Page 1 of 7 123 ... LastLast
Results 1 to 15 of 92

Thread: Does Bracing Work?

  1. #1
    Join Date
    Dec 2008
    Posts
    494

    Does Bracing Work?

    The million dollar question: "Does Bracing Work?".

    I submit the clear answer is YES

    Now, I know that this is something that we've discussed on other threads here. I've been wrestling with this concept for a while.

    Here is the caveat: It all depends what is meant by the word "work".

    Dr. Dolan and the BrAIST team in Iowa have made a compeling case that we dont know if bracing works to reduce the incidence of surgery.

    What they have not done (or attempted to do) is to show that we dont know if bracing works to alter the natural history of AIS. That's because we do know that it indeed alters the natural history.

    A very knowlegable poster on this forum often says
    Surgery is the only proven option to reduce and stabilize curves permanently.

    That assertion has always bothered me. The whole "permanent" thing bothers me because the "surgical Revision" thread on this forum is so large. What also bothers me is the "end point" used in the statement: "reduce and stabilize".

    The very recent Danielson paper that looked at the Swedish patients involved with the 1995 SRS bracing study makes the following conclusion:

    We therefore think that the basic findings, that well-performed brace treatment can stop curve progression and that observation will allow some curves to progress until treatment is needed, are still valid.

    There are loads of other papers that show bracing alters the natural history. The BrAIST study is designed to see if it alters the ultimate need for surgery.

    Surgery, that is what Dr Dolan says we should worry about. I dont know, it seems we should worry about both curve stabilization (and reduction for the case of the SpineCor) and surgery.

    Now, we can argue the difference between "thinking" something and "knowing" something. We can discuss the merits of the papers. We can discuss the ethics of the research. But, it seems pretty clear that bracing does indeed work so far as stabilizing curves when compared to observation. If Dr. Dolan had done her systematic review using that criteria the results would have been dramatic.

    Just my opinion and subject to change.

  2. #2
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,903
    Quote Originally Posted by concerned dad View Post
    What they have not done (or attempted to do) is to show that we dont know if bracing works to alter the natural history of AIS. That's because we do know that it indeed alters the natural history.
    News to me. How do we know this?

    That assertion has always bothered me. The whole "permanent" thing bothers me because the "surgical Revision" thread on this forum is so large.
    We have to be very careful here. The revisions, to my knowledge are for very old style instrumentation that caused OTHER, NEW problems or for pseudoarthroses. Also, some fusions were not internaly held.

    The new instrumentation, absent pseudoarthroses, is a new ballgame. The old revisons stats do not apply. They are claiming cures with the new hardware. No brace or PT program or prayer ever produced a cure like modern fusion surgery.

    Now I don't know if they were claiming cures with the old style instrumentation and how exactly they can now claim cures with the new instrumentation. I'm just saying they do.
    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."

  3. #3
    Join Date
    May 2008
    Location
    reno,nevada
    Posts
    3,555
    Does bracing work?

    Bracing is a tool. It is a temporary tool that is certainly worth a try, to help control scoliotic curves and "buy time". In the beginning it is the most logical decision.

    With the extreme un-balanced forces that we have in our backs, it is a blessing that it can even hold a spine at its current state.

    Dental bracing works well, but once the teeth are straightened, there are no forces to knock them back out of alignment, unless you work for the circus and pull trains with your teeth. Now if we all had dental braces and pulled trains with our teeth, then there would be all sorts of studies, to see if dental bracing is successful or not.

    " I pulled 5 cars 100 feet and my teeth are straighter?' "Wow, who is your dentist and what braces did he use?"

    After becoming an adult, after being weaned from the brace, what would happen if one pulled trains without braces? "severe malocclusion?"

    Unless one is prepared to wear a brace 30 hours per day for the rest of their life, and drive themselves absolutely bonkers doing just that, well then we all know what the next step is.

    Surgery is the best answer that we have today. Yes, its a difficult decision, and we have made great leaps in improvement through the years. The fact that some of us have to have revision surgeries down the line should not be a stop sign. Surgeons and insurance companies address this daily and strive to improve the initial procedure.

