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Thread: Janzen Bracing System for JIS

  1. #1
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    Janzen Bracing System for JIS

    I am new to this forum. Just over 4 months ago, our two children were thriving as far as we knew, and we were doing what normal families do. Then, 4 months ago, scoliosis with largest curve of 24 degrees was confirmed in my son of 5 years old. We thought we should get our daughter checked as well, and a couple weeks ago an S-curve in my 8 year old daughter was confirmed with 19 and 20 degree curves. I've done a ton of research and we found an amazing treatment center. Our son has been in a brace since late August and our daughter is being fitted for a brace as I write this.

    I plan to write more on this thread, but here is my recent comment on another thread to a person that was understandably skeptical of the bracing method that we have chosen:


    I understand your skepticism. I am a physical therapist who is very skeptical of a lot of chiropractic methods, and I am a skeptic in general.

    Our son has a 24 degree curve that was identified in July this year and he is only 5 years old. I read all the pertaining peer-reviewed literature that I could find for scoliosis treatment, and was deflated to find that I would just be told to wait and see if it gets worse. We were referred to Shriner’s near where we live in Washington State, but we didn't go. In doing my online searches, I came across this place in California that claimed to be not only preventing progression of curves, but significantly reducing them with a bracing technique that is entirely their own. Compared to the literature, there claims seemed to be too good to be true. In addition, the person behind this is a chiropractor, so I initially dismissed this as fake.

    But in doing more research, I found no other alternatives. So I thought, why not give them a call. That call was at least convincing enough to do a Skype consult (free) with Dr. Matt Janzen, who started this method of scoliosis treatment. I now regret how short I was with him at first, but I immediately wanted to know why there is nothing in the literature about this method and why no one else seems to know about this and why every kid with scoliosis isn’t going there. He explained that, about 10 years ago, he decided that there has to be a better way of addressing idiopathic scoliosis than the standard "wait and see method" until they reach bracing level. Then go to a brace that might slow progression until the 40 degree mark usually resulting in a recommendation for surgery.

    At this point, I will tell you that this guy has an understanding of the pertaining anatomy as well as any orthopedic surgeon. He is also a mechanical/fabrication whiz.

    Without disclosing proprietary information for a method that is really innovative and new by medical standards (10 years is nothing by medical standards), here are some keys to the method.
    1. The process to get the patient measured for the brace to have it be corrective is one-of-a-kind and I’m sure proprietary. I won’t describe it in detail, but it is genius.
    2. They rarely use x-rays (maybe one or 2 if needed). They use a stand-up, open MRI unit to get the baseline spine image and throughout the brace fitting and adjusting periods. These non-diagnostic MRIs only take 2.5 minutes (versus a typical diagnostic MRI that would be 30-60 minutes). They do as many MRIs (could be 10 or more but usually less than that) as needed to get the initial brace fit as good as they feel like they can. For example, my son was at 24 degrees out of brace. He is now at essentially neutral in brace – less than 2 degrees of lateral curve anywhere along his spine. It took repeated brace adjustments and 4 MRIs and even scrapping the first brace and starting a new one to get his spine to be neutral in brace. It then takes more adjusting to eliminate pressure points. The measuring and fitting process takes several days typically.
    3. Brace wearing for the typical idiopathic scoliosis that they treat is usually 23-24 hours per day and the braces are very snug. Bracing continues until skeletal maturity. After the puberty stage of rapid growth ends – usually around 13 or so for girls (probably 95% of who they see are girls – since most idiopathic scoliosis occurs in girls), brace time each day can sometimes be reduced.
    4. Matt Janzen believes that nerve tension (spinal cord and spinal nerves not growing fast enough to stay with spine growth) is a huge causative factor if the not the primary cause of what is currently known as idiopathic scoliosis. For this reason, in most patient cases, neural stretching is a big emphasis to go along with bracing.
    5. Another part of the program for many patients is a custom “stretching chair” that stretches against the curves even more aggressively than the brace, but just for 20-30 minutes, 2-3 times per day. This unit stretches rotationally at any angle as well as addressing the curvature.
    6. There are some additional and more minor measures that they sometimes employ as well.
    7. Key to their method is the idea of addressing the scoliosis three-demensionally. Reducing rotation is as important as reducing lateral curvature and they go together usually.
    8. They are aware of the danger of rib deformation with long-term bracing, and their system accounts for this.
    9. They have exercises to address the trunk strength loss that can occur with long-term bracing.


    This is better than their average results, but we met a family there with a 10 year old girl who arrived a year ago with an S shaped scoliosis with two, 60-degree curves. Her curves are now in the 20-25 degree range out of brace and in the single digits in brace. Of course her parents were told at Shriner’s and Seattle Children’s hospital that surgery was the only option and that she would be limited her entire life. Her long-term outlook is now looking amazing! She could be scoliosis free when bracing is done.

    We talked to family after family from all over the US and all over the world that were in the midst of various stages of correction of curves.

    This method started 10 years ago. They now have many former patients, told that surgery was their best hope, who now live normal lives. Some don’t even technically have scoliosis anymore with curves in the single digits.

    Have they had some patient’s that didn’t get better? Yes. Is this rare for them? They say yes and I’m now inclined to believe them. They point to compliance with bracing time, because not everyone keeps their kid in brace for the prescribed times. And even with good compliance, there could be some cases that don’t work out for whatever reason. When we were there with our son, we talked to as many families as possible that had been coming for a while, and they were all seeing curve correction to some degree.

