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Thread: Fascinating Presentations at the 2009 POSNA Annual Meeting

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    Fascinating Presentations at the 2009 POSNA Annual Meeting

    I think this link deserves its own post in the Research section of this forum. The video presentations are absolutely fascinating...if you're in to this kind of stuff...heh.

    http://posna.gmetonline.com/Presenta...onpackageid=31

    Click on the link entitled "One Day Course - Adolescent Idiopathic Scoliosis: Understanding the Deformity and Current Treatment (April 29, 2009)"

    The link with the keynote speaker Dr. Dubousset is especially fascinating to me. At 7:30 minutes, Dr. Dubousset is discussing the fact that he always casts scoliosis patients (note the very large person getting a cast in the picture) before bracing to reduce the torsion (he calls it detorsion) of the spine, which he says is most important, and I have to agree with him on that. He mentions Min Mehta at some point and that must be part of her casting procedure on infants.

    I think Sealy at the Scoliosis Support site may be onto something...she says she's leaving open the option of casting her daughter when she reaches the adolescent growth spurt. Perhaps that is the best thing that can be done for detorsion prior to getting a firmer brace. It's very interesting....perhaps that's what's missing in the US's bracing procedures. The detorsion is required first prior to the brace.

    Now that would be an interesting study!

    At the end of the lecture, he has a very hopeful comment about the future. He talks about in 2020, taking a pill for scoliosis instead of rods and braces...isn't that something exciting to hopefully look forward to! That sounds right up your alley, Dingo!

    Oh, and here is Dr. Dubousset's bio for anyone interested in his background in helping to perfect the spinal instrumentation used in today's scoliosis surgeries.

    http://www.cotrelspinalresearchfound...0Dubusset.html
    Last edited by Ballet Mom; 09-07-2009 at 02:09 PM.

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    You're very welcome! I'm glad I ran across these....I only hope they are left up on the website so others in the future can also watch. They might disappear at some point, unfortunately.

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    I have to say I feel a lot better about the Scoliscore after watching the presentation from Dr. Ogilvie of Shriner's Utah about the predictive genetic tests. Starting at minute 4:26 he talks about the predictive values and it looks to me that the ranges they are using could actually end up being quite helpful to doctors to help determine how to treat initially. I think things are looking up in the treatment of scoliosis area and helping to prevent bracing of the kids most likely to not progress.

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    Thanks for the post

    Ballet Mom

    Thanks for the link I'm watching the videos now.

    Dr. Dubousset is correct, drugs are being developed to treat Scoliosis. It now appears likely that the problem is caused by a buildup of Calmodulin on the convex side of the curve.

    Half of the scoliosis blood test which may be out as soon as this year is designed to look for increasing levels of Calmodulin.

    Tamoxifen (an older drug used to treat breast cancer and other disorders) is a Calmodulin antagonist and has been used succesfully to treat Scoliosis in animals.

    I should add that Calmodulin is significantly impacted by exercise. This may be part (or all) of the reason that Torso Rotation Strength Training has been found to be almost universally effective at treating small and medium curves. It's possible that strength training may do more than just build muscle. It may repair or at least improve the biology of the paraspinal muscles.
    Last edited by Dingo; 09-07-2009 at 04:20 PM.

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    Hi Ballet Mom,

    Thanks for the fascinating-looking links. My mac won't cooperate today, so I will have to check out the links further at work.

    I do not think body casting of adolescents will ever catch on!!!!!!! If you think adolescents hate wearing their braces to school, imagine how much they will resist casting! I speak from experience--I had to wear a body cast for 3 months after my uninstrumented fusion surgery in 1984, and although I felt fine physically, I refused to go to high school in it. My mom had to get a home teacher through the school district. The cast was huge and hot, and nothing fit over it at all. This was not a happy time for me, let me tell you.
    Last edited by leahdragonfly; 09-07-2009 at 04:45 PM.
    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

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    Quote Originally Posted by leahdragonfly View Post
    I do not think body casting of adolescents will ever catch on!!!!!!!
    That is seven exclamation points. Must you be so understated? Don't hold back... say what you mean!

    I don't know. If casting for AIS was 100% effective at avoiding fusion FOR LIFE, and the duration is measured in months not years, I think a case could be made. Of course we will likely never see that case made.
    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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    Torso rotation is universally effective?