    These are more important questions.

    How many brace wearers didn't need surgery?.............................
    How will bracing affect the quality of my life? ................................
    How will surgery affect the quality of my life?...............................
    How long should I brace?.....................................
    When should I have my surgery?...................................

    All are very difficult questions with different answers for everyone and with the common denominator "quality of life"

    Ed
    49 yr old male, now 58, the new 53...
    Pre surgery curves C12,T70,L70
    ALIF/PLIF T2-Pelvis 01/29/08, 01/31/08 7" pelvic anchors BMP
    Dr Brett Menmuir St Marys Hospital Reno,Nevada

    Bending and twisting pics after full fusion
    http://www.scoliosis.org/forum/showt...on.&highlight=

    My x-rays
    http://www.scoliosis.org/forum/attac...2&d=1228779214

    http://www.scoliosis.org/forum/attac...3&d=1228779258

  4. #4
    Join Date
    Jan 2009
    Location
    New Hampshire
    Posts
    18

    trust me on this one!)

    Dear concerned dad,

    bracing does work. i wore a brace for over 2 years. before my treatment, my curvatures were 37 degrees. today (still in a brace) they are 25 degrees. if you have any questions, please feel free to post one on my page.

    -Hannah
    AKA: cactigirl96
    Hey guys!
    My name is Hannah, I'm 14 years old, and I had a spinal fusion on 8/27/09
    I feel great now!
    Pre-op = 28T and 45L
    Post-op = 18T and 22L

  5. #5
    Join Date
    Jan 2008
    Location
    Oregon
    Posts
    1,162
    Quote: "What they have not done (or attempted to do) is to show that we dont know if bracing works to alter the natural history of AIS. That's because we do know that it indeed alters the natural history."


    Hi Concerned Dad,

    I can't speak for you, and everyone is entitled to their own opinion. But in my mind, I do not believe that we know whether or not bracing alters the natural history of AIS. Yes, there have been many studies both pro and con, but they are very flawed. I don't know how anyone can "know" with conviction and scientific backing that bracing alters the natural history if AIS because we don't have valid studies that are randomized and have a comparable control group.

    And as an adult who was braced very unhappily for two years as a young teenager, it bothers me immensely (and should bother at least some others) that there may be inummerable kids out there who are being subjected to brace wear that might be unnecessary because their curve will not progress anyway, or will progress to surgery no matter what.

    Concerned Dad, I think you are lucky in a sense because your daughter should be beyond bracing age in the near future (if not already, it sounds like). Those of us whose kids are really young have many more years and greater risk of curve progression to factor into an already difficult decision.

    This is definitely an interesting topic.

    Regards,
    Gayle, age 50
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    2010 VBS Dr Luhmann Shriners St Louis
    2017 curves stable/skeletely mature

    also mom of Torrey, 12 y/o son, 16* T, stable

  6. #6
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    Quote Originally Posted by cactigirl96 View Post
    ... bracing does work. i wore a brace for over 2 years. before my treatment, my curvatures were 37 degrees. today (still in a brace) they are 25 degrees.
    Hannah, honey, you are 13 (at my best guess), and you're still in a brace. This isn't the type of information being discussed. I hope bracing works for you: It doesn't for everyone.

    Quote Originally Posted by concerned dad
    What they have not done (or attempted to do) is to show that we dont know if bracing works to alter the natural history of AIS. That's because we do know that it indeed alters the natural history.
    I'm with Sharon on this. "We" know this how??

    "We" don't know anything other than some curves progress despite bracing, and some curves don't without bracing. The variables are far too numerous to assert any "natural history" has been - or is - altered.

    Quote Originally Posted by concerned dad
    A very knowlegable poster on this forum often says
    Surgery is the only proven option to reduce and stabilize curves permanently.
    And she's right. Fusion (outside of pseudoarthrosis or hardware failure) DOES stabilize curves. To say bracing has that consistent effect is ridiculous. One need only look at all the formerly braced surgical patients roaming around here to see the folly of that assertion.