    Back to the question of why they do not have published research in peer-reviewed journals. They are only 10 years into this. To do studies that meet standards, they will have to have their braces electronically monitored for patient time-in-brace, just like previous studies of the Boston Brace and other braces. This will be expensive. They are working on a plan for this. In the mean time they are loaded with patients from all over the world and trying to hire to keep up.

    What we seem to have here is a really smart and capable guy with a sound knowledge of anatomy and physiology that has invented a method superior to any other. He happens to be a chiropractor. When he pointed it out to me, I realized that there is a lot in the medical literature that supports his method – relating to prolonged stretch on body tissues and nerve tension being a factor in scoliosis. It’s just that no one else has pieced it together and attempted a solution, or was capable of pulling it off.

    Are some chiropractors quacks? Sure. Are some MDs/surgeons quacks? Definitely. I gave this guy the benefit of the doubt, and he is legit.
    Last edited by Dustin76; 10-27-2019 at 11:47 PM. Reason: Potentially misleading title

  2. #2
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    This is post of the month in my opinion. See comments below

    Quote Originally Posted by Dustin76 View Post
    I am new to this forum. Just over 4 months ago, our two children were thriving as far as we knew, and we were doing what normal families do. Then, 4 months ago, scoliosis with largest curve of 24 degrees was confirmed in my son of 5 years old. We thought we should get our daughter checked as well, and a couple weeks ago an S-curve in my 8 year old daughter was confirmed with 19 and 20 degree curves. I've done a ton of research and we found an amazing treatment center. Our son has been in a brace since late August and our daughter is being fitted for a brace as I write this.
    I am sorry to hear your kids have scoliosis. Both my twins do also.

    I understand your skepticism. I am a physical therapist who is very skeptical of a lot of chiropractic methods, and I am a skeptic in general.
    Beyond excellent. You having science training. Chiros do not.

    Our son has a 24 degree curve that was identified in July this year and he is only 5 years old. I read all the pertaining peer-reviewed literature that I could find for scoliosis treatment, and was deflated to find that I would just be told to wait and see if it gets worse. We were referred to Shriner’s near where we live in Washington State, but we didn't go. In doing my online searches, I came across this place in California that claimed to be not only preventing progression of curves, but significantly reducing them with a bracing technique that is entirely their own. Compared to the literature, there claims seemed to be too good to be true. In addition, the person behind this is a chiropractor, so I initially dismissed this as fake.
    You have to be careful and clearly state you are dealing with JIS which is known to respond differently to bracing than AIS. We have had cases of "stone age" braces here that corrected JIS curves. So that is not unique to the chiro's brace.
    As I recall, while most JIS cases entail progression, a fair number spontaneously correct. Anyone studying JIS and making claims abut JIS has to beat that background spontaneous correction. The other thing with JIS is that unlike AIS, braces seems to correct the curve at least in the short term. Are the chiros claiming the brace corrects AIS curves? That would be unheard of and almost certainly not true. In AIS, braces at best can prevent progression but never effect a permanent correction.

    But in doing more research, I found no other alternatives. So I thought, why not give them a call. That call was at least convincing enough to do a Skype consult (free) with Dr. Matt Janzen, who started this method of scoliosis treatment. I now regret how short I was with him at first, but I immediately wanted to know why there is nothing in the literature about this method and why no one else seems to know about this and why every kid with scoliosis isn’t going there.
    LOL well chiros are probably used to being verbally assaulted because chiro is not a science, chiros have no science training, and should not be dabbling in scoliosis. That said, there are a lot of other lay people playing in this sandbox besides chiros... Schroth was invented by a lay person (and it shows). Her grandson is an orthopedic surgeon and tried to find results for the method before abandoning it and going to bracing. So it's a free for all.

    At this point, I will tell you that this guy has an understanding of the pertaining anatomy as well as any orthopedic surgeon. He is also a mechanical/fabrication whiz.
    He didn't acquire that in chiro chollege I can guarantee you that. Chiro schools have been likened to trade schools which required the lowest GPA of all the allied medical fields. He probably should have gone to med school.

    Without disclosing proprietary information for a method that is really innovative and new by medical standards (10 years is nothing by medical standards), here are some keys to the method.
    1. The process to get the patient measured for the brace to have it be corrective is one-of-a-kind and I’m sure proprietary. I won’t describe it in detail, but it is genius.
    It is CAD/CAM? I think that is being used.

    2. They rarely use x-rays (maybe one or 2 if needed). They use a stand-up, open MRI unit to get the baseline spine image and throughout the brace fitting and adjusting periods.
    That's good to hear because some of these chiros were taking a boatload of radiographs. Chiros taking radiographs is a combination that should not exist given their training.

    3. Brace wearing for the typical idiopathic scoliosis that they treat is usually 23-24 hours per day and the braces are very snug. Bracing continues until skeletal maturity. After the puberty stage of rapid growth ends – usually around 13 or so for girls (probably 95% of who they see are girls – since most idiopathic scoliosis occurs in girls), brace time each day can sometimes be reduced.
    I will bet my bank account the AIS results are different from the JIS results. Also, controlled studies indicate about half of the kids who wear a brace wore it needlessly. So half their successes are not due to the brace most likely. Then there are the failures despite brace wear. That needs to be honestly reported for JIS and AIS separately. Then there is how to define success. The BrAIST study defined "success" as having a curve up to 49* with up to 25% growth remaining. They needed to define something but what they selected in fact is not commensurate with how patients and parents define success which is no surgery. Some of these "successes" of bracing will in fact go on to surgery as a metaphysical certainty.

