Does Bracing Work?

[Pooka1]

Gotta start somewhere.

If those data are too scattered, I'd break it down further.

[concerned dad]

Gotta start somewhere.

If those data are too scattered, I'd break it down further.

The three curves in the original figure are not scattered, why break it down in the first place?

To look at more subgroups you would need a larger sample size to maintain significance.

Perhaps it would be useful to answer more questions, but the fundamental question of "does bracing have any measureable effect" seems to be addressed by the figure.

[Pooka1]

The three curves in the original figure are not scattered, why break it down in the first place?

Well, for one, we have some evidence T curves and L curves respond differently to bracing. Lumping them together is not correct per se.

[The Slice]

Well, I see there's a lot of debate over statistics here. As a person who as gathered some info on scoliosis (as a hobby of sorts) let me add a couple of thoughts. I think everyone has come to the same conclusion that this is not an exact science. Remember that years ago, people braced for scoliosis, were typically braced with a Milwaukee brace, or something of that nature. Through the years, there have been fewer and fewer Milwaukee type braces used as the evidence has shown that the cervical curve will usually correct itself. The exception is a double major curve that is very high (primarily involving the cervical and thoracic spine). What I've always understood, is that the idea of bracing is not to correct, or "cure" the scoliosis, but to attempt to slow the progression of the curve until the child has reached the majority of their skeletal growth. I would imagine that during this time, there are more chances for permanent deformation of the bones and am wondering if this could also have an effect on the severity of scoliosis. A couple of you have spoken about having surgery later in life after supposedly being "cured" of scoliosis in childhood/young adulthood. I wonder how many of those who have found severe curves later in their 40's, 50's, and 60's have other reasons for the progressing curves such as osteoporosis. Of course, the reason for trying to slow the progression is to decrease the chances of surgery, and more importantly, keep the degree of curvature low as this along with other factors such as age at the time of surgery can affect the degree of correction. Well, why not send them right to surgery? The fact is that going under the knife is risky, and if you can avoid the risk, and all the other things that go with the surgery, why not? The other reason for the delay is that the spine growth is in the last part of the growth spurt of adolescence (this is why so many kids look so long limbed and often times very skinny). The point is that if you do the surgery too soon, you may end up with a shorter torso which can affect the organs both in the chest and abdomen. I can't say anything based on experience, but I think if it were me, or a child that I was responsible for, I'd want to go for the bracing if it meant that I could either avoid surgery, or significantly affect the outcome of surgery in a positive way. Yeah, I have a good idea what some of you are going to say to that, but consider this, while it is true that many kids have a hard time dealing with the brace, there are plenty of others that have done just fine with it. Again there are so many different variables involved here as well including how well the brace is fitted, attitudes of both the child and their parent(s), and more. The bottom line here is to get the best possible outcome for medical reasons first, and cosmetic reasons second, at the least risk to the person's health and or safety.

[tonibunny]

The other reason for the delay is that the spine growth is in the last part of the growth spurt of adolescence (this is why so many kids look so long limbed and often times very skinny). The point is that if you do the surgery too soon, you may end up with a shorter torso which can affect the organs both in the chest and abdomen.

This is interesting, where did you hear this? I have always been told that by about 13 the spine has stopped growing, and by the age of 10 it has reached about 80% of its potential adult size - and that after this, most of the growth will be in an adolescent's limbs.

I was fused from T1-T12 at 10, with a residual curve of 45 degrees/35 degrees, yet I don't look noticeably short in the torso and have no probs from this. The only way it affects me is that straps on tops sometimes need adjusting or they fall down

Having said that, I also agree that it's preferable to put surgery off for as long as possible, and would rather any child of mine wore a brace rather than went straight for surgery (I wore a Milwaukee and plaster bodycasts for years as a child, and TLSOs post op, so I know what they're like).

[debbei]

I wonder how many of those who have found severe curves later in their 40's, 50's, and 60's have other reasons for the progressing curves such as osteoporosis.

Nope, no osteoporosis in my case. I just kept on progessing like crazy as I got older. If I kept going another 20 years without surgery, both my curves would probably have reached 100 degrees by then. There would be nothing left of my torso.

[Karen Ocker]

No osteoporosis here either

I had excellent bone density measurements and normally formed vertebrae--other than the wedge shape from progressing scoliosis--- and my spine marched to its own drummer.

[Pooka1]

First, it is not true that the spine matures last after the limbs according to our surgeon IIRC. I'm trying to remember... it's in one of my earlier posts... I think he said there is no set pattern.

Second, I have been thinking about what our surgeon said about the reason why the average adult has a far harder time than the average kid with the surgery. He said it was because they have other problems that need fixing besides the curve. That suggests to me that simply having scoliosis for years and years may necessarily cause further and other damage if not corrected early.