    Quote Originally Posted by concerned dad
    The whole "permanent" thing bothers me because the "surgical Revision" thread on this forum is so large. What also bothers me is the "end point" used in the statement: "reduce and stabilize".
    Look at the types of hardware most revision patients have, CD. Harrington rod technology is by far the majority of that group, and some in the revision section didn't even HAVE hardware.

    What bothers you about that end point, exactly? It's valid.

    Quote Originally Posted by concerned dad
    ... it seems pretty clear that bracing does indeed work so far as stabilizing curves when compared to observation.
    Without knowing which patients would have progressed with or without a brace (and it varies from patient to patient), you have no solid data upon which to base that conclusion. If you can prove it (after such a short time in this world), you need to publish it and straighten out all the people who've been researching it for years (pity the answer was right under their noses all the time ;-).

    I'm not sure why you pulled up an SRS statement from 1995. 13 year old data is so ... well ... 13 years old. Do you not realize how much prevailing opinion has changed in that time?

    You're apparently very hung up on the BrAIST study. While it MIGHT prove useful, it's not YET (and may never be). Personally, I'll be skeptical even when I see the data because, *again*, curves can't be compared apples to oranges. My surgeon is actually the contact for BrAIST (at Shriners Houston) ... so I will be following it.

    You seem to be missing the part in the BrAIST goals that states:

    "The purpose of this study is to compare the risk of curve progression in adolescents with AIS who wear a brace versus those who do not and to determine whether there are reliable factors that can predict the usefulness of bracing for a particular individual with AIS.

    Until you - or anyone - can explain why one person's 40 curve shoots to 65 between the ages of 30-40 (while mine sat static at a point where it *should* have progressed a degree a year - and we were both braced, but I was NON-compliant), I'm not buying your point of view.

    I'm not sure what you're getting at with "Here is the caveat: It all depends what is meant by the word "work". "

    "WORK" would be defined by stabilizing a curve so it doesn't progress later, and/or avoiding pain. How many definitions do you think "work" has in this scenario? That's about the ONLY simple part.

    I realize you really WANT bracing to be effective, but you're pounding a square peg in a round hole.

    Regards,
    Pam
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

  7. #7
    Join Date
    Dec 2008
    Posts
    494
    Quote Originally Posted by txmarinemom View Post
    I'm not sure why you pulled up an SRS statement from 1995. 13 year old data is so ... well ... 13 years old. Do you not realize how much prevailing opinion has changed in that time?
    I dont have much time today to reply, but I wanted to clarify a point I should have been clearer on.
    The quote from the paper bears repeating.
    We therefore think that the basic findings, that well-performed brace treatment can stop curve progression and that observation will allow some curves to progress until treatment is needed, are still valid.

    That appeared not 13 years ago, but less than 2 years ago in the Journal Spine.

    It is so recent that Dr Dolans systematic review of the literature which was used (in part) for justification of the BrAIST study did not include the results.

    Perhaps the point of my post is that Dr Dolan defines "work" in my original question as "preventing surgery". So the question, "does bracing work to prevent surgery" has an answer of "we dont know".
    But, the question, "Does bracing work to alter the natural history of scoliosis", well, I believe the data shows that the answer is yes. Clearly not for everyone, but statistically it has an effect.

    When a doctor says to you "We dont know if bracing works". You really should push them to define what they mean by "works".

    So, by some peoples definition of "works", the following statement
    well-performed brace treatment can stop curve progression
    means that we dont know if bracing "works" because stopping curve progression is not the same as avoiding surgery. And this warrants some explanation because intuitively it sounds strange. No time right now though.....
    Last edited by concerned dad; 03-02-2009 at 10:57 AM.

  8. #8
    Join Date
    Dec 2008
    Posts
    494
    And, as Pam noted above, prevailing opinion has changed over the last few years.
    I think that what has changed is the definition of the word "work" (as used in the context of this thread title).

    What happens if you do a systematic review like Dr. Dolan did but, instead of considering surgery, you consider curve progression/stabilization?
    You get a result like this:

    A Meta-Analysis of the Efficacy of Non-Operative Treatments for Idiopathic Scoliosis in The Journal of Bone and Joint Surgery 79:664-74 (1997)

    With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. <snip details> The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis.

