Page 1 of 5 123 ... LastLast
Results 1 to 15 of 65

Thread: Can conservative treatment permanently reduce or eliminate AIS curves?

  1. #1
    Join Date
    Oct 2019
    Posts
    39

    Can conservative treatment permanently reduce or eliminate AIS curves?

    This is my first thread in a series of threads that I hope to post to address what I consider to be very important questions to ask of the pertaining literature and of those treating scoliosis.
    ------------------------------------------------------------------------------------------------------------------------------------
    When our 5 year old son was diagnosed with scoliosis in June of 2019, I was determined to get the best medical care possible. I started digging into the pertaining literature and talking to doctors, other physical therapists (I am a physical therapist myself), orthotists, and other medical professionals. My search for a good grasp on what should be done, or should not be done for scoliosis was further intensified when my daughter was diagnosed with scoliosis a few months later.

    Through this process, I came up with what I consider to be some very important questions that I have asked, and continue to ask, of the available literature and the professionals that treat scoliosis.
    - Can scoliosis progression be slowed down or stopped?
    - Can scoliosis related spinal curves be reduced in severity or even eliminated?
    - What are the risks of bracing?
    - What are the risks of not bracing?

    Of course there is a bit of “it depends” involved with all of these questions since each child’s case is different. This is very true for our children as one has what can be classified, so far, as idiopathic (unknown cause) scoliosis and one has a condition thought to be causing or significantly contributing to the scoliosis. I plan to post more about their cases in the future.

    In light of the generally agreed upon potential for bracing to be beneficial, my continued research lead me to a very specific question as follows: Can bracing (especially when applied by experienced and highly skilled bracing specialists) significantly reduce or eliminate scoliotic curves with sustained curve reductions over the long-term after bracing stops? As I was doing my review of the literature, I narrowed my focus to a review of the possibility of permanent curve reductions in those with adolescent idiopathic scoliosis.

    I want to focus on the more specific question concerning curve reduction potential in adolescent idiopathic scoliosis (AIS) for a few reasons. One reason is that AIS is the most common and therefore most researched type of scoliosis. Another reason is that it is generally agreed upon by scoliosis experts that AIS will not improve when left to its natural course with many getting worse as they progress through adolescents. If AIS curves can be permanently reduced in conjunction with bracing, then the curve improvements can be entirely attributed to bracing. On the other hand, early onset scoliosis, scoliosis present before the adolescent stage, can sometimes stop progressing, improve, and even completely resolve on its own in some cases which makes it difficult to measure the effects of pre-adolescent bracing.

    This brings me to the copy of my literature review, posted on the next comment, intended to explore the question as follows: Can bracing permanently reduce the scoliotic curves of AIS when bracing ceases at skeletal maturity?

  2. #2
    Join Date
    Oct 2019
    Posts
    39

    My literature review

    Brace Induced Long-term Curve Reduction in Adolescent Idiopathic Scoliosis: A physical therapist and parent of two children with scoliosis investigates

    For the purposes of this “hybridization” of a literature review and personal story, I will not defend statements via citation in this article that contain assertions with overwhelming consensus in the body of pertaining available literature. The primary purpose, or primary question at hand is as follows: Can bracing result in long-term correction of a scoliotic curve in adolescent idiopathic scoliosis (AIS) after the period of bracing has concluded? Hopefully the specific nature and importance of this question will be adequately illustrated as this article proceeds.

    First, it is helpful to understand how idiopathic scoliosis has been categorized. It is important to note that scoliosis categorization is according to age groups and current status. These categories do not speak to when the scoliosis started, as the actual time of onset is often unknown.

    The following definitions are as set forth by the Scoliosis Research Society (SRS). Early onset scoliosis is defined as scoliosis existing in infants or children between birth and age 10, or before puberty. Infantile idiopathic scoliosis, a sub-category of early onset scoliosis, is scoliosis of unknown cause that is present in a child from birth to 3 years of age. Juvenile idiopathic scoliosis (JIS), a second sub-category of early onset scoliosis, is defined as scoliosis without a known cause that exists in children between ages four and ten. Adolescent idiopathic scoliosis (AIS) is defined as scoliosis without a known cause that is present in children at 10 years of age or older. The 4-year-old mark seems somewhat arbitrarily assigned as the line between infantile and juvenile scoliosis. The 10-year-old age mark, however, is intended to indicate a more significant categorical transition point, which is the average age of onset of puberty for girls. Idiopathic scoliosis is predominately found in girls and most studies concerning idiopathic scoliosis will have exclusively female participants.

