How tight should a night time brace be?

[flerc]

Pooka made some claims about the research (and the researchers) which I do not find to be substantiated, and I wanted to correct those statements specifically for the parent pursuing this treatment.

I may say exactly the same about LITERALLY thousands of Pooka1's claims. But she is saying to be a scientist. May someone imagine a scientist not substantiating her claims?. I can't.

[hdugger]

Here is my hasty summary of the currently published data on VBS, gleaned from PubMed:.

Thank you Gayle. I was hoping you'd have a better list.

Briefly:

1 - is the study I referred to as dismissing because it dealt solely with younger children and we were specifically discussing AIS
2 - your removal
3 - as in 1, for younger children, not AIS
4, 5, 6 - the Betz studies I was referring to. As best I can tell, these all deal with the same 28 or 29 patients. This is the number I'm using
7 - Review paper of the overall field. Coverage of VBS refers back to the Betz work - no original work
8 - predates the Betz work. 6 patients with very poor results - most of the patients advancing. Author recommends "A more general use of this technique is not recommended at this time."
9 - Not a clinical study - they're modeling staples, not actually using them on patients
10, 11 - Review studies

So, again, I'm only finding 28 or 29 unique patients covered in the VBS research that Betz specifically uses in his reviews, and only some of these are AIS. I think the original summary I posted from Blue Cross is on target, and I realize now that it is actually updated through 2013.

That's not a problem, for me. I completely understand why a parent would choose to be an early adopter. But I did want to make clear that torso rotation, which FAHSAI is pursuing, has a comparable research record.

I clarify all of this in this thread specifically to be *on* topic - FAHSAI is pursuing torso rotation. Pooka made some claims about the research (and the researchers) which I do not find to be substantiated, and I wanted to correct those statements specifically for the parent pursuing this treatment.

[flerc]

You are saying there is not any reason to believe it may work, right? You must to justify why are you saying that. Well, you should if you would be honest of course.. but you know moderator will always allows you to do what you want here. Good team!

Don't pretends now Pooka1 to not answer this question because you don't want to hijack this thread with out off topic discussions. It always was your work in the non surgical sections here. If you don't reply again one of my direct questions to you is because you cannot. In this thread or in any other.

[hdugger]

The record is Mooney was not being straight on a number of issues, not the least of which is double publishing without saying he was double publishing.

After a good deal of searching to find the actual text of the 2003 study, I find that your statement here is simply untrue.

Here is the reference, in Mooney's 2003 article, to the previous study:

"A prospective study measuring torso rotation strength with a specific tool and the effect of resisted exercises on the strength was performed and reported in a preliminary study.’9 This article reports the continued efficacy with less complex equipment on additional patients.

...

The first study was comprised of 12 patients and 8 additional patients were added to the follow up study.

Patients in the combined studies are listed in the Table.
"

It could not be clearer what he is doing. There is *no* ethical issue here, no duplicity whatsoever.

[Note 12/29 - I have added this information as a note to my earlier posts to make clear that the ethical claims against Mooney are untrue.]

[flerc]

I apologize to fahsai for the wasted space in this thread.

If you would be honest you should to do the same with.. how many other members here? You should, as you should to update/delete thousands of your posts. But of course you will not do it. You are only here to convince people that surgery is the only one option.

[flerc]

BTW nobody asked me, but I think you two should move your discussion onto it's own thread, since FAHSAI's thread has been massively hijacked. I am pleasantly surprised to see he is still hanging in here, despite 16 pages of arguments that do not pertain to his daughter's situation. Enough said.

Of course!, it's the Pooka1's unmoral work. She is doing it in the non surgical sections since many years ago. Is she agreeing now to not hijack this thread any more? I cannot believe it, she cannot stop to do her work, is something impossible, except some action would be taken from outside.

[flerc]

You can stop with all the bracing and PT if she has little to no growth remaining.

You are saying there is not any reason to believe it may work, right? You must to justify why are you saying that. Well, you should if you would be honest of course.. but you know moderator will always allows you to do what you want here. Good team!

[Pooka1]

BTW nobody asked me, but I think you two should move your discussion onto it's own thread, since FAHSAI's thread has been massively hijacked. I am pleasantly surprised to see he is still hanging in here, despite 16 pages of arguments that do not pertain to his daughter's situation. Enough said.

Gayle, you are correct.

I just reached my limit with hdugger. I am done.

I apologize to fahsai for the wasted space in this thread.

[leahdragonfly]

research articles about VBS

Hdugger,

I am really reluctant to post OT on FAHSAI's thread because I think it is rude, so I am going to keep my comments brief. BTW nobody asked me, but I think you two should move your discussion onto it's own thread, since FAHSAI's thread has been massively hijacked. I am pleasantly surprised to see he is still hanging in here, despite 16 pages of arguments that do not pertain to his daughter's situation. Enough said.

