Natural fusion from calcification/arthritis

[mamamax]

http://scoliosisjournal.com/content/4/1/27

If you read Table 2, using method #1

T4-T11 in 1990 was 47 - 24 in 2005

L1-L4 in 1990 was 26 - 10 in 2005

Method #1:
Values for Cobb angle represent means and standard deviation from triplicate readings by each of three readers independent of this study, according to protocols defined by Goldberg et al. [66].

Reference 66: Goldberg MS, Poitras B, Mayo NE, Labelle H, Bourassa R, Cloutier R: Observer variation in assessing spinal curvature and skeletal development in AIS.
Spine 1988 , 13:1371-1378. PubMed Abstract | Publisher Full Text

[Pooka1]

Tell the authors to read the table. Why do you suppose they don't stand behind those numbers in the remainder of the paper? The reason seems to be they are not using the most tilted vertebrae. Look at the end vertebrae.

[Pooka1]

By the way, if you measure from T1 to L5 I'm guessing her Cobb angle is ~0*.

Look at the radiographs. Print them out and superimposed them if you can't eyeball them.

Finally ask Hawes why they don't stand behind the lower recent number and ask her why the huge discrepancy between that and the other measurements. And ask her why they aren't highlighting that Cobb angle decrease in the paper when all the forum folks are focused ENTIRELY on that.

There is a reason.

There is a reason.

[mamamax]

I don't have to ask her anything - the answer is found in the definition of Method #1

[Pooka1]

Why are you ignoring the 34* and 35* when the authors themselves are going with those numbers?

The editor of that paper clearly dropped the ball. It's okay to present disparate data in a table but the authors have to explain why the data differ and why they selected the set they did. None of that happened in that paper. Can editing be any worse? (Don't answer that!)

[hdugger]

Sorry, missed the main thread.

I'd suggest that the "how much reduction past the significant 10" line of inquiry obscures the important point.

The natural course of scoliosis includes zero cases (to the best of my knowledge) of significant curves (>35 degrees) in adults reducing by more than 10 degrees and holding that reduction xray after xray. Again, to the best of my knowledge, that event only occurs 1) with surgery (which reduces the curve by changing the function of the spine) or 2) in several cases (including Hawes) through exercise which reduces the curve without changing the function of the spine.

10 is the magic number A consistent 10 degrees change gets you out of a chance measurement and onto the solid terrain of the real. Hawes has done that. Any contested measurement *beyond* those 10 degrees doesn't alter the significant fact. It just adds color. So, if we all agree that the curve went from 47 to 34, she's 3 degrees beyond the divide between "chance" and "change."

[mamamax]

hdugger - exactly.

[Pooka1]

That Spinecor article showed you can get an 11* reduction just standing differently. But that said, it is obvious she reduced the curve. I hope she never has to stop exercising/PT.

I just can't get over the lack of editing and the lack of attention to even obvious points in that article. And I don't understand why the two tables detailing her PT and massage over the years differ between this article and the one before. One or both are wrong.

These points don't inspire confidence in the claims in general. And the problem is compounded because Hawes is a publishing plant pathologist. I would love to ask her how the editing in this scoliosis journal compares to that in the plant path journals where I can only hope none of htis stuff occurs.

[mamamax]

Case Study compared to Poster Presentation (Hawes, et al)

Reversal of childhood idiopathic scoliosis in an adult, without surgery: a case report and literature review (2009), is the first case study of it's kind and is written according to the guidelines for a specific journal publication.

The case study published in 2009 was probably written for the scientific/medical community highlighting the important data (as noted by dhugger); and presented in a manner required for Journal publication - vs in a manner to be acceptable to forum folk ;-) Just my guess.

The only other material found in the Scoliosis Journal is a poster presentation for SOSORT 2007:

Results
Stable, progressive improvement in Cobb angle occurred over a fifteen-year period in response to physical methods. The improved curvature occurred in correlation with progressive improvement of chest wall morphology and excursion.

Conclusion
The forty percent (thoracic curve) and fifty percent (lumbar curve) reduction in curvature magnitude compares favorably with results from surgical intervention [1].

Reference #1: Bradford DS, Kay BKB, Hu SS: Adult scoliosis: surgical indications, operative management, complications and outcomes. Spine 1999 , 24:2617-2629

The conclusion appears in keeping with the information offered in Table 2, Method #1 of the case study.

[Pooka1]

The case study published in 2009 was probably written for the scientific/medical community highlighting the important data (as noted by dhugger); and presented in a manner required for Journal publication - vs in a manner to be acceptable to forum folk ;-) Just my guess.

Are you are sure about that as that Fix stopped screwing around with my account as you previously claimed?

[hdugger]

I hope she never has to stop exercising/PT.

