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  • #16
    Originally posted by structural75
    The vestibular system consists of the inner EAR, not the eyes as this poster has wrongfully assumed. It is established in many, many studies done by M.D.s specializing in this field (neurophysiology).

    They are FAR more than eye exercises.. had she known what vestibular was she wouldn't make such brash statements. Nobodies "trying" to do anything, they've been "legitimized" already.

    We know now that it is: not a chiro thing, but an MD, not about the eyes/eye exercises per se, but the inner ears, and that the field is not "bogus, but very much scientifically validated for its importance/relevance in a variety of conditions including scoliosis.

    I never had the intention of taking personal assualt on anyone, but in the heat of the moment it was all I could do to defend legitimate ground.


    Posted by Majestnic when she was seeing Dr. D. in New York before switching to Dr. Rivard:

    Nicole has specific exercises to do to strengthen her eye muscles. They involve eye tracking, etc.

    Posted by LATigner:

    My daughter also had the neurological testing done. Dr. Ron Marinaro explained what it was for and we chose to do it - no pressure or other tactics to try and force us. The reason we elected to do the testing is that there is a theory that occular vestibular inbalance is associated with scoliosis. Dr. Ron said that all of the scoliosis patients he has tested have had positive results. He was also clear that it is unknown whether this causes scoloisis or is a result of scoli. But it makes sense to me that if a person's brain does not perceive the vertical plane correctly and thinks they are standing up straight when they are not - this is a deterimental thing.

    Yes, the testing added $1200 to the cost but we were willing to try it based on our own research and conversations with Dr. Ron and others. Our daughter has some simple eye excercises to do.


    Posted by BlueCrystalMan:

    As for the extra testing... the data collected is going toward research, as there is a possible correlation between the ocular vestibular imbalance and scoliosis... the way I understood it is that the mind thinks the patient is out of balance and the brain uses the back muscles to balance a person. Over time, the muscles on one side or the other, depending on the perception of which way the body thinks its falling, get built up and in turn pull the spine that way. The testing determines which side is the more dominant side, and based on the data, eye exercises are prescribed to 'retrain' the brain to eliminate the imbalance. The testing goes toward prescribe specific exercises for the specific curves in his spine.

    The exercises prescribed, both for the eyes and the physical part go toward helping to eliminate the curve and its causes. Software is provided to help retrain the brain for a minute every day, and he has to do a spinning exercise in his desk chair while focusing on his thumb in the distance. All this goes toward helping the brain adjust to the fact that my son isn't really off balance.

    So personally, the tests made sense, and the data compiled for the greater good of current and future patients, and no I don't think I was scammed at all. Research dictates that they are on the right track, and so far my son's progression in terms of doing his exercises has been tremendous... I can see difference in his balance already both on the exercise ball and when doing his eye exercises.
    Last edited by Celia; 12-28-2006, 06:41 AM.

    Canadian eh
    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

    Comment


    • #17
      Celia,

      I thought we laid this one to rest...

      You Said:
      The rest of us were having a discussion on scoliosis it was pretty clear to all you were out in left field arguing the relevance of vestibular rehab as it pertains to *other* medical conditions.
      What you're calling a discussion consisted of you telling people that vestibular testing/rehab was a bunch of nonsense. You wouldn't let me past first base in terms of having a discussion on its relevance to scoliosis. You clearly felt it was irrelevant.

      I will kindly say... It was obvious I was arguing the relevance of vest testing/rehab as it pertains to scoliosis. I used its application to "other" medical conditions (once or twice) to exemplify its scientific validity and proven effect, which was originally discredited by you. You kept telling others and myself there was no evidence that it works, much less has anything to do with scoliosis. So I used "other" scientific applications of it to show its legitimacy and likely relevance to scoliosis, despite the lack of studies specifically in regards to scoliosis.. .

      If you hadn't been on my case the entire time, arguing against its validity and relevance to scoliosis, then maybe we could have gone in a more positive and productive direction with the "discussion". My original effort was to support the validity of the vest. testing as it related to scoliosis, and you wouldn't let that happen.

