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.
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.
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