EDIT
I see this thread has received over 6000 views.
I feel I need to edit this post and say up here in the front that we have decided AGAINST the SpineCor after trying it for 2 months.
Not ready to get into details, but in the interest of completeness I wanted to add this to the post.
OK, this may be a long post. It is a continuation of a couple of threads
Here and Here where my understanding and thinking on the whole topic of bracing has evolved.
Although I use the singular "I", a more accurate title might be "Why WE decided to brace our daughter with SpineCor" as it was a mutual decision between my wife, my daughter and myself. But since "I" am the one who is writing this, I am writing in that voice.
On the other thread, forum participants asked some good questions regarding the SpineCor. While thinking about the response I realized it is basically a summary of “Why I decided to brace my daughter with the SpineCor”. I can totally respect and understand a parent looking at the same information and coming to a completely different decision. Each child is different, every family is unique, and we all must bear the personal responsibility for our decisions. I am putting this in a separate post in case someone out there is in the same situation as I was in 6 weeks ago, it may be easier to find. Perhaps this can be used as a STARTING point for their own personal research. Everything you read on this forum is just a personal opinion, and this is no different. I suggest anyone using this site to continually read the disclaimer on the introductory page. And then read it again.
If you are going to try to learn about the issue and controversy about bracing I strongly suggest that you gain access to the medical literature. PubMed is a good starting point but they only provide the abstracts. There is much to learn by reading the full papers. The discussions about bracing trials are more statistical than medical. Most large universities with a medical school have the journals. Anyone (not just the med students) affiliated with the university has access to the libraries. Most libraries are also open to the local communities. Once you have access you will find most of the journals are available electronically. I also suggest you read the letters to the editors. Often, controversial studies are further discussed and debated in the “letters” section of the journals several months after the original paper is published.
My dear 14 year old daughter was diagnosed with AIS 6 weeks ago at her yearly well child visit. We quickly met with an orthopedic surgeon who said the curve was 38 degrees and told us she should be braced. She is Risser 0 which means she likely has not finished growing although she is almost 1 year post menarche. He recommended the Boston Brace. I have learned that with her low Risser and high curve angle, she has a higher likelihood of ultimately progressing to surgery. EDIT - her skeletal age appears to be older than her Risser suggests - see discussion below here.
OK, so what have I learned about bracing? It can basically be summed up as follows:
There is no clear consensus.
On the other threads you can read discussions about some of the pro and con arguments regarding brace efficacy. (there we are talking about bracing in general, not one brace vs another.) It is my personal opinion that bracing is beneficial in many children. Many people, far more knowledgeable than I, share this view. Although I acknowledge that a valid case has been made by some researchers that, basically, the jury is still out. There is a large trial underway now where they are randomly assigning children to either be braced or unbraced and the study will follow and compare the progression of their AIS. It will probably be several years before we know the results.
Now, if you’re still with me, you’ll see that we have decided to have our daughter braced. If her curve were significantly different (one way or the other) or if she were in a different point of her growth, we may have come to a different decision. The next decision for us was which brace to use.
Anyone who googles “scoliosis” will be bombarded by advertisements for SpineCor providers. I found this troubling. It seems very commercial and drove home the “for profit” aspect of a medical device. If we view it in the context of Sally Field hawking Boniva and Bob Dole with Viagra I suppose it is more understandable. Anyway, I got over it, but it caused me to be more even more suspect of the literature. It was going to take more to convince me than just personal testimonies, the bar was raised.
I think SpineCor made a bad business decision marketing the brace largely through Chiropractors here in the US. Most successful orthopedic doctors probably don't have the time to devote to the training necessary to fit the SpineCor (although a few hospitals in the states are using it) The orthopods leave much of the Boston brace fitting to orthotisists. If an orthopedic doctor wanted to fit a patient with a SpineCor he would have to rely on one of the several trained chiro’s to help. Many orthopods don’t have high respect for chiropractors. The chiro’s DO often have access to an x-ray machine and that is necessary. And I would guess that the vast majority of chiropractors are caring legitimate professionals who, if trained, have the skills and knowledge to use the SpineCor brace.
It is unfortunate that most of the literature on the SpineCor is written by the doctors who developed it. There may be bias, I don't see how there can NOT be bias. But, unless there is actual malfeasance, the data in the published literature on the SpineCor looks pretty compelling. I am not going to link the papers here, but they are not that hard to find.
There is a common theme on the bracing forum where one gets the impression that the hard braces are very difficult to wear and adjust to. The technical literature on bracing studies notes that compliance is a real issue. I get the impression after reading posts here that for children wearing the SpineCor, it is not that difficult to tolerate.