If that is true, and if the new instrumentation is all that it is claimed to be in the long run, then that would argue for early fusing all curves with any reasonable chance of progressing to surgery territory over a life time.

It sounds reasonable. There is really no other rational explanation I have heard for the huge difference in recovery between the average kid and average adult getting fused. Also, the earlier fusion may allow a shorter fusion.

Just some thoughts.

[The Slice]

Sharon, I'm not going to tell you that you or your doctor are right or wrong, but I offer this bit of info from the BBC series "Teen Species". You can check out the website based on the series at http://www.bbc.co.uk/science/humanbo...s/growth.shtml

The part to which I refer is the following which is either a paraprasing, or transcription from the series regarding skeletal growth: "Regular trips to the shoe shop and trousers that rapidly become too short are common occurrences during puberty.
In their teens, children put on an amazing growth spurt to reach their final adult height. At their fastest, boys can grow taller by as much as 9cm a year and girls at a rate of 8cm a year. It's no wonder teenagers are clumsy. Their body is shooting upwards at a speed their brain simply cannot keep up with.
Outside-in
This phenomenal growth starts at the outside of the body and works in. Hands and feet are the first to expand. Needing new shoes is the first sign of trouble.
Next, arms and legs grow longer, and even here the 'outside-in' rule applies. The shin bones lengthen before the thigh, and the forearm before the upper arm.
Finally the spine grows. The very last expansion is a broadening of the chest and shoulders in boys, and a widening of the hips and pelvis in girls."

I copied just the text of the applicable section. If you look around at kids nearing puberty, one of the obvious ways you can tell that they have arrived is the growth spurt. One of the most obvious things is that their arms and legs are disproportionately long compared to their torso for some time. It's what gives them that gangly, or spindley appearance. Another part of that is that the bones lengthen faster than they gain mass as do the muscles. That's the other significant reason why pubescent kids sometimes look as if they might be anorexic. As you will see by reading the info further, that's why kids, especially boys seem rather uncoordinated for a while. It's because the skeletal growth is so rapid compared to muscle growth that until the muscles catch up, they're actually somewhat undersized. The other part to that is that it takes more time for the brain to get used to the physical change in the body, and the change in center of gravity.

[Pooka1]

Well, maybe there is as much consensus on this among experts as there is on the efficacy of bracing which is to say little to none.

[Pooka1]

By the way, here is another quote from the same BBC site:

femur

"Long bone growth comes to an end around the end of puberty. When long bone growth stops, you stop getting taller."

Now if you stop getting taller when long bone grow stops then that means either that the spine has previously stopped growing or that the growth remaining in the spine is not significant to change height.

[The Slice]

From what I understand, in many cases, doctors are looking for the point where there will be minimal effect to the spinal growth, not when bone growth has stopped. I believe that in many cases, at least for the girls, the point at which the doctor says that they are skeletally mature enough for spinal surgery is at or after the start of menarche. For the most part, girls usually don't grow more than about 2" once menarche has started. This of course would also correlate with what you were saying. The point here is that if scoliosis is detected early relative to the start of menarche, the hope is that by bracing them, until they are mature enough for surgery, that the progression of the curve(s) can, if nothing else, be slowed down. Where this can be a benefit is if there are other contraindications to surgery, and if the growth can be slowed down, perhaps it can be kept at a level where surgery would not absolutely be necessary. Another benefit is that the smaller the curves pre-surgery, hopefully the better the correction that can be achieved. The bottom line here is that there is no absolute as you're talking one about the human body, not a robot, and you're talking about the fact that humans are caring for the child. There are so many variables there such as complicity from the child, the fitting of the brace just to name a couple. I suspect that the medical community is already gearing toward the idea that bracing, depending on the severity of the curve, and the age of the child is more likely aimed at optimizing the surgical outcome as much, or more so than preventing surgery. From the stories I 've read, it seems as if surgery is ultimately inevitable uness the diagnosis happens early, and the curve is relatively small. There's a caveat here too. If the doctor doesn't recommend bracing either instead of, or until surgery is possible, they may run the risk of a malpractice suit for negligence. Unfortunately we have gotten into a really litigious society, and this only complicates things even more.

[concerned dad]

From the stories I 've read, it seems as if surgery is ultimately inevitable uness the diagnosis happens early, and the curve is relatively small.

I'm not sure if I understand or agree with this. It seems to me that the argument AGAINST bracing is that most curves would not have progressed to surgical levels anyway. And hence, bracing has the effect of overtreating many to save a few. (not that I agree with this argument)

[SARAHR1999]

9 year old got brace two months ago

Started with a 47 degree curve now in the brace only two months and it is 24 degrees. Boston Brace works great

[SmileyGirl8]

Yes it does work

All you really have to do is to belive. I belive that it will work because I have people around me saying that it will work. My doctor says 100% well maybe not 100% but it does work. So thats what I belive in.