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Thread: Janzen Bracing System for JIS

  1. #31
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    I remember reading, and I’ll have to get the references, but there was evidence of those curves that are 30+ progressing further in adulthood at some frequency and then high likelihood of progression in adulthood if coming in at 50 degrees +. Curves of idiopathic origin were unlikely if ever progressing if reaching skeletal maturity in 20s degrees if I remember right.
    Curves under 30 are highly unlikely to progress as an adult. Curves over 50 are almost certain to progress 1-2 degrees a year. Curves in between 30-50 are a huge gray area and are somewhat controversial. I think that probably the best way to look at these "intermediate" curves is that they do progress but very slowly, so that if you're on the bottom end of the range, they might not grow big enough to cause problems in your lifetime. On the other hand, a 45+ curve likely will, because even at half a degree a year, you're a decade or less from 50.

    1)However positive bracing results are defined, It seems consistent that more time in brace = better results across the board for the studies that exist.
    2)BrAIST (maybe the best bracing study so far) was consistent with this: 72% of the braced group did not progress on to surgery, but in breaking it down further, 93% of kids that stayed in brace at least 12.9 hours per day did not progress to surgical level - it seems this includes some kids with curves in 30s and near 40. The participants were asked to get 18 hours per day, but it looks like compliance for the study was not great overall. What if all/most participants were in brace the prescribed 18 hours per day? Maybe 100% avoid progression to surgical?
    The BrAIST study showed diminishing returns. The 12+ group was in the high 80s (by their criteria), whereas the 18+ group was "only" in the low 90s. Extrapolating that out, if there is any benefit from bracing 20+ hours per day vs. 18, it's likely to be tiny -- a percent or two. Some kids also progress no matter how much they brace. No one really knows why.

    Even more frustrating, is that I can’t find any studies discussing the amount of correction achieved in brace. Is it just assumed that there will be no or minimal correction in brace??
    There are plenty of studies that compare braces that measured in-brace correction and treatment success rate. Keep looking. (I'm not being a jerk by not providing links -- I'd have to search myself for them.)

    4) It seems supported in the literature and very reasonable to propose that, IF good in-brace correction can be attained and maintained through to skeletal maturity, it could be maintained out of brace in skeletal maturity if in low 20 degree curves or less. It also seems reasonable to propose that, the closer to neutral spine achieved in brace, the less likely there will be regression when skeletally mature.
    I saw a clip from Larson at Mayo where she basically explained it like this: Scoliosis to a large degree is a vicious cycle. The spine starts to curve, which puts more pressure on the inside of the curve, and less on the outside. Bones under pressure grow more slowly (hence VBT!). That means the inside of the curve grows more slowly than the outside -- which in turn causes the spine to curve even more. What a brace primarily does is try to take some of the pressure off of the vertebrae on the inside of the curve. The more in-brace correction that can be achieved, the better it does that. So yes. The more in-brace correction you can get, the better, at least in theory.

  2. #32
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    Concerneddad, I am very impressed with your command of this field. I confidently class you among the top players I have seen post in this sandbox. Dustin you are pretty good also. It is refreshing to see that. Most parents have no science background and struggle mightily.

    In re correction amount in brace, the marquee brace paper before BrAIST was Katz et al. (I think 2008 but not sure). That paper also purported to shown the efficacy of bracing and they did not see a correlation between amount of in-brace correction and "success." Of course equipoise was declared at some point so I am not sure Katz moved any needle ultimately though several parents hung their hats on it.

    I found a very recent review article on risk factors for brace failure. I will post it when I get home as I can't do it from this tab. It is El Hawary et al. July 2019 online The Spine Journal. The .pdf is available.
    Last edited by Pooka1; 10-23-2019 at 04:25 PM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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  3. #33
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    https://www.thespinejournalonline.co...19)30878-2/pdf

    Brace treatment in adolescent idiopathic scoliosis: risk factors for failure—a literature review
    Ron El Hawary, MDa,b,
    *, Daphna Zaaroor-Regev, PhDc
    ,
    Yizhar Floman, MDd
    , Baron S. Lonner, MDe
    ,
    Yasser Ibrahim Alkhalife, MBBS, SBf
    , Randal R. Betz, MDg

    Received 28 January 2019; revised 12 July 2019; accepted 15 July 2019

    Abstract
    Brace treatment is the most common nonoperative treatment for the prevention of curve progression in adolescent idiopathic scoliosis. The success reported in level 1 and 2 clinical trials is approximately 75%. The aim of this review was to identify the main risk factors that significantly reduce success rate of brace treatment.

