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Thread: ANother case of bracing only delaying surgery

  1. #1
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    ANother case of bracing only delaying surgery

    http://drlloydhey.blogspot.com/2012/...ent-young.html

    Wore her brace 22 hours/day for four years and still needed surgery as a young adult for a 12* progression to 48*. That means she was at 36* when she stopped being braced. This is not jaw-dropping... above 30* at maturity is not protective against progression to surgical range.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  2. #2
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    Poor thing, although I thought my scoliosis journey was over 7 yrs ago and now i have major progression and have to have a full fusion I'm so pleased I didn't have to wear a brace at any stage
    27 yr old Female.
    Scoliosis since 12yrs, fusion to lower curve in 1998, costioplast 2001 and further corrective surgery 26 July 2012.
    Now the proud owner of a very straight spine. T1- L5 fusion.
    Mr Dunsmuir, Orthopaedic Surgeon, LGI Leeds.

  3. #3
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    Quote Originally Posted by Jenna.KB View Post
    Poor thing, although I thought my scoliosis journey was over 7 yrs ago and now i have major progression and have to have a full fusion I'm so pleased I didn't have to wear a brace at any stage
    One of my twnis wore a brace (as directed, 100% compliant) and the other was never braced. Since they both needed fusion, it is very obvious the braced one had the rawer deal by far.

    Bracing is very experimental. Surgeons do not adequately get this point across as far as I can tell. I think ethicists need to visit this topic and make changes to the standard of care. Or at least make parents sign a paper sayng they were made aware there is no good evidence bracing works and make sure the kid knows it.

    Bracing has not been disproven either so they shuold know that. But it has been established that there is a very high overtreatment rate. People need to know the odds of failure AND the odds of useless treatment, and that is just to the point of maturity. As we have seen, curves >30* at maturity are at risk of progression to surgery territory. Surgeons need to balance everything with the idea of saving levels, especially in the lumbar in my opinion.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
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    Quote Originally Posted by Pooka1 View Post
    http://drlloydhey.blogspot.com/2012/...ent-young.html

    Wore her brace 22 hours/day for four years and still needed surgery as a young adult for a 12* progression to 48*. That means she was at 36* when she stopped being braced. This is not jaw-dropping... above 30* at maturity is not protective against progression to surgical range.
    Brace comments without saying the percentage reduction in brace, should to be forbidden, in the same way that should to be forbidden the use of braces without an important percentage reduction in it.

  5. #5
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    Quote Originally Posted by Pooka1 View Post
    Surgeons need to balance everything with the idea of saving levels, especially in the lumbar in my opinion.
    The high intelligence doing human bodies, took into account physics laws and concluded that lumbar vertebras, having to support greater weight, should to be the greatest.
    I donít know if that intelligence only contemplated normal spines, or thinking in the possibility of a lateral curve, also contemplated some mechanisms as stronger ligaments or muscles or fascias in that zone.

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    If braces sometimes avoid surgeries (as I believe it should to happens when are used in the right way) it should never be discarded

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    If that were true, flerc, I would whole-heartedly agree, but I don't see the evidence.

    Also, are you saying that most doctors and patients use braces incorrectly? I'm sure that happens occasionally, but it (bracing) isn't rocket science and the doctors I have dealt with over the past decade seem to have been very knowledgeable about how to use a brace - and have also worked with top-notch orthotists. Each time my son was fitted for a brace, they took an x-ray in the brace to make sure it was achieving the desired correction, etc. So, in my view anyway, misuse of bracing is not the issue.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

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    Mariaf, I'm almost sure that in many cases, the reduction was not so much significant and was used anyway. The reduction not depends only on how good is the orthotists, but mainly on how much flexible is the spine. If the reduction in brace is not significant, nobody may hope that may work. There should to be a protocol saying that when reduction is under x%, the brace not may be used, and as I know there is not one.
    I wish to know about brace studies indicating the reduction in brace.

  9. #9
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    Quote Originally Posted by flerc View Post
    There should to be a protocol saying that when reduction is under x%, the brace not may be used, and as I know there is not one.
    Certainly, what the protocol should to say is that flexibility should to be achieved first.

  10. #10
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    Thanks for clarifying, flerc.

    I thought you were referring more to the skill of the orthoist (and knowledge of the surgeon) regarding bracing. However, I see that you mean that certain cases should probably not be included in the bracing studies. Makes perfect sense.

    Even with regard to VBS, they try to target the kids who will have the greatest chance of success with it.

    That should be the goal of any treatment method, I agree.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

    http://pediatricspinefoundation.org/

  11. #11
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    Mariaf, certainly Iím saying both. The wrong cases should not be included in any study and it should not be wrong cases. In that cases the brace is not guilty, only the professionals. I donít think that surgeons may ignore the protocol and decide for themselves. And the protocol only refer to age, Cobb angle and Riser.. flexibility as I know is not included as a variable, so it would be possible that for instance, a kid with 40į (I believe this is the limit for the protocol) with not a flexible spine only could getting an insignificant reduction in brace and surgeon recommends it anyway. This would be a clear wrong case, at least in theory.

    I believe that in that case, the risk of the spine moving inside the body (fixed because the brace) is really high, then probably worst that anything.
    Absolutely different would be if the reduction would be very much significant.. the spine would be forced to accompany the body during growth.

    Iím sure that when all girls were forced to use braces (semi rigids!) IS was something really so much strange.

    Regards.

  12. #12
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    Quote Originally Posted by flerc View Post
    The reduction not depends only on how good is the orthotists, but mainly on how much flexible is the spine. If the reduction in brace is not significant, nobody may hope that may work. There should to be a protocol saying that when reduction is under x%, the brace not may be used, and as I know there is not one.
    I agree, flerc.

    I know that doctors will tell you they hope to see 50% reduction with bracing, but I don't know of any protocol that says 'do not brace unless x% of correction is achieved in brace'. And I agree that such a protocol would make sense.
    mariaf305@yahoo.com
    Mom to David, age 17, braced June 2000 to March 2004
    Vertebral Body Stapling 3/10/04 for 40 degree curve (currently mid 20's)

    https://www.facebook.com/groups/ScoliosisTethering/

    http://pediatricspinefoundation.org/

  13. #13
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    Yes Mariaf.. I only have heard about a Dr. always refusing to indicate brace if the reduction is under the 40%, recommending in that cases some exercises to get flexibility so then, brace may be used.

    So I think that what should to be done, is not to hate braces, trying to deletes them form the face of the earth, but to change the protocol in the same way that this Dr. works (may be 50% instead of 40%), so braces would be always used in a right way.

  14. #14
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    But Ďstandard protocolí (I believe is only one) not take into account flexibility and reduction percentage.. or it does?

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    I did not see the video, but I believe they are referring only to the maximum angle and hours per day, but not about reduction in brace.. anyway it seems they are talking about 'Changes in brace program'.
    Certainly I believe that braces could be used with more than 40į, if the reduction is really important.
    I believe that some flexibility in the protocol is needed. Certainly the protocol should to be only a reference, not an order.

    When I talk with a surgeon (not only a spine surgeon) I feel Iím talking with a computer program, because as programs does, they requires an input (age, Riser, Cobb angle) and they only follow the instructions saying what to do.. saved in the PROTOCOL.
    May be in some gray zones as 41į-39į, the protocol leaves some space for creative reasoning.

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