    Dingo,

    I am absolutely astounded by your assertion above that torso rotation is "almost universally effective at treating small and medium curves". Do you have some new evidence for this? Any evidence for this at all? Such a statement seems very reckless without evidence.

    If this were true, I would sure love to know, because it would virtually eliminate the need for bracing.

    Can you please elaborate on your comments?
    Last edited by leahdragonfly; 09-07-2009 at 04:49 PM. Reason: typo
    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

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    Quote Originally Posted by leahdragonfly View Post
    Dingo,

    I am absolutely astounded by your assertion above that torso rotation is "almost universally effective" in treating small and medium curves. Do you have some new evidence for this?

    If this were true, I would sure love to know, because it would virtually eliminate the need for bracing.

    Can you please elaborate on your comments?
    Gayle, I don't know why you commented on that post. He continually makes claims along those lines on this and at least two other fora. This one isn't special or unusual in his claims that exceed the evidence.

    It is how a lay person with no training talks. Pnuttro has tried to explain the issue to him to no avail. She has ground to stand on in doing this. If he won't take it from her he won't take it on board from anyone.
    Last edited by Pooka1; 09-07-2009 at 09:58 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."

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    Hi Leah...

    I also thought about the casting, however, it sounds like it is a temporary cast just made to derotate (detorsion) the spine. I don't think that it is worn very long. He says he does it prior to putting the kids in a brace. It would be very interesting to know how long that period is.....a couple of weeks? a month? Don't know, but if it was short and temporary, I think kids could probably get through it. Just my thoughts. I'd love to know more about it.

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    Torso Rotation Strength Training

    leahdragonfly

    Read through the thread and watch the video. Every time this type of PT is tested or studied it is found to be almost universally effective at treating small and medium curves.

    If you know of any studies that suggest otherwise please post them.

    As for either bracing or casting I'm not against either.

    But according to Dr. Vert Mooney

    2007 - The Journal Of Musculoskeletal Medicine: Exercise for managing adolescent scoliosis

    In most cases the curvature can be reduced. Brief exercises performed twice a week are adequate. Braces are not necessary.
    Last edited by Dingo; 09-07-2009 at 05:08 PM.

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    There's a very interesting presentation by Dr. Betz about vertebral stapling. It basically answers the question that we discussed earlier about why my daughter wasn't viable for stapling by the surgeon we visited. He had said that my daughter's 35 degree curve was too large to be stapled.

    Dr. Betz discusses in this presentation that thoracic curves measuring less than or equal to 35 degrees pre-op had a 79% success rate. While curves that measured less than 20 degrees on the first erect radiograph had an 86% success rate (after the surgery, I presume). However, he said that patients with thoracic curves greater than 35 degrees, the results "were dismal"...with 6/8 progressing past 50 degrees. So apparently the surgeon we went to was simply being cautious with my daughter, since she was right on the cut-off, which I greatly appreciate.

    Apparently the lumbar curves are more successful. Lumbar curves up to 45 degrees had an overall 87% success rate.

    A girl's x-rays and a boy is shown having grown a lot and he looks great and her x-rays look great!

    The very last slide states on it that "Other fusionless strategies are close on the horizon" but he chose not to talk about them.

  12. #12
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    Quote Originally Posted by hdugger View Post
    As the parent of a young adult with something like a 55 degree curve, I was very interested in the 10:25 presentation - SESSION 2: AIS - SURGICAL DECISION MAKING 55 Degree Curves, How Do You Treat Them? PANEL AND AUDIENCE DISCUSSION.
    I saw that. I was floored by the range of opinions which didn't overlap from putatively experienced surgeons.

    That seems like a pretty important point of difference!
    See now here you went with one exclamation point whereas I think between 3 and 5 would be in order.
    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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    Quote Originally Posted by Pooka1 View Post
    That is seven exclamation points. Must you be so understated? Don't hold back... say what you mean!
    Well Sharon, I actually erased a few because it seemed, perhaps, a few too many. LOL
    Last edited by leahdragonfly; 09-08-2009 at 05:22 PM.
    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

  14. #14
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    Leahdragonfly,

    I had to wear a body cast for 3 months after my uninstrumented fusion surgery in 1984, and although I felt fine physically, I refused to go to high school in it. My mom had to get a home teacher through the school district.
    I think your mom was very smart and I wouldn't hesitate to do the same with any child that was having problems adjusting at school with a temporary body cast. I suspect the school districts would certainly understand.

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