Torso Rotation Strength Training for Scoliosis

[mamamax]

It could be that virtually all kids are treated uselessly prior to fusion. That is a valid conclusion from the data in hand.

I don't know about that, I really don't. And if that may be a valid conclusion from the data on hand - I would have to question the data .. or lack thereof. What I mean by that is: I just don't see that all bases have been fully covered, sufficiently enough, to make that conclusion without question in all cases. But then again, I'm just a patient and certainly no expert.

[Pooka1]

I don't know about that, I really don't. And if that may be a valid conclusion from the data on hand - I would have to seriously question the data .. or lack thereof actually. What I mean by that is: I just don't see that all bases have been fully covered, sufficiently enough, to make that conclusion without question.

Okay which conservative treatments do we know keep kids out of surgery for life who would otherwise have progressed to surgery? Please list them below.

If you can't list anything then my conclusion remains consistent with the data in hand though of course that doesn't mean is is correct. That is an important distinction. All anyone can do is work with the data in hand which in that case may or may not be incomplete with respect to PT permanently reducing curves when the treatment is stopped.

[Pooka1]

I don't know about that, I really don't. And if that may be a valid conclusion from the data on hand - I would have to seriously question the data .. or lack thereof actually. What I mean by that is: I just don't see that all bases have been fully covered, sufficiently enough, to make that conclusion without question.

By the way, I say of the treatments available today. That includes everything we have discussed on this forum and then some.

[mamamax]

Okay which conservative treatments do we know keep kids out of surgery for life who would otherwise have progressed to surgery? Please list them below.

If you can't list anything then my conclusion remains consistent with the data in hand though of course that doesn't mean is is correct. That is an important distinction. All anyone can do is work with the data in hand which in that case may or may not be incomplete with respect to PT permanently reducing curves when the treatment is stopped.

My list always begins with Joe O'Brien who kept two kids out of surgery with bracing. Unfortunately, we do not have an international data bank that would prove a sufficient expanded listing for this discussion. But his story is played out every day among other families. And in this we find the missing data.

Does this mean all kids can be kept out of surgery with bracing? No. But it does mean some can.

[Pooka1]

My list always begins with Joe O'Brien who kept two kids out of surgery with bracing.

You can't prove that. All you can say from that is that the kids didn't get surgery to date.

Science 101.

[mamamax]

Oh that's great - then bottom line is ... there is no proof that bracing works and there is no proof that it does not (basing proof on cradle to grave statistics). I'm glad we solved that one! Someone alert the press.

Science 102

[Pooka1]

Oh that's great - then bottom line is ... there is no proof that bracing works and there is no proof that it does not (basing proof on cradle to grave statistics).

Correct.

I'm glad we solved that one! Someone alert the press.

Science 102

Some among the press have known that for years. All who are familiar with the literature have known that for years. Not news.

[txmarinemom]

My list always begins with Joe O'Brien who kept two kids out of surgery with bracing. Unfortunately, we do not have an international data bank that would prove a sufficient expanded listing for this discussion. But his story is played out every day among other families. And in this we find the missing data.

Does this mean all kids can be kept out of surgery with bracing? No. But it does mean some can.

Maxene,

Joe's kids might (operative word) have stayed out of surgery with Spinecor, any brace - or no brace. You keep bringing up his family, and I'm sure you want to believe there are givens there (I wish I could), but there's NO *definitive* proof bracing is what tipped the scale.

There's just NOT.

If I can, I'll grab the full paper for you tomorrow. I could be delayed as I'm getting ready for my Marine to come home on leave (out of Afghanistan safely a few weeks ago). Lots to do this weekend!

Pam

[txmarinemom]

Yes Please! I would like the full article of the abstract you mention - so, that is something given to adult surgical patients, how often?

rhBMP-2 is used fairly often these days (at least I know my surgeon uses it) in adult fusions. I received it in Feb 2008 - and my surgery photos show the placement via absorable collagen sponges very clearly.

I will always feel it cut my restriction/recovery time dramatically, and at 22 months out my fusion is solid.

[jrnyc]

Dear Pam
how wonderful that you have a marine, your marine, coming home safely!

what a great holiday gift!

best regards
jess

[mamamax]

Maxene,

Joe's kids might (operative word) have stayed out of surgery with Spinecor, any brace - or no brace. You keep bringing up his family, and I'm sure you want to believe there are givens there (I wish I could), but there's NO *definitive* proof bracing is what tipped the scale.

There's just NOT.

If I can, I'll grab the full paper for you tomorrow. I could be delayed as I'm getting ready for my Marine to come home on leave (out of Afghanistan safely a few weeks ago). Lots to do this weekend!

Pam

Hey Pam! Look forward to the paper. Let the Marine know we are grateful! Have a super weekend. As for proof - dang, it's so subjective! But I don't really want to debate it :-) We could just go round and round eternally/infernally. Not too supportive to those patients & parents involved in bracing treatment, and in the end .. we really just don't have enough data to make definitive statements either way. Hence, the BrAIST study in the never ending quest to know for sure. Just my opinion :-)

[mamamax]

rhBMP-2 is used fairly often these days (at least I know my surgeon uses it) in adult fusions. I received it in Feb 2008 - and my surgery photos show the placement via absorable collagen sponges very clearly.

I will always feel it cut my restriction/recovery time dramatically, and at 22 months out my fusion is solid.

Maybe it should be used in adult bracing

Seriously, I look forward to reading it - thanks!

[hdugger]

Well, I think we know that there simply aren't enough controlled studies to be able to answer this question one way or another. It would take something extraordinary (a curve reduction) to be able to address this question given the state of the literature.

But, the problem is clearly the state of the literature. Even a great alternative treatment, so long as it simply stopped progression and didn't reduce a curve, would be unknown given the state of the literature.

Okay which conservative treatments do we know keep kids out of surgery for life who would otherwise have progressed to surgery? Please list them below.

[mamamax]

Did I just hear the voice of reason enter the room?

[Pooka1]

Well, I think we know that there simply aren't enough controlled studies to be able to answer this question one way or another. It would take something extraordinary (a curve reduction) to be able to address this question given the state of the literature.

Yes exactly my point.

But, the problem is clearly the state of the literature. Even a great alternative treatment, so long as it simply stopped progression and didn't reduce a curve, would be unknown given the state of the literature.

Yes. Consider the following:

1. My one kid was stable while in the 30s for at least 6 months while out of brace. Had she happened to be enrolled in that torso rotation study she would be considered a success. Yet she went on to fusion later.

2. Pam stopped wearing her brace and got to ~50* as a teenager and then STAYED there for about 2 decades. Had she been wearing a brace as directed that would have been considered a bracing success.

3. Your own son is stable absent brace or PT.

Proponents of conservative treatments will have to somehow control for these types of cases if they are going to claim efficacy.