    As Leah and others note, bracing can be very difficult to endure. Perhaps looking at surgery rates is totally valid if the treatment is so hard to tolerate. Especially true if surgical advancements have been significant. But, if the treatment is not that hard to tolerate (read: SpineCor) perhaps we (or some of us) should at least realize that the thing that changed with bracing studies over the last few years is the outcome measurement - "Work".

  9. #9
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,903
    Quote Originally Posted by concerned dad View Post
    I dont have much time today to reply, but I wanted to clarify a point I should have been clearer on.
    The quote from the paper bears repeating.
    We therefore think that the basic findings, that well-performed brace treatment can stop curve progression and that observation will allow some curves to progress until treatment is needed, are still valid.
    CD, that is a faith statement, not one based on evidence. Moreoever, these researchers will not deny that. What you won't see is anyone claiming they showed this based on evidence. It sounds more like it is their sense of the (flawed) data in hand which is fine. They "think" it but they damn well don't "know" it.

    Perhaps the point of my post is that Dr Dolan defines "work" in my original question as "preventing surgery". So the question, "does bracing work to prevent surgery" has an answer of "we dont know".
    But, the question, "Does bracing work to alter the natural history of scoliosis", well, I believe the data shows that the answer is yes. Clearly not for everyone, but statistically it has an effect.
    Beyond holding a curve not only below surgery territory but also below the point where virtually all curves of that magnitude will likely progress to surgery in one's lifetime, I don't see another definition for "work."

    To date, only fusion surgery has been shown to have a chance of "working." Other treatment modalities might work but the world is still waiting on the evidence. They might work but we don't know. It has to be shown, especially with something as odious as bracing.

    When a doctor says to you "We dont know if bracing works". You really should push them to define what they mean by "works".
    If a surgeon or anyone has a different definition than the one I typed above, I'd like to see them defend it.

    So, by some peoples definition of "works", the following statement
    well-performed brace treatment can stop curve progression
    means that we dont know if bracing "works" because stopping curve progression is not the same as avoiding surgery. And this warrants some explanation because intuitively it sounds strange. No time right now though.....
    Here's how I look at it...

    success = halting a curve below the point where surgery is needed now or likely to be needed in the lifetime of a patient.

    If someone can defend a radically different definition, I'd like to read it.
    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
    Jan 2008
    Location
    NC
    Posts
    8,903
    CD,

    A meta-analysis of flawed, uncontrolled studies data canNOT be counted on to yield unflawed results/conclusions.

    And until they address themselves to stabilizing/reducing a curve not only below surgery territory but below the territory where most curves will progress to surgery in one's lifetime or produce too much pain, they are spinning their wheels.

    Just asking a general question if bracing slows or halts curves where that question isn't tethered to the magic angles that are known to need surgery now or to progress is not really striking at the heart of the problem, is it?
    Last edited by Pooka1; 03-04-2009 at 12:28 PM.
    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."

  11. #11
    Join Date
    Dec 2008
    Posts
    494
    Quote Originally Posted by Pooka1 View Post
    success = halting a curve below the point where surgery is needed now or likely to be needed in the lifetime of a patient.

    If someone can defend a radically different definition, I'd like to read it.
    How about this

    success = preventing a curve from advancing 6 degrees.

    That is what Nachemson used. Radically different in its implications.

  12. #12
    Join Date
    Dec 2008
    Posts
    494
    Quote Originally Posted by Pooka1 View Post
    CD,

    A meta-analysis of flawed, uncontrolled studies data canNOT be counted on to yield unflawed results/conclusions.
    Isnt this exactly what Dr Dolan did in her meta-analysis paper. Same methodology. Only difference was the definition of the outcome.

  13. #13
    Join Date
    Dec 2008
    Posts
    494
    Quote Originally Posted by Pooka1 View Post
    Originally Posted by concerned dad
    What they have not done (or attempted to do) is to show that we dont know if bracing works to alter the natural history of AIS. That's because we do know that it indeed alters the natural history.