      Therefore, I'm a bit confused about the content of your last post here. It seems to point out everything that I've been trying to say this entire time.

      I'm not certain why you posted those quotes from me... they seem to make perfect sense, especially in context to your previous assumptions and comments. And the testimonials below them show positive and relevant application of vestibular testing/rehab in cases of scoliosis. Isn't this what I've been trying to say all along???

      Our proprioceptive inputs for balance and coordination (which then informs the musculoskeletal systems) comes from both the inner ear and eyes alike (vestibular and occular). I'm pretty certain I mentioned that earlier somewhere...
      ...not about the eyes/eye exercises per se, but the inner ears,
      and
      They are FAR more than eye exercises..
      was meant to be a simple correction in the purpose of vest. test, specifically the actual system those "eye exercises" are working to correct. By doing eye exercises, as well as others, they're working to correct the discrepency between the vestibular system (inner ear) and the proprioception of the eyes.

      So what seems to still be the problem?

      structural

      Comment


      • #18
        Originally posted by Mom37
        I just wanted all to know that my Insurance covered in it full, so I meant 100 percent, and considered it medically necessary. It is something that must be researched and decided upon individually. My understanding was that it was in connection with the whole Spinecor treatment. It is true not all doctors who fit Spinecor use that testing. It is like Spinecor, still being used by some doctors, but not all.
        Would you mind telling us what insurance company covered the testing? Just curious.

        Thanks.

        --Linda
        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

        Comment


        • #19
          Originally posted by structural75
          ...What you're calling a discussion consisted of you telling people that vestibular testing/rehab was a bunch of nonsense. You wouldn't let me past first base in terms of having a discussion on its relevance to scoliosis. You clearly felt it was irrelevant..
          One simply has to look at the length of your posts to know this is total rubbish! Your "poetic slamming" consists of going off on a tirade discussing matters totally unrelated to scoliosis.

          Originally posted by structural75
          ...Therefore, I'm a bit confused about the content of your last post here. It seems to point out everything that I've been trying to say this entire time. I'm not certain why you posted those quotes from me... they seem to make perfect sense, especially in context to your previous assumptions and comments. And the testimonials below them show positive and relevant application of vestibular testing/rehab in cases of scoliosis. Isn't this what I've been trying to say all along???
          There could only be one of two things: 1) there is something wrong with your mental faculties or 2) you think we're all a bunch of idiots! I personally think it's the former and I would highly recommend having vestibular testing done for yourself

          Originally posted by structural75
          ...My original effort was to support the validity of the vest. testing as it related to scoliosis, and you wouldn't let that happen.
          In response to this please refer to the following article: "Etiology of Idiopathic Scoliosis by T.G. Lowe and C.H. Rivard et/ al., ," Page 1161 - 1162 under the heading: Neurological Mechanisms, http://www.scoliosis-support.org/upl...ysfunction.pdf

          Further...*nowhere* in the following quote that you posted previously does it specifically state that the testing should be done for scoliosis. Your arguments are a SHAM!!!!!



          Why get vestibular tests ?

          1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety. Recent studies have suggested that vestibular tests are more accurate than clinical examination in identifying inner ear disorders (Gordon et al, 1996). Hearing pathway tests (audiometry, ABR, ECOG) can also be used for the same purpose, and are frequently combined with vestibular tests. In a cost-effectiveness analysis for evaluation for vertigo it was concluded that hearing testing followed by either posturography or ENG (electronystagmography) was the most effective method (Stewart et al, 1999).
          2.To detect central disorders. Recent studies have suggested that internuclear ophthalmoplegia, a central eye movement disorder, is missed by 71% of physicians unaided by quantitative oculomotor testing (Frohman et al, 2003).
          3.To decide if more expensive tests like MRI (Magnetic Resonance Imaging) are needed. Vestibular testing is more accurate than clinical symptoms in predicting whether neuroimaging tests will be abnormal.(Levy and Arts, 1996)
          4.To document objectively vestibular conditions such as BPPV and Perilymph fistula, which commonly occur after head injury, vestibular neuritis, and Gentamicin ototoxicity, which commonly is a side effect of medication.
          Last edited by Celia; 12-28-2006, 06:56 AM.

