Advanced Maternal Age Associated with AIS?

[Ballet Mom]

It's not present in all locations at all times. That one is obviously not ubiquitous.

It doesn't have to be in all places at all times. It moves into the spinal ganglia and stays there.

[Pooka1]

It doesn't have to be in all places at all times. It moves into the spinal ganglia and stays there.

What is the evidence is it ubiquitous enough in space and time to explain AIS incidence? Note this requires at least a few references.

[Pooka1]

And by the way, if the nail is in the coffin on the autosomal dominant form and both forms are really the same animal then that is the official end to the germ theory of AIS. As if it ever actually started.

[Ballet Mom]

And by the way, if the nail is in the coffin on the autosomal dominant form and both forms are really the same animal then that is the official end to the germ theory of AIS. As if it ever actually started.

This from a person who yesterday was loudly denying the fact that familial scoliosis even existed.

[Pooka1]

This from a person who yesterday was loudly denying the fact that familial scoliosis even existed.

Please follow along.

All AIS is familial.

Also, some people refer to the apparently autosomally dominant inheritance pattern as "familial."

Same word, two different usages. You were trying to say that not all AIS was familial. It is.

[hdugger]

They may talk about it, but they've developed a genetic test using familial genes.

As best I can tell, they don't consider the test base to be familial. I'm guessing (based on no evidence whatsoever) that what looks like familial is actually multifactorial with a very strong tendency to progress (i.e, a score above 180). That would make it much like my niece, who has a genetic predisposition to produce bad cholesterol, and who therefore has be to extra careful about her heart.

Also, as best I can tell from the Scoliscore research, the trigger is entirely environmental, even in high-scoring children. So, there could be tons of kids with scores of 180 who never show up in the doctor's office at all.

[hdugger]

This from a person who yesterday was loudly denying the fact that familial scoliosis even existed.

Again, the *trigger* is unknown, even in those most likely to progress. The genes only appear to affect the chance of progressing. If those with the greatest tendency to progress avoid the environmental trigger, they won't have scoliosis.

That is, I don't see anything in the research which refutes any theory on the environmental trigger.

[Ballet Mom]

Please follow along.

All AIS is familial.

Also, some people refer to the apparently autosomally dominant inheritance pattern as "familial."

Same word, two different usages. You were trying to say that not all AIS was familial. It is.

Sorry, this doesn't cut it.

[Ballet Mom]

Again, the *trigger* is unknown, even in those most likely to progress. The genes only appear to affect the chance of progressing. If those with the greatest tendency to progress avoid the environmental trigger, they won't have scoliosis.

That is, I don't see anything in the research which refutes any theory on the environmental trigger.

Let me repeat my main issue with this test. I could care less whether or not Axial Biotech actually believes there is an environmental trigger or not.

The main issue with the test is this...if it's accurate and works, it's okay to use it. Unfortunately, it obviously doesn't work well enough. It lets kids progress to at least forty degrees and lets many of them progress to surgery anyway without treatment. As far as I'm concerned, it would be a travesty to use this test as the standard of care.

It's like doctors stating that the odds of that colon polyp changing into a cancerous tumor is low, and therefore we won't remove it. And if you're one of the unlucky ones that has a polyp that turns into colon cancer, well...we have surgery to fix it. I'm sure no one will mind having a colostomy. What a bizarre way to conduct medicine. As far as I'm concerned it's a "scientific" way to remove the cost of bracing and office visits from the medical system. And it's not right.

And did anyone notice that the inventors of the Scoliscore test have a vision with no place for bracing in the future? And much less treatment of all cases. How is that okay? Bracing has saved my daughter and I resent any scientist stating that others will not be able to receive that same treatment that worked perfectly well for her and avoided surgery.

[hdugger]

That may be how the Scoliscore people imagine that things will go, but they have no control whatsoever over setting the treatment protocol. I can't imagine a surgeon who has used braces, suddenly deciding *not* to use them with a child continuing to progress over 30 degrees, no matter what their score is.

My *only* concern is that the net is cast so wide that kids likely to progress to 40 degrees aren't being monitored closely enough to catch them in this critical period.

[skevimc]

More conspiracy theories?

I'd suggest you stop talking about conspiracy theories. It's not a conspiracy theory, it is what it is.

"AIS predictive test could eliminate inefficiencies
in the mild scoliosis group at great individual and
aggregate savings."

Paradigm shift described from bracing to no bracing and early fusion/fusionless surgeries with most cases of scoliosis not treated.

Ogilvie presentation http://www.vinzenzgruppe.at/vinzenzg...3Ogilivie.pdf/

Of course, "mild" scoliosis is all the way up to surgical levels. No skin off his nose.

I understand how you think this presentation says that "mild" goes all the way up to surgical range, but it doesn't. He's clearly referring to the examples he gives which were ~10°. These examples were given in the context of "what do you tell your patient and family when they present with a small curve but have a lot of growth left".

As well, a paradigm shift is only being suggested for those with high scoliscore numbers since the data strongly supports that high scores >190 are not affected by bracing. So the idea that catching a patient with a 10° curve at age 10 with a scoliscore of 195, suggests with >99% accuracy that her curve will progress to >40° and will probably be unaffected by bracing, thus other treatments need to be discussed immediately.

