have shown that yes, the progression of scoliosis was stopped by fusion surgery and that surgery was more effective than bracing.

    Minimal "settling" of the fused spine is expected following a fusion surgery. Any surgeon will tell you this pre-operatively and one needs to be aware of this when considering these results. Besides, the "minimal progression" of 3.5 degrees over 23 years is well within the accepted +5/-5 degree margin of error when reading x-rays - in other words, it wouldn't usually even be considered to be progression! The bracing statistic, however, is larger than this and thus really does show that there's slight progression.

    You asked for something that showed that fusion prevents deterioration of spinal curvatures after 10 years, and this study shows that. In fact, it shows that deterioration of spinal curvatures has been halted for over twice that long This is for the "first generation" of spinal instrumentation, if you like -obviously more modern hardware systems have been developed, but it is still data that is relevant for instrumented spinal fusion, no matter what sort of metalwork is used.

    If you've decided, simply because this study doesn't use the word "halt", that this data is useless to you then that's up to you. It's your back! I do think you should have this discussion with a scoliosis surgeon, one who is a member of the SRS and thus has a lot of expertise; they will be able to tell you truthfully about how surgery can "halt" scoliosis. If you can't trust what they tell you then really surgery isn't for you anyway! To be honest, you seem happy to carry on with your nonsurgical treatments and I was surprised to hear you say you were considering surgery. Different things work for different people - just do what you're most comfortable with
    Yes exactly Toni - it is a matter of semantics I suppose. You see there exists literature which states that surgery does not halt deterioration 10 years post operatively. I've tried to personally search the literature to test that statement. Seems it is true - in speaking about what the literature supports. No, of course exploring this is not a deal breaker in the course of making my personal decisions.

    As for semantics - the term deterioration may mean more than simply curvature progression. I'm trying to clarify that with a medical professional now. I cant find a clear definition of clinical deterioration in terms of spinal surgery, but I've been reading things that suggest it may refer to more than just curvature progression. Like unresolved (or increased) pain, progressive limited mobility, lung function, etc etc. If the clinical use of the term deterioration is multi factorial - then it does become more important to me in terms of future outcomes - and something I want to watch for in the literature.

    You are right it is my back and my choice. As it is for anyone. I support and respect the choices anyone makes - surgical or non surgical. My choice at this point in my life is to explore rehabilitation. I could use some support while keeping an eye on all options - that is something I will be doing for the rest of my life because one never knows with any real certainty which direction any given case may go.

    My current pain issues are not horrendous, but it was not that long ago I was ready for surgery because of debilitating pain, 24/7. That was a phase that lasted two years, the suffering of it was enough to bring me to the table without question. I am most grateful to have taken one last chance at a rehabilitative method in order to to circumvent surgery, given my age, medical condition, and life style. I was able to move past that experience - but because of the experience, I remain ever mindful of the unknown. Only now I ask questions in earnest while in search of future choices that may improve the quality of my life - regardless of which direction things may go. I'm grateful for many here who have a knowledge greater than mine, and who have helped me better understand many things.

    My current choice is to continue with rehabilitation over the course of the rest of my life - I cannot know if that will be possible or not. So I must keep an eye on both areas - surgical and non surgical. Also given the genetics of IS I could easily have a grandchild one day, who could benefit from what I learn. And there is always the off chance that someone else in our support forum may benefit from my own experience - as I have benefited from others here.

    I hope this better explains my purpose here - if that needs to be explained.

    As for the comparison between surgery and bracing in the study - I didn't make up the obvious ... it's right there in black and white. Of course it is only one - rather limited study.
    Last edited by mamamax; 08-04-2010 at 09:22 PM.

  10. #100
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    Let's see now, they started out with 283 patients and attempted to follow their progress longterm. They were able to follow 252 of them for at least 22 years.

    There were 156 surgically treated people and they were able to follow 142 for 23 years. After that time, every single one of them showed no change in Cobb Angle (because 3.5 degrees is well within the accepted +5/-5 degree margin of error).

    Thus, this study shows that surgery is extremely successful in halting deterioration of scoliosis in terms of the progression of the curves. 100% of participants in the study experienced no discernable curve progression. That's quite an impressive statistic! And, since scoliosis is medically defined as an "abnormal lateral curvature of the spine", it is evident that spinal fusion surgery does halt scoliosis and this study is proof of that.

    Your worries seem to be concerning the secondary problems that can be associated with scoliosis, rather than the actual scoliosis itself. You want to know if these problems can be halted too. Not everyone has pain, but quite naturally this is what you're most worried about, because pain has been the major issue for you. I don't need to go hunting for studies about this because it is well known that surgery doesn't always fix pain. All anyone can do is talk to their surgeon about their own particular case and ask them to use their expertise to judge whether surgery would be likely to help their pain or not.

