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  1. #1
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    More Good Evidence Bracing Works in AIS

    Here is a video presented by Dr. William Shaughnessy at the Mayo Clinic from the last POSNA meeting. The results of the Mayo Clinic changing their ineffective scoliosis bracing program with a new program had dramatic results in their bracing success in AIS.

    Here are their conclusions:

    -Effective bracing changes the natural history of AIS

    -Changes in brace program significantly improved results

    -Brace program changes led to significantly less progression AND less surgery

    -Poor compliance is the single most important determinant of brace failure

    -We now assume progression is due to poor compliance until proven otherwise. (Remember they're talking about AIS, not congenital or other types).

    -Psychological co-morbidity has significant negative impact on compliance and success.

    -In this series there was NO progression to surgery if:

    -initial curve magnitude was less than 40 degrees and
    -bracewear greater than fifteen hours per day


    The study states that the psychological co-morbidity of brace failure they discovered was due to ADHD, anxiety disorder, oppositional defiance disorder, or depression being treated with medication.


    Click on the May 13th presentation link "Bracing for Adolescent Idiopathic Scoliosis: Determinants of Success" presented by William J. Shaughnessy, MD


    http://posna.gmetonline.com/Presenta...onpackageid=84
    Last edited by Ballet Mom; 11-02-2011 at 09:26 PM.

  2. #2
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    Hi hdugger,

    Yes, I believe that if someone is interested in bracing their child, they definitely need to look into which orthopedists actively support bracing beforehand.

    Apparently the Mayo Clinic had a bracing program that ten years ago i.e. 2000, was very similar to the natural history...i.e. not doing anything effective and the surgeons, patients and parents were quite dissatisfied.

    40% of brace patients required surgery!

    60% of patients showed progression greater than 5 degrees.

    So Mayo revamped their bracing program and went with a custom molded TLSO, orthotist retraining with a Risser casting frame with aggressive manual manipulation of the mold requiring a 50% correction or they'd change the brace that day, constantly emphasizing compliance and they added nurse practitioners for counseling, education and followup.

  3. #3
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    What I find most interesting is this:

    In this series there was NO progression to surgery if:

    -initial curve magnitude was less than 40 degrees and
    -bracewear greater than fifteen hours per day


    How does Scoliscore work into this? According to them there are people with high Scoliscores that are completely resistant to bracing. So does that mean that over the course of ten years, no one with a high Scoliscore was seen at Mayo Clinic or somehow all fell into the non-compliant group? Highly unlikely.
    Last edited by Ballet Mom; 11-01-2011 at 09:03 PM.

  4. #4
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    Revised Link

    If necessary, navigate to the 2011 Annual Meeting, presentations from 5/13/11

    The one thing that I have some concern about is that it appears that they cherry picked the patients in the "good" group. So, if the child has no psychological issues and will wear their brace >14 hours a day, they have a good outcome, at least at 3M following treatment.

    To really know if it works, however, they're going to have to find out in 50 years, how many of those patients didn't eventually need surgery. While I still think I'd consider putting my child into a brace if all the planets aligned perfectly, I honestly don't think we'll know if bracing is a potentially successful treatment until we know their COMPLETE natural history. I know this is the same old debate we've been having for years, but everyone who is going to have to go through the turmoil of bracing a child, needs to understand that they may just be putting the necessity to have a scoliosis fusion off for 20, 30, 40, or 50+ years. While the parents may not be around for that eventuality, we need to consider if the braced kids have a better quality of life in the end, than the non-braced kids.
    Last edited by LindaRacine; 11-01-2011 at 11:47 PM.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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  5. #5
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    i agree with you completely, Linda...
    the only way to know for sure is to check again in 50 years...

    jess

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    I must have missed something about scoliscore. I don't recall ever reading that people with high scores are resistant to bracing. I thought it just indicated that the curve was likely to progress to surgical stage. My question is, do they mean surgical stage before skeletal maturity or just sometime in that persons life? Bracing and scoliscore are both highly debated and HOT topics on the forum. I see plenty of people on the forum that were braced for years as kids and told they were out of the woods, so to speak, only to have surgery later on as middle aged or older adults. So what is considered successful bracing? Getting them to 18 years old with a subsurgical curve or keeping them subsurgical for life? I'm not for or against bracing. I think that is an individuals choice to make for their own children. But, whatever the root cause of scoliosis is, which we still don't know, will likely still be present in adulthood. It's easier for kids to recover than older folks. On the other hand, I can understand as a parent myself, that no parent WANTS their child to have surgery. Sometimes it just boils down to surgery now or surgery later. There's just no clear cut way to determine that because each individual is unique.
    Last edited by rohrer01; 11-02-2011 at 01:46 AM.

  7. #7
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    Quote Originally Posted by LindaRacine View Post

    The one thing that I have some concern about is that it appears that they cherry picked the patients in the "good" group. So, if the child has no psychological issues and will wear their brace >14 hours a day, they have a good outcome, at least at 3M following treatment.

    To really know if it works, however, they're going to have to find out in 50 years, how many of those patients didn't eventually need surgery. While I still think I'd consider putting my child into a brace if all the planets aligned perfectly, I honestly don't think we'll know if bracing is a potentially successful treatment until we know their COMPLETE natural history. I know this is the same old debate we've been having for years, but everyone who is going to have to go through the turmoil of bracing a child, needs to understand that they may just be putting the necessity to have a scoliosis fusion off for 20, 30, 40, or 50+ years. While the parents may not be around for that eventuality, we need to consider if the braced kids have a better quality of life in the end, than the non-braced kids.
    The study isn't cherry picked, it's simply where the patients ended up in results of the study. If I were a doctor or a parent, I would certainly seriously consider doing something different, such as vertebral stapling rather than bracing, if my patient or child had one of the pscyhological co-morbidities.

    I would certainly take my chances with bracing versus early surgery as there is plenty of longterm experience that most curves don't progress until fifty degrees. I don't think these surgeons are making up that number for nothing, at least in the thoracic curves. And I'd guess it's probably better not to fuse lumbar curves early, even if they do eventually progress. And there are many surgeries without a completely great outcome, so those complications are avoided in the process.

    In terms of longterm studies, I would think they could start compiling the longterm data on the Harrington Rods soon. :-) There is a good video on that same POSNA meeting site by Dr. Colin Moseley and if you watch the first few minutes he states that the problem with longterm outcomes is that the patient outlives the surgeons by a whole generation. So really, all these surgical procedures have less information regarding longterm outcomes than the bracing. ("Evidence Based Medicine Not A Slam Dunk" from day one of the meeting 5/11/2011).

  8. #8
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    Quote Originally Posted by Ballet Mom View Post
    The study isn't cherry picked, it's simply where the patients ended up in results of the study. If I were a doctor or a parent, I would certainly seriously consider doing something different, such as vertebral stapling rather than bracing, if my patient or child had one of the pscyhological co-morbidities.
    They started out the study with more patients than they ended up with, by removing some patients who had psychological issues and removing at least some of the kids who wore the brace less than 13 hours.
    Quote Originally Posted by Ballet Mom View Post
    In terms of longterm studies, I would think they could start compiling the longterm data on the Harrington Rods soon.
    •Spinal range of motion, muscle endurance, and back pain and function at least 20 years after fusion or brace treatment for AIS
    •Back pain and function 23 years after fusion for AIS
    •Childbearing, curve progression, and sexual function in women 22 years after treatment for AIS
    •Radiologic findings and curve progression 22 years after treatment for AIS: comparison of brace and surgical treatment with matching control group of straight individuals
    •Long-term results of the Harrington operation. Apropos of a series of 200 cases (1964-1986)
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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