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  • when should bracing be done?

    My 14 year old daughter was just diagnosed with double scoliosis. The doctor said the upper curvature "was about 19 and the lower was about 17" Then he went on to say there could be a 4 degree variance....he told us to come back for x-rays in 4 months. She has been checked at school for the past 3 years with no concerns. Now, I just noticed the hump on her shoulder. I am afraid to wait. Why should we wait for it to get worse? What is the least curvature someone had, when they got their brace?

  • #2
    Hi Worrier...

    Depending on whether your daughter is skeletally mature or not, she may have only a very small chance that her curves will progress. Putting a kid in a scoliosis brace is a pretty big deal, and most teens don't tolerate it very well. So, putting a kid in an expensive brace, when there's a good probability that she won't need it, is overkill. Did the doctor tell you what your daughter's Risser grade is? Has she started her periods? If so, how long ago?

    Here's a research paper on the probability of progression:

    http://www.vh.org/pediatric/provider...abilities.html

    Regards,
    Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

    Comment


    • #3
      Hi Linda,

      Thanks for your reply. No, her doctor did not tell us her Risser grade. She started her periods about 7 months ago and is just now starting to develop. I am just worried because I see a hump now and one hip is slightly higher. I just don't want it to become really obvious. I read on one site that bracing should be considered if the curvature is 20 to 30 degrees. So, if he thinks there could be a 4 degree variance that could put both curves above 20. Of course, it also could be lower. I really don't want her in a brace because it would devastate her, however progressive physical changes would also devastate her. I am just thinking if we put a brace on now or in the near future, maybe she wouldn't have to wear it very long. From what I read the brace won't fix the curvature, it just stops the progression. So, why should we wait for the deformity to worsen and then put a brace on? It will stop the progression but leave her with the deformity.

      Thanks,
      worrier

      Comment


      • #4
        Hi Worrier...

        If your daughter started her period 7 months ago, she's almost certainly at the end of her skeletal growth, which means that she's probably a Risser 4 or 5. With small curves and a high Risser score, she has very little probability that her curves will ever increase. Once a child is skeletally mature, a brace would be of no benefit.

        Regards,
        Linda
        Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
        ---------------------------------------------------------------------------------------------------------------------------------------------------
        Surgery 2/10/93 A/P fusion T4-L3
        Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

        Comment


        • #5
          bracing's an issue that depends on where in the world you are. i live in the uk and here i would say that most doctors would get your daughter cast and wearing a brace as though they are surgeons they believe that if surgery can be avoided, it should. although like linda said if your daughter's curves are currently under 20 degrees and she is almost skeletally mature, progression is possibly unlikely, but i think most doctors here wouldn't take that chance. if you're very concerned i would say seek a second opinion and get her curves measured by someone else. my surgeon told me that every doctor in the world could measure a patient's xrays and come up with different answers, but if your second opinion found a significant difference there could be cause for concern. it's hard to give advice like this though as i don't know the ins and outs of your situation.

          as you can see in my signature, i was diagnosed at 14 and my curves were more than double your daughter's. braces aren't just used to prevent progression - if the spine is flexible enough (before skeletal maturity is reached) and the patient is dedicated to brace-wear, then correction can be achieved (though 100% correction is unlikely, it can be corrected by maybe 50%)...so what i'm saying is, at the same age, i and other people were a lot worse, so perhaps your doctor is right and there isn't cause for concern.

          my main piece of advice would be seek a second opinion if you are worried
          diagnosed aged 14 (2001)
          braced from july 2001 to february 2003 to hold curves
          fused T11-L3 on july 16th 2005 (aged 18)
          Discharged by surgeon july 11th 2007 (aged 20 and almost 2 years post-op)
          scoliosis support forum

          Comment


          • #6
            Worrier,

            I think your concern is a valid one ! It's easy to talk about statistics and probabilities and look at the overall picture, but the most important person in all of this is your daughter - do you really want to be playing russian roulete with your daughter's health ? It's quite possible that a few years from now you'll be kicking yourself for not taking action. True, nowadays you can't expect braces to 'correct' a curve and if it happens, that's a major bonus and it's usually on average about 5 degrees. If your daughter's curve progresses, don't expect sympathy from the doctors because they stand to profit financially from performing the surgery - I know this sounds harsh, but it's true If your daughter has a hump, there is probably rotation and this is not good. Do all that you can to help your daughter and be thankful she is almost finished growing. She has the rest of her life ahead of her and you don't want her living with a painful deformity.

            Oh, to answer your question, I've seen children with curves of 15 degrees treated with the SpineCor brace.



            Celia
            Last edited by Celia; 10-04-2005, 01:04 PM.

            Canadian eh
            Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

            Comment


            • #7
              Worrier,

              My daughter was diagnosed at age 11, her curve then was low 20's. She was checked every four to six months and her curve went up and down every visit. She got her period at ten years old, which is a big plus. She was never braced, although at one point her curve was borderline. Just recently went for her final check up (almost 19 yrs. old) and her curve is under 20 degrees. She never suffered from any pain. I on the other hand suffered from pain as a very young girl until I had the surgery at 28. I would wait at least for the first four months for a re-check and see how her curve is. Good luck, LYNN
              1981 Surgery with Harrington Rod; fused from T2 to L3 - Dr.Keim (at 26 years old)
              2000 Partial Rod Removal
              2001 Right Scapular Resection
              12/07/2010 Surgical stabilization L3 through sacrum with revision harrington rod instrumentation, interbody fusion and pre-sacral fusion L5-S1 - Dr. Boachie (at 56 years old)
              06/11/14 - Posterior cervical fusion C3 - T3 (Mountaineer System) due to severely arthritic joints - Dr. Patrick O'Leary (at age 59)

              Comment


              • #8
                Hi...

                While I agree that when it's you or your child, statistics mean nothing, I believe we still owe it to our fellow citizens to be socially responsible in utilizing healthcare. The same argument could be made for surgery. Most kids with small curves never need surgery, but some do. Does that mean we should have all kids with curves of 20 degrees or more go through surgery? Of course not.

                This child has no history of progression yet and is probably skeletally mature or close to it. If we were to brace everyone in that category, it would cost all of us a considerable amount. We all have the responsibility to keep healthcare and healthcare insurance affordable so that as many people as possible have access to it. If we brace every kid with a 20 degree curve, then there are going to be a whole lot of kids with much larger curves who probably won't have access to bracing or surgery.

                Now, if everyone who wants to put their kids in a brace before it's deemed medically necessary wants to pay for the brace out of their own pocket, I have no argument other than that you're probably making the kid go through some real emotional turmoil for no reason.

                Regards,
                Linda
                Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                ---------------------------------------------------------------------------------------------------------------------------------------------------
                Surgery 2/10/93 A/P fusion T4-L3
                Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                Comment


                • #9
                  Linda,

                  Worrier's daughter has a rib hump ! I doubt whether the calculation given by her ortho is even accurate, he even qualified the calculation by saying it could be off by 4 degrees or so. I don't want to sound like an alarmist, but I've come across far too many "just wait and watch" scenerios where the curve progresses within a matter of months to surgery level. I've also read of many cases where orthos only begin to brace when the curve is already at 45 degrees !!!! Now tell me this downright unfair ! How do those kids even have a chance in hell of stopping the curve from progressing ?! I've also come across individual cases (titanium rib) where surgery costs for ONE child approximates a million dollars !!! These are children with idiopathic scoliosis who were told to watch and wait ! Is society better off ? Is health care better off ? I doubt it.

                  Canadian eh
                  Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

                  Comment


                  • #10
                    Celia...

                    When a skeletally immature child has a good chance of curve progression to the surgical stage, bracing is a very good option. That's not the case we're talking about here. In your scenario, you'd put every kid with at least a 20 degree curve in a brace, regardless of Risser and regardless of lack of documented progression. Where should we draw the line? Anyone with a 19 degree curve doesn't get a brace? The medical community has studied this subject and has recommended that a child like Worrieds should not be braced. If, at the 3-4 month checkup, significant progression is seen, then bracing may be appropriate. By the way, even if the kid is put in a brace today, there's no guarantee that it will stop progression. I will always believe that putting a child in a scoliosis brace before it's medically warranted is cruel to the child and detrimental to society.

                    --Linda

                    P.S. There is always about a +/- 5 degree margin of error in measuring curves. As Worried pointed out, it could be -5 degrees, in which case, there's about zero chance that the curves will ever increase.
                    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                    ---------------------------------------------------------------------------------------------------------------------------------------------------
                    Surgery 2/10/93 A/P fusion T4-L3
                    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                    Comment


                    • #11
                      Originally posted by LindaRacine
                      Celia...

                      In your scenario, you'd put every kid with at least a 20 degree curve in a brace, regardless of Risser and regardless of lack of documented progression. Where should we draw the line? Anyone with a 19 degree curve doesn't get a brace?
                      Nope, documented progression, level of rotation, RVAD - YES brace. I don't think waiting for a curve to progress to 30 or 45 degrees and then bracing is very effective. Worrier's daughter obviously has rotation and uneven hips - a sure sign for progression. I think quality of life for ALL is very important, especially the quality of life of an individual whose scoliosis is left untreated and allowed to progress in a relentless fashion. How many braces can we buy with one million dollars ?

                      Canadian eh
                      Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

                      Comment


                      • #12
                        why on earth should money come into the wellbeing of and future of your child's health?
                        diagnosed aged 14 (2001)
                        braced from july 2001 to february 2003 to hold curves
                        fused T11-L3 on july 16th 2005 (aged 18)
                        Discharged by surgeon july 11th 2007 (aged 20 and almost 2 years post-op)
                        scoliosis support forum

                        Comment


                        • #13
                          Marmyte...

                          In my opinion, if the excessive healthcare of some causes millions of others to have no access to healthcare, then the greater good should be considered.

                          --Linda
                          Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                          ---------------------------------------------------------------------------------------------------------------------------------------------------
                          Surgery 2/10/93 A/P fusion T4-L3
                          Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                          Comment


                          • #14
                            Celia...

                            I've never personally seen a kid with at least a 20 degree curve who doesn't have rotation.

                            --Linda
                            Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
                            ---------------------------------------------------------------------------------------------------------------------------------------------------
                            Surgery 2/10/93 A/P fusion T4-L3
                            Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

                            Comment


                            • #15
                              Linda,

                              I'm sure Worrier really appreciates all the time we're spending on her case What was I going to say ?..... Oh yes, spinal surgery costs/revision surgery will surely bankrupt the system.

                              Canadian eh
                              Daughter, Deirdre born Oct 2000. Diagnosed with 60 degree curve at the age of 19 months. Serial casting by Dr. Hedden at Sick Kid's Hospital. Currently being treated by Dr. Rivard and Dr. Coillard in Montreal with the Spinecor brace and curve is holding at "2" degrees. Next appointment 2008

                              Comment

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