Results 1 to 12 of 12

Thread: Cobb angle in braced patients and the future

Hybrid View

Previous Post Previous Post   Next Post Next Post
  1. #1
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,903

    Cobb angle in braced patients and the future

    Here is a quote from a recent paper in Scoliosis Journal that was co-authored by Joe O'Brien that concludes, in part, that two RCTs of brace treatment have or should settle the question of brace efficacy (that they work)...

    This is even more striking when it is recognized that the new epidemiological data indicate that 58 % of patients between 20 and 40 will progress to surgery, or above 50 of Cobb Angle, if left untreated [6].
    http://scoliosisjournal.biomedcentra...013-015-0046-7

    Well doesn't between "20 and 40" about cover the population of "successful" bracing treatments? So essentially, 58% of "successfully" treated brace patients are expected to progress to surgery. Then we have the ~50% of patients who are braced needlessly (would not progress anyway) but who are also in this curve magnitude range. Fifty-eight percent of them are expected to progress to surgery.

    So now we need data actually showing that curve magnitude is rigorously tied to progress to surgery in that angle window. If that isn't rigorous tied together, I think this blows bracing completely out of the water despite the two RCTs that are touted in this paper.

    What am I missing?
    Last edited by Pooka1; 03-16-2016 at 08:19 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."

  2. #2
    Join Date
    Jan 2008
    Location
    Oregon
    Posts
    1,161
    Well Sharon the flip side is that 42% of the patients would never progress to surgery anyway, which means that potentially 42% of scoliosis kids are being subjected to the very difficult brace treatment needlessly. That's a huge number, then you have to factor in the failure rate of bracing, and you have a majority proportion of pts being braced unnecessarily. That should give serious pause to any family facing a scoliosis diagnosis.
    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

  3. #3
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,903
    Excellent points, Gayle.

    And that is just to the point of skeletal maturity. Some of these "bracing successes" will get surgery anyway due to later progression or pain from damage. I would love to see a followup on kids who ended bracing north of 40 degrees. If some or many of them go onto need surgery, the actual bracing success is still wildly inflated. Weinstein and company casually only focus on the microsecond of maturity or actually the microsecond of no more than 25% growth remaining. And they STILL to my knowledge have not published the ending Cobb angles for the BrAISt study. A child with a 49 degree curve with up to 25% growth remaining is a "success". I am wondering if they want to preserve the original conclusion at all costs.
    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
    Join Date
    Jan 2008
    Location
    Oregon
    Posts
    1,161
    I was braced at age 13, pre-menarchal for double curves, about 33 and 34 degrees. I had my last x-Ray when I was deemed skeletally mature at age 14 and hadn't worn the brace in at least 6 months. That x-Ray measured in the very low 20's on both curves, and no further x-rays were done until I had pain at age 42. Those curves measures low 20's on thoracic and 35 on lumbar. Two years later the lumbar curve had shot up to 47, and you know the rest of my story! Hardly a bracing success.
    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

  5. #5
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,903
    Quote Originally Posted by leahdragonfly View Post
    I was braced at age 13, pre-menarchal for double curves, about 33 and 34 degrees. I had my last x-Ray when I was deemed skeletally mature at age 14 and hadn't worn the brace in at least 6 months. That x-Ray measured in the very low 20's on both curves, and no further x-rays were done until I had pain at age 42. Those curves measures low 20's on thoracic and 35 on lumbar. Two years later the lumbar curve had shot up to 47, and you know the rest of my story! Hardly a bracing success.
    I am so grateful you and others are on this forum, Gayle.

    I am thinking it is probably past time that Weinstein and company would publish any more data from BrAIST. We may never know the final curve range (and how many had growth remaining) of the "successful" bracing patients.

    As Dr. McIntire said when this paper first came out, there is no way he would have gotten away with not including the end curves in his studies. Yet Weinstein and company are allowed to publish without that KEY piece of information. I think this issue has departed science and arrived at politics.

    As Arsenio Hall used to say on his late night talk show... "things that make you go, 'hmmm....'".
    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. #6
    Join Date
    Sep 2011
    Posts
    239
    I have been asked to contribute to a journal produced in the UK for private physios regarding my personal experience of scoliosis. My main tack is going to be to expose the lack of conservative treatment options within the NHS due to lack of published evidence.

    I am going to refer to the paper. But ( and this is because I have been ill and only just coming back to form) can you advise where I could find the references that are listed by number at the bottom of this paper.

    Also in the paragraph before CONCLUSION I am unsure if nos 17, 18 and 35 are being included as good studies or damaging studies? I would quite like the article to be a little bit scientific as well as personal experience.
    Last edited by burdle; 03-17-2016 at 11:09 AM.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •