I was at St Justine’s this week and had the chance to speak with Dr Rivard about some of the SpineCor data. On the wall of the clinic was a Table (similar to the one attached) which aggregates the results of SpineCor bracing.
I had two main questions relative to this Table. One, if not both, of them we have discussed here (well, maybe not here in ‘research’, but on the bracing forum).
I asked for clarification on weaning explaining that on some of the powerpoint presentations and technical papers the term is used to suggest the present tense, ie, weaning is ongoing or occurring for a long period of time. He said that the when they say 5 years weaning, they mean 5 years w/o any brace wear at all.
The other question I had related to the population of patients reported in the attached table who reached 5 years post bracing (N=69). They report an average POST BRACE Cobb angle for this population but only an average initial Cobb angle of the whole population (N=298). I wanted to know what the initial Cobb angle was for this smaller population (the last column in the attached table). Had these early patients all had smaller initial curves (than the later patients), the aggregated data suggesting a continued decrease in curve size would be highly questionable.
I guess I was pretty surprised at what he did next. He got on the phone and called another fellow (perhaps a student or assistant involved with the data processing). This other fellow came in and Dr. Rivard explained the question to him. He opened the main data base and extracted the data of initial Cobb angle and Risser of just those patients who are 5 years post bracing (now in the N=90’s). He calculated the average initial Cobb angle for those patients and, you know what, it was 26 degrees, the same as the average initial Cobb angle for the whole population. (For anyone not following along, in my mind at least, this increases the validity/significance of the Spinecor results.) I have to say I was impressed with the openness of the calculation. Had the calc shown a significantly lower avg initial Cobb angle, it would have really brought into question the results. His response wasn’t ‘let me look into it and get back to you” it was more along the lines of ‘lets see’.
Now, I would have loved to sit down and play with them and the data for the rest of the afternoon. Not only was the brace clinic busy but my daughter started to look a bit agitated with me.
But, I still wanted to talk about what these results imply because that is really why we are giving the SpineCor a try. These data (again, attached figure) show that, even after SpineCor bracing has stopped the curve continues to decrease. This is in stark contrast to the Daniellson data (posted on another thread) showing a gradual (or not too gradual – not enough data points there to define the shape of the curve) increase over time post TSLO bracing.
I asked Dr. Rivard about the mechanism of continued improvement after bracing ceases. He said that they believe that because the brace is dynamic, it trains the muscles over time to apply the corrective movement necessary to reduce the curve. After enough time wearing the brace, the muscles are trained to do it w/o the brace and continued correction is often seen (not a direct quote, just the gist I took away from the chat). Now the next question for us was what is “enough time”? Dr. Rivard said that if you quit bracing too early you loose all correction and it is as though all the bracing you endured was a waste of time. He would like to see my daughter braced until Risser 4 (and I lean more towards sticking with it till her digital skeletal age indicates maturity - the whole hand xray thing as my daughter Riser and skeletal age are discordant).
The last thing we talked about that may be of general interest is related to strap tension. I asked if we couldn’t just tighten the straps up a bit to shorten the treatment time. He said that would be a big mistake. There is a sweet spot in the necessary tension (my gist, not a quote). He said that a SpineCor clinic in Europe aggressively tightened the tension and the results were terrible.
I had two main questions relative to this Table. One, if not both, of them we have discussed here (well, maybe not here in ‘research’, but on the bracing forum).
I asked for clarification on weaning explaining that on some of the powerpoint presentations and technical papers the term is used to suggest the present tense, ie, weaning is ongoing or occurring for a long period of time. He said that the when they say 5 years weaning, they mean 5 years w/o any brace wear at all.
The other question I had related to the population of patients reported in the attached table who reached 5 years post bracing (N=69). They report an average POST BRACE Cobb angle for this population but only an average initial Cobb angle of the whole population (N=298). I wanted to know what the initial Cobb angle was for this smaller population (the last column in the attached table). Had these early patients all had smaller initial curves (than the later patients), the aggregated data suggesting a continued decrease in curve size would be highly questionable.
I guess I was pretty surprised at what he did next. He got on the phone and called another fellow (perhaps a student or assistant involved with the data processing). This other fellow came in and Dr. Rivard explained the question to him. He opened the main data base and extracted the data of initial Cobb angle and Risser of just those patients who are 5 years post bracing (now in the N=90’s). He calculated the average initial Cobb angle for those patients and, you know what, it was 26 degrees, the same as the average initial Cobb angle for the whole population. (For anyone not following along, in my mind at least, this increases the validity/significance of the Spinecor results.) I have to say I was impressed with the openness of the calculation. Had the calc shown a significantly lower avg initial Cobb angle, it would have really brought into question the results. His response wasn’t ‘let me look into it and get back to you” it was more along the lines of ‘lets see’.
Now, I would have loved to sit down and play with them and the data for the rest of the afternoon. Not only was the brace clinic busy but my daughter started to look a bit agitated with me.
But, I still wanted to talk about what these results imply because that is really why we are giving the SpineCor a try. These data (again, attached figure) show that, even after SpineCor bracing has stopped the curve continues to decrease. This is in stark contrast to the Daniellson data (posted on another thread) showing a gradual (or not too gradual – not enough data points there to define the shape of the curve) increase over time post TSLO bracing.
I asked Dr. Rivard about the mechanism of continued improvement after bracing ceases. He said that they believe that because the brace is dynamic, it trains the muscles over time to apply the corrective movement necessary to reduce the curve. After enough time wearing the brace, the muscles are trained to do it w/o the brace and continued correction is often seen (not a direct quote, just the gist I took away from the chat). Now the next question for us was what is “enough time”? Dr. Rivard said that if you quit bracing too early you loose all correction and it is as though all the bracing you endured was a waste of time. He would like to see my daughter braced until Risser 4 (and I lean more towards sticking with it till her digital skeletal age indicates maturity - the whole hand xray thing as my daughter Riser and skeletal age are discordant).
The last thing we talked about that may be of general interest is related to strap tension. I asked if we couldn’t just tighten the straps up a bit to shorten the treatment time. He said that would be a big mistake. There is a sweet spot in the necessary tension (my gist, not a quote). He said that a SpineCor clinic in Europe aggressively tightened the tension and the results were terrible.
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