    News to me. How do we know this?
    How about the attached figure from the 2007 Danielson Spine Paper.
    Note that here we are looking at bracing "altering" the natural history without looking at incidence of surgery.

  14. #14
    Join Date
    May 2008
    Location
    Central NJ
    Posts
    1,956
    I can only speak for myself. When my scoliosis was diagnosed, my curves were approximately 40 & 35. They were brought down to both in the 20-ish degrees while in the brace, and after about 3 years out of the brace, at 22, my curves were both about 35. Fast forward 25+ years, and BIG surprise to me, both curves were 66 degrees. At the time I was released from my orthopedic doctor at 22, I was a 'success.' If I never had the brace at all, I am sure that both curves would have ended up at 66 as they did in the end; however, would it have been earlier in my life? I don't know, and I don't think anyone can answer that for sure.

    I think in my case, the bracing didn't work in the long run. However, maybe it postponed the inevitable surgery until a time when technology was better than it was back in the mid-70's when I was diagnosed.

    Just my opinion.
    __________________________________________
    Debbe - 50 yrs old

    Milwalkee Brace 1976 - 79
    Told by Dr. my curve would never progress

    Surgery 10/15/08 in NYC by Dr. Michael Neuwirth
    Pre-Surgury Thorasic: 66 degrees
    Pre-Surgery Lumbar: 66 degrees

    Post-Surgery Thorasic: 34 degrees
    Post-Surgery Lumbar: 22 degrees

  15. #15
    Join Date
    Nov 2007
    Location
    Houston, TX
    Posts
    1,757
    Quote Originally Posted by concerned dad View Post
    How about this

    success = preventing a curve from advancing 6 degrees.

    That is what Nachemson used. Radically different in its implications.
    CD, as I said before, there are too many adults here that were braced kids, with stable (it seemed) curves, that later needed surgery because it progressed in adulthood to count.

    At what age do you define bracing "worked"? 20? 40? 60?

    There are people in ALL those groups here who were braced as children. Some steadily progressed, some took huge jumps (presumably from progesterone) during pregnancy, and some just went to doctor for something unrelated and had to go "Sh**. What curve? They FIXED that thing!"

    And I'm not anywhere *near* buying Nachemson's definition of "work" as progression of < 6: Starting where? At the point they'll brace? If you start with a kid at 25 and they end up at skeletal maturity at 32 what do you (not YOU ... the collective you) have to be smoking to deem it a failure?

    Also, by the "avoiding surgery" definition, my brace may have played ~some~ part in keeping mine under 50 (I'd say it had little effect on stability). Does that mean bracing "worked" for me even though I ended up choosing surgery later for pain (and, no ... not to *cause* it, to remedy it ;-).

    I'm still very skeptical of the accuracy of ANY study on bracing when the scenarios can be - and often are - so radically different. Personally? I'm not a big proponent of bracing; probably because I wore one - and never had back pain at all *until* I was put in one.

    But on the other hand, the magic number for surgery is 50 ... and that's the SAME point curves can *typically* be expected to progress a degree a year.

    ... which brings me back around to the question ...

    If you keep a kid with AIS under 50 at end of bracing, and they creep up to 65 at age 40 (and need surgery), what do you have? A treatment that "worked" or failed?

    The data doesn't mean squat when you have a fairly sizable group who, like Debbe, weren't NEAR 50 when released from bracing, but progressed anyway. The studies say *I* should have progressed and she shouldn't have. As long as there are cases like us, I will always believe the research is inherently flawed.

    Pam
    Last edited by txmarinemom; 03-02-2009 at 07:33 PM.
    Fusion is NOT the end of the world.
    AIDS Walk Houston 2008 5K @ 33 days post op!


    41, dx'd JIS & Boston braced @ 10
    Pre-op 53, Post-op < 20
    Fused 2/5/08, T4-L1 ... Darrell S. Hanson, Houston


    VIEW MY X-RAYS
    EMAIL ME

Posting Permissions

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