          Canadian eh
          Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

          Comment


          • #20
            Celia,
            you continue w/ the personal attacks...
            posted by Celia: There could only be one of two things: 1) there is something wrong with your mental faculties or 2) you think we're all a bunch of idiots! I personally think it's the former and I would highly recommend having vestibular testing done for yourself
            "you think we're all a bunch of idiots!"... Don't be silly, I'm only having this dialogue with you . Are you saying people with balance/coordination problems are stupid as well (intellectually challenged)? Vest. testing for me??? maybe I wasn't clear on what the vestibular system was... because I don't have any issues with balance, coordination, proprioception, etc.? I realize it must be frustrating to try and dig yourself out of the hole you're in, but seriously... act like an adult and move on........ !!
            Further...*nowhere* in the following quote that you posted previously does it specifically state that the testing should be done for scoliosis. Your arguments are a SHAM!!!!!
            That quote I posted was to point out the purpose/importance of vestibular testing in general. If you have a difficult time seeing the neurologic connection with scoliosis here then maybe I can spell it out to you in another lengthy, "irrelevant" post. Do you see the reason why this keeps going in circles yet?

            I acknowledged there aren't formal studies specifically pertaining to vest. testing/rehab in the treatment of scoliosis (hopefully that will change). Clinical successes and relevance, as the ones you highlighted in that previous post, do not need formal studies for confirmation. As for the rest of your posts, I simply won't dignify your attempt at redemption with a response. You're clearly reaching with all your might here, picking my skin out from under your fingernails.

            I have a few questions... Do you think scoliosis is more than just a curvature of the spine? Do you believe that it can affect, or can be affected by, other systems in the body? Is there validity in taking a multi-faceted approach, especially in ideopathic cases, to address these other systems? What do you consider relevant in the treatment of scoliosis? So what are the causes of ideopathic scoliosis or the progression of any scoliosis? What would assist bracing to have a better success rate? What is your medical/health training that makes you an expert on musculoskeletal dysfunctions, or the significance/insignificance of the nervous system as it pertains to scoliosis?

            Just curious.
            Last edited by structural75; 12-28-2006, 03:49 PM.

            Comment


            • #21
              Originally posted by structural75
              Celia,
              you continue w/ the personal attacks...

              Are you saying people with balance/coordination problems are stupid as well (intellectually challenged)? Vest. testing for me???

              One of the *many* reasons for getting vestibular tests:

              Why get vestibular tests ?

              1.Vestibular tests are tests of function. Their purpose is to determine if there is something wrong with the vestibular portion of the inner ear. If dizziness is not caused by the inner ear, it might be caused by disorders of the brain, by medical disorders such as low blood pressure, or by psychological problems such as anxiety.




              I may not be an expert but I can tell what is genuine from deception. The spinecor brace is attempting to address the neuromusculo-skeletal side to this scoliosis puzzle and neither vestibular tests nor phoney baloney eye exercises have to be conducted to know that the system is being affected.


              Excerpt from Spinecorporation Website:


              THE CONCEPT

              Scoliosis is not only a deformation of the spinal column, it is also a disease of the neuro-musculo-skeletal system. If it progresses, it can have serious consequences for the patient. This complex system's unstable balance during growth may, perhaps, be governed by the theory of chaos.

