Originally posted by hdugger
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More Good Evidence Bracing Works in AIS
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Originally posted by hduggerThat's an important point in these discussions. For some reason, bracing is considered to have "failed" if the patient ever requires surgery, while, for people needing revision surgery it's somehow deemed "successful" because it gave them 10 or 20 good years. Either needing surgery later in life is a failure for both, or putting it off for 10 or 20 years is a success for both. We can't make an adequate comparison unless success and failure are defined in the same way for both.
Originally posted by Pooka1 View PostBracing of kids is done to avoid surgery FULL STOP. Defining "failure" in that context is beyond obvious. There is no fuzzy area here.
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Success of bracing and success of surgery are apples and oranges because one is to avoid the other.
Originally posted by rohrer01 View PostSome docs are very misleading and should NEVER tell anyone they are out of danger of progression.
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Originally posted by Kevin_Mc View PostI'm not sure it's apples and oranges. If someone is braced and then requires surgery later, while I don't see that as an outright failure of bracing, I see the point. But if someone gets surgery and then later requires an additional surgery, well, they both kind of seem similar to me. I guess it depends on how you phrase the 'goal' of the treatment. You're saying that bracing is only used to avoid surgery forever. So then what are the goals of surgery? To avoid continued progression forever? To straighten the spine/reduce the curve forever? To avoid future surgery forever? To 'cure' scoliosis forever? Based on how someone phrases what the goals of a treatment will determine if it's considered successful or a failure in the long-term. And I would say that the time frame of the goals should be included in that, e.g. avoid progression through adolescence, avoid surgery forever, etc... If the goals of bracing and surgery are similar, e.g. avoid progression forever, then success can be judged similarly. Thus, if the brace wearer or surgical patient eventually progresses in the future then both treatments would be deemed a failure. (Although I wouldn't say that. But just using this as an example for the discussion.)
Thus brace failure is measured in surgery at any point whatsoever. That logically and necessarily follows from the fact that bracing is only done to avoid surgery. You have to disagree that that is the sole reason why bracing it done to argue this follow on. I don't believe that can be credibly argued.
It seems likely that the odds of needing a revision (or more than one revisions) are IDENTICAL in the braced population and the non-braced population. They appear to be related to things like curve location and bone character rather than if surgery is required due to failed bracing or as an initial treatment. If that is the case then bracing success and surgical success can't be judged similarly in principle. The question becomes what is least successful:
1. bracing plus surgery versus surgery
2. bracing plus surgery plus revision versus surgery plus revision
Bracing will always be worse because it is one more treatment and one that explicitly failed.Sharon, mother of identical twin girls with scoliosis
No island of sanity.
Question: What do you call alternative medicine that works?
Answer: Medicine
"We are all African."
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Originally posted by Pooka1 View PostI suggest it is fair to say that not a single person in the known universe would agree to brace their child unless they thought it would avoid surgery for life. Not a single one. That is the sole role and goal of bracing as far as I know. I hope that doesn't put too fine a point on it.
Thus brace failure is measured in surgery at any point whatsoever. That logically and necessarily follows from the fact that bracing is only done to avoid surgery. You have to disagree that that is the sole reason why bracing it done to argue this follow on. I don't believe that can be credibly argued.
I seriously don't buy the argument that most curves under fifty degrees are progressing to surgery as adults. The medical textbooks and medical journal papers all have that breakout of the almost guaranteed no progression if a thoracic curve stops at under thirty degrees when physically mature, possible to progress between 30 and 50, and at fifty degrees you're almost guaranteed of progression. I don't believe these surgeons would still be being taught this, if orthopedists had found it to not be true. I am aware that lumbar curves are likely to progress at a much lower Cobb angle.
People with normal straight spines deteriorate into lumbar scoliosis with age too.
Originally posted by Pooka1 View PostIt seems likely that the odds of needing a revision (or more than one revisions) are IDENTICAL in the braced population and the non-braced population. They appear to be related to things like curve location and bone character rather than if surgery is required due to failed bracing or as an initial treatment. If that is the case then bracing success and surgical success can't be judged similarly in principle. The question becomes what is least successful:
1. bracing plus surgery versus surgery
2. bracing plus surgery plus revision versus surgery plus revision
Bracing will always be worse because it is one more treatment and one that explicitly failed.
You forgot bracing that never needs surgery at the cost of five or ten thousand dollars for one or two braces, versus surgery at $200,000+ and one or two or three more revision surgeries varying from a half a million to a million dollars each, along with possible pain medication and disability for life etc. for some of those patients.
Or bracing that holds off surgery for thirty years at a cost of five or ten thousand dollars and a new, improved surgery in thirty years and no revision needed in the future.
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Originally posted by hduggerI think there's a real error in doctors giving the impression that any scoliosis treatment is a "cure." Once you have a curve in your spine, there is no way to cure it - i.e., return the spine to its previous, natural, uncurved state. You'll always be at greater risk of back problems, no matter what you do or don't do. I've been to lots of doctor appointments, and I've heard lots of people talking about seeing a doctor as a teenager, and I don't think I've ever heard of a doctor making that point clear.
Scoliosis is a little like cancer - you can go into remission (not have back problems), but you can never be cured.