    I follow here with some findings upon which there is general consensus among scoliosis experts, be they researchers or bracing practitioners. The most important finding for purposes of this article is that idiopathic scoliosis present in adolescence will not improve and carries the highest risk of progression, sometimes very rapid progression, during the growth spurts associated with puberty. Conversely, idiopathic scoliosis present before onset of puberty (early onset scoliosis) can stay at a mild level or even improve and completely resolve on its own with no intervention. At any stage though, once scoliosis is present, some level of progression is more likely than not. This information leads to an important conclusion. If solid evidence is sought that indicates permanent scoliosis curve reductions as a result of bracing, then a first priority is to find evidence of brace induced curve reductions among those with documented adolescent idiopathic scoliosis – the category with generally no cases of curve improvement when curves are left to their natural course.

    There is a generally agreed upon conclusion (including the conclusion of respected literature reviewers, and institutions like the SRS) that bracing carries the possibility of altering the natural history of curve progression in a positive way, including those with AIS. That is to say that there is solid evidence that bracing can stop or at least slow the progression of curves in a significant percentage of cases.

    Since the SRS repeatedly reports the goal of idiopathic scoliosis bracing as stopping or slowing the progression of scoliotic curves, one could assume that long-term, out-of-brace reductions of curves are extremely rare or impossible.

    Well, when our first child was diagnosed with scoliosis at age 5, I was determined to dig deep into the literature regarding scoliosis and treatment options. But as I began this journey, I also began talking to “boots on the ground” practitioners who were conservatively treating scoliosis as well as looking at their published and unpublished research reports and case studies. What I found in gaining information from several reputable orthotists and one reputable chiropractor (“reputable chiropractor” equals oxymoron to some academics and pseudo academics in the medical community, but I will consider the rationale and results of any medical practitioner with a hat in the ring) dedicated to scoliosis treatment, is that what they were reporting about the possibility of brace induced long-term curve reduction in adolescent idiopathic scoliosis via bracing was very different than what the SRS suggests. They were indicating that it was not only possible once in a great while, but that major and stable curve reductions were routinely happening for a significant portion of the patients that they were treating. The differing stances of some national scoliosis organizations and that of reputable bracing practitioners left me with more questions than answers – and with a lot of work ahead of me.

    Regarding the bracing practitioners, maybe they were exaggerating their results to sell their product. Maybe curves were improved while in brace, and for minutes after coming out of brace, and then later settled back to a state of no improvement or worse than before bracing started. Or maybe they were outright lying to me. On the other hand, maybe they had just a few cases of reduced curves over many years and were just assuming a greater frequency of reduced curves. Or maybe, since it is reasonable to assume that bracing techniques have improved over the decades, they are applying techniques and seeing results that have yet to hit the literature. Maybe we are in an era of rapidly advancing bracing technology.

    Regarding the positions held by the Scoliosis Research Society, do their literature reviews taking into account the most recent studies enough to reasonably say that stable curve correction is impossible at this point in time? Are they allowing more recent bracing studies to represent what is going on or are they lumping these studies in with the more substantial amount of literature from decades ago that pretty solidly discounted long-term stable curve corrections for those eras?

    Continued on next post.........

  3. #3
    Join Date
    Oct 2019
    Posts
    39

    Literature review continued

    The foremost problem I found in scouring the literature is that sustained curve reduction after bracing is not even an outcome consideration for most studies. Nor is curve correction an outcome criterion on the list of outcome criteria proposed by the SRS. How can we find out if curve correction is possible if, for the most part, researchers aren’t even looking for the possibility? Along the same line, how can the SRS take a position that AIS curve correction is impossible if this possibility is not on their radar? A second problem I found is that the bracing studies often have little to say about the experience and skill of the bracing specialists.

    Where the brace type was identified, I began to see a pattern of European bracing methods, especially the Cheneau variations, outperforming the most often employed American brace, the Boston Brace [1-5]. If just looking at the Boston brace, I think the Scoliosis Research Society’s position holds essentially true – that of AIS permanent curve reduction being impossible. I can find no evidence of Boston braces resulting in lasting AIS curve reductions after bracing has discontinued. However, when looking exclusively at the more effective of European models in the hands of experienced and highly skilled bracing practitioners, such as the Cheneau Brace and its derivatives, a very different picture emerges.