    4. Matt Janzen believes that nerve tension (spinal cord and spinal nerves not growing fast enough to stay with spine growth) is a huge causative factor if the not the primary cause of what is currently known as idiopathic scoliosis. For this reason, in most patient cases, neural stretching is a big emphasis to go along with bracing.
    There either is or is not medical evidence for this claim.

    5. Another part of the program for many patients is a custom “stretching chair” that stretches against the curves even more aggressively than the brace, but just for 20-30 minutes, 2-3 times per day. This unit stretches rotationally at any angle as well as addressing the curvature.
    Pass


    7. Key to their method is the idea of addressing the scoliosis three-dimensional. Reducing rotation is as important as reducing lateral curvature and they go together usually.
    All braces address the curve 3 dimensionally. Most work by removing the kyphosis as far as I know.

    8. They are aware of the danger of rib deformation with long-term bracing, and their system accounts for this.
    How?

    9. They have exercises to address the trunk strength loss that can occur with long-term bracing.
    Not possible with 24 hr/day bracing, yes?

    This is better than their average results, but we met a family there with a 10 year old girl who arrived a year ago with an S shaped scoliosis with two, 60-degree curves. Her curves are now in the 20-25 degree range out of brace and in the single digits in brace. Of course her parents were told at Shriner’s and Seattle Children’s hospital that surgery was the only option and that she would be limited her entire life. Her long-term outlook is now looking amazing! She could be scoliosis free when bracing is done.
    JIS. This is probably not an unusual trajectory for JIS with all bracing. Let's see what happens when she comes out of the brace in her teens if she sticks with it that long. She may be bitter she was not offered tethering so she doesn't have to wear a brace.

    This method started 10 years ago. They now have many former patients, told that surgery was their best hope, who now live normal lives. Some don’t even technically have scoliosis anymore with curves in the single digits.
    Not AIS cases. Braces don't correct AIS curves. You must be referring to JIS cases.

    Have they had some patient’s that didn’t get better? Yes. Is this rare for them? They say yes and I’m now inclined to believe them. They point to compliance with bracing time, because not everyone keeps their kid in brace for the prescribed times. And even with good compliance, there could be some cases that don’t work out for whatever reason. When we were there with our son, we talked to as many families as possible that had been coming for a while, and they were all seeing curve correction to some degree.
    You should consider all the families that failed their system and went to a surgeon and were tethered or something. You have no way to gauge how large that group is compared to the group you are meeting.

    Back to the question of why they do not have published research in peer-reviewed journals. They are only 10 years into this. To do studies that meet standards, they will have to have their braces electronically monitored for patient time-in-brace, just like previous studies of the Boston Brace and other braces. This will be expensive. They are working on a plan for this. In the mean time they are loaded with patients from all over the world and trying to hire to keep up.
    Tethering might be about that old. Maybe somewhat older. They have papers and talks and results.
    Last edited by Pooka1; 10-17-2019 at 11:01 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


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  3. #3
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    Quote Originally Posted by Pooka1 View Post
    This is post of the month in my opinion.
    It is....

    We don't get too many young kids around here, and its hard to comment as a lifer and a former bracer. There are 9000 members here and I don't think we have a single positive review on any braces. There is a psychological impact that happens when these things don't work which has happened to most of us. Hope is a good thing, and 3D printing braces makes all the sense in the world even if it doesn't work.

    I would probably do the same thing you are doing if I were in your situation. I know it doesn't sound like it makes any sense since we have been pushing and pulling on scoliosis curves for 2000 years, so that makes just about everything we do stone age. Bracing and rods are not the answer or cure but we do what we have to do. Surgery should always be thought of as a last ditch effort, but when it needs to be done, it needs to be done. Timing is everything in scoliosis.

    I used Chiropractic for over 30 years for pain and I am a former Copes bracer. These guys kept me walking for many years. I was a Luque wire candidate in 1975 and was told I needed surgery by every single doctor I ever met including my Chiropractors....I used around 12 different Chiropractors and learned a lot from those guys. Scoliosis provides our own specific learning curve, its not cheap, and can be extremely painful as an adult. I spent over 100K on massages alone over the years. (Before surgery)

    Physical therapy was also one of the brighter points, or might I say, healing times, that provided hope. Before and after surgery....It was very supportive and that's what we need since the disease changes us....I do appreciate everything that has been done by everyone that worked on me even if it didn't work, scoliosis is a tough one being its CNS disease which makes it that much more complicated.

    I have said here in the past "Gotta love a nurse" and now I will say "Gotta love a physical therapist" (smiley face)

    Welcome to the forum Dustin

    Ed
    49 yr old male, now 60, the new 55...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  4. #4
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    Reply to Sharon's points

    Sharon,
    In this post, I am trying to respond to the major points of yours that I haven't addressed on this thread and the other one.

    You have stated that Janzen’s can’t say how successful their treatment is without controls, yet they (and I) should be shouting out how great their method is. With all due respect, these statements of yours are conflicting.