There is no statement about a 15° curve in a 12 year old female with a scoliscore of 100. This is especially true in regards to what treatments need to be employed for that patient.


As a side note, this also provides an opportunity for bracing to improve/show that it is effective. If it doesn't work now for high scoliscores, then how can it be improved? What happens when better exercise and bracing protocols are developed? Bracing companies have a lot of money in this game as well and a lot of patients have been braced unnecessarily as a result. Bracing isn't going away any time soon. But hopefully it can be used more appropriately.

Bracing has saved my daughter and I resent any scientist stating that others will not be able to receive that same treatment that worked perfectly well for her and avoided surgery.

I think you'd be well advised to actually go read some of these research papers without an ideological slant. Apparently that's what universities are for these days, the propagation of ideology, not the quest for truth.

As a scientist, I resent someone suggesting that academic institutions are only for the propagation of ideology and not out for truth.

[hdugger]

As well, a paradigm shift is only being suggested for those with high scoliscore numbers since the data strongly supports that high scores >190 are not affected by bracing. So the idea that catching a patient with a 10° curve at age 10 with a scoliscore of 195, suggests with >99% accuracy that her curve will progress to >40° and will probably be unaffected by bracing, thus other treatments need to be discussed immediately.

I thought the test was designed to be negatively predictive - if you scored low then you didn't need rigorous following - but that it wasn't designed to accurately mesaure the positive case. That makes it seem a little risky for pulling those high-risk kids out of braces.

[Pooka1]

Sorry, this doesn't cut it.

Research scientists and bunnies... separated by a common language.

You have to come up to speed on the language or you can't play the game FULL STOP.

[Ballet Mom]

I understand how you think this presentation says that "mild" goes all the way up to surgical range, but it doesn't. He's clearly referring to the examples he gives which were ~10°. These examples were given in the context of "what do you tell your patient and family when they present with a small curve but have a lot of growth left".

Kenneth Ward, MD this month: "With the SCOLISCORE Test, we proved that patients with low-risk scores often do not develop progressive scoliosis, which means surgeons can determine a more appropriate treatment path. "

(along with more specific "cost savings" associated with this).

http://www.beckersorthopedicandspine...-axial-biotech

Is that good enough for your daughter if she was diagnosed with scoliosis? Not good enough for mine if I know that they set the parameters at 40 degrees and many kids are progressing to that.

Oh look, we'll just ignore this: "A family in their church recently lost a child due to
AIS (complications of A/P fusion and instrumentation)". No problem, there's no risk in surgery, let's drop bracing.

Let's hope all treatment plans in medicine don't simply become a rolling of the dice for treatment, simply based on statistically crunched odds. Think of the cost savings that can occur! No more pap smears...no more breast exams...the odds are so low for them to occur and think of all the money we can save...and we have surgery if you're an unfortunate soul. Welcome to the new dark ages of medicine.

As well, a paradigm shift is only being suggested for those with high scoliscore numbers since the data strongly supports that high scores >190 are not affected by bracing. So the idea that catching a patient with a 10° curve at age 10 with a scoliscore of 195, suggests with >99% accuracy that her curve will progress to >40° and will probably be unaffected by bracing, thus other treatments need to be discussed immediately. .

There is no suggestion in that slide regarding the paradigm shift that it only reflects those with high scoliscore numbers. It is a slide representing the entire population.

As a side note, this also provides an opportunity for bracing to improve/show that it is effective. If it doesn't work now for high scoliscores, then how can it be improved? What happens when better exercise and bracing protocols are developed? Bracing companies have a lot of money in this game as well and a lot of patients have been braced unnecessarily as a result. Bracing isn't going away any time soon. But hopefully it can be used more appropriately.

Let's hope that actually happens before everyone jumps onto the no bracing bandwagon. It would be nice if more kids could be braced at night if they simply did specific exercises in addition to the brace.

As a scientist, I resent someone suggesting that academic institutions are only for the propagation of ideology and not out for truth.

Well excuse me for offending your sensibilities...but scientists in universities nowadays seem to think that anyone opposing their agendas are big targets to offend. Look at AGW, or "human caused" global warming. Scientists, including several from Stanford, of all places, send a letter to congress calling those who don't agree "deniers". University scientists think anyone who disagrees with them is part of some right wing agenda against them, a good target to be verbally abused.

Pooka feels perfectly free to continually castigate me for emotionalism or whatever for believing in God, and she is certainly not alone, even though she seems to have less of an idea of what's going on in the scoliosis research than me. But she supposedly has the big university awarded Ph.D. My science background isn't worth anything apparently.

Most universities quite clearly have a leftist agenda nowadays, and they think it's fine to obnoxiously attack anyone who disagrees, whether or not the person disagreeing has impeccable credentials or not. The university scientists have brought this on themselves and really should do a lot of self-reflection in order to improve the light they are viewed in. Not everything from the left is the correct answer.

[Ballet Mom]

Research scientists and bunnies... separated by a common language.

You have to come up to speed on the language or you can't play the game FULL STOP.

Just cut it out. I read the research papers and you obviously did not. If you did, you didn't understand them. I did.