Originally posted by Pooka1
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There is no global statement that will cover every patient.
...JIS is much more amenable to bracing than is AIS.
Fusion of T curves has been shown to stabilize the spine including the L curve for at least two decades (the length of hte study) with minimal impact in remaining discs for all patients (small study though).
"Minimal impact in remaining discs"...as you say, small study, and "minimal" might be enough to cause major pain and worse.
I'm not picking nits, but you keep making sweeping statements that are not accurate.
Other fusions, those that are largely in the lumbar or that extend below about L3 are known to be problematic.
Those patients often need revision as I understand this... even pedicle screw constructs are not a stable, long-term solution necessarily when they extend that far in to the lumbar.
Before and after radiographs, while abundant in the surgical sections, tend to be conspicuous by their absence in the bracing/PT threads.
And furthermore, perhaps the dangerous practice of multiple x-rays by those who post them in the surgical sections is indicative of the utterly pointless proliferation of x-rays in this "watch and wait till the curves progress" culture.
Martha Hawes has done this and did improve her curve but it seems like that resulted from the change in her chest cavity shape. She was not trying to decrease her curve but was only trying to avoid respiratory symptoms.
Another case is the guy who did post his before/after PT radiographs, it was obvious he just decreased the compensatory lumber through exercise and/or postural change. The structural T curve was not affected and may have gotten a bit worse.
The only way bracing and PT can gain a foothold is with evidence of efficacy which is hard to come by when even large curves stop progressing on their own as seen by a few cases on this group.
It's a game of cutting loses in my opinion. People who don't have rabid curves have time to try different things. Some kids don't have that luxury.
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