My "little" (actually ~5' 9" ) Willow had a 6-month radiograph done. It was 36* so no change from the last visit when it was 40*.
Still almost no rotation. I wonder if the spine can physically curve any more if it doesn't start to rotate. Maybe it is locked at this angle and can't go higher unless it starts to rotate. We'll take that if it is true.
The curve was stable in the last six months after moving ~8* in the previous six months (while wearing the brace) and being stable during the six months before that (before the brace).
Clearly, the curve moves when it wants to move irrespective of brace wear.
So here's the new deal as we know it today (subject to change):
1. Risser is ~3 but he said not Risser, not Tanner-Whitehouse, not any other bone age indicators etc. were going to determine the maturity w.r.t. curve progression... in fact they are coming back to chronological age as the main predictor of maturity (if you can believe it) although he mentioned menarche onset also.
2. He agrees with my assessment that the bracing literature is a miasma... can't tell up from down. He still doesn't believe bracing has been shown to be efficacious. Bracing certainly might work but nobody has shown it yet in a well-designed study.
3. I voiced my concern about if Willow stays at ~40* when she reaches maturity and that would lock her out of surgery as a teenager and would seem to doom her to progression through life and eventual surgery as an adult. He said that 50* is the point where you expect most folks to have a progression through life that might necessitate surgery later on. He said Willow will likely not need surgery as an adult if it stays at ~40*.
I asked about pregnancy and progesterone and he denied that that triggers progression in a previously stable curve. That is, he seems to be claiming that progesterone or anything pregnancy-related won't jump-start a previous stable curve of Willow's magnitude.
I asked why the huge difference in average recovery between kids and adults and he said it was because most adults are not just having AIS corrected but have other problems being fixed. That's my understanding of what he said.
So it was a very good visit. We went in there expecting that we would be scheduling surgery in early summer. We came out thinking there was half a chance Willow would never need surgery for scoliosis. There was much rejoicing. And I again credit the power of no prayer whatsoever.
Still almost no rotation. I wonder if the spine can physically curve any more if it doesn't start to rotate. Maybe it is locked at this angle and can't go higher unless it starts to rotate. We'll take that if it is true.
The curve was stable in the last six months after moving ~8* in the previous six months (while wearing the brace) and being stable during the six months before that (before the brace).
Clearly, the curve moves when it wants to move irrespective of brace wear.
So here's the new deal as we know it today (subject to change):
1. Risser is ~3 but he said not Risser, not Tanner-Whitehouse, not any other bone age indicators etc. were going to determine the maturity w.r.t. curve progression... in fact they are coming back to chronological age as the main predictor of maturity (if you can believe it) although he mentioned menarche onset also.
2. He agrees with my assessment that the bracing literature is a miasma... can't tell up from down. He still doesn't believe bracing has been shown to be efficacious. Bracing certainly might work but nobody has shown it yet in a well-designed study.
3. I voiced my concern about if Willow stays at ~40* when she reaches maturity and that would lock her out of surgery as a teenager and would seem to doom her to progression through life and eventual surgery as an adult. He said that 50* is the point where you expect most folks to have a progression through life that might necessitate surgery later on. He said Willow will likely not need surgery as an adult if it stays at ~40*.
I asked about pregnancy and progesterone and he denied that that triggers progression in a previously stable curve. That is, he seems to be claiming that progesterone or anything pregnancy-related won't jump-start a previous stable curve of Willow's magnitude.
I asked why the huge difference in average recovery between kids and adults and he said it was because most adults are not just having AIS corrected but have other problems being fixed. That's my understanding of what he said.
So it was a very good visit. We went in there expecting that we would be scheduling surgery in early summer. We came out thinking there was half a chance Willow would never need surgery for scoliosis. There was much rejoicing. And I again credit the power of no prayer whatsoever.
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