    A literature search using the MEDLINE and Embase databases was conducted. Studies were included if they identified specific risk factor(s) for curve progression. Studies that looked at nighttime braces, superiority of one type of brace over another, the effect of physical therapy on brace performance, cadaver or nonhuman studies were excluded. A total of 1,022 articles were identified of which 25 met all of the inclusion criteria. Seven risk factors were identified: Poor brace compliance (eight studies), lack of skeletal maturity (six studies), Cobb angle over a certain threshold (six studies), poor in-brace correction (three studies), vertebral rotation (four studies), osteopenia (two studies), and thoracic curve type (two studies). Three risk factors were highly repeated in the literature which identified specific subgroups of patients who have a much higher risk to fail brace treatment and to progress to fusion. This data demonstrates that 60% to 70% of the patients referred to bracing are Risser 0 and 30% to 70% of this group will not wear the brace enough to ensure treatment efficacy. Furthermore, Risser 0 patients who reach the accelerated growth phase with a curve ≥40˚ are at 70% to 100% risk of curve progression to the fusion surgical threshold despite proper brace wear. Skeletally immature patients with relatively large magnitude scoliosis who are noncompliant are at a higher risk of failing brace treatment.
    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. #34
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    I am trying to find a table that was published in the 1980s I think that showed the zero or near zero progression to surgery territory in small curves but I am instead finding papers that show a non-zero percent for some progression. I may have dismembered those data. It may have been for small curves in higher Risser patients as I think Dustin guessed. If I find it I will post it.

    What I did find is the SRS stating braces do NOT or "rarely" correct curves but can only prevent or slow progression for both AIS and JIS. So all the before and after cases that the chiros have must be in brace or shot immediately our of brace. There is a reason surgeons tell patients to stay out of brace 24-48 hours before imaging.

    Early onset https://www.srs.org/patients-and-fam...nset-scoliosis

    Rarely does a brace permanently correct scoliosis, instead the goal of bracing is to allow the child to grow before a surgical procedure is done. The purpose of the brace is to slow the inevitable progression of the curve, not to correct the curve.
    AIS https://www.srs.org/patients-and-fam...thic-scoliosis

    The job of a scoliosis brace is to halt or slow progression of the curve – with an ultimate goal of avoiding a spinal fusion surgery (and the recovery and limitations that go with it).
    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."

  5. #35
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    There is some reason that the SRS recommends watch and wait in small curves. That reason I think is the literature I am trying to find. We know it exists because at some point these people decided the ethical thing to do was not brace small curves. That is, I don't think there is equipoise on this point; people trained to treat scoliosis agree on this as a rule. In addition, I don't think it is known whether bracing is at all effective in small curves.
    Last edited by Pooka1; 10-24-2019 at 07:50 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."

  6. #36
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    Quote Originally Posted by Pooka1 View Post
    Concerneddad, I am very impressed with your command of this field. I confidently class you among the top players I have seen post in this sandbox. Dustin you are pretty good also. It is refreshing to see that. Most parents have no science background and struggle mightily.

    In re correction amount in brace, the marquee brace paper before BrAIST was Katz et al. (I think 2008 but not sure). That paper also purported to shown the efficacy of bracing and they did not see a correlation between amount of in-brace correction and "success." Of course equipoise was declared at some point so I am not sure Katz moved any needle ultimately though several parents hung their hats on it.

    I found a very recent review article on risk factors for brace failure. I will post it when I get home as I can't do it from this tab. It is El Hawary et al. July 2019 online The Spine Journal. The .pdf is available.

    Sharon and Concerneddad,
    I really appreciate you both taking time out of your days to respond to my posts.

    With the roller coaster of dealing with this discovery of scoliosis in both kids in the last 4-5 months, I think I’ve bounced back and forth between irrational hope and more rational thinking regarding interventions and risk of progression, and other factors.

