FAO BigBlueFrog - RCS brace and double curves

[Pooka1]

You mentioned that the Schroth types were telling you not to go with Spinecor and to go instead with the RSC brace.

I have been looking for studies with this brace I can only find one and it specifically says it is NOT suited for double major curves like you daughter has. I am mentioning this especially because they are trying to get you to pay an outrageous $6,000 for this brace that is not likely to help your daughter. That is equally outrageous of them.

There is also a deleterious effect on the sagittal plane that sounds close to flatback syndrome which is caused by Harrington rods in the lumbar in some patients. This brace needs further study in my opinion but what do I know?

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Ann Readapt Med Phys. 2007 Apr;50(3):125-33. Epub 2006 Nov 27.
[Evaluation of the Chêneau brace in adolescent idiopathic scoliosis]

[Article in French]

Pham VM, Herbaux B, Schill A, Thevenon A.

Service de médecine physique et réadaptation, hôpital P.-Swynghedauw, rue du Professeur-A.-Verhaeghe, 59037 Lille cedex, France.

OBJECTIVE: We aimed to evaluate the Chêneau brace in the orthopedic treatment of adolescent idiopathic scoliosis to better determine the indications under which it could be prescribed. MATERIALS AND METHODS: This was a retrospective study including 63 patients treated by Chêneau brace for adolescent idiopathic scoliosis between 1997 and 2006. The Cobb angles of the curves in the frontal and sagittal planes as well as rotations and rib hump were measured at the beginning of treatment, with the brace, at the end of treatment and 2 years after discontinuing the brace. A variation of+/-10 degrees in angle was selected to judge the results. RESULTS: At the end of the treatment, 25.4% of the curves were improved and 60.3% stabilized, with 14.3% aggravated; 5 patients (7.9%) required surgery. At 2 years, the reduction in angle was 1.8 degrees, on average. The best results were obtained for the lumbar and dorsolumbar curves. A significant improvement was noted for the dorsal curves; the major double curves are not as accessible to the treatment. For curves whose initial angle was less than 30 degrees , an initial reduction of higher than 50% with the brace presented the best improvement at the end of the follow-up. We note a significant reduction of the rib hump but not accompanied by a reduction of rotation. Finally, we note a deleterious effect in the sagittal curves, with a slight flatness of the spinal profile. CONCLUSION: The continuous wearing of the Chêneau brace can stabilize the evolution of adolescent idiopathic scoliosis, apart from the forms with major double curves, which are not as accessible to the treatment. However, the improvement comes at the price of a slight flatness of the curves of the spine in the sagittal plane. The loss of the correction after discontinuing the brace is minor. We emphasize, therefore, the necessity to monitor the sagittal aspect of the spine as well as the possibility of early treatment, strict surveillance and prolonged follow-up.

[mamandcrm]

Just FYI

The Cheneau brace and the Rigo-Cheneau brace are different braces.

[Pooka1]

How so?

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[mamandcrm]

I don't know the specific differences, but the RC is a modified version of the Cheneau. It may not impact the study you found but it is different, as is the Cheneau light brace. Not interested in a dog-fight with you. Just pointing something out.

[Pooka1]

They appear to work on the same principle and are not claimed to be different other than Rigo uses some "classification system" which is beyond my comprehension.

One person's dog fight is another person's regard for facts.

[bas2101]

If you look at the figures and the rest of the article: of the 63 patients at the end of the 2 year follow up, 19 were double curves. Of those 19, 11 were stable, 1 was improved, 3 worsened without surgery, and 4 went onto surgery. It says that for double curves, this brace is not AS accessible to this treatment, but not that it doesn't work at all. As for the rest of the results: thoracic (22): 15 stable, 3 improved, 3 worsened, 1 surgery; thoracolumbar (12): 11 stable, 1 improved; lumbar (10): 5 stable, 5 improved. I don't know why in the conclusion it seems to indicate that the brace does not help double curves, when 12 of the 19 patients (63%) were either stable or improved.

As far as flat back, it says "the improvement comes at the price of a slight flatness of the curves of the spine in the sagittal plane." Our orthotist did mention this to us as a possibility. But, this may be a possibility of other braces as well. I am not sure.

As far as the brace costing $6000. I have never seen it cost this much. I am not sure why it is so much more by this particular orthotist. I have always heard around $3500-4500. In Spain, we paid $2200 including all follow up visits (exchange varies). With insurance chipping in, it ended up being around $500. Granted we had to pay to go to Spain, but in the end we still only spent around $3000 total per brace.

The Schroth PT's are not trying to get any parent to wantonly spend $6000. They suggest this brace (which can be obtained from a few places in the U.S.-some costing more than others), because they believe it works best in tandem with Schroth. Financially, they gain nothing in suggesting it. And, for many, insurance will cover it, or at least part of it.

[Pooka1]

Wow that's some good information!

I still think they are holding her up. It shocks my conscience actually, especially if her insurance won't cover it. That would be crazy if she paid $6K out of pocket when there is some indication from these authors at least that it isn't necessarily so good for double major curves.

[leahdragonfly]

brace flattening saggital contours of spine

Hi Sharon,

I think most if not all hard braces (temporarily) flatten the saggital contours of the spine at least to some degree. On top of that, many kids with scoliosis are hypokyphotic in the thorax to begin with.

Boston braces for instance are built with a 15-degree lumbar lordosis. This is a bit flatter than normal, but by flattening the lumbar it apparently helps stabilize/immobilize the pelvis and reduce the coronal curve/cobb angle (front or back view of the scoliosis curve).

I know I personally have a completely flat (entirely hypokyphotic) thoracic spine, which is felt to be due to my brace-wearing as a teenager.

[Pooka1]

More good info! Thanks.

IIRC, both my girls had some hypokyphosis in association with their scoliosis but I could be wrong. And the Charleston than the one kid wore seemed pretty darn flat over the entire back portion.

[jrnyc]

wow..before i spent $6,000 on a brace, i'd want some guarantees, which i know medical professionals dont/cant give anyone...

now...for botox..not in my back (which is covered by insurance), but for my face the sky's the limit...$6000 is nothin'!!

actually, i guess if it were for my child, i'd spend anything/everything i had, just on the chance it would fix the problem....but do you have to keep wearing it for the benefit..forever..or can you stop...cause i dont think i know i wouldnt want to wear one forever...

i know there are children who were helped by the brace...but have they been followed for 25-30 years to see how many of them need surgery years later cause the curves progressed after the brace came off?

jess

[LindaRacine]

Just my $.02, but you couldn't pay me enough $ to have anyone other than a certified orthotist, working with an orthopaedic surgeon, create a brace for my child. Why anyone would pay $6K for one of these braces... probably not even fit by an orthotist... is beyond me. Unfortunately, we can't protect people from themselves.

[bas2101]

I am not sure why you would assume anyone other than an orthotist would be fitting this brace. All Cheneau braces in the U.S. are fit by orthotists.

[Pooka1]

I guess I might assume that too when someone is charging a few thousand more for a brace that one could get for less even making several round trips to Europe.

Also there is the fact that the Schroth purveyor is trying to pressure her into buying the $6K RSC brace and the surgeon is completely out of that loop. It is unclear if any pediatric orothpedic surgeon has even suggested a brace for this kid. Therefore is is unclear if she will get radiographs to check the fit. Orthotists, no matter how good they might be, are not enough... the surgeon is equally a key player in bracing and makes all final calls as to the brace.

Orthotists are not trained to do what the surgeons do in brace fitting.

[bas2101]

The PT's are suggesting that this child get an RCS brace, not a $6000 brace. The orthotist closest to them just happens to be charging this amount, which is above and beyond what other orthotists charge for this brace in the U.S.

If the surgeon is not in the loop, he probably either does not agree with the protocol, or more likely, is not familiar with this brace, as many ortho surgeons in the U.S. are not.

My daughter's orthotist is also an M.D. who has been fitting this brace for something like 30 years. I would certainly trust his fitting the brace over anyone else.

Radiographs get be obtained easily from any doctor willing to order them. The parent can also obtain a brace prescription from their family M.D. or pediatrician willing to order it. I know several parents who go this route, yet who still see their ortho surgeon regardless of whether or not their surgeon is on board with the RSC brace.

[mariaf]

Orthotists, no matter how good they might be, are not enough... the surgeon is equally a key player in bracing and makes all final calls as to the brace.

Orthotists are not trained to do what the surgeons do in brace fitting.

I would agree with this. As good and experienced as the orthotist at Shriners is, the doctors still check all braces. They take in-brace x-rays, read them, and check the fit. The same was true of our former surgeon and the orthotist she worked with. The orthotist made the brace, but the orthopedic surgeon checked the fit, very thoroughly I might add.

Bottom line - having a skilled orthotist is very important, but in order to be the perfect "team", there must also be an expereinced orthopedic surgeon overseeing things.