              Scoliosis is more than a 3D deformation of the spine. It also involves postural disorganization, neuro-musculoskeletal dysfunction and unsynchronized growth patterns all evolving with time. Using these four defining criteria, we can adopt a more specific approach to the static and dynamic properties of scoliosis that evolve over a period of time. Scoliosis is a four-dimensional deformation! Even though the aetiology of scoliosis remains unknown in 80% of cases, technological progress and the creation of multi-disciplinary teams mean that, in addition to the spinal deformation, a child's or adolescent's morphological and postural abnormalities can be recognized, together with their dysfunction, growth and maturation problems. The therapeutic concept of the SpineCor System is closely related to the aetiopathogenic concept. In keeping with this therapeutic concept, the design of this Dynamic Corrective Brace incorporates various independent, yet related, components.

              It provides dynamic control of the shoulders and pelvic girdles and thorax, controls movement, and modifies the three-dimensional postural geometry. This allows us to correct the three-dimensional deformation while harmonizing the function and maintaining it over time. More harmonious growth patterns can thus be achieved.
              Last edited by Celia; 12-29-2006, 09:49 PM.

              Canadian eh
              Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

              Comment


              • #22
                Originally posted by LindaRacine
                Would you mind telling us what insurance company covered the testing? Just curious.

                Thanks.

                --Linda
                I am insured by American Airlines, which self funds our health insurance, but is underwritten by United Healthcare. It was covered in full. Ultimately I paid for it, being self funded, but didn't find any need for concern. It now is a help to us to support further explanation of our daughters symptoms of nystagmus and scoliosis caused by Chiari and Syringomyelia. Information on eye movement evaluation from Dr. D in NYC can be found on www.scoliosissystems.com/neuro.html
                Last edited by Mom37; 12-29-2006, 12:43 AM. Reason: corrections
                Shirley
                Mom to Amanda, 18, Scoliosis T58, previous Spinecor bracing for 9 months before diagnosed with Chiari I CM, and Syringomyelia (Syrinx) SM. CM/SM decompression surgery 12/4/06, Spinal fusion surgery with titanium rods and hardware and full correction 8/1/07 at Texas Scottish Rite Hospital for Children.

                Also mom to Megan, 14, with diagnosis PDD-NOS on the autism spectrum

                Comment


                • #23
                  Celia,

                  Anxiety is not an intellectual deficit, nor do psychological problems necessarily reflect ones intellectual capacities.

                  Fact or Fiction?
                  Without neurologic testings, beyond vestibular as well, how does one determine precisely where the neurologic problem might be? How do you treat the neurologic component of this puzzle if you don't know precisely where the dysfunction is? It's like saying you don't need x-rays because you already know that scoliosis is a curvature of the spine, and any trained eye can see that without an x-ray.?? Putting on a brace and hoping for the best is a shotgun approach, as we've seen with unsuccessful bracing attempts.

                  I think the spinecor brace is certainly adding a general functional neurologic component to the treatment, however it's quite far from being the be all, end all in regards to this aspect.

                  Comment


                  • #24
                    Originally posted by structural75
                    Without neurologic testings, beyond vestibular as well, how does one determine precisely where the neurologic problem might be? How do you treat the neurologic component of this puzzle if you don't know precisely where the dysfunction is?
                    I've already stated my case and I have nothing further to say to you! If you need further clarification please re-read *any* of the references I've referred to already. Dr. Rivard's article specifically states that no clear cut neurological tests either for diagnosing idiopathic scoliosis or predicting it's progression have been established. Further... please re-read the following:


                    1: Clin Orthop Relat Res. 1980 Oct;(152):232-6.

                    Equilibrium factors as predictors of the prognosis in adolescent idiopathic scoliosis.

                    Sahlstrand T, Lidstrom J.

                    Postural equilibrium factors were evaluated as indicators of the prognosis in 52 patients with adolescent idiopathic scoliosis. The hypothesis was that dysfunction in these equilibrium factors might imply a higher risk for the curve to progress. The postural equilibrium was studied by stabilometry, and the function of the central nervous system was assessed by electoencephalography (EEG) and the vestibular function by electronystomography (ENG). During a follow-up period averaging 2.9 years, ten patients showed progression of the scoliosis. No differences were found in the distribution and frequency of abnormalities between the patients with progressive and nonprogressive scoliosis. Stabilometry, electroencephalography, and electronystomography as used in this study did not seem to be of predictive value for the outcome in the individual case.
                    PMID: 7438607 [PubMed - indexed for MEDLINE]


                    If you want to ponder those questions please do so, either by going back to medical/chiropractic/osteopathic school or where ever it is you got your "training".
                    Last edited by Celia; 12-30-2006, 08:07 AM.