    A study by Aulisa et. al. published in the journal, Scoliosis, in 2009, indicated phenomenal results with use of a European brace [4]. They demonstrated AIS curve reduction in 94% of participants and curve stabilization in 6% based on a 2-year follow-up post-bracing x-ray. Understandably, since the more brace time, the better the results (this is generally agreed upon), participants in this study were not included if they did not average at least 18 hours per day in brace. In one of the more impressive retrospective observational studies, a very experienced bracing specialist trained by Dr. Cheneau himself stopped scoliosis progression in 100% of the 48 girls with AIS that were admitted to the study [5]. The girls were braced by this practitioner for various time intervals within the time period between 1994 and 2009. But, in addition to stopping progression for all of the girls, there was a mean of a 59% curve reduction (yes, in AIS curves) determined via x-ray at the 5-year (mean) follow-up [5]. For some of these girls, this essentially amounted to “curing” their scoliosis since they had their curve reduced to less than 10 degrees and it stayed less than 10 degrees at follow-up. Less than 10 degrees is not even considered scoliosis. One good prospective study published in 2014, along with indicating that AIS curves can be improved and maintained, suggested that the SRS should include maintainable AIS curve reduction as a possible outcome criterion (focus of research) to be added to the SRS list of scoliosis research criteria [6]. In light of recent research, and to spur on a progressive mindset for better research, the standard inclusion of such research criteria seems essential. Sustainable post-bracing curve reductions have been indicated by numerous other peer reviewed studies of good methodology as well [7-11].

    Not only is there evidence within the more recent literature that AIS curves can be reduced and maintained in a reduced state after bracing ceases at skeletal maturity, but a 2017 SOSORT award winning study indicates that skeletally mature curves that were braced prior to skeletal maturity are more stable, wherever they happen to land at skeletal maturity, than curves that naturally progress to wherever they land at skeletal maturity [12]. In this 2017 study, skeletally mature, 30+ degree curves had progressed by only 2-4 degrees (a pretty negligible increase) over 15 years in those who had been previously braced. This is quite different from skeletally mature, 30+ degree curves with no history of bracing intervention that tend to progress at least 1-2 degrees per year when beyond skeletal maturity and sometimes at a much greater rate [12-14]. A literature review conducted in 2001 and a study in 2016 seem to corroborate the findings of a lot less progression of skeletally mature curves in those who were previously braced compared to those who were never braced [15-16].

    What can be concluded from all this? Here is what I see. I see at least 10 studies of good methodological quality that indicate significant reductions in AIS curves have been not only attained, but maintained with minimal to mild worsening for years – 15 to 20+ years in some cases – after bracing ceases. A common denominator for all if these studies and reviews is that they all were completed after the year 2000. Prior to the year 2000, I see hardly any findings of, or even attempts to find, evidence of brace induced curve reductions that are maintained when bracing ceases. If the reports from the “front lines” by orthotists and other bracing practitioners of routine reductions of AIS curves in a significant portion of AIS patients seemed far fetched before I started my literature review, their claims do not seem so outside of reality now. For me personally, I add the acquaintance of real patients (I owe them a lot for sharing their stories and images) walking this earth right now who are holding essentially stable in the skeletal maturity stage of their lives having had double digit reductions in AIS curves as a result of bracing that ceased anywhere from months to years ago. So, I conclude that, for some patients, bracing can result, and has resulted, in long-term correction of scoliotic curves in AIS after the period of bracing has concluded.

    See references on next post.......