    I did find a few studies looking at the amount of in-brace correction of curve. One study: mean curve correction of 50% with average initial out-of-brace curve at 30 with range of 18-46. Looks like the Boston Brace is getting 50-60% a fair amount of the time. The Providence brace (night-time only brace) was reported in one study to get 95 degrees plus of curve correction for “major and minor curves”. At the place we are attending, and for what I was able to experience with our kids and see/hear parents report that were there, there was, more often than not ,90-100% curve correction going on in brace for the images that I got to see, regardless of how that plays out over time. They don’t get that all at once with the large curves. I’m pretty confident that they are good at the in-brace correction. I guess the Providence brace in the right hands can do this too, so what I am seeing is not a “never done before” situation as far as in-brace correction.

    Where I’m at now with our kid’s bracing:
    - I like that they monitor in-brace/out of brace with MRI only – no radiation
    - They appear good at in-brace correction and are meticulous about getting as much correction as possible.
    - They see their patients every 3 months, whether bracing or some more conservative (minimal evidence-based, but could help) measures, to monitor curves as curves have been known to rapidly progress in some cases
    - They spend A LOT of time with measuring, fitting, adjusting braces – not the too often “rush you in and rush you out” at many orthopedic offices
    - With the cases of 20+ hours of prescribed brace time, I’m concerned about long-term effects on lung function, so I’m thinking if it came down to it, I would draw the line at 18 hours/day max. (and maybe less), giving 6 hours/day for lung expanding and chest wall expanding activity/exercises. Granted that lung function issues can go along with significant thoracic curves regardless of bracing. Loss of trunk strength is an issue too, but I could see that recovering more easily.
    - I’m still not convinced that a JIS case like my daughter’s doesn’t carry significant risk that bracing won’t reduce to some degree, especially for getting through the rapid growth of puberty – see a couple studies on my next post.

  7. #37
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    Risk of progression to surgical stage and ability of brace to reduce risk

    Regarding: Can bracing reduce risk of progression to surgical stage:

    BMC Musculoskelet Disord. 2018; 19: 88.
    Published online 2018 Mar 27. doi: 10.1186/s12891-018-1987-9
    Association between braced curve behavior by pubertal growth peak and bracing effectiveness in female idiopathic scoliosis: a longitudinal cohort study

    This study concluded, “Sustained curve correction following bracing despite early onset and rapid pubertal growth was strongly predictive of effective brace control of scoliosis.” They note that in-brace correction was a factor in bracing effectiveness and they describe 10-40% correction of initial curve as poor. Other places in the literature seem to indicate that 50% or greater initial curve correction in brace is good. The newer Boston Brace advertises commonly getting 50% or more curve correction. In any case, this study shows that bracing is favorable (along with BrAIST study and others) and might get a kid through the rapid growth of puberty more safely than doing nothing.
    -----------------------------------------------------------------------------------------------------------------------------------------------
    Regarding risk of progression:

    The study below (abstract) is alarming for how many JIS cases (no bracing intervention) they looked that progressed to surgical stage if at various ranges of curve at the time they hit puberty (by this time they are classified AIS I guess?). If at or just under 20 degrees at puberty, 15% progressed to surgical. If in 21-30 degree range at puberty, 75% progressed to surgical. If over 30 degrees when hitting puberty, 100% went to surgical level.


    Progression risk of idiopathic juvenile scoliosis during pubertal growth.
    Charles YP1, Daures JP, de Rosa V, Diméglio A.
    Abstract

    STUDY DESIGN:
    A retrospective study investigated the progression risk of juvenile scoliosis until skeletal maturity or spinal fusion.

    OBJECTIVES:
    To define risk factors of curve progression during pubertal growth and analyze the timing of arthrodesis.

    SUMMARY OF BACKGROUND DATA:
    Juvenile scoliosis is characterized by a major, extremely variable progression risk. Peak growth velocity is the most critical period. Curve progression related to growth needs to be analyzed critically for an adequate treatment.

    METHODS:
    A total of 205 patients, including 163 girls and 42 boys, with juvenile scoliosis were reviewed at skeletal maturity. The scoliosis was divided into juvenile I with an onset of 4-7 years (52 patients) and juvenile II with an onset of 8-10 years (153). Standing and sitting height, weight, Tanner signs, skeletal age, and menarche were regularly assessed. Topographies and Cobb angles of primary and secondary curves were referred to the pubertal growth diagram.