                    Canadian eh
                    Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

                    Comment


                    • #25
                      Celia,

                      Thank goodness... !

                      p.s. - I know you're not answering any of my questions, so take these as retorical.
                      The spinecor brace is addressing the neuromusculo-skeletal side to this scoliosis puzzle and neither vestibular tests nor phoney baloney eye exercises have to be conducted to know that the system is being affected.
                      As Gerbo has pointed out many times, how do we know if it's being affected for the better or for the worse? Given that some bracing attempts are not successful, how do we know it's not because the affect on the nervous system is actually harmful in those cases? How long do we wait to find out its actual affect? Maybe testing and specific neurologic rehab would shed some light on this matter, rather than just assuming its affect. Much the same as repeated x-rays show the progress, or lack thereof, of the curvature for confirmation of therapeutic effect. If the testing revealed that neurolgic deficits were worsening then appropriate intervention could happen sooner than later. (In the same way that the studies you referenced on the predictability factor could allow proper intervention BEFORE an ideopathic scoliosis asserted itself. Address the neurologic imbalance and maybe the potential scoliosis won't have an opportunity to occur.?). Just another musing to consider.

                      Given that every individual is different, we cannot expect a 'one-size-fits-all' approach to affect everyone the same.

                      Comment


                      • #26
                        This makes sense to me-re: "idiopathic scoliosis"

                        This Polish study(among others they have done) makes a lot of sense to me especially since my surgeon noted, during one of my abdominal surgeries, that my right rectus abdominus muscle was abnormal. It says nothing about the vestibular system:


                        http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum
                        Last edited by Karen Ocker; 12-30-2006, 10:11 AM. Reason: spelling
                        Original scoliosis surgery 1956 T-4 to L-2 ~100 degree thoracic (triple)curves at age 14. NO hardware-lost correction.
                        Anterior/posterior revision T-4 to Sacrum in 2002, age 60, by Dr. Boachie-Adjei @Hospital for Special Surgery, NY = 50% correction

                        Comment


                        • #27
                          I just read all of this and got absolutely lost. Am I dumb, no I am just a person who has lived with scoliosis for 40 years and was operated on many years ago.

                          I enjoy reading posts from people who actually are experiencing the scoliosis itself and from parents who are looking to help their little ones, but as far as people who have no idea what it is like to live with it, well please just keep your opinions to yourself. You see you have no first hand experience to back up anything you say as you have not FELT it yourself.

                          Dont start another getting nasty lession on me either ,as this forum is here to help each other.
                          If you havent felt the pain, havent felt the brace, havent felt the plaster cast as in my case,,well in my opinion you havent got a clue.

                          Macky
                          Last edited by macky; 12-30-2006, 04:56 AM.
                          Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
                          Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

                          Comment


                          • #28
                            Macky,

                            Why so rude and bitter. Please be clear, you know nothing about me, or my experiences.

                            Do all, or any of the Doctors helping people with scoliosis have it themselves?... hhmmmm? I work with people with scoliosis so I'd say I have a pretty good idea of what they're going through. Practitioners of any discipline do not need to suffer from a condition to be able to provide assistance to others. My education and profession in the health care/medical field is plenty to "back up" my statements. If you want to share you're personal experiences, that's obviously fine.