  4. #4
    Join Date
    Oct 2019
    Posts
    39

    References for literature review

    References
    1. Minsk, M.K., Venuti, K.D., Daumit, G.L. et al. Effectiveness of the Rigo Chêneau versus Boston-style orthoses for adolescent idiopathic scoliosis: a retrospective study. Scoliosis 12, 7 (2017). https://doi.org/10.1186/s13013-017-0117-z
    2. Ovadia D, Eylon S, Mashiah A, Wientroub S, Lebel ED. Factors associated with the success of the Rigo System Chêneau brace in treating mild to moderate adolescent idiopathic scoliosis. J Child Orthop. 2012;6(4):327–31.
    3. Zaborowska-Sapeta K, Kowalski IM, Kotwicki T, Protasiewicz-Faldowska H, Kiebzak W. Effectiveness of Chêneau brace treatment for idiopathic scoliosis: prospective study in 79 patients followed to skeletal maturity. Scoliosis. 2011;6(1):2.
    4. Aulisa AG, Guzzanti V, Galli M, Perisano C, Falciglia F, Aulisa L. Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria. Scoliosis. 2009;4:21.
    5. De Giorgi, Silvana & Piazzolla, Andrea & Tafuri, Silvio & Borracci, C & Martucci, Antonio & de giorgi, Gioacchino. (2013). Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery?. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 22. 10.1007/s00586-013-3020-1.
    6. Negrini S, Donzelli S, Lusini M, Minnella S, Zaina F. The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study. BMC Musculoskelet Disord. 2014;15:263. Published 2014 Aug 6. doi:10.1186/1471-2474-15-263
    7. Coillard C, Vachon V, Circo AB, Beausejour M, Rivard CH. Effectiveness of the SpineCor brace based on the new standardized criteria proposed by the scoliosis research society for adolescent idiopathic scoliosis. J Pediatr Orthop. 2007;27(4):375–379.
    8. Negrini S, Negrini F, Fusco C, Zaina F. Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements. Spine J. 2011;11(5):369–380.
    9. Negrini S, Atanasio S, Fusco C, Zaina F. Effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: results according to the SRS criteria for bracing studies - SOSORT Award 2009 Winner. Scoliosis. 2009;4:19.
    10. Rigo M, Reiter C, Weiss H. Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil. 2003;6:209–214.
    11. Maruyama T, Kitagawa T, Takeshita K, Mochizuki K, Nakamura K. Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment? Pediatr Rehabil. 2003;6(3–4):215–219.
    12. Aulisa AG, Guzzanti V, Falciglia F, Galli M, Pizzetti P, Aulisa L. Curve progression after long-term brace treatment in adolescent idiopathic scoliosis: comparative results between over and under 30 Cobb degrees - SOSORT 2017 award winner. Scoliosis Spinal Disord. 2017;12:36. Published 2017 Oct 30. doi:10.1186/s13013-017-0142-y
    13. Bjerkreim I, Hassan I. Progression in untreated idiopathic scoliosis after end of growth. Acta Orthop Scand. 1982;53(6):897–900. doi: 10.3109/17453678208992845.
    14. Weinstein SL. Natural history. Spine. 1999;24(24):2592–2600. doi: 10.1097/00007632-199912150-00006.
    15. Danielsson AJ, Nachemson AL. Radiologic findings and curve progression 22 years after treatment for adolescent idiopathic scoliosis: comparison of brace and surgical treatment with matching control group of straight individuals. Spine (Phila Pa 1976). 2001 Mar 1;26(5):516-25. PubMed PMID: 11242379.
    16. Pellios S, Kenanidis E, Potoupnis M, et al. Curve progression 25 years after bracing for adolescent idiopathic scoliosis: long term comparative results between two matched groups of 18 versus 23 hours daily bracing. Scoliosis Spinal Disord. 2016;11:3. Published 2016 Mar 9. doi:10.1186/s13013-016-0065-z
    Last edited by Dustin76; 06-05-2020 at 09:55 PM.

  5. #5
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,309
    Hey welcome back, Dustin.

    Nice analysis, nicely written.

    I don't understand this point, though...

    The foremost problem I found in scouring the literature is that sustained curve reduction after bracing is not even an outcome consideration for most studies. Nor is curve correction an outcome criterion on the list of outcome criteria proposed by the SRS. How can we find out if curve correction is possible if, for the most part, researchers aren’t even looking for the possibility? Along the same line, how can the SRS take a position that AIS curve correction is impossible if this possibility is not on their radar? A second problem I found is that the bracing studies often have little to say about the experience and skill of the bracing specialists.
    Why do you think they won't report curve correction if it was found? I think you have this backwards... curve correction isn't among the criteria because it hasn't been observed to date. If it occurred it would certainly have been noted. There is no embargo on reporting curve corrections had it been observed. In the course of looking for curve stabilization or slowing progression, curve correction would have certainly been easily noted had it occurred.

    In re brace skills, that is a bit all over the board. If we take percent correction in brace as a surrogate for brace skills, it's a mixed bag whether percent correction correlates with "success".
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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


    "We are all African."

  6. #6
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,309
    I see at least 10 studies of good methodological quality that indicate significant reductions in AIS curves have been not only attained, but maintained with minimal to mild worsening for years – 15 to 20+ years in some cases – after bracing ceases.
    Are these largely in very small curves? Are they all unequivocally AIS?
    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."

