First shot across the BrAIST bow...

[Pooka1]

Here is a presentation in the upcoming SRS meeting this September in Prague...

http://www.srs.org/UserFiles/file/am16-prelim-4web.pdf

Paper # 102 Is the Story Over: Progression After Bracing in AIS
Rachel Mednick Thompson, MD; Elizabeth Walker Hubbard, MD; Don Virostek; Lori Ann Karol, MD

---------

They are starting to ask the question of what is the failure rate after bracing "success"?

Take the BrAIST study where bracing "success" includes kids with a up to a 49* curve with up to 25% growth remaining. You read that right... a child with a 49* curve with 25% growth remaining was counted as a "success" in BrAIST. We don't know how many "successes had large curves with growth remaining because the authors DID NOT publish the curve magnitudes at the end if you can believe it. This might be the only published study that failed to do that. And yet it is ironically viewed as a hallmark study.

Anyway, just knowing that alone and all by itself we can bet our bank account that the failure rate after bracing "success" is non-zero. The question is how far from zero is it? Dropping out half the kids who wore the brace needlessly (some of whom do progress after the brace treatment), few/some/most of the bracing "successes" will eventually be classified as failures. It is possible that between the kids who wear and brace and progress later after skeletal maturity, and the kids who don't wear a brace and progress later after skeletal maturity, it would be very informative to eventually know what percentage of kids in the bracing range are going to need surgery no matter what they do or don't do. That's what kids and parents need to know.

The point is BrAIST can be halted early in dramatic fashion and can claim victory but the question of progression after bracing "success" is still obviously wide open. 23/7 Bracing is so difficult that most kids will do it only if it helps then avoid surgery for life. That is exactly what is being questioned and kids should be told.

[Prfbones]

So they are given a whole four minutes to present their hypothesis, their methodology and their findings. How generous!

Wait for the publication before drawing any conclusions on work that ultimately may never see the light of day in a peer-reviewed journal.

One major issue in trying to study bracing is while protocols exist, so many orthopods have their own criteria for bracing and for how long. A surgeon also has to take into account the aggressiveness of the curve, the suppleness of the spine, the family history, the child's temperament/honesty, the parent's attitude, etc. So no one protocol can ever be used. There are so many variables in trying to study the "success" of bracing, that it's almost impossible to have an accurate large-scale study of this subject. There are just so many variables to try and control for. It's like trying to predict the weather ten years out. They're working on it, but...

[Pooka1]

So they are given a whole four minutes to present their hypothesis, their methodology and their findings. How generous!

Wait for the publication before drawing any conclusions on work that ultimately may never see the light of day in a peer-reviewed journal.

You are preaching to the choir. :-) Research is a tough game. Most published studies are false and Retractionwatch.com is a busy place.

That said, there is plenty of reason to suggest bracing probably avoids much less surgery over a lifetime than most people surmise. In that sense, this work is not surprising.

And when a kid with a 49* curve with up to 25% growth remaining is categorized as a "success" in BrAIST, we can expect the long term to differ wildly from the picture shown in that study. Last, that is probably the only bracing study that didn't post the ending curve magnitudes. Very, very, very odd.

One major issue in trying to study bracing is while protocols exist, so many orthopods have their own criteria for bracing and for how long. A surgeon also has to take into account the aggressiveness of the curve, the suppleness of the spine, the family history, the child's temperament/honesty, the parent's attitude, etc. So no one protocol can ever be used. There are so many variables in trying to study the "success" of bracing, that it's almost impossible to have an accurate large-scale study of this subject. There are just so many variables to try and control for. It's like trying to predict the weather ten years out. They're working on it, but...

I agree. This is a very tough area of research.

[Pooka1]

Not to beat a dead horse and just to flesh out the bottom line here...

Some non-zero percent of the "bracing successes" in the BrAIST study and also in the dose-response curve cases have a 40+ and even 45+ degree curve. Raise your hand if you believe these people are never going to need surgery in their life.

It is interesting to contemplate if some of the basis of the dose-response curve was kids with large curves desperately wearing the brace long hours. So perhaps some of the dozen or so kids in the most successful group who didn't wear the brace needlessly have curves so large that we can reliably predict they will need surgery at some point.

I would have loved to have seen the curve ranges of the cases in the dose-response curve. I think there is some chance it would blow that publication out of the water. There is some reason they withheld the ending curves. And dramatically ending the study early probably added to the "successes" in that those curves in the high 40 degrees with 25 percent growth remaining might have been counted as failures if the study wasn't stopped early.