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Thread: The Braist Study

  1. #46
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    Sorry if the actual article was posted before, I have not all the day to read all what is posted here as you. Please try to understand what thinking really means before giving that kind of nonsense advices.

  2. #47
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    Quote Originally Posted by flerc View Post
    Sorry if the actual article was posted before, I have not all the day to read all what is posted here as you.
    If you aren't going to follow along then why post at all? What are the chances you will post something relevant?
    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."

  3. #48
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    The actual article as you said was posted before in this forum? That is the problem for you? Or do you are simply criticizing I posted that New York Times article instead the other one?

  4. #49
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    Another BrAIST article... I think they will publish several before it's all said and done.


    October 01, 2013 - Volume 38 - Issue 21
    pp: i-i,1799-1903,E1291-E1360

    Design of the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST)

    Weinstein, Stuart L.; Dolan, Lori A.; Wright, James G.; More

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    Study Design. Descriptive.

    Objective. To describe the design and development of Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST).

    Summary of Background Data. Bracing has remained the standard of care for the nonoperative treatment of adolescent idiopathic scoliosis since the introduction of the Milwaukee brace in the late 1940s, but it has never been subjected to a rigorous evaluation of either its efficacy or its effectiveness. The BrAIST was designed to address the primary question: Do braces (specifically a thoracolumbosacral orthosis) lower the risk of curve progression to a surgical threshold (≥50) in patients with adolescent idiopathic scoliosis relative to watchful waiting alone?

    Methods. The authors describe the rationale for BrAIST, including the limitations of the current literature evaluating bracing for adolescent idiopathic scoliosis. Second, the authors describe the preliminary work, including the preparation of the National Institutes of Health clinical trials planning grant. Finally, the authors describe the trial design in detail.

    Results. BrAIST was conducted in 25 sites in North America. Subjects were treated either with a thoracolumbosacral orthosis or watchful waiting and followed every 6 months until they reached skeletal maturity or the surgical threshold of 50 Cobb angle.

    Conclusion. Clinical decision making will be improved by translation of the BrAIST results into evidence-based prognosis and estimates of how the prognosis, specifically the risk of progressing to surgery, may be altered by the use of bracing.

    Level of Evidence: N/A
    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."

  5. #50
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    Quote Originally Posted by Pooka1 View Post
    Another BrAIST article... I think they will publish several before it's all said and done.
    For those researchers, probably not all but very much seems to be already said:

    'In conclusion, bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. Longer hours of brace wear were associated with greater benefit.'

  6. #51
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    Why it is important to know NOT just that these "successes" were <50* at maturity but what exactly the curves were at maturity... five will get you ten that kids are only willing to wear a brace if it avoids surgery for life, NOT if it avoids surgery until you are 15 ore 16. If it doesn't make sense then it probably isn't true.

    Over the weekend, I've been in email contact with a 33 yo woman from Houston Texas who shared her story of curve progression from the 30's now into the 40's with her thoracolumbar curve now after pregnancy, where surgery has been recommended.
    http://drlloydhey.blogspot.com/2013/...ion-of-my.html
    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. #52
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    Obviously, kids are not stupids. Who said that?. If NECESSARILY progression until surgery need should to happen to every kid using braces at 15, 16 or then, then parents/surgeons opting for/recomending braces would be insane. Do you believe that? If it doesn't make sense then it probably isn't true.
    Last edited by flerc; 10-12-2013 at 09:22 PM.

  8. #53
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    These kids all probably think they are avoiding surgery for life if the brace is successful. That is clearly false.

    It's isn't a matter of intelligence. It is a matter of having or not having specific knowledge.
    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."

  9. #54
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    These kids all may trust that people saying them to have chances of avoiding surgery for life if the brace is successful has enough intelligence and specific knowledge in order to say that.

  10. #55
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    That's a faith position, not a scientific one. What is the evidence they have a chance to avoid surgery for life? Virtually all these braced kids are >30* at maturity.
    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."

  11. #56
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    Quote Originally Posted by Pooka1 View Post
    Virtually all these braced kids are >30* at maturity.
    Who said that? Is far to be according the cases I know. And not every people with >30* at maturity are sentenced to have surgery.

  12. #57
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    Quote Originally Posted by flerc View Post
    Who said that? Is far to be according the cases I know. And not every people with >30* at maturity are sentenced to have surgery.
    No but there is a reason that <30* is said to be protective against surgery. So the question is are these braced kids told that anything >30* is not protective against the possibility of surgery?

    Kids need to see some stats on actual progression rates starting from various curve magnitudes. I note that Dr. Hey doesn't seem shocked when someone comes into his office who needs surgery when they are in the 30s* at maturity. If it was rare then he should be shocked and not have so many cases on his blog.
    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. #58
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    I originally was diagnosed with a Thoracolumbar S curve, with curves of 35 and 36 degrees at age 13. I wore my brace and my x-rays some months after being done with bracing showed my curves in the low 20's at age 15. Somewhere between there and age 40 my lumbar curve returned to 30-35, and two years later the lumbar curve was 47. Curiously the thoracic curve stayed around 25 all those years.

    So for me I ended up with relatively small curves at maturity but then had a huge, rapid progression after age 40. I know I am not the only one here with this type of story. Dr Hey talks about people similar to me all the time.

    What gets me is the statistics strongly imply (at least 70% chance) that my curve would not have progressed without a brace. I was braced immediately based on cobb angle, I never had any documented progression. So it is impossible to say if I was one of the ones who was "saved" from surgery with the brace, or if I was one of the 3 children who are braced unnecessarily for every one child who is saved from surgery. Definitely something to think about.
    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. #59
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    Quote Originally Posted by flerc View Post
    Who said that? Is far to be according the cases I know.
    You didn't answer that.
    Do you believe that everyone knowing to have >30* at maturity would prefer to have surgery anyway?

  15. #60
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    Quote Originally Posted by flerc View Post
    You didn't answer that.
    Do you believe that everyone knowing to have >30* at maturity would prefer to have surgery anyway?
    Nobody prefers surgery. You seem to think that choosing not to brace is choosing surgery. Most cases do NOT progress to surgery so that makes no sense. Most braced kids are braced needlessly. BrAIST showed this yet again. This is not new.

    I think kids should know that even if they wear their brace as prescribed, if they are >30* at maturity, there is no guarantee they can avoid reaching surgical range. The brace is NO GUARANTEE to avoid surgery and I wonder how many kids are clear on this point.
    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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