    RESULTS:
    Of 205 patients, 99 (48.3%) were operated on. Of 109 curves < or = 20 degrees at onset of puberty, 15.6% progressed > 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves > 30 degrees . Curves > 20 degrees, which increased and were operated on, progressed significantly during peak growth velocity (P = 0.0014). Curves that progressed by 6 degrees to 10 degrees/y were fused in 70.9%, curves which increased > 10 degrees/y in 100% of cases (P = 0.0001). This risk was highest for primary thoracic curves: King V, III, and II (P = 0.0001). There was no difference between males and females or juvenile I and II.

    CONCLUSIONS:
    Curve pattern, Cobb angle at onset of puberty, and curve progression velocity are strong predictive factors of curve progression. Juvenile scoliosis > 30 degrees increases rapidly and presents a 100% prognosis for surgery (curve > 40 degrees to 45 degrees ). Anticipation is necessary if the scoliosis progresses during the first year of puberty. The prediction is difficult for curves of 21 degrees to 30 degrees during the first 2 years of puberty. Curve pattern and curve progression velocity are useful to detect which curves are likely to progress. From this retrospective analysis, spinal fusion could have been indicated earlier sometimes. An earlier intervention is probably preferable to obtain better curve reduction on a supple spine, even if a perivertebral fusion is necessary. We use the 3 parameters for operative indications. If an early spinal fusion leads to better curve correction needs to be verified on prospective data.

  8. #38
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    Quote Originally Posted by Pooka1 View Post
    There is some reason that the SRS recommends watch and wait in small curves. That reason I think is the literature I am trying to find. We know it exists because at some point these people decided the ethical thing to do was not brace small curves. That is, I don't think there is equipoise on this point; people trained to treat scoliosis agree on this as a rule. In addition, I don't think it is known whether bracing is at all effective in small curves.
    Yes, I'm interested in what you can find. Often the best and most up-to-date information in the literature lags behind in practice (the practice of orthopedic surgeons making recommendations). See my last post on this thread for more on this. Thanks.

  9. #39
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    Quote Originally Posted by Pooka1 View Post
    There is some reason that the SRS recommends watch and wait in small curves. That reason I think is the literature I am trying to find. We know it exists because at some point these people decided the ethical thing to do was not brace small curves. That is, I don't think there is equipoise on this point; people trained to treat scoliosis agree on this as a rule. In addition, I don't think it is known whether bracing is at all effective in small curves.
    Where do you draw the line? The experts drew it at 25 degrees. When the majority of a population will not need medical intervention, the ethical thing to do is to wait and see. Treating a child when the odds are that they'll never actually benefit from that treatment, is borderline unethical, especially when the outcome to those who would have benefitted from the treatment, can be surgically fixed. (Caveat: If kids could receive a safe and inexpensive vaccine to keep their curves from increasing, I would be all for it.)

    While a very small percentage of the "wait and see" population will progress so quickly that surgery is the only option, most "wait and see" kids whose curves progress, are caught in time to be braced. Why not give it 6 to 12 months to see if there is progression?

    There's also the impact on the child... When you talk to adults who were braced as children, a large percentage will tell you that the brace had a very negative impact on their life.

    ... and the cost to society. Lastly, at an average cost of bracing a child of ~$5,000, I can't even imagine what it would cost society to brace all those kids who would never actually need the brace. Those healthcare dollars that are saved are probably much more beneficial in other areas.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  10. #40
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    Quote Originally Posted by LindaRacine View Post
    Where do you draw the line? The experts drew it at 25 degrees. When the majority of a population will not need medical intervention, the ethical thing to do is to wait and see. Treating a child when the odds are that they'll never actually benefit from that treatment, is borderline unethical, especially when the outcome to those who would have benefitted from the treatment, can be surgically fixed. (Caveat: If kids could receive a safe and inexpensive vaccine to keep their curves from increasing, I would be all for it.)

    While a very small percentage of the "wait and see" population will progress so quickly that surgery is the only option, most "wait and see" kids whose curves progress, are caught in time to be braced. Why not give it 6 to 12 months to see if there is progression?

    There's also the impact on the child... When you talk to adults who were braced as children, a large percentage will tell you that the brace had a very negative impact on their life.