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Originally posted by Ballet Mom View PostI don't buy that for an instant. I braced my child to stop her progression, not to avoid surgery and I suspect any number of parents AND patients would do this. I wanted to stop the deformity that was occurring to her back. If that cessation of progression caused my child to avoid surgery, that's great....whether it's for twenty years, thirty years or her entire life.
Would you have put her in a 23 hour/day hard brace strictly for cosmetic reasons??? Didn't you lament that the surgeon only gave her a night-time brace and not a 23 hour/day brace? Do you think he was bracing her for anything other than surgery avoidance?
Hello?
You forgot bracing that never needs surgery at the cost of five or ten thousand dollars for one or two braces, versus surgery at $200,000+ and one or two or three more revision surgeries varying from a half a million to a million dollars each, along with possible pain medication and disability for life etc. for some of those patients.
Or bracing that holds off surgery for thirty years at a cost of five or ten thousand dollars and a new, improved surgery in thirty years and no revision needed in the future.Sharon, mother of identical twin girls with scoliosis
No island of sanity.
Question: What do you call alternative medicine that works?
Answer: Medicine
"We are all African."
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Originally posted by Pooka1 View PostSo you are saying you braced your child for cosmetic reasons? Really? Seriously? Does you daughter know this??? Didn't you tell her the bracing was to hopefully avoid surgery? How is that remotely ethical?
Would you have put her in a 23 hour/day hard brace strictly for cosmetic reasons??? Didn't you lament that the surgeon only gave her a night-time brace and not a 23 hour/day brace? Do you think he was bracing her for anything other than surgery avoidance?
Hello?
We were discussing bracing failure. If you want to add back unnecessary bracing then we can start a new thread.
That is an excellent point. Best one you have made in this thread. But I still challenge you to find a single person who would brace their child unless they thought the goal was to avoid surgery for life. It can't be done.
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Originally posted by hduggerPooka's doctor told her something similar about post surgical spines, but I'm not at all certain about either claim. I do believe that, under a certain degree of curve, you're unlikely to progress, but I can't accept that a curved spine (or a curved-then-fused spine) is the same as a spine that has never curved.
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Originally posted by Ballet Mom View PostExcuse me. You were the one that wanted your daughter to take off her brace and progress to surgery because you thought your first daughter's surgically corrected spine looked better than the twisted one.
And finally, whether or not a child wears a brace does not have a predictable relationship to progressing to surgery. So your comment claiming I was linking taking the brace off with necessarily progressing to surgery is patent nonsense. It is a non-sequitor. Only YOU link non-brace wear with necessary progression to surgery, not me.
And you were the one that wanted to decrease the Cobb angle at which surgery is done because of the cosmetics.Last edited by Pooka1; 11-04-2011, 05:42 AM.Sharon, mother of identical twin girls with scoliosis
No island of sanity.
Question: What do you call alternative medicine that works?
Answer: Medicine
"We are all African."
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Originally posted by Ballet Mom View PostExcuse me.Sharon, mother of identical twin girls with scoliosis
No island of sanity.
Question: What do you call alternative medicine that works?
Answer: Medicine
"We are all African."
Comment
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Originally posted by Pooka1 View PostBracing of kids is done to avoid surgery FULL STOP. Defining "failure" in that context is beyond obvious. There is no fuzzy area here.
There is no sane person who would brace if the hope wasn't to avoid surgery. Nobody. You can't even get some kids to comply even when they have been convinced (i.e., lied to) that not wearing the brace will result in surgery.
Success of bracing and success of surgery are apples and oranges because one is to avoid the other.
As I said, we really need to know what happens to these folks in 20, 30, 40, & 50 years.Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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Originally posted by LindaRacine View PostI think we may eventually find that a large percentage of people with scoliosis end up needing treatment in later life, whether nothing is done, bracing is done, or surgery is done. If bracing for a few years kept someone out of surgery for 40 years, I can see that some people might make that choice. It would essentially be the same as someone having surgery as a teen and then having to have a revision 40 years later. (It possible that the brace may allow some of these folks to have only one surgery instead of two.)
Originally posted by LindaRacine View PostAs I said, we really need to know what happens to these folks in 20, 30, 40, & 50 years
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Originally posted by Ballet Mom View PostPerhaps you could show us some actual stats on that, otherwise it's just your opinion perhaps reflecting a surgical group that is sought out by old people with problems with their aging scoliotic spines and your experience with this website for people with scoliosis decisions/problems. It may not reflect the general population at all. It doesn't jive with anything I've seen in the research papers, book chapters, what the actual surgeons state or what I see in the ballet world with their high incidence of scoliosis. And I see no reason why these surgeons wouldn't be telling the truth.
Go back to sleep.Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
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Surgery 2/10/93 A/P fusion T4-L3
Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
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Originally posted by Ballet Mom View Post
I seriously don't buy the argument that most curves under fifty degrees are progressing to surgery as adults. The medical textbooks and medical journal papers all have that breakout of the almost guaranteed no progression if a thoracic curve stops at under thirty degrees when physically mature, possible to progress between 30 and 50, and at fifty degrees you're almost guaranteed of progression. I don't believe these surgeons would still be being taught this, if orthopedists had found it to not be true. I am aware that lumbar curves are likely to progress at a much lower Cobb angle.
The medical "professionals" taught bloodletting for many, many years.Be happy!
We don't know what tomorrow brings,
but we are alive today!
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