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Thread: ANother case of bracing only delaying surgery

  1. #16
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    Quote Originally Posted by flerc View Post
    If braces sometimes avoid surgeries (as I believe it should to happens when are used in the right way) it should never be discarded
    I don't think there is any evidence bracing even sometimes avoid surgery.
    Sharon, mother of identical twin girls with scoliosis

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  2. #17
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    Quote Originally Posted by flerc View Post
    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.
    But flexibility and reduction percent in brace was NOT correlated with outcome in everyone's favorite bracing study as I mentioned in the other thread.
    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."

  3. #18
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    Quote Originally Posted by flerc View Post
    <snip>but I believe they are referring only to the maximum angle and hours per day, but not about reduction in brace..<snip>.


    I think Mayo's other requirement was a minimum of 50% in-brace correction. They discussed their program and protocols at a recent POSNA (I think 2011) if anyone is interested in the details.
    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

  4. #19
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    Quote Originally Posted by leahdragonfly View Post
    I think Mayo's other requirement was a minimum of 50% in-brace correction. They discussed their program and protocols at a recent POSNA (I think 2011) if anyone is interested in the details.
    That rings a bell. I think you are correct, Gayle.

    I have checked periodically for this study to be published and I don't think it has been yet. That might mean it either wasn't written up or was rejected for publication perhaps due to reasons stated here and probably elsewhere.
    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."

  5. #20
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    Here are Shaughnessy's pubs.

    http://www.ncbi.nlm.nih.gov/sites/en...aughnessy%20wj[Author]%20AND%20mayo[All%20Fields]%29

    He has been working on other matters and may have dropped the claims he tried to make in the 2009 POSNA talk. They seemed irrationally exuberant any road.
    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."

  6. #21
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    Quote Originally Posted by leahdragonfly View Post
    I think Mayo's other requirement was a minimum of 50% in-brace correction. They discussed their program and protocols at a recent POSNA (I think 2011) if anyone is interested in the details.
    This must to be part of the standard protocol followed by every surgeon. Is a matter of common sense.

  7. #22
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    Yes and if is not possible to get a minimum of 50% in-brace correction, the corresponding methods should to be indicated in order to achieve flexibility until it would be possible.
    I cannot understand why those changes are not applied to the protocol.
    Last edited by flerc; 07-19-2012 at 10:09 PM.

  8. #23
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    Quote Originally Posted by flerc View Post
    This must to be part of the standard protocol followed by every surgeon. Is a matter of common sense.
    It shouldn't be the protocol until they show it matters. It probably makes the brace more uncomfortable.

    If everyone's favorite bracing study(TM) found no relationship then that should be explicitly tested, not just assumed to be correct.

    I think people who are in no danger of ever wearing a brace tend to be very cavalier about brace wear.
    Last edited by Pooka1; 07-20-2012 at 07:01 AM.
    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."

  9. #24
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    Quote Originally Posted by flerc View Post
    Yes and if is not possible to get a minimum of 50% in-brace correction, the corresponding methods should to be indicated in order to achieve flexibility until it would be possible.
    I cannot understand why those changes are not applied to the protocol.
    Because there is no evidence it matters coupled with potentially more discomfort for kids. You are very cavalier about OTHER people wearing braces. You would want some evidence if YOU had to wear a brace.

    The average in-brace correction of kids who didn't progress in Katz (2010) was 43% as I recall and 47% in kids who did progress. Now those are the same numbers but they are both less than 50%. How do you explain that if you want to defend the minimum 50%?

    Also, what is the evidence that flexibility can be improved and that it translates to in-brace correction?

    This is very complex and the common sense of a lay person is not necessarily helpful. That's why we have researchers on the case.
    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."

  10. #25
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    Quote Originally Posted by Pooka1 View Post
    I think people who are in no danger of ever wearing a brace tend to be very cavalier about brace wear.
    That is so true, Sharon!! And I can say that as a person who wore a brace as a child and is also the mother of a child who wore a brace.
    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

  11. #26
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    Quote Originally Posted by leahdragonfly View Post
    That is so true, Sharon!! And I can say that as a person who wore a brace as a child and is also the mother of a child who wore a brace.
    It's really quite exquisitely obvious in some instances. In one case, we had a person come on here wistfully saying she would have put her child in a Milwaukee brace for at least 5 years if it had been suggested. I suspect that was a case of the surgeon protecting the kid against the mother.