  7. #7
    Join Date
    Oct 2019
    Posts
    39
    Quote Originally Posted by Pooka1 View Post
    Hey welcome back, Dustin.

    Nice analysis, nicely written.

    I don't understand this point, though...



    Why do you think they won't report curve correction if it was found? I think you have this backwards... curve correction isn't among the criteria because it hasn't been observed to date. If it occurred it would certainly have been noted. There is no embargo on reporting curve corrections had it been observed. In the course of looking for curve stabilization or slowing progression, curve correction would have certainly been easily noted had it occurred.

    In re brace skills, that is a bit all over the board. If we take percent correction in brace as a surrogate for brace skills, it's a mixed bag whether percent correction correlates with "success".
    Curve correction has been observed and it is enough for the SRS to take notice and ask the question. When the SRS is doing their literature reviews, they need to actually ask the question, "can scoliosis curves improve and be stable as a result of bracing?" I get the impression that the answer to this question is being assumed and not discovered. If they don't ask the question of the literature, they won't find the studies I found. Even if they do find the studies I found, they are only asking whether bracing can alter the natural history. I'm not a big fan of regarding anything as impossible.....especially with mounting evidence to the contrary. It is just not very progressive way to operate. If a massive literature review were done that includes data from the 1950s to present, there is a lot more to suggest that improving curves doesn't happen than that it does. But if you just look at bracing studies from 2000 and beyond, there is plenty to say that curves can be reduced and maintained in AIS. One thing to consider is that, just as in any area of science, methods advance over time, sometimes very rapidly. It is great to stay evidence based, even essential to stay evidence based, but there is more to the story than scholarly stances based in good part on old information. I'm not saying the SRS is doing a bad job. They just can't stay on top of everything all the time. There are too many specific questions to ask of the literature for the SRS to touch them all at a frequency to stay up to date with everything.

  8. #8
    Join Date
    Aug 2019
    Posts
    45
    Quote Originally Posted by Dustin76 View Post
    Curve correction has been observed and it is enough for the SRS to take notice and ask the question. When the SRS is doing their literature reviews, they need to actually ask the question, "can scoliosis curves improve and be stable as a result of bracing?" I get the impression that the answer to this question is being assumed and not discovered. If they don't ask the question of the literature, they won't find the studies I found. Even if they do find the studies I found, they are only asking whether bracing can alter the natural history. I'm not a big fan of regarding anything as impossible.....especially with mounting evidence to the contrary. It is just not very progressive way to operate. If a massive literature review were done that includes data from the 1950s to present, there is a lot more to suggest that improving curves doesn't happen than that it does. But if you just look at bracing studies from 2000 and beyond, there is plenty to say that curves can be reduced and maintained in AIS. One thing to consider is that, just as in any area of science, methods advance over time, sometimes very rapidly. It is great to stay evidence based, even essential to stay evidence based, but there is more to the story than scholarly stances based in good part on old information. I'm not saying the SRS is doing a bad job. They just can't stay on top of everything all the time. There are too many specific questions to ask of the literature for the SRS to touch them all at a frequency to stay up to date with everything.
    I'll just report my kid's bracing results over 10 months without comment. All measurements are mine. I finally got in back to work the other day so I can play with her last scans to my heart's content (I don't have a CD drive at home). Btw, bracing was 17.6 hours a day from 9/19 until 12/19, and 19.8 hours per day from 12/19 to 5/20. I've run the heat sensor chips.

    8/2019: Diagnosis. 38.5T/35.0L. Risser not observable due to poor scan quality, but very likely on the border between Risser 1 and 2. Note: The initial radiologist significantly undermeasured the top curve (s/he had 29) to the point where I think s/he was probably measuring from the wrong level. I'm 99% confident in this. I consistently measure the curve at 37-39, and eyeballing the scans, it's not really changed from subsequent scans.

    10/2019: First in-brace x-ray. 29.0T/28.0L. Risser solid 2. The ped-ortho is disappointed because of the "poor correction."

    12/2019: Follow-up x-ray. 37.5T/33.5L. Risser between 3 and 4 left hip, still Risser 2 right hip. I've measured these scans hundreds if not thousands of times, and I'm convinced there was small but observable correction.