                            People come to this forum for many reasons. Support, comfort, empathy and first-hand experience are among those very important and necessary reasons. I have never attempted to give my "opinions" on those matters. However, some are also seeking input from others on this vast and elusive condition.
                            parents who are looking to help their little ones
                            It would be a shame if those parents you speak of didn't do everything they could... clearly surgery alone is generally a temporary fix. And if treatment hasn't changed much in the past thirty years despite the results (surgery + bracing), then I would be curious myself about additional options in management and self-care. Your body is telling you now that it is not a machine or an inanimate object, and you can't continue treating it as such. Just because the curve has been reduced with implants, doesn't mean you're out of the woods.

                            If you don't agree with non-surgical approaches, then stay out of those threads! But don't be a discouraging obstacle to others who believe in a more comprehensive approach, and aren't too lazy to do all they can to help themselves. And remember, this forum represents only a minute fraction of the population of people throughout the world who are afflicted with this condition. Nobody on this forum, including myself, has the final word on what works, and what doesn't... That is a unique and individual experience.

                            structural
                            p.s. - This is the vestibular thread... Did you have anything productive to say about it?
                            Last edited by structural75; 12-30-2006, 06:41 AM.

                            Comment


                            • #29
                              Sorry guys for saying language like I did which I have now edited out.

                              I knew you would post back Structural and I dont know why. You are so defensive.

                              What upsets me and really breaks my heart is that all this medical jargon that is going on about non surgical scoliosis fixes, well people dont have any idea at all what the end result will be. It certainly hasnt been around long enough for it to be proof that in years to come the spines will not curve once again.

                              We all have our opinions and I have as much right to disagree with you as anyone else and to post on here if I want. I wish with all my heart that all the medical research will one day help scoliosis and people will not have to have operations. Until all this is proved, I myself ,and I am allowed to my own opinion, cannot agree.

                              I am a mum of two adult boys I am not rude or bitter, just a person who has lived with scoliosis for 40 years and it hurts me that people like yourself get up on your soap boxes. You probably mean well but you could also be offering false hope. My surgery, and I was so very lucky even though I have pain which I cope with, was not a tempory fix, it was a permanent one and has not in any way stopped me from living a full life.
                              Now please I do not want to go on with this. This is my opinion and mine only, and maybe in 10 - 20 years time if I have any proof that any of this will actually be one of the medical discoveries of our time, I may apologise, but I dont think I will have too.

                              I absolutely do not like putting this opinion on here because everytime I feel like I have to be truthful with my own self and post same, I know I will get abused and I just did. I now know my place and will make sure I keep it from now on.

                              Macky
                              Last edited by macky; 12-30-2006, 05:23 AM.
                              Operation 1966, Fused from T4 to L3, had Harrington rods inserted. Originally had an 85 degree Thoracic curve with lumbar scoliosis as well but had a good correction.
                              Perfectly normal life till 1997 but now in a lot of pain daily. Consider myself very fortunate though.

                              Comment


                              • #30
                                Macky,

                                I'm only defensive because certain people are offensive toward me. I respect your position to disagree... but it often goes beyond disagreement and becomes insulting and denigrating. Let's please just end the personal insults and I won't have a need to defend. I do it primarily because some of you have driven others off this site in the same manner, and I don't think that's fair or appropriate simply because you disagreed.

                                I completely understand your point. However I really don't believe that I have suggested the use of any of these non-surgical approaches in exclusivity from surgical ones or as "fixes", but rather as an a compliment to a well rounded and realistic treatment strategy. I strongly believe they have value in combination... so that doesn't put forth "false hope" of any kind. It could very likely increse the longevity of the surgical procedures, minimizing or reducing the likelyhood of problems later on, such as your own. I'm certain that surgery helped you for many years, and since you can't have another, maybe some type (I'm not suggesting vestibular testing for you specifically) of non-surgical approach could bring you a better quality of life and comfort. I wish you the best with whatever you do.

                                Non-surgical approaches are not new. The Scroth Method has been around for quite some time. It's no less valid than the spinecor brace, which doesn't yet have the longevity that you're asking for. Nobody here knows what the spincor brace will do for someone in 20, 30, or 40 years down the road... so that is still speculative at this point, but clearly worth the effort.

                                structural

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