    As you'll know, surgery for pain is nearly always the last resort and people are generally advised to try all sorts of other pain management techniques first. Your use of the Spinecor brace seems to be working for you, and I'm very glad to hear it

  11. #101
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    Quote Originally Posted by tonibunny View Post

    Thus, this study shows that surgery is extremely successful in halting deterioration of scoliosis in terms of the progression of the curves. 100% of participants in the study experienced no discernable curve progression. That's quite an impressive statistic!
    Somewhat of a minor point, but thought I'd clarify. The study does not say that 100% of surgical participants experienced no discernible progression. The average was 3.5° ± 3.9° with a range of -9° to +14°. Probably safe to say that 70% definitely saw no discernible progression. The next ~20% saw 5-9° progression with the remainder probably close to the 14° high end.

    The benefits of bracing would be blurred as well.

  12. #102
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    Ah, I see, thank you! I only had access to the abstract. I did think that the results were surprisingly good

  13. #103
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    Smile Thank you skevimc

    It is difficult to use surface information only when trying to make an interpretation that can be applied in forming any logical conclusion. It really does take a keen eye to read and understand these presentations.

    I’ll never be an expert at it – and will always appreciate experience like yours - thank much for showing me how to read this a bit better.

    Without more information specific to each and every patient participating in any study it is difficult to do more than speculate in terms of approximations.

    I think reading such studies is a fine art – thank you for the clarification. Like Tonibunny, I do think the results are surprisingly good, for both methods - on the surface :-)

  14. #104
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    Quote Originally Posted by tonibunny View Post
    Let's see now, they started out with 283 patients and attempted to follow their progress longterm. They were able to follow 252 of them for at least 22 years.

    There were 156 surgically treated people and they were able to follow 142 for 23 years. After that time, every single one of them showed no change in Cobb Angle (because 3.5 degrees is well within the accepted +5/-5 degree margin of error).

    Thus, this study shows that surgery is extremely successful in halting deterioration of scoliosis in terms of the progression of the curves. 100% of participants in the study experienced no discernable curve progression. That's quite an impressive statistic! And, since scoliosis is medically defined as an "abnormal lateral curvature of the spine", it is evident that spinal fusion surgery does halt scoliosis and this study is proof of that.

    Your worries seem to be concerning the secondary problems that can be associated with scoliosis, rather than the actual scoliosis itself. You want to know if these problems can be halted too. Not everyone has pain, but quite naturally this is what you're most worried about, because pain has been the major issue for you. I don't need to go hunting for studies about this because it is well known that surgery doesn't always fix pain. All anyone can do is talk to their surgeon about their own particular case and ask them to use their expertise to judge whether surgery would be likely to help their pain or not.

    As you'll know, surgery for pain is nearly always the last resort and people are generally advised to try all sorts of other pain management techniques first. Your use of the Spinecor brace seems to be working for you, and I'm very glad to hear it
    On the surface, and without more information than the abstract provides: The deterioration of the curves was around 3.5° for the surgically treated subjects and around 7.9° for the brace-treated subjects. While the figures for the surgically treated patients are quite low indeed – so are the figures for the brace treated patients. Making a case for both treatments, considering that on the surface, observations 22 years post treatment show: the difference between treatments is around 4.4°. Without more specific data on each and every single study subject, initial results are impressive, albeit “blurry.” Very interesting study this one from 2001, which examines both treatments as applied over 40 years ago among two groups 22 years post treatment. Since then, both methods find improved methodology and perhaps as patients we are provided more justifiable choices (when choice is possible).

    Thank you for the kind wishes on my adult rehabilitative experience so far – I pray the benefits continue as I search out more rehabilitative methods to better support the condition of my condition in the years ahead, as best I can with my methods of choice. I would say the future is more hopeful in both surgical and rehabilitative arenas – for both adolescents and adults, than was the case 40 years ago in the US.

    As for the cosmetic comparisons between both methods (not discussed in the above study), there exists comparisons today between surgical and rehabilitative results among those like Hawes (rehabilitative based exercise without bracing) and Schroth (which uses bracing in addition to a structured scoliosis specific rehabilitative based exercise), etc. Admittedly at my age, the cosmetic concern is not foremost in my mind – I’m happy to avoid looking like Kieth Richards in my old age (or so called golden years) and I’m personally more concerned with avoiding the possibility of difficult to handle health and well being issues in the future - still, it is possible that acceptable levels of comparative cosmetic improvement may be found for both adolescents and adults, in my opinion. Cosmetics (and certain other effects) of course being a highly subjective thing, as evidenced by the dissonance effect discussed in the literature.

  15. #105
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    Question starting curves

    I am wondering what the starting curves were either at surgery or at bracing.
    Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
    Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

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