    While they are at the lower qualities of evidence stage for their bracing method, they (as anyone with a new method) have to start somewhere. I am not sure if you are aware of levels of evidence progression/pyramids, but it doesn’t really work to jump from having a working model to the let’s do randomized controlled studies stage. They are more at the case study level of evidence stage and probably a long, long way from the randomized, controlled studies stage. Their stage in the process does not, by itself discredit them. So, can someone say that their method works based on a case study level of evidence – yes. Does that only hold so much weight – yes. Are there good and bad ways to assert case study levels of evidence – yes. Are before and after radiographs pretty good evidence for case study level – yes, if done right. You brought up a valid question about the circumstances of the “after” images as far as in/out of brace and how long after coming out of brace. I am looking into this and will eventually get back to you on that. It would be pretty dumb of them to be doing those final images in brace, so that probably isn’t even a question, but I’m still asking. We (my wife and I) are just getting acquainted with a bunch of families at different stages of treatment. At least one, and I think 2, are near to skeletal maturity and will be weaning from the brace soon with the expectation that most of gains made will hold out of brace since the patients are skeletally mature. The Janzen’s and the parents so far seem to have nothing to hide. I will be looking into getting in contact with “graduates” of the method who have been out of brace for years, to see if they will allow me to see their before/after images. Again, by academic standards, this is all related to the lower level evidence of case studies but impressive if it plays out like I think it will for this level of evidence.
    All this to say that I respectfully disagree with you that this group or any group can’t say that a given method works based on case study levels of evidence. You say that there are no controls and you are right, but that by itself doesn’t discredit them from saying “this works based on all of these case studies so far”.


    You stated that this method should already be published if they are 10 years into it.

    At one point you suggested that there should already be studies/papers written on this method since tethering has all of this already. I can’t say much about tethering specifically yet as I’m not familiar with it enough yet. The process for tethering or other interventions developed by orthopedic surgeons often have funding readily available that they don’t have to raise themselves. The method that I am speaking of will face an extremely (and I see more now than a few months ago how extreme) uphill battle to get quality studies done and published. The funding would be an extreme challenge alone. But the “we are going to shut you out before you can even say a word” mentality in a fair portion of the medical community could be insurmountable. If these guys are idiots, I’m going to give them the chance to prove it to me, within reason of course. The jury is still out for me personally on this method, but I’ve seen enough to believe that we are safely proceeding for both kids so far. We can pull out at any time. Nothing irreversible is going to be done to our kids being brace for the next few months while I check this out. The Janzen’s have mentioned nothing about backlash from medical doctor or others. But, from what some of the parents that we talk to have dealt with from mostly well intentioned acquaintances, I’m sure the Janzen’s have been told by plenty of medical professionals how stupid they are, but I haven’t asked.


    JIS compared to or relating to AIS

    While there may be some cases of JIS improving without intervention, my preliminary review of the literature says that this is rare. I’m seeing in the literature that somewhere in the neighborhood of 70% of JIS cases progress to surgical stage. This progression that happens to push them over the edge to surgical stage usually happens *during the rapid growth spurts of puberty*. I’m still looking into any information about the remaining 30% since I didn’t see much about that. Here are some of my conclusions so far: 1) Some of the 30% probably got worse but not to the point of needing surgery. 2) Some probably just didn’t change. 3) Some might have got better. I’ll keep digging, but it was probably very few that actually got better. 4) I don’t like these odds and the most often plan of “wait and see”. 5) I’m not seeing this great distinction in the literature between JIS and AIS as you are touting. I’m not see that the definition of AIS is IS that started in adolescence. It seems to me that the 70+% of JIS cases that don’t improve to the point of not having scoliosis any more, that turn 10+ years of age, are now AIS patients, right? I can’t back this up yet, but it seems like lots of AIS cases could have had their scoliosis start as juveniles whether it was diagnosed when they were juveniles or not. To me it looks like the inferred definition in the literature for JIS is “a juvenile that has IS”. It looks like the definition of AIS is “an adolescent that has IS regardless of when the scoliosis started”. Feel free to correct me if you have better information. So if Janzen’s, or anybody, can have a lot less than 70% of their JIS cases progress on to surgery, whether at juvenile age or adolescent age, that’s saying something even at case study levels of evidence. If they can repeatedly reduce AIS curves and have that maintained out of brace at skeletal maturity, that is saying something, even at case study levels of evidence. He has made no mention of it, but what if Janzen attempted to submit a case study to some sort of publication with some general respect in the medical community. Would they say, “ Oh cool, let me review what you’ve got and we’ll see about it.” No, they would say, “get the heck out of here will your witchcraft BS.”


    You referred to lacking science or evidence-based practice with chiropractors. I guess I never viewed it as having no basis in science what so ever. I haven't had a lot of interaction with chiropractors or had a reason to look into their training until recently.

    I have been looking more into chiropractic education. It looks like they have similar musculo-skeletal and biomechanics training as physical therapists. Due to MD training covering such a vast amount of material including a lot of internal medicine stuff, they actually spend less time on musculoskeletal and biomechanics training than physical therapists or chiropractors. It looks like both physical therapists and chiropractors have about the same musculoskeletal training as orthopedic surgeons minus the surgical techniques. The biggest difference I see is that chiropractor treatment philosophy/theory has been very different over time than traditional medicine. Spinal manipulations, which chiropractors, DOs, and physical therapist all employ have little supporting evidence in the literature it seems and of course will not help scoliosis. Looks like they have some published papers in the British Medical Journal among others. It appears that they do have some level of classes in differential diagnosis as well. I'll keep looking into it.

