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Thread: Ultra Long-Term Follow-Up

  1. #1
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    Ultra Long-Term Follow-Up

    Ultra-long-term follow-up of pediatric spinal deformity problems: 23 patients with a mean follow-up of 51 years.
    Winter RB, Lonstein JE.

    Twin Cities Spine Center, 913 East 26th Street, Suite 600, Minneapolis, MN, 55404, USA.

    BACKGROUND: The aim of this study was to analyze the true outcomes of a unique cohort of patients with spinal deformities who were treated as children and followed for 40 or more years. METHODS: Altogether, 23 patients were reviewed who had been originally treated in our community, whose original charts and radiographs were still available, and who had undergone recent evaluation. RESULTS: The diagnoses were congenital deformity in eight, adolescent idiopathic scoliosis in four, poliomyelitis in three, infantile idiopathic scoliosis in two, spondylolisthesis in two, and one each of tuberculosis and dwarfism. Sixteen had undergone fusion surgery. CONCLUSIONS: Early spine fusion for deformity produced far better results than delayed fusion. A solid fusion at the end of growth remained unchanged. Degenerative changes outside the fusion area were rare and seldom required further surgery. In summary, 23 patients with a mean follow-up of 51 years after treatment are presented. Early fusion was far superior to delayed or nonsurgical treatment.

  2. #2
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    Thank you for posting this abstract. It is very reassuring/comforting to me.
    Laurie

    Mother of Alexander & Zachary:
    Alex is 16 years old and in the 11th grade. He has congenital scoliosis due to a hemivertebrae at T10. Wore a TLSO brace for 3 1/2 years. Pre-op curves were T45 & L65; curves post-op are approx. T31 & L34. Had a posterior spinal fusion from T8 to L3 on 7/12/07 at age 12. Doing great now in so many ways, but still working on improving posture.
    Zach is 13 years old and very energetic.

  3. #3
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    Pretty darned interesting

    Degenerative changes outside the fusion area were rare and seldom required further surgery

    That's pretty interesting. Scientists suspect that fusion causes degeneration on adjacent vertebrae but they can't absolutely prove it. Although this is a small sample it runs counter to their assumptions.

    Early fusion was far superior to delayed or nonsurgical treatment.

    Once again early treatment is found to be the most effective for this or almost any other disorder. It make me wonder why bracing is discouraged before 25 degrees.

  4. #4
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    Quote Originally Posted by Dingo View Post
    [COLOR="RoyalBlue"]Once again early treatment is found to be the most effective for this or almost any other disorder. It make me wonder why bracing is discouraged before 25 degrees.
    I suspect it is because it is an extremely arduous treatrment and there is no good evidence it will work in any case.

    Bracing is not in the same league as fusion surgery in terms of treating/curing scoliosis.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

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    I don't know if I'd go that far

    I don't know if I'd go that far.

    I suspect it is because it is an extremely arduous treatrment and there is no good evidence it will work in any case.

    23/7 bracing in a hard brace sounds pretty heroic. But night bracing (although not exactly a great time) seems a lot more doable for most kids. There is a lot of evidence that bracing works for some kids.

  6. #6
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    Quote Originally Posted by Dingo View Post
    There is a lot of evidence that bracing works for some kids.
    News to me.

    What is this evidence that bracing works? Can you cite any papers?

    Did you know the bracing literature is a miasma?
    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."

  7. #7
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    Oodles of studies

    There must be 100s of studies that have found bracing to be effective.

    Google search: scoliosis bracing effectiveness

    I'm not saying that I couldn't find a page of counterevidence as well.

    But I wouldn't say that there is no good evidence that bracing helps some kids. Adding the whole thing up my sense is that bracing helps some kids, particularly if they have smaller curves. Anything over 30 degrees is hit and miss. If my child had a progressive curve that wouldn't respond to bracing and it was approaching 30 degrees I'd strongly consider VBS.

    Did you know the bracing literature is a miasma?

    I had never heard of a Miasma before. "poisonous air?"
    Last edited by Dingo; 04-06-2009 at 08:58 AM.

  8. #8
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    Quote Originally Posted by Dingo View Post
    There must be 100s of studies that have found bracing to be effective.
    This is going to be a journey


    It all depends on what you mean by "effective".