    ... and the cost to society. Lastly, at an average cost of bracing a child of ~$5,000, I can't even imagine what it would cost society to brace all those kids who would never actually need the brace. Those healthcare dollars that are saved are probably much more beneficial in other areas.
    These are valid points, Linda.

    I guess my thinking (subject to change) at this point is this. My son is already 25 degrees. My daughter is 20. They are braced at neutral spine position right now - 100% in-brace correction (better than average?) with no skin irritation or pressure points at all so far. My son is sleeping 9-10 (took him 3 days to get to this) hours through the night leaving just a few daytime hours to get to the 13-14 target right now. My daughter is in her first week adjusting but has slept though the night twice now. They will be tested every 3 months for lung capacity (baseline already noted). They will have at least 2 stand-up MRIs (no radiation) every 3 months to monitor in-brace/out-of-brace curve measures. The stand-up MRI will look at rib position as well. They each get 10-11(of 14) daytime hours out of brace for fun/exercise. We don't sit them in front of a screen all day long (hardly at all) like a lot of kids end up. With this monitoring, I really don't think we will do psychological or physical damage to our kids. I'm not going to let that happen. They should be on track to eventually enter puberty at 0 in brace and hopefully no worse than now out of brace (maybe better than now out of brace which is a loaded thing to say and hard to prove). I just don't want to look back and say, "I just wish we would have at least tried this." I'll pass on the cost to society thing other than to say we are likely going to pay for all or most of this out of our pocket. We are still going to consult a specialist (again) at Seattle Children's Hospital who is supposed to be an internationally recognized expert on this stuff.

  11. #41
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    Quote Originally Posted by Dustin76 View Post
    Regarding: Can bracing reduce risk of progression to surgical stage:

    BMC Musculoskelet Disord. 2018; 19: 88.
    Published online 2018 Mar 27. doi: 10.1186/s12891-018-1987-9
    Association between braced curve behavior by pubertal growth peak and bracing effectiveness in female idiopathic scoliosis: a longitudinal cohort study

    This study concluded, “Sustained curve correction following bracing despite early onset and rapid pubertal growth was strongly predictive of effective brace control of scoliosis.” They note that in-brace correction was a factor in bracing effectiveness and they describe 10-40% correction of initial curve as poor. Other places in the literature seem to indicate that 50% or greater initial curve correction in brace is good. The newer Boston Brace advertises commonly getting 50% or more curve correction. In any case, this study shows that bracing is favorable (along with BrAIST study and others) and might get a kid through the rapid growth of puberty more safely than doing nothing.
    -----------------------------------------------------------------------------------------------------------------------------------------------
    This study seems to deliberately mix JIS and AIS. To the extent these are clinically separate conditions, this study seems bizarre.

    The truly shocking thing is that Milwaukee braces are still being used. I did not know that. That is flat out unethical in the dawn of tethering in my opinion FULL STOP.

    Regarding risk of progression:

    The study below (abstract) is alarming for how many JIS cases (no bracing intervention) they looked that progressed to surgical stage if at various ranges of curve at the time they hit puberty (by this time they are classified AIS I guess?). If at or just under 20 degrees at puberty, 15% progressed to surgical. If in 21-30 degree range at puberty, 75% progressed to surgical. If over 30 degrees when hitting puberty, 100% went to surgical level.


    Progression risk of idiopathic juvenile scoliosis during pubertal growth.
    Charles YP1, Daures JP, de Rosa V, Diméglio A.
    Abstract
    Given the number of AIS brace articles and still we are where we are, the problem is magnified several fold for JIS with so few articles. Just in reading this forum, it seems that bracing can appear to be more successful in JIS than AIS but that is against a background of higher progression in JIS versus AIS in general. Also I think it has been shown that bracing can reduce JIS curves at least until adolescence whereas they can't reduce AIS curves. More proof these are clinically distinct conditions.

    Just curious, what is the protocol for imaging w.r.t. brace wear at the Janzenes clinic? Do they image kids in brace? Do they tell them to stay out of brace 24-48 hours before imaging?
    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."

  12. #42
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    Quote Originally Posted by Dustin76 View Post
    These are valid points, Linda.