    Lay people who have no clue about how to approach evidence about medical treatments need more guidance. Surgeons need to do a better job at presenting the evidence case for bracing in a more understandable manner. Parents just want to try anything that might have some hope of avoiding surgery. But kids have a much higher standard for risk reduction because they have to wear the damn thing. You understand that and others understand that. Some parents resist it and would brace a kid with only a 1% chance of succeeding I suspect.
    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."

  12. #27
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    Quote Originally Posted by Pooka1 View Post
    Because there is no evidence it matters coupled with potentially more discomfort for kids. You are very cavalier about OTHER people wearing braces. You would want some evidence if YOU had to wear a brace.

    The average in-brace correction of kids who didn't progress in Katz (2010) was 43% as I recall and 47% in kids who did progress. Now those are the same numbers but they are both less than 50%. How do you explain that if you want to defend the minimum 50%?

    Also, what is the evidence that flexibility can be improved and that it translates to in-brace correction?

    This is very complex and the common sense of a lay person is not necessarily helpful. That's why we have researchers on the case.
    Certainly I cannot know if the minimum should to be 50 or 40 as I mentioned in a previous post.. of course might be a not significant difference, who knows?
    And certainly if I could change this ancient protocol, I would not avoid a priori the use of brace in any case, even if reduction would be minimal. What Id avoid is the use of brace, before being sure that is not possible to get more flexibility (of course, times should to be considered) and if anyway the reduction is minimal, a carefully monitoring should to be performed and if the curve continuous growing, yes, the brace removing should to be seriously considered before the curve reach more degrees.

    For every person with a minimal rational mind, is obvious that chances are greater when reduction in brace is greater. They clearly seem to be in a directly proportional relationship. You should not to underestimate the logic and the physics laws!.. and also the common sense.
    The only way that someone may say that chances would be the same with a great reduction or a minimal reduction would be knowing about an specific fact balancing those extremes, as some intricate property of some body component, leading to a negative behavior when the spine is stretched.

    But it seems that medical community is only worried to not provoke discomfort until fusion. Anyway this change in the protocol, would not be against that purpose.

  13. #28
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    Quote Originally Posted by Pooka1 View Post
    It shouldn't be the protocol until they show it matters.
    The current protocol is showing really good outcomes? It not need revisions? How old is that protocol?

    Quote Originally Posted by Pooka1 View Post
    It probably makes the brace more uncomfortable.
    I don't see why

    Quote Originally Posted by Pooka1 View Post
    If everyone's favorite bracing study(TM) found no relationship then that should be explicitly tested, not just assumed to be correct.
    If something seems obvious should not be delayed, as is happening since so many decades ago.

    Quote Originally Posted by Pooka1 View Post
    I think people who are in no danger of ever wearing a brace tend to be very cavalier about brace wear.
    What some people should not to be cavalier is about something as fusion, so they should not try to vanish the possibility to avoid that kind of surgery , even if the way is using something not comfortable.

    I was never cavalier about the real risks of braces. Certainly I said that protocol should to contemplate more when it should to be removed or probably never used. Also I said I believe about the possibility of the spine growing in a different direction inside the body if brace not works and then being worst than anything.

    But anyway Im sure that the best non surgical solution should to include brace or something following the same principle and even I don't believe that should to be absolutely discarded when growth is finished, so I think that people wanting to erase braces from the face of the earth, should to think better what they really wants.

  14. #29
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    Quote Originally Posted by flerc View Post
    What some people should not to be cavalier is about something as fusion, so they should not try to vanish the possibility to avoid that kind of surgery , even if the way is using something not comfortable.
    Nobody is cavalier about fusion.

    Being realistic about fusion is often confused with promoting fusion.

    Some people equate not bracing with being pro-fusion. That would only make sense if bracing was known to avoid fusion for life. That is NOT known. Equating not bracing with fusion doesn't make any sense because there is no good evidence bracing avoids fusion for life. With the large overtreatment rate and the overt failures (some perhaps due to non-compliance) not-bracing can't possibly account for more than a small percentage of fusions. And there is no good evidence it can even account for those cases.

    Lay people can't seem to grok that something can be a standard of care AND ALSO be completely experimental. I certainly can't grok it. It makes no sense.
    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."

  15. #30
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    Quote Originally Posted by hdugger View Post
    Unfortunately, there's no research to show that either of these treatments will guarantee you a life without pain or further surgery.
    There is no good evidence that bracing does that for any curves. There is some evidence that surgery can likely do that for certain curves.
    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."

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