    5/20: Follow-up x-ray. 39.0T/36.5L. Risser 4 -- left hip completely capped, right hip 85% capped. Definite progression from 8/19 scan, although slight. Interestingly it's all in L1 -- the distal vertebrae in both curves. I haven't measured the tilt, but eyeballing it is's 2-3 degrees more. L4/L5 tilt unchanged, T9/T10 tilt unchanged. Doc starts weaning off of the brace because she's basically mature.

    So, bottom line. I think the brace basically did what it was designed to. It achieved some modest initial improvement, but that went away after nine months or so. The good news is that it bought time until she could be skeletally mature. I think that's probably the realistic goal with bracing. Improve a couple of degrees, reset the clock, and slow down progression and buy time. For a lot of girls diagnosed in the 12-13 yo range, if you can buy a year, they'll hit spinal maturity in a sub-surgical range. I've also heard that bracing is especially good at keeping lumbar curves flexible so that if they do need surgery selective fusion is still on the table, but I'm unaware of any studies on that.

  9. #9
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,309
    Quote Originally Posted by Dustin76 View Post
    Curve correction has been observed and it is enough for the SRS to take notice and ask the question. When the SRS is doing their literature reviews, they need to actually ask the question, "can scoliosis curves improve and be stable as a result of bracing?" I get the impression that the answer to this question is being assumed and not discovered. If they don't ask the question of the literature, they won't find the studies I found.
    Why do you assume they haven't asked the question and already gotten an answer to date?

    Even if they do find the studies I found, they are only asking whether bracing can alter the natural history.
    Are you saying they can read those studies and still conclude AGAINST EVIDENCE that bracing can't permanently reduce AIS curves? Isn't is infinitely more likely they consider those studies part of the "train wreck" of the literature?

    I'm not a big fan of regarding anything as impossible.....especially with mounting evidence to the contrary.
    No competent scientist is doing that.

    It is just not very progressive way to operate.
    Who do you think is operating this way?

    If a massive literature review were done that includes data from the 1950s to present, there is a lot more to suggest that improving curves doesn't happen than that it does. But if you just look at bracing studies from 2000 and beyond, there is plenty to say that curves can be reduced and maintained in AIS.
    Can you list the 3 best studies that show this? I will read them.

    One thing to consider is that, just as in any area of science, methods advance over time, sometimes very rapidly. It is great to stay evidence based, even essential to stay evidence based, but there is more to the story than scholarly stances based in good part on old information.
    Who exactly are you saying has their science mired in "old information"? Which researchers?

    I'm not saying the SRS is doing a bad job. They just can't stay on top of everything all the time. There are too many specific questions to ask of the literature for the SRS to touch them all at a frequency to stay up to date with everything.
    Are you saying these researchers aren't keeping up with their own field? If they aren't then nobody is.
    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."

  10. #10
    Join Date
    Oct 2019
    Posts
    39
    Quote Originally Posted by Pooka1 View Post
    Are these largely in very small curves? Are they all unequivocally AIS?
    The curves are in a wide range probably averaging moderate I would say. 25 degrees to beyond surgical range. They are AIS according to the studies. I referenced one study done by a highly skilled Cheneau bracing specialist that had curve reductions in 94% of those in the study, but they were easier to deal with curves in that they were single curves in those who were very compliant with bracing. While they were single curves, there were curves near 40 degrees that were reduced well under 10 degrees that were still under 10 degrees years after bracing ceased - I don't care what anybody says, this is essentially curing near surgical range scoliosis. And there are recent studies to suggest that these corrected curves will maintain well over 15-20 years - even more so because they were braced. While it could be small minority of bracing practitioners accomplishing these things, I believe that it is happening. Based on the literature and on those that I now know that are living it.

    My kids are not adolescent scoliosis....yet. I want them corrected down to near neutral spine before they get there. (My daughter is nearly there with her 20 and 20 S curve down to 6 and 12 after 6 months of bracing so far. As a late JIS, she would still probably be 20/20 or worse by now without bracing. Sure I could bank on a 1% chance that they will spontaneously resolve on their own, but no thanks. Their outlook is really bright if they can be held neutral or mildly overcorrected through the rapid growth spurts of puberty. I have reviewed this bracing plan with a respected pediatric orthopedic surgeon and we will be seeing another one in a month or so. The orthopedic surgeon was really impressed with the bracing and the radiation-free MRI imaging to monitor the curves. He said that he would have recommended bracing for both of them if they were not already braced. This is a respected surgeon at a major center.

    In contrast, I find no evidence so far of significant curve reductions with use of the Boston Brace which is still very frequently used in the US.

