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  • I just want to clarify a point here.. bracing does NOT claim to reduce curves beyond the wearing period (or perhaps some early part of weaning).

    VBS and tethering do reduce curves.

    Therefore these treatment modes are not comparable on this score.

    To the extent that getting the best alignment reduces problems down the road, VBS and tethering appears more promising all else equal (which it is not).
    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."

    Comment


    • Originally posted by Pooka1 View Post
      I just want to clarify
      I don't believe your statement is correct, or maybe it's just hard to read. The way Maria stated it is the way that I understand it - young kids (basically JIS kids) have their curves reduced with both bracing and VBS, older kids (AIS) have their curves stabilized with both VBS and bracing. They work the same way in the two populations. It would be good news if what Maria states about VBS reducing the curves more than bracing does in JIS kids plays out - I'll wait for the research to come in on that before I pin too much on that.

      Tethering and fusion are both similar in taking a large curve which is at risk of causing problems in adulthood and reducing the size of that curve. Both suffer from having unknown long term results. For tethering, we really just have the shortest of short-term results. Fusion has a longer history, but still not all that long. Again, we're all hopeful that these surgeries give kids a long, happy, and pain free life, but so far the jury is out.

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      • For tethering, that's just for thoracic curves, isn't it? I had the feeling that kids with lumbar curves were still bracing that part of the curve even after tethering.

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        • JIS is different. Those are a tough nut to crack.

          For AIS, bracing does NOT claim to reduce curves. At best, it claims to hold curves in place, not allowing them to worsen during growth. There is no guarantee of stability once the brace is off, especially for curves >30*.

          Maria will correct me but VBS when done for AIS is only done with significant growth remaining and so I think they expect curve regression when successful due to growth. Also, there is immediate curve correction at the time of the procedure and since the staples are expected to stay in, there is absolute correction in every case where it is successful correction UNLIKE bracing where no permanent correction is ever expected. I could be wrong.
          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."

          Comment


          • hdugger, kids with lumbar curves after tethering have a few options: Some brace (at night, generally) and some receive VBS for the lumbar. A few lumbar curves have been tethered, but it is not being done often at this time.
            Emily, 43
            approx 50 T, 36 T/L

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            • Originally posted by 3sisters View Post
              hdugger, kids with lumbar curves after tethering have a few options: Some brace (at night, generally) and some receive VBS for the lumbar. A few lumbar curves have been tethered, but it is not being done often at this time.
              I think these lumbar cases should get a lot of attention in terms of non-fusion surgery to hopefully avoid fusion.
              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."

              Comment


              • Originally posted by Pooka1 View Post
                For AIS . . .
                Correct, bracing is meant to hold a curve in AIS cases. In JIS cases, it may reduce the curve.

                Originally posted by Pooka1 View Post
                There is no guarantee of stability . . .
                There's no guarantee of what kids with scoliosis will look like with any of these treatments. For surgical cases, there's not only no guarantee, there are no data points from which one can extrapolate. There are no odds because none of these kids are old enough to have followed that far.

                For braced kids, there are lots of long term studies which, while not offering a guarantee, at least clearly lay out the odds. I quoted one of them here recently - on average, the curves were 34 degrees at the start of bracing, and they were 35 degrees 20 years later. Adults who had been braced looked good 20 years out - comparable on the SRS22 to surgical patients who were 10 years younger. That doesn't tell you how any one case will turn out, but it gives you a good idea of what you might expect.

                For VBS, we'll need to wait for the data to catch up. Right now, we barely even have kids in their 20s, so we have no idea what it will look like in the long run. Even for the short-term, I'd need a study to even hazard a guess on the comparison between bracing and VBS. The populations are just so different - you'd have to really work to match them before you could make a reasonable comparison.

                Comment


                • Originally posted by 3sisters View Post
                  hdugger, kids with lumbar curves after tethering have a few options: Some brace (at night, generally) and some receive VBS for the lumbar. A few lumbar curves have been tethered, but it is not being done often at this time.
                  Thanks, Emily. That's helpful.

                  is there a reason that they favor the night-time brace? I'd understood that wearing a brace a bit longer (more like 13 hours) yielded a better result.

                  Comment


                  • Originally posted by hdugger View Post
                    There's no guarantee of what kids with scoliosis will look like with any of these treatments. For surgical cases,
                    Well Boachie seems to have some idea for fusions ending at T12 or L1... he seems to think it is one-stop shopping for surgery as does our surgeon. And they go on record.

                    And given it is looking excellent even for lumbars in false doubles (an extreme case among cases perhaps) then I can easily understand the optimism voiced by experts in re certain fusions.
                    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."