I don't think surgery ever stops being a threat for any scoliosis patients. A significant number of adult patients with subsurgical curves will progress into surgical territory, and a significant number of surgically treated patients will require revision surgery. So, no matter what path you choose, you're likely to have surgery and/or additional surgery. I wish the future looked different, but for right now, it doesn't.

For those with surgically-treated spines, and for those who haven't hit on a way to hold their curve from progressing, it's all up to fate. Martha has the advantage of having the progression under her control. If she loses that ability, she's no worse off than anyone else with a subsurgical curve. As long as she retains the ability, she's miles ahead.

[Pooka1]

I don't think surgery ever stops being a threat for any scoliosis patients. A significant number of adult patients with subsurgical curves will progress into surgical territory,

Actually there is some evidence that curves <30* will not progress to surgery territory. That is not to say they won't be fused due to pain from ancillary damage though but it likely will not be due to progression. And I suspect many curves <40* will also not progress though some certainly will as we have seen. What appears fairly clear at the moment is that I have no idea where surgeons ever got the idea that <50* was protective against fusion for progression. That is a mystery to me.

and a significant number of surgically treated patients will require revision surgery. So, no matter what path you choose, you're likely to have surgery and/or additional surgery. I wish the future looked different, but for right now, it doesn't.

Depending on what you mean by "significant," that is almost certainly false as far as I know because the majority of curves are thoracic. It is false even for adults per all the abstract published here.

For those with surgically-treated spines, and for those who haven't hit on a way to hold their curve from progressing, it's all up to fate. Martha has the advantage of having the progression under her control. If she loses that ability, she's no worse off than anyone else with a subsurgical curve. As long as she retains the ability, she's miles ahead.

Correct. It is easy to get the false impression around here that people are similarly situated and they simply come to a different concussion about fusion. That is rarely the case except for a few adults whose pain isn't quite at the point yet to drive them to fusion. Bunnies don't know that though.

The only actual debates here are whether conservative treatments can alter the natural history in a meaningful way, risk/benefit of the countdown for lumbar fusions, and whether minimally invasive lumbar is "there." Maybe a few other issues that I'm forgetting also.

[hdugger]

Sorry, I see my miswrite. "Significant number" is correct for both cases - subsurgical and post-surgical - but "likely to" is a miswrite. I meant more that, no matter what course you take, the possibility of surgery/further surgery always looms. There's no "cure" for scoliosis, and, once you curve past a certain point, you're always at risk for future surgery, whether you're unfused or fused. That point often seems to get lost in these discussions about alternative treatments.

For the actual numbers, I don't know. The two papers that Linda cited had a revision rate between 10 and 25 percent, and that's not a lifetime's worth of follow-up. How many will eventually need revision over the course of a lifetime using the current hardware just isn't known. But the basic take-away is that having surgery is in no way 100% protection against future surgery. You have surgery because you need it right now, not because it will help you avoid surgery in the future.

It's that discussion that befuddled us in the scoliosis presentation - does surgery stop the clock on current degeneration? Or does it start the clock on future degeneration? If the surgeons don't know, I sure as hell don't

[Pooka1]

I meant more that, no matter what course you take, the possibility of surgery/further surgery always looms. There's no "cure" for scoliosis, and, once you curve past a certain point, you're always at risk for future surgery, whether you're unfused or fused. That point often seems to get lost in these discussions about alternative treatments.

No you have to drop out the vast majority of T fusions from this grouping per what is known. Those are mostly one-stop shopping whether it is H rods or third generation per what is known. Most of those patients are not thought to be at risk for any more surgery in their life.

For the actual numbers, I don't know. The two papers that Linda cited had a revision rate between 10 and 25 percent, and that's not a lifetime's worth of follow-up. How many will eventually need revision over the course of a lifetime using the current hardware just isn't known. But the basic take-away is that having surgery is in no way 100% protection against future surgery. You have surgery because you need it right now, not because it will help you avoid surgery in the future.

Equally there is no guarantee you won't get hit by a bus. The long term on H rods for T fusions is pretty good per what Linda has stated and posted.

It's that discussion that befuddled us in the scoliosis presentation - does surgery stop the clock on current degeneration?

Yes for the majority of T fusions per what is known now.

Or does it start the clock on future degeneration? If the surgeons don't know, I sure as hell don't

Surgeons know there is a "countdown" as Boachie referred to it on that one video that starts when fusing into the lumbar. That is not the case with the majority of T fusions.

[hdugger]

You're only looking at revision surgery to extend the fusion due to degeneration below the fusion. Yes, that's normally for lumbar patients. But people with thoracic fusions face the risk of other revision surgeries - for infection, pseudoarthritis, junctional kyphosis, sagittal balance, hardware removal, broken rods, etc. The "between 10 and 25 rate" I quoted was for these kinds of revisions - not for extending the fusion into the lumbar spine.

You only have to take a cursory glance through the revision forum to confirm that having surgery in no way guarantees that you won't have more surgery, regardless of what type of curve you have.