  5. #5
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    Quote Originally Posted by Dustin76 View Post
    Sharon,
    In this post, I am trying to respond to the major points of yours that I haven't addressed on this thread and the other one.

    You have stated that Janzen’s can’t say how successful their treatment is without controls, yet they (and I) should be shouting out how great their method is. With all due respect, these statements of yours are conflicting.
    I am speaking from THEIR perspective. They think they are getting this crazy high success rates so THEY should be shouting the results. They may have controls. Besides the BrAIST results which show that about half of kids are braced needlessly, I am sure they had kids who refused brace and just did chiro. Those are controls because is no evidence chiro is an effective treatment for scoliosis. Since they cite the BrAIST study, the least they could have done was admit half of kids who are braced are braced needlessly and made that clear instead of posting crazy high "success" rates. Because the Janzenes realize they need to monitor brace time with temp sensors and they are STILL seeing these amazing success rates without controlling for brace wear time, that should have set off an alarm bell that some of these patients were braced needlessly.

    I will be looking into getting in contact with “graduates” of the method who have been out of brace for years, to see if they will allow me to see their before/after images. Again, by academic standards, this is all related to the lower level evidence of case studies but impressive if it plays out like I think it will for this level of evidence.
    Great idea. I hope you can find some who are willing to have their radiographs posted. Also need accurate time since last brace wear.

    All this to say that I respectfully disagree with you that this group or any group can’t say that a given method works based on case study levels of evidence. You say that there are no controls and you are right, but that by itself doesn’t discredit them from saying “this works based on all of these case studies so far”.
    They should at least admit that about half of braced kids are braced needlessly. By the way, are the Janzenes claiming they are the only people designing braces to address three dimensions? I meant to ask you this earlier.


    You stated that this method should already be published if they are 10 years into it.

    At one point you suggested that there should already be studies/papers written on this method since tethering has all of this already. I can’t say much about tethering specifically yet as I’m not familiar with it enough yet. The process for tethering or other interventions developed by orthopedic surgeons often have funding readily available that they don’t have to raise themselves. The method that I am speaking of will face an extremely (and I see more now than a few months ago how extreme) uphill battle to get quality studies done and published. The funding would be an extreme challenge alone.
    I agree this is a challenge. Also there is no reason to do any studies when their waiting room is full. There is nothing to gain and everything to lose.


    But the “we are going to shut you out before you can even say a word” mentality in a fair portion of the medical community could be insurmountable. If these guys are idiots, I’m going to give them the chance to prove it to me, within reason of course. The jury is still out for me personally on this method, but I’ve seen enough to believe that we are safely proceeding for both kids so far. We can pull out at any time. Nothing irreversible is going to be done to our kids being brace for the next few months while I check this out.
    I hope your children are being followed by a board certified pediatric orthopedic surgeon. Those are the only people trained to treat scoliosis.

    The Janzen’s have mentioned nothing about backlash from medical doctor or others. But, from what some of the parents that we talk to have dealt with from mostly well intentioned acquaintances, I’m sure the Janzen’s have been told by plenty of medical professionals how stupid they are, but I haven’t asked.
    Doctors should be applauding that these particular chiros who admitted chiro doesn't work for scoliosis have abandoned it completely for bracing. Bracing is still very experimental in my opinion but it isn't woo-woo.


    JIS compared to or relating to AIS

    It seems to me that the 70+% of JIS cases that don’t improve to the point of not having scoliosis any more, that turn 10+ years of age, are now AIS patients, right?
    I am not clear on this either but I think they are hanging their hat on the fact that JIS is about 50%-50% male-female and AIS is mostly female. Unless someone is going to stand up and say most of the boys cases of JIS resolve before adolescence for some reason, this seems to be good evidence these are different creatures. Couple that with the evidence that JIS can resolve even without treatment whereas AIS does not. Also the curve direction can change in JIS but that is never seen in AIS. Also I think (not sure) the prevalence/incidence (can't remember) of left-sided curves is much higher in JIS versus AIS. Taken together, these look like very different conditions. Now are some AIS cases originally JIS? Probably. Maybe some of the left-side curves in boys might be JIS originally. Who knows.

    I can’t back this up yet, but it seems like lots of AIS cases could have had their scoliosis start as juveniles whether it was diagnosed when they were juveniles or not. To me it looks like the inferred definition in the literature for JIS is “a juvenile that has IS”. It looks like the definition of AIS is “an adolescent that has IS regardless of when the scoliosis started”. Feel free to correct me if you have better information.
    I think you are right. It does not seem robust.

    If they can repeatedly reduce AIS curves and have that maintained out of brace at skeletal maturity, that is saying something, even at case study levels of evidence.
    That is a priori publishable in a top shelf journal because it has never been shown. Nobody with any training will claim a brace can reduce an AIS curve. The only claim of all braces is that they can hope to prevent progression. The befores are controls for the afters. They will be in the running for the Nobel in physio or med if they can prove they are permanently reducing AIS curves outside the noise.