  11. #11
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,309
    Quote Originally Posted by Dustin76 View Post
    While they were single curves, there were curves near 40 degrees that were reduced well under 10 degrees that were still under 10 degrees years after bracing ceased - I don't care what anybody says, this is essentially curing near surgical range scoliosis.
    Reference please.

    And there are recent studies to suggest that these corrected curves will maintain well over 15-20 years - even more so because they were braced.
    References please.

    I have reviewed this bracing plan with a respected pediatric orthopedic surgeon and we will be seeing another one in a month or so.
    Are you still dealing with the chiro???? Did you read what I posted about chiro chollege? GPAs for admission?? etc.???
    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. #12
    Join Date
    Oct 2019
    Posts
    39
    Quote Originally Posted by Pooka1 View Post
    Why do you assume they haven't asked the question and already gotten an answer to date?



    Are you saying they can read those studies and still conclude AGAINST EVIDENCE that bracing can't permanently reduce AIS curves? Isn't is infinitely more likely they consider those studies part of the "train wreck" of the literature?



    No competent scientist is doing that.



    Who do you think is operating this way?



    Can you list the 3 best studies that show this? I will read them.



    Who exactly are you saying has their science mired in "old information"? Which researchers?



    Are you saying these researchers aren't keeping up with their own field? If they aren't then nobody is.

    I'm just going to say that if looking for curve correction is not part of SRS research outcome criteria, then to me they are not up to date. You can disagree if you want. You have said yourself that AIS curve correction is impossible. Where do you get this idea? The SRS appears to me to let old information speak too heavily into bracing capability. It just doesn't match what is happening in the field well enough. The possibility of correction is mentioned no where in their stuff. Not only am I seeing it happening in real people's lives, but there is enough in the literature to back it up.

    Here is the study that I was just talking about:
    De Giorgi, Silvana & Piazzolla, Andrea & Tafuri, Silvio & Borracci, C & Martucci, Antonio & de giorgi, Gioacchino. (2013). Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery?. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 22. 10.1007/s00586-013-3020-1.

    Another:
    Aulisa AG, Guzzanti V, Galli M, Perisano C, Falciglia F, Aulisa L. Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria. Scoliosis. 2009;4:21.

    Another:
    Negrini S, Donzelli S, Lusini M, Minnella S, Zaina F. The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteria: a prospective study. BMC Musculoskelet Disord. 2014;15:263. Published 2014 Aug 6. doi:10.1186/1471-2474-15-263

    P.S. - I just corrected my references. I had one mistake that through the numbers off for half of them. Should be fixed now.

  13. #13
    Join Date
    Oct 2019
    Posts
    39
    Quote Originally Posted by Pooka1 View Post
    Reference please.



    References please.



    Are you still dealing with the chiro???? Did you read what I posted about chiro chollege? GPAs for admission?? etc.???

    References are listed in my literature review. Yeah, I read all your chiro stuff. What you said could have truth to it, but I take each person, one at a time. I don't go with the theory that 100% or chiropractors know nothing. I heard this guy out. They orthopedic surgeon that we saw knows nothing about the guy other than seeing his braces on our kids and he was really impressed.

  14. #14
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,309
    Here is the study that I was just talking about:
    De Giorgi, Silvana & Piazzolla, Andrea & Tafuri, Silvio & Borracci, C & Martucci, Antonio & de giorgi, Gioacchino. (2013). Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery?. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 22. 10.1007/s00586-013-3020-1.
    48 patients hand selected out of how many treated? Thousands? Are they doing continued PT? Is there something unusual about this small group? Late-diagnosed EOS?

    23 hours a day plus an hour of PT every day. This reminds me of the claim that if you laid in bed 24/7 during the growth spurt a curve would not progress. This is why studies report stats on an intent to treat basis.
    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. #15
    Join Date
    Jan 2008
    Location
    NC
    Posts
    9,309
    Another:
    Aulisa AG, Guzzanti V, Galli M, Perisano C, Falciglia F, Aulisa L. Treatment of thoraco-lumbar curves in adolescent females affected by idiopathic scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria. Scoliosis. 2009;4:21.

    Fifty adolescent females.

    Since 1976, we have been treating thoraco-lumbar and lumbar idiopathic curves with the Progressive Action Short Brace (PASB).

    Seems like operatic levels of data selection and that group is highly unusual in some respect.
    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."

Posting Permissions

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