We are going with the SpineCor. If it fails to stop the curve progression I can at least find solace in the thought that perhaps NO brace would have stopped the curve and I didn't subject her to years of hard brace treatment. And, some people, not all, maybe not the majority, but some, have experienced pretty remarkable results.
Which brings me to addressing the following comments. Sharon on the other thread asks?
Is there any evidence to date in hand that Spinecor can actually permanently reduce a curve? Is there any evidence that Spinecor holds the curve such that growth corrects the curve like has been seen with VBS?
If so, I think it is the first brace to ever accomplish that. It would be huge. To date, only surgery, fusion and non-fusion, can reduce a curve permanently as far as I know. Someone correct me if I'm wrong.
and
Do they have JIS patients yet who were braced through growth spurts and have reached skeletal maturity and have a stable Cobb angle less than the highest measured at any point?
If they do, it will be huge.
Well, Yes, there is some evidence that some patients have had permanent reductions. Bare with me while I walk you through this.
Montgomery (in 1990 Journal of Pediatric Orthopedics) makes the case that 2 years post bracing is sufficient for predicting progression. He says “A follow-up of 2 years was sufficient to predict with great accuracy (97%) all incidences of failure.” Perhaps this is why the new SRS study guidelines call for the inclusion of data 2 years post bracing.
What do we know about the boston brace 2 years post bracing? Curves revert to prebrace amplitudes. That’s not bad, in fact that’s great if it means the curve is stopped and surgery is avoided. It is considered a resounding success.
But what about the data for the SpineCor? A paper published in 2007 (Colliard, Journal of Pediatric Orthopedics) complied with the new SRS guidelines for bracing studies. (And, correct me if I am wrong, I think this is the first Brace paper that came out presenting data in accordance with the new SRS guidelines). They presented their data for SpineCor patients 2 years after bracing ceased. They report: “Comparing the end of bracing Cobb angle to the one at 2 years after bracing, our study reveals that the follow-up of orthopaedic treatment was a success in 95.7% of the patients, with a mean correction angle of 8.6 +/- 1.7 degrees.“.
Dr. Colliard in an earlier paper showed a graph (attached). This was from an earlier study with a smaller group of patients. But it shows similar results. I added the red horizontal line marking before brace average curve. Compare it with the 2 year post brace curve amplitude. Pretty impressive.
Some patients had an 8.6 degree correction maintained 2 years after removal of the brace (ie permanent). That is indeed, as Sharon says, “huge” and that is “Why I decided to brace my daughter with the SpineCor”.
I see this thread has received over 6000 views.
I feel I need to edit this post and say up here in the front that we have decided AGAINST the SpineCor after trying it for 2 months.
Not ready to get into details, but in the interest of completeness I wanted to add this to the post.
OK, this may be a long post. It is a continuation of a couple of threads
Here and Here where my understanding and thinking on the whole topic of bracing has evolved.
Although I use the singular "I", a more accurate title might be "Why WE decided to brace our daughter with SpineCor" as it was a mutual decision between my wife, my daughter and myself. But since "I" am the one who is writing this, I am writing in that voice.
On the other thread, forum participants asked some good questions regarding the SpineCor. While thinking about the response I realized it is basically a summary of “Why I decided to brace my daughter with the SpineCor”. I can totally respect and understand a parent looking at the same information and coming to a completely different decision. Each child is different, every family is unique, and we all must bear the personal responsibility for our decisions. I am putting this in a separate post in case someone out there is in the same situation as I was in 6 weeks ago, it may be easier to find. Perhaps this can be used as a STARTING point for their own personal research. Everything you read on this forum is just a personal opinion, and this is no different. I suggest anyone using this site to continually read the disclaimer on the introductory page. And then read it again.
If you are going to try to learn about the issue and controversy about bracing I strongly suggest that you gain access to the medical literature. PubMed is a good starting point but they only provide the abstracts. There is much to learn by reading the full papers. The discussions about bracing trials are more statistical than medical. Most large universities with a medical school have the journals. Anyone (not just the med students) affiliated with the university has access to the libraries. Most libraries are also open to the local communities. Once you have access you will find most of the journals are available electronically. I also suggest you read the letters to the editors. Often, controversial studies are further discussed and debated in the “letters” section of the journals several months after the original paper is published.
My dear 14 year old daughter was diagnosed with AIS 6 weeks ago at her yearly well child visit. We quickly met with an orthopedic surgeon who said the curve was 38 degrees and told us she should be braced. She is Risser 0 which means she likely has not finished growing although she is almost 1 year post menarche. He recommended the Boston Brace. I have learned that with her low Risser and high curve angle, she has a higher likelihood of ultimately progressing to surgery. EDIT - her skeletal age appears to be older than her Risser suggests - see discussion below here.
OK, so what have I learned about bracing? It can basically be summed up as follows:
There is no clear consensus.