    You referred to lacking science or evidence-based practice with chiropractors. I guess I never viewed it as having no basis in science what so ever. I haven't had a lot of interaction with chiropractors or had a reason to look into their training until recently.
    https://sciencebasedmedicine.org/sci...-chiropractic/

    https://www.forbes.com/sites/stevens.../#2510f91b68c8

    https://www.chirobase.org/
    Chiropractic Education
    A Warning for Pre-Chiropractic Students (posted 3/22/99) FEATURE
    Why I Dropped Out of Chiropractic School after Ten Days (revised 1/5/16)
    Many Chiropractic Students Hold Non-Evidence-Based Beliefs (post
    ed 3/19/18)
    The Student Loan Mess: Why Chiropractic Is in Trouble (posted 4/23/03)
    Palmer College of Chiropractic Catalog (1953) posted 8/6/18)
    Requirements for Admission to Schools of Chiropractic (JAMA 1964) (posted 8/3/99)
    Educational Background of Chiropractic School Faculties (JAMA 1966) (posted 8/4/99)
    Dr. Homola's Chiropractic School Experience (revised 1/2/12)
    Canadian Professors Visit Three Chiropractic Schools (1962) (posted 9/7/04)
    Visit to a Chiropractic College (Medical Economics 1968) posted 11/24/98)
    Recent Visits to Two Chiropractic Colleges (updated 12/13/01)
    Improper Claims on Chiropractic College Web Sites (posted 3/6/04)
    Overview of Chiropractic Philosophy Taught in Chiropractic Colleges (posted 3/21/05)
    Chiropractic Educators Comment on Current and Future Chiropractic Education (posted 4/2/06)
    Prevalence of the Term Subluxation in North American English-Language Doctor of Chiropractic Programs (posted 3/28/12)
    Chiropractic Admission Standands Lowest among Health Professionals (posted 12/24/01)
    Life University:
    Some Notes on Its Assembly and "Money Hum" (updated 8/26/01)
    Administrators' Salary Criticized as Exhorbitant (posted 2/17/00)
    Life University College of Chiropractic Placed on Probation (posted 6/17/01)
    A Brief Query to "Dr. Sid" (posted 12/20/01)
    An Open Letter to Life University Students (updated 5/28/03)
    Life Life University Loses CCE Accreditation (updated 11/6/02)
    Students Sue Life University (posted 10/11/02)
    CCE Issues Open Letter about Life University (posted 11/13/02)
    Sherman College Placed on Probation (posted 6/29/08)
    Controversy Erupts over Proposed Chiropractic College at Florida State University (posted 12/31/04)
    Council on Chiropractic Education Standards (2007) (link to CCE site)
    Unscientific Teachings at Canadian Memorial Chiropractic College (updated 12/12/99) FEATURE
    Licensing Exam Results for Candidates from Different Schools (link to another site)
    WHO Guidelines on Basic Training and Safety in Chiropractic (2005)
    LVCAHF Opposition to Chiropractic Accreditation (1979) (posted 5/4/19)

    Spinal manipulations, which chiropractors, DOs, and physical therapist all employ have little supporting evidence in the literature it seems and of course will not help scoliosis.
    There is a cottage industry of chiros claiming to treat scoliosis effectively with chiro. The Janzenes, to their credit, have gone exclusively to a mainstream treatment, albeit one with significant questions remaining as to effectiveness.
    Last edited by Pooka1; 10-21-2019 at 03:37 PM.
    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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    https://sciencebasedmedicine.org/the...-chiropractic/

    If chiropractors reject the conclusions of the Mirtz et al. paper, the burden of proof falls on them to show

    that the subluxation can be objectively demonstrated,
    that it does cause interference with the nervous system, and
    that it does cause disease.
    They have failed to do so for 114 years.

    Most chiropractic research falls under the category of Tooth Fairy Science. Instead of doing good basic research to examine the subluxation construct as a falsifiable hypothesis, they blindly forged ahead, implemented it for diagnosis and treatment, and studied various aspects of its clinical use.

    The chiropractic emperor has no clothes, and now even some chiropractors have realized that. This study should mark the beginning of the end for chiropractic, but it won’t. Superstition never dies, particularly when it is essential to livelihood.
    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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    I think this is the Soucacos paper I mentioned earlier but I have to read it to see if the issue if JIS versus AIS is clearly delineated.

    Assessment of curve progression in idiopathic scoliosis

    P. N. Soucacos K. Zacharis J. Gelalis K. Soultanis N. Kalos A. Beris T. Xenakis E. O. Johnson

    European Spine Journal

    August 1998, Volume 7, Issue 4, pp 270–277

    https://link.springer.com/article/10...Fs005860050074

    Abstract
    In a 5-year prospective study on idiopathic scoliosis, an attempt was made to elucidate the natural history of the disease and to determine which factors contribute to curve progression. A total of 85,622 children were examined for scoliosis in a prospective school screening study carried out in northwestern and central Greece. Curve progression was studied in 839 of the 1,436 children with idiopathic scoliosis of at least 10° detected from the school screening program. Each child was followed clinically and roentgenographically for one to four follow-up visits for a mean of 3.2 years. Progression of the scoliotic curve was recorded in 14.7% of the children. Spontaneous improvement of at least 5° was observed in 27.4% of them, with 80 children (9.5%) demonstrating complete spontaneous resolution. Eighteen percent of the patients remained stable, while the remaining patients demonstrated nonsignificant changes of less than 5° in curve magnitude. A strong association was observed between the incidence of progression and the sex of the child, curve pattern, maturity, and to a lesser extent age and curve magnitude. More specifically, the following were associated with a high risk of curve progression: sex (girls); curve pattern (right thoracic and double curves in girls, and right lumbar curves in boys); maturity (girls before the onset of menses); age (time of pubertal growth spurt); and curve magnitude (≥ 30°). On the other hand, left thoracic curves showed a weak tendency for progression. In conclusion, the findings of the present study strongly suggest that only a small percentage of scoliotic curves will undergo progression. The pattern of the curve according to curve direction and sex of the child was found to be a key indicator of which curves will progress.
    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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    Here is the entire article and it is pretty wild. It is not the one I was thinking of that showed curve pattern changing in what I think were JIS cases.

    https://www.ncbi.nlm.nih.gov/pmc/art...070270.586.pdf

    Anyway they were showing not only decreasing curves but complete spontaneous remission in UNTREATED JIS and AIS cases. Pretty wild.