    I guess my thinking (subject to change) at this point is this. My son is already 25 degrees. My daughter is 20. They are braced at neutral spine position right now - 100% in-brace correction (better than average?) with no skin irritation or pressure points at all so far. My son is sleeping 9-10 (took him 3 days to get to this) hours through the night leaving just a few daytime hours to get to the 13-14 target right now. My daughter is in her first week adjusting but has slept though the night twice now. They will be tested every 3 months for lung capacity (baseline already noted). They will have at least 2 stand-up MRIs (no radiation) every 3 months to monitor in-brace/out-of-brace curve measures. The stand-up MRI will look at rib position as well. They each get 10-11(of 14) daytime hours out of brace for fun/exercise. We don't sit them in front of a screen all day long (hardly at all) like a lot of kids end up. With this monitoring, I really don't think we will do psychological or physical damage to our kids. I'm not going to let that happen. They should be on track to eventually enter puberty at 0 in brace and hopefully no worse than now out of brace (maybe better than now out of brace which is a loaded thing to say and hard to prove). I just don't want to look back and say, "I just wish we would have at least tried this." I'll pass on the cost to society thing other than to say we are likely going to pay for all or most of this out of our pocket. We are still going to consult a specialist (again) at Seattle Children's Hospital who is supposed to be an internationally recognized expert on this stuff.
    Glad to hear you're paying for it out of pocket. If you want to put your kids through it, and can afford it, then who am I to say you shouldn't. Good luck.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  13. #43
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    Quote Originally Posted by Pooka1 View Post
    The truly shocking thing is that Milwaukee braces are still being used. I did not know that. That is flat out unethical in the dawn of tethering in my opinion FULL STOP.
    It's pretty rare that any child is put in a Milwaukee brace these days. When they do, it's typically because the child has a very unusual, high curve, that would be considered very lethal.
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  14. #44
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    Getting back to BrAIST, here is a thread I started a few years ago. On here you can see a researcher (PhD in muscle physiology) lamenting that he would never be able to publish a study without showing the final Cobb angles on the patients yet that is EXACTLY what the BrAIST researchers were allowed to get away with. So what we have here is a "hallmark" bracing paper that doesn't have what every other bracing paper has... final Cobbs. I think this is was done deliberately to hide the fact that kids left north of 40* with no growth and north of 35* with up to 25% growth remaining probably not being actual bracing "successes" in terms of avoiding surgery even in the near term.

    I asked one of the authors about this issue of final Cobbs when she came on this forum to do a survey. She ignored my questions about final Cobbs but answered other questions so she read my post. As a fellow scientist, I was shocked at that behavior.

    With this paper, we have left the realm of science and entered politics.

    http://www.scoliosis.org/forum/showt...ure&highlight=

    Here is another on this issue of post-brace Cobb and declaring success for bracing...

    http://www.scoliosis.org/forum/showt...bow&highlight=

    The problem is patients and parents define bracing success as avoiding surgery for life and that is not how this research is conducted by necessity. There is a HUGE disconnect there.
    Last edited by Pooka1; 10-25-2019 at 06:02 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."

  15. #45
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    Quote Originally Posted by Pooka1 View Post
    Getting back to BrAIST, here is a thread I started a few years ago. On here you can see a researcher (PhD in muscle physiology) lamenting that he would never be able to publish a study without showing the final Cobb angles on the patients yet that is EXACTLY what the BrAIST researchers were allowed to get away with. So what we have here is a "hallmark" bracing paper that doesn't have what every other bracing paper has... final Cobbs. I think this is was done deliberately to hide the fact that kids left north of 40* with no growth and north of 35* with up to 25% growth remaining probably not being actual bracing "successes" in terms of avoiding surgery even in the near term.

    I asked one of the authors about this issue of final Cobbs when she came on this forum to do a survey. She ignored my questions about final Cobbs but answered other questions so she read my post. As a fellow scientist, I was shocked at that behavior.

    With this paper, we have left the realm of science and entered politics.

    http://www.scoliosis.org/forum/showt...ure&highlight=

    Here is another on this issue of post-brace Cobb and declaring success for bracing...

    http://www.scoliosis.org/forum/showt...bow&highlight=

    The problem is patients and parents define bracing success as avoiding surgery for life and that is not how this research is conducted by necessity. There is a HUGE disconnect there.

    It's amazing what gets past peer review sometimes. You think the authors of BrAIST did it on purpose? Could have been an honest mistake that they just don't want to own up to. Were the authors of BrAIST biased toward bracing?

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