On the other threads you can read discussions about some of the pro and con arguments regarding brace efficacy. (there we are talking about bracing in general, not one brace vs another.) It is my personal opinion that bracing is beneficial in many children. Many people, far more knowledgeable than I, share this view. Although I acknowledge that a valid case has been made by some researchers that, basically, the jury is still out. There is a large trial underway now where they are randomly assigning children to either be braced or unbraced and the study will follow and compare the progression of their AIS. It will probably be several years before we know the results.
Now, if you’re still with me, you’ll see that we have decided to have our daughter braced. If her curve were significantly different (one way or the other) or if she were in a different point of her growth, we may have come to a different decision. The next decision for us was which brace to use.
Anyone who googles “scoliosis” will be bombarded by advertisements for SpineCor providers. I found this troubling. It seems very commercial and drove home the “for profit” aspect of a medical device. If we view it in the context of Sally Field hawking Boniva and Bob Dole with Viagra I suppose it is more understandable. Anyway, I got over it, but it caused me to be more even more suspect of the literature. It was going to take more to convince me than just personal testimonies, the bar was raised.
I think SpineCor made a bad business decision marketing the brace largely through Chiropractors here in the US. Most successful orthopedic doctors probably don't have the time to devote to the training necessary to fit the SpineCor (although a few hospitals in the states are using it) The orthopods leave much of the Boston brace fitting to orthotisists. If an orthopedic doctor wanted to fit a patient with a SpineCor he would have to rely on one of the several trained chiro’s to help. Many orthopods don’t have high respect for chiropractors. The chiro’s DO often have access to an x-ray machine and that is necessary. And I would guess that the vast majority of chiropractors are caring legitimate professionals who, if trained, have the skills and knowledge to use the SpineCor brace.
It is unfortunate that most of the literature on the SpineCor is written by the doctors who developed it. There may be bias, I don't see how there can NOT be bias. But, unless there is actual malfeasance, the data in the published literature on the SpineCor looks pretty compelling. I am not going to link the papers here, but they are not that hard to find.
There is a common theme on the bracing forum where one gets the impression that the hard braces are very difficult to wear and adjust to. The technical literature on bracing studies notes that compliance is a real issue. I get the impression after reading posts here that for children wearing the SpineCor, it is not that difficult to tolerate.
We are going with the SpineCor. If it fails to stop the curve progression I can at least find solace in the thought that perhaps NO brace would have stopped the curve and I didn't subject her to years of hard brace treatment. And, some people, not all, maybe not the majority, but some, have experienced pretty remarkable results.
Which brings me to addressing the following comments. Sharon on the other thread asks?
Is there any evidence to date in hand that Spinecor can actually permanently reduce a curve? Is there any evidence that Spinecor holds the curve such that growth corrects the curve like has been seen with VBS?
If so, I think it is the first brace to ever accomplish that. It would be huge. To date, only surgery, fusion and non-fusion, can reduce a curve permanently as far as I know. Someone correct me if I'm wrong.
and
Do they have JIS patients yet who were braced through growth spurts and have reached skeletal maturity and have a stable Cobb angle less than the highest measured at any point?
If they do, it will be huge.
Well, Yes, there is some evidence that some patients have had permanent reductions. Bare with me while I walk you through this.
Montgomery (in 1990 Journal of Pediatric Orthopedics) makes the case that 2 years post bracing is sufficient for predicting progression. He says “A follow-up of 2 years was sufficient to predict with great accuracy (97%) all incidences of failure.” Perhaps this is why the new SRS study guidelines call for the inclusion of data 2 years post bracing.
What do we know about the boston brace 2 years post bracing? Curves revert to prebrace amplitudes. That’s not bad, in fact that’s great if it means the curve is stopped and surgery is avoided. It is considered a resounding success.
But what about the data for the SpineCor? A paper published in 2007 (Colliard, Journal of Pediatric Orthopedics) complied with the new SRS guidelines for bracing studies. (And, correct me if I am wrong, I think this is the first Brace paper that came out presenting data in accordance with the new SRS guidelines). They presented their data for SpineCor patients 2 years after bracing ceased. They report: “Comparing the end of bracing Cobb angle to the one at 2 years after bracing, our study reveals that the follow-up of orthopaedic treatment was a success in 95.7% of the patients, with a mean correction angle of 8.6 +/- 1.7 degrees.“.
Dr. Colliard in an earlier paper showed a graph (attached). This was from an earlier study with a smaller group of patients. But it shows similar results. I added the red horizontal line marking before brace average curve. Compare it with the 2 year post brace curve amplitude. Pretty impressive.
Some patients had an 8.6 degree correction maintained 2 years after removal of the brace (ie permanent). That is indeed, as Sharon says, “huge” and that is “Why I decided to brace my daughter with the SpineCor”.
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