    Eighty patients (9.5%; 33 boys and 47 girls) showed
    complete spontaneous resolution of the scoliotic deformity.
    The patients who demonstrated a decrease in curve
    magnitude were similar in age to those who had curve
    progression (mean age 11.9 and 12.5 years vs 12 and 12.5
    years for boys and girls, respectively). However, the size
    of the scoliotic curve at the first visit was smaller in those
    children who demonstrated improvement (11.7° and 13.6°
    for boys and girls, respectively) than in those who showed
    progression of the curve (16.7° and 16.4° for boys and
    girls, respectively).
    Last edited by Pooka1; 10-20-2019 at 08:47 PM.
    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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    Dustin, here is an example of how spectacularly misleading the Janzenes page is.

    They report a 100% success rate for treating curves 10*-24*. Sitting on the couch eating ice cream also would have a 100% success rate in the population size they are dealing with.

    They are misleading parents by not stating that these curves are very unlikely to progress even with NO treatment. They are either ignorant or lying about this. There is no third option.

    I also wonder if these are consecutive cases or if they are cherry-picked. And how do they handle the kids who leave treatment? Are they only counting the kids who stay? That will ignore MANY treatment failures as parents wise up and go to a board certified pediatric orthopedic surgeon.
    Last edited by Pooka1; 10-21-2019 at 12:18 PM.
    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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    The AVERAGE GPA of chiro school enrollees is 2.90(!), the LOWEST among allied med schools.

    https://www.chirobase.org/03Edu/adm.html

    This is why I don't think it is rational to go to a chiro for anything ESPECIALLY scoliosis. This is serious business.
    Last edited by Pooka1; 11-10-2019 at 09:37 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."

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    Quote Originally Posted by Pooka1 View Post
    Here is the entire article and it is pretty wild. It is not the one I was thinking of that showed curve pattern changing in what I think were JIS cases.

    https://www.ncbi.nlm.nih.gov/pmc/art...070270.586.pdf

    Anyway they were showing not only decreasing curves but complete spontaneous remission in UNTREATED JIS and AIS cases. Pretty wild.
    Interesting. I'll look at it.

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    Quote Originally Posted by Pooka1 View Post
    Dustin, here is an example of how spectacularly misleading the Janzenes page is.

    They report a 100% success rate for treating curves 10*-24*. Sitting on the couch eating ice cream also would have a 100% success rate in the population size they are dealing with.

    They are misleading parents by not stating that these curves are very unlikely to progress even with NO treatment. They are either ignorant or lying about this. There is no third option.

    I also wonder if these are consecutive cases or if they are cherry-picked. And how do they handle the kids who leave treatment? Are they only counting the kids who stay? That will ignore MANY treatment failures as parents wise up and go to a board certified pediatric orthopedic surgeon.
    Here is how I see this so far from what I am seeing with them and in the literature. 70% of JIS cases are going on to reach surgical stage per literature reports. Yet, only 10% of AIS cases are being reported as going on surgical stage in the literature. Something about that doesn't seem to jive. But anyway, even with a 10% chance of going on to surgery with the AIS cases, the Janzen's are saying that, over the course of their history of treating AIS cases, they have a 100% success rate so far for keeping the 10-24 degree range from going on to surgical stage. I think they would agree that it could be 90% chance versus 100%. If you could choose to be treated and instead of a 10% chance of having rods put in your back, you have a 0%, would you do it (assuming you were buying into the methods - which I know you are not)? I would, especially seeing that their interventions at the just over 10 degree range are pretty minimal. Age of the patient here would be a huge factor in the treatment plan as well. 20 degree curve in 14 y/o is a lot different animal than 20 degree curve in a 10 y/o(almost still JIS category).
    As to your question about how they handle kids that leave treatment, I'm not sure. I know they said their statistics include non compliant patients. They probably have no way to follow the course for patients that leave care before skeletal maturity. I would guess the "100%" is referring to people that have stuck with them to skeletal maturity and that the average curve reductions in each category include the data of all patient's until they leave early or go through to the end. But I can ask.

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    Quote Originally Posted by Pooka1 View Post
    Dustin, here is an example of how spectacularly misleading the Janzenes page is.

    They report a 100% success rate for treating curves 10*-24*. Sitting on the couch eating ice cream also would have a 100% success rate in the population size they are dealing with.

    They are misleading parents by not stating that these curves are very unlikely to progress even with NO treatment. They are either ignorant or lying about this. There is no third option.

    I also wonder if these are consecutive cases or if they are cherry-picked. And how do they handle the kids who leave treatment? Are they only counting the kids who stay? That will ignore MANY treatment failures as parents wise up and go to a board certified pediatric orthopedic surgeon.
    Also, regarding your statements above and regarding the BrAIST study that you mentioned.
    I get the gist of the BrAIST study, but I'm just now digging into it more. One interesting thing that I am seeing so far with the BrAIST study is this: They (the BrAIST authors) start out initially saying that 10% of all AIS go on to surgical stage which they define as 50 degrees. Yet, in the BrAIST trial, 25% or so of the braced group goes on to surgical and close to 60% of the non-braced go on to surgical. They included kids with a largest curve in the 20-40 degree range in the study.

