in-brace vs. out-of-brace x-rays/progression question

[leahdragonfly]

Our 6 y/o daughter just started wearing a boston brace for JIS, and we have encountered a difference of opinion regarding follow-up x-rays. We saw Dr Betz at Shriners Philly because we are interested in vertebral body stapling. He wanted Leah to wear a brace for a year to allow her to grow until age 7 before having the VBS surgery. He wants Leah to have x-rays every three months with a 48-hour period out of the brace before each x-ray.

He had us transfer our care to Shriners Portland, which is in our home state, for follow-up. We met Dr d'Amato, who concurred with the bracing until VBS plan, but he said he prefers in-brace x-rays. It is pretty critical to detect progression if it happens in Leah, because if it does, we will proceed to VBS sooner. So my question is, how well can you detect progression with in-brace x-rays? If the brace gives, say, a 50% curve correction (or more), than a small progression of several degrees would be halved, and then would it not probably be considered "margin of error?" We like and trust Dr d'Amato very much, and we will ask him at our upcoming appt about this, but I am just wondering about the experiences of other parents here. We hate to insist on out-of-brace x-rays just because "Dr Betz said so."

If anyone out there has any advice, we would greatly appreciate it. I know the Spinecor protocol involves in-brace x-rays, can anyone help?

[mariaf]

Hi,

I asked Dr. Betz SPECIFICALLY about that once and he said if the brace isn't off at least 24 hours prior to an x-ray you could get a lower reading on the degrees than is accurate. He said it takes at least that long for the muscles to return to their natural position. I believe there was someone else who posted recently saying the same thing.

I'm sure you could e-mail him or Janet for clarification. If you need either of their addresses, let me know.

[malka22]

Gayle, I hope you don't mind, but I have a question for you that's unrelated to VBS. I notice in your signature, you mention "non-union in fusion." Could you please explain what that is? Thanks so much, & best of luck with your daughter!

[leahdragonfly]

non-union of fusion

Hi Martha,

It sounds like your daughter got an awesome correction from her recent surgery! Her back must look great.

A non-union is also known as pseudoarthrosis. It is when a fused area fails to heal, in other words, the fusion doesn't take. Apparently it can be very hard to detect on x-rays. In my case, I haven't had an x-ray for 24 years after my surgery, and when I had recent x-rays, the area that was supposed to be fused is not, the bone graft is gone except for some small remnants (I guess reabsored, I'm not sure).

I hope that makes sense! Take care,

Gayle

[sparklegirl59]

well, God will be with her. good luck!!! she's in my prayers.