    I suppose the best evidence that scientists dont know if bracing avoids surgery is the very existence of the Braist trial.

    I originally equated it with unethical research. After looking into it further, I found I was wrong. But bottom line, if they thought bracing was effective at avoiding surgery they would not ethically be able to conduct the random controlled BrAIST trial. They ARE performing the RCT. Therefore they DO NOT currently know if bracing avoids surgery.

    The last big RCT by the SRS in 1995 (Nachemson) had problems. It wasnt really random, the curves types were stratified between braced and unbraced groups, and they defined "failure" as an increase in curve of 5 degrees or more. (The argument is, if a curve goes from say 20 to 25 degrees unbraced, is it really a "failure").

    You may be interested to read some of the research from the folks in Iowa (Lori Dolan). pretty interesting stuff.

  9. #9
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    If you've got brace links post em!

    You may be interested to read some of the research from the folks in Iowa (Lori Dolan). pretty interesting stuff.

    I would love to read anything pro/con on bracing.

    From what I've read bracing appears to work for a lot of kids, especially those with curves less than 35 degrees. It's hard for scientists to determine how effective bracing is because compliance is based on the honor system. How can anyone know if a child is using it as prescribed?

    The results of surgery are easy to study because the human element is taken out. That doesn't mean that surgery is better, it's just very easy to study.

  10. #10
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    Quote Originally Posted by concerned dad View Post
    (The argument is, if a curve goes from say 20 to 25 degrees unbraced, is it really a "failure").
    I found the quoted "argument". Goldberg says it better

    As pointed out by Skaggs,31 an untreated thoracic curve progressing from 25 to 35 but at maturity being acceptable cosmetically and not requiring surgery would be regarded as a success by the child who had had an untrammeled adolescence.

  11. #11
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    Quote Originally Posted by Dingo View Post
    But I wouldn't say that there is no good evidence that bracing helps some kids.
    Maybe you wouldn't say that but plenty of orthopedic surgeons say it.

    Did you know there are surgeons who don't brace and are still not sued for malpractice?

    If there was good evidence that bracing worked, how do you explain that?

    The literature is a miasma. That's how I explain it.
    Last edited by Pooka1; 04-06-2009 at 03:27 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."

  12. #12
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    Quote Originally Posted by concerned dad View Post
    I found the quoted "argument". Goldberg says it better

    As pointed out by Skaggs,31 an untreated thoracic curve progressing from 25 to 35 but at maturity being acceptable cosmetically and not requiring surgery would be regarded as a success by the child who had had an untrammeled adolescence.
    They may have an untrammeled adolescence but what percentage of kids with a 35* curve avoid later fusion surgery?

    The results of the ultra long term study and what our surgeon told us about why most adults have a far harder time than most kids with the surgery are all in keeping with the thought that fusion at the earliest possible time is the best, most definitive option.

    For example, although our surgeon claims that if my daughter can emerge from adolescence with a <50* curve and expect to be stable for life, the testimonials on here belie that claim. I think that's why some surgeons will fuse kids who are less than 50*... they have seen the results of not doing so.
    Last edited by Pooka1; 04-06-2009 at 03:32 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."

  13. #13
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    Quote Originally Posted by Pooka1 View Post
    They may have an untrammeled adolescence but what percentage of kids with a 35* curve (CD edit - at skeletal maturity)avoid later fusion surgery?
    Darn good question.
    I would guess the vast majority of kids who reach skeletal maturity w/ a 35 degree curve will indeed avoid later surgery.

  14. #14
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    Bracing

    Pooka1

    Did you know there are surgeons who don't brace and are still not sued for malpractice?

    I'm not a lawyer but I would guess that's true because you can't absolutely prove or disprove if bracing will work in any given case. It's impossible to know.

    BTW I know that we are all in the same boat trying to help our kids. It's hard to know what to do.

  15. #15
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    Quote Originally Posted by concerned dad View Post
    Darn good question.
    I would guess the vast majority of kids who reach skeletal maturity w/ a 35 degree curve will indeed avoid later surgery.
    So our surgeon says.

    But there are any number of folks just in this little sandbox who progressed to needing fusion despite being at skeletal maturity and at a then-sub-surgical angle.

    I am going to ask our surgeon if he has a hypothesis to explain that.
    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."

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