    So, to me one thing among many things, that this study is suggesting, is that IF a kid is in 20-40 degree range of AIS and not braced, *they have a near 60% chance of going on to surgical level*. So, it's a little more complicated than your, "They are misleading parents by not stating that these curves are very unlikely to progress even with NO treatment. They are either ignorant or lying about this. There is no third option." statement. I disagree with you on this.

    Anything over 20 degrees could really be playing with fire with up to 60% chance of progression to surgical - again, really depending on skeletal maturity level. BrAIST findings do, however, suggest that under 20 degrees and not rapidly progressing could be good grounds for the wait and see approach. I asked Janzen's what they do with just-over 10 degrees curves and if I remember right, they said either wait and see, soft brace, exercises, etc. If it progressed, say from 10 to 20 in just 3 months (they monitor every 3 months via non-harmful, 2.5 minute upright MRI) they might lean toward some frequency of rigid brace I would think, but not sure.

    I'm sure I'll have more on the BrAIST study after I get through it.

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    Quote Originally Posted by Dustin76 View Post
    Also, regarding your statements above and regarding the BrAIST study that you mentioned.
    I get the gist of the BrAIST study, but I'm just now digging into it more. One interesting thing that I am seeing so far with the BrAIST study is this: They (the BrAIST authors) start out initially saying that 10% of all AIS go on to surgical stage which they define as 50 degrees. Yet, in the BrAIST trial, 25% or so of the braced group goes on to surgical and close to 60% of the non-braced go on to surgical. They included kids with a largest curve in the 20-40 degree range in the study.

    So, to me one thing among many things, that this study is suggesting, is that IF a kid is in 20-40 degree range of AIS and not braced, *they have a near 60% chance of going on to surgical level*. So, it's a little more complicated than your, "They are misleading parents by not stating that these curves are very unlikely to progress even with NO treatment. They are either ignorant or lying about this. There is no third option." statement. I disagree with you on this.

    Anything over 20 degrees could really be playing with fire with up to 60% chance of progression to surgical - again, really depending on skeletal maturity level. BrAIST findings do, however, suggest that under 20 degrees and not rapidly progressing could be good grounds for the wait and see approach. I asked Janzen's what they do with just-over 10 degrees curves and if I remember right, they said either wait and see, soft brace, exercises, etc. If it progressed, say from 10 to 20 in just 3 months (they monitor every 3 months via non-harmful, 2.5 minute upright MRI) they might lean toward some frequency of rigid brace I would think, but not sure.

    I'm sure I'll have more on the BrAIST study after I get through it.
    Keep in mind that Risser 0-2 was a criteria. Even a kid with a 40+ curve is unlikely to *need* surgery at Risser 3-4. (Though said kid very well may progress to needing it over her lifetime and reasonably may choose to have it at an earlier age when recovery is easier.)

    Also keep in mind that the difference between curves near 20 and curves near 40 is enormous. A kid with the former at Risser 0-2 very well may not ever need surgery, especially at Risser 2. A kid with the latter likely will, especially at Risser 0-1. When doctors recommend observation under 25 degrees, they are only capturing the very low end of the 20-40 group that the BrAIST study looked at. Presumably that cohort in the observation group progressed to treatment failure at a much lower clip than the 58% that the entire group did.
    Last edited by Concerneddad; 10-22-2019 at 02:17 PM.

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    Quote Originally Posted by Concerneddad View Post
    Keep in mind that Risser 0-2 was a criteria. Even a kid with a 40+ curve is unlikely to *need* surgery at Risser 3-4. (Though said kid very well may progress to needing it over her lifetime and reasonably may choose to have it at an earlier age when recovery is easier.)

    Also keep in mind that the difference between curves near 20 and curves near 40 is enormous. A kid with the former at Risser 0-2 very well may not ever need surgery, especially at Risser 2. A kid with the latter likely will, especially at Risser 0-1. When doctors recommend observation under 25 degrees, they are only capturing the very low end of the 20-40 group that the BrAIST study looked at. Presumably that cohort in the observation group progressed to treatment failure at a much lower clip than the 58% that the entire group did.
    I agree with everything you are saying. That was kind of my point. Susan was saying that it is not a big deal to claim 100% success (whether it's true or not) at keeping a group of kids out of surgery that are in the 10-24 degree range. If this 10-24 degree group is mostly in the 10-15 degree range and near skeletal maturity, then Susan is probably right. If it is wide ranging for curve degree and Risser score or leaning more toward the 20s degrees with low Risser, then it is more of a substantial claim. That is why the authors saying that only 10% of AIS kids go on to need surgery is such a generalized statement that it can be misleading. Within that 10% are all kinds of "subsets" that carrying varying degrees of risk, some really high, some really low. If all I as a parent did was say, well my kid has AIS, so only a 10% chance of going on to surgery, then we will wait and see. Instead you would want to consider all the pertaining factors to determine risk if possible.

    Maybe the 10-24 degree claim doesn't mean much without knowing more about who is included, but the higher curve category claims are big time claims (if true) no matter the specifics of who is in the category.

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