How important is the skill of the Brace Fitter?

[txmarinemom]

It's interesting alright, it's happening, there's a, yet to be marketed test, that will show the genetic markers that supposedly will show whether your child will progress regardless of bracing . . it'll be really interesting to see what it does to the whole "bracing industry." And how fast it gets out on the market; money talks.

pat,

The test you refer to is VERY limited and only covers a small subset of patients. It's not the panacea many think it is from what I've read. How fast it gets on the market is really irrelevant to most because it they aren't candidates *anyway*.

It's a start, but it's overrated in its current form.

[Karen Ocker]

Would a brace have helped me???

Karen, do you think that if you had been offered a brace, your curve would have stayed relatively moderate rather than progressing to 100 degrees? Or are you happy that you didn't wear one?

by Tonibunny

Dr. Cobb didn't believe braces helped.(in the 1950s). I personally believed it would not have helped my curves and it's just as well because I was miserable enough from my physical appearance than to wear a brace as well.
I often thought my scoliosis was "malignant" and that's even the word I used sometimes to describe it.

The treatment those days involved being put in a cast -head to knee- with a hinge on one side and a turnbuckle on the other. That was to gradually stretch put the major curve to balance it with the smaller curves. A hole was then cut through the back of the cast for the fusion surgery--no hardware done those days. I could not walk for a year while the fusion healed!!!
-Even after all that my fused spine did not prevent curving over my adulthood. But it kept me functioning for 40+ years.
If that couldn hold me how in the world would a brace???

Happily, the new revision procedure done 6 years ago has held the excellent correction and I am pain free living a perfectly normal life.

[tonibunny]

Hi Karen, I was just wondering if you thought a brace could have slowed your progression, rather than halted it, and whether you thought that would have been worth it in your case

I don't believe that bracing can halt progression in large progressive curves either. In 1976 I was diagnosed with a 62 degree thoracic curve/40 degree lumbar curve as a 6 month old baby (idiopathic infantile scoliosis) and was put straight into Minerva casts and then wore Milwaukee braces alternating with EDF casts from the age of 4 until I was 10, when I had my first surgery. I do believe that the bracing helped to slow my progression as my thoracic curve was only 76 degrees by the time I had the surgery done, so for me, I think it was worth it. I had halo traction and wore plaster casts for a year following the surgery but I ended up with a 45 degree post-op thoracic curve, which I think is a fantastic result for the time considering how I started out. I believe that if I hadn't had a brace or casts, my curve would have ended up a lot more severe and it would have been impossible to get such a good correction.

I have a friend who started out with a 40 degree curve before the age of 5 and was not offered bracing - she ended up with a 120 degree double curve by the time she had surgery in her teens, and by then the surgeons found it impossible to implant a Harrington Rod because the curve was so severe and so stiff. All they could do was fuse the spine where it was I have another friend who also started out with minimal juvenile IS curves, but with no bracing ended up with a 155/80 degree curve! These friends are from Ireland by the way, which was way behind other countries in scoliosis treatment in the 1970s.

Because of this, my view is that bracing is worth it, even if it can't prevent surgery, because it can help to minimise the curve so that the best possible correction can be achieved.

I do understand though that it is a lot lot harder for adolescents to tolerate braces than for children who have grown up since infanthood wearing casts and braces To suddenly be faced as a teenager with an old-style Milwaukee (such as we wore back then) must have been terrifying, so I can definitely understand why you wouldn't want that additional trauma.

[Karen Ocker]

I was perfectly straight until age 11 so I cannot relate to infantile or juvenile scoliosis.

I've heard of serial casting working in those groups. Perhaps other genetic factors as well as spinal malformations are causes. For example, if a spine is missing or has malformed vertebrae the spine is not supported in the way is was designed to do. It can curve or collapse. Not sure bracing/casting be a permanent solution but would hold until maturity when surgery would hold or prevent the spine from collapsing again.

When polio was prevalent(as when I was a teen), muscle weakness might have been the cause. I had a few hospital roommates who developed scoliosis after polio.

[tonibunny]

Well, we all have idiopathic scoliosis, rather than congenital scoliosis - no vertebral malformations - and none of us had polio.

Corrective serial casting wasn't available when I was a child - I was born two years too early. Min Mehta started her work on this in 1977 at the hospital where I was treated, but she initially worked with infants with much smaller curves than I had, and sadly I was considered too old by then anyway. I knew Min Mehta as I grew up because she was a colleague of my own consultant and I'd see her around. The casts I wore simply held my curves in the same way that the braces did.

I am pretty much convinced that the Milwaukee braces I wore helped to slow the progression of my curves, because I can compare myself and other friends who wore braces with groups of friends who didn't. I can't say whether they would have worked for anyone else, I'm just interested to hear if other people think they themselves would have benefitted from bracing or not