                    Comment


                    • Originally posted by hdugger View Post
                      is there a reason that they favor the night-time brace? I'd understood that wearing a brace a bit longer (more like 13 hours) yielded a better result.
                      Maybe the thought it the child has been put through enough and the odds aren't good enough to go to more bracing. <shrug>
                      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."

                      Comment


                      • Originally posted by Pooka1 View Post
                        Maria will correct me but VBS when done for AIS is only done with significant growth remaining and so I think they expect curve regression when successful due to growth. Also, there is immediate curve correction at the time of the procedure and since the staples are expected to stay in, there is absolute correction in every case where it is successful correction UNLIKE bracing where no permanent correction is ever expected. I could be wrong.

                        You are correct that one of the main factors weighed when evaluating a patient for VBS is the amount of growth remaining. Some patients do not meet the criteria for VBS precisely for that reason - they don't have enough growth remaining for VBS to work.

                        As for the long-term effects, hdugger is correct that the oldest patients are in their 20's. In addition, we do have a good number now that have reached skeletal maturity. And while nobody can see into the future, up to this point we could not have asked for more in terms of lack of complications (both short term, meaning immediately after surgery; and also to date), and virtually all of these kids are doing great - many are nearing the decade mark since their surgery. Even the small number who went on to need fusion for very aggressive curves that could not be stopped despite trying bracing and/or VBS have no regrets. These were, for the most part, kids who found bracing very, very difficult and most have said they would have VBS again even to avoid a few years of bracing.
                        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/

                        Comment


                        • Originally posted by mariaf View Post
                          You are correct that one of the main factors weighed when evaluating a patient for VBS is the amount of growth remaining. Some patients do not meet the criteria for VBS precisely for that reason - they don't have enough growth remaining for VBS to work.

                          As for the long-term effects, hdugger is correct that the oldest patients are in their 20's. In addition, we do have a good number now that have reached skeletal maturity. And while nobody can see into the future, up to this point we could not have asked for more in terms of lack of complications (both short term, meaning immediately after surgery; and also to date), and virtually all of these kids are doing great - many are nearing the decade mark since their surgery. Even the small number who went on to need fusion for very aggressive curves that could not be stopped despite trying bracing and/or VBS have no regrets. These were, for the most part, kids who found bracing very, very difficult and most have said they would have VBS again even to avoid a few years of bracing.
                          Thanks, Maria for that interesting information. It's so valuable having you on this forum.

                          It just seems to me that if you need metal stables or some kind of tether to arrest growth on one side and allow it on the other, I just don't see how external bracing, and especially (intermittent) PT could be any type of long term solution.
                          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."

                          Comment


                          • Originally posted by Pooka1 View Post
                            one-stop shopping
                            I understand that some surgeons may feel optimistic - I don't imagine one could be a surgeon without a tendency to be optimistic.

                            But this optimism is based on zero data points. Not just no research - no data on which one could do research. I trust that surgeon's guesses are of better quality than my guesses, but they remain just that - a guess. Anyone considering surgery would have to weigh those statements as what they are - well-educated speculation.

                            [Note - 12/29 - On locating the Boachie quote, he does not go on the record as saying that thoracic patients can have "one-stop shopping (basically, have no future problems for the rest of his life). What he does say is that patients with fusions that go lower are guaranteed to have problems 20 to 25 years later, while those that stop higher can avoid such guaranteed problems provided certain other conditions are met. Here is Boachie's quote - read it for yourself "If you fuse a 13-year-old to L4, 20 to 25 years later, at the most, he or she is going to have problems at L4-5 and L5-S1 levels. But if you fuse them to L1 or T12, they can do very well for the rest of their lives, provided the remaining lumbar spine is properly aligned and has not shifted." Since I only found the actual quote at the end of the discussion about one-stop shopping, I am going back to add this note to all of my posts on the topic.]
                            Last edited by hdugger; 12-29-2013, 04:26 PM.

                            Comment


                            • Originally posted by Pooka1 View Post
                              I just don't see how . . .bracing . . . could be any type of long term solution.
                              And yet, long terms studies on bracing show just that - braced kids can be stable 20 years out with no serious issues.

                              Sometimes the facts of the case get ahead of our ability to figure out the cause of the case. We don't know why spines curve, but they do. We don't know why bracing is working in these kids, but it is. We'll have to wait on more info to show just how it's working.

                              Comment


                              • Originally posted by hdugger View Post
                                I understand that some surgeons may feel optimistic - I don't imagine one could be a surgeon without a tendency to be optimistic.

                                But this optimism is based on zero data points.
                                That is false. I have posted long term studies. Are you really suggesting the surgeons are guessing completely in the dark? Does that make sense to you?
                                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."

                                Comment

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