Here is my hasty summary of the currently published data on VBS, gleaned from PubMed:

1.
Vertebral body stapling in children younger than 10 years with idiopathic scoliosis with curve magnitude of 30° to 39°.
Theologis AA, Cahill P, Auriemma M, Betz R, Diab M.
Spine (Phila Pa 1976). 2013 Dec 1;38(25):E1583-8. doi: 10.1097/BRS.0b013e3182a8280d.

(2. removed, it is an early animal model study)

3.
Thoracoscopic vertebral body stapling for treatment of scoliosis in young children.
Laituri CA, Schwend RM, Holcomb GW 3rd.
J Laparoendosc Adv Surg Tech A. 2012 Oct;22(8):830-3. doi: 10.1089/lap.2011.0289.

4.
Vertebral body stapling as an alternative in the treatment of idiopathic scoliosis.
Trobisch PD, Samdani A, Cahill P, Betz RR.
Oper Orthop Traumatol. 2011 Jul;23(3):227-31. doi: 10.1007/s00064-011-0032-z.

5.
Clinical outcomes of nitinol staples for preventing curve progression in idiopathic scoliosis.
Lavelle WF, Samdani AF, Cahill PJ, Betz RR.
J Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S107-13. doi: 10.1097/BPO.0b013e3181ff9a4d. Review.

6.
Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis.
Betz RR, Ranade A, Samdani AF, Chafetz R, D'Andrea LP, Gaughan JP, Asghar J, Grewal H, Mulcahey MJ.
Spine (Phila Pa 1976). 2010 Jan 15;35(2):169-76. doi: 10.1097/BRS.0b013e3181c6dff5.

7.
Growth modulation in the management of growing spine deformities.
Akel I, Yazici M.
J Child Orthop. 2009 Feb;3(1):1-9. doi: 10.1007/s11832-008-0145-6. Epub 2008 Nov 20.

8.
[Results of treatment of progressive scoliosis with SMA staples].
Stücker R.
Orthopade. 2009 Feb;38(2):176-80. doi: 10.1007/s00132-008-1364-8. German.

9.
Finite element modeling of vertebral body stapling applied for the correction of idiopathic scoliosis: preliminary results.
Lalonde NM, Aubin CE, Pannetier R, Villemure I.
Stud Health Technol Inform. 2008;140:111-5.

10.
Newer technologies for the treatment of scoliosis in the growing spine.
Torre-Healy A, Samdani AF.
Neurosurg Clin N Am. 2007 Oct;18(4):697-705. Review.

11.
Fusionless treatment of scoliosis.
Guille JT, D'Andrea LP, Betz RR.
Orthop Clin North Am. 2007 Oct;38(4):541-5, vii. Review.

Several of these are published by other well-known pediatric surgeons such as Samdani, Schwend, and Diab. I don't have time to review all of these full articles, although I have in the past. The list of references is priceless in some of these articles and includes literature reviews of the topic. There have also been some very informative conference presentations about VBS over the last 5 years at POSNA (Pediatric Orthopedic Scoiety of North America). Tethering has been presented at least once at POSNA, also, and Lenke published a single case study of an early tethering case.

[flerc]

The record is Mooney was not being straight on a number of issues, not the least of which is double publishing without saying he was double publishing. You are free to ignore reality and to not understand the gravity of this.

Is not Dr. Mooney a surgeon? Did you forget how you used to say that all surgeons are the most honest and right people of the world? Do you believe is coherent with what you are saying now?

[Pooka1]

I think we can drop the discussion of Mooney's character.

Good for you. Have fun with that.

[hdugger]

not grasping that magnitude of the dishonesty .

I don't think I'm alone in that.

Without any easy way of measuring how this is perceived in the medical field, I looked through Kevin's posts on Mooney's two studies. I certainly don't get any sense from them that he's discussing a huge ethical issue. He describes the second paper as thin, says repeating data is a no-no, and that says that he was disappointed in the missed opportunity (to publish some follow up data). In the following post he talks about how much respect the surgeon he worked with (Asher) had for Mooney.

So, again, I don't get the sense that it's a big ethical issue in the field. The only place where it's described as a huge issue - so large that it calls Mooney's veracity into question - is in your posts.

I think we can drop the discussion of Mooney's character. I find the topic very unpleasant - the man did some good work on his own dime and now he is dead - and I find nothing to support your notion that his character is in question in any way.

He published some data, and that really is the only thing that need be considered here.

[Added correction - 12/29] Upon locating the Mooney paper in question, I discovered that the repeated reference to his dishonesty in double publishing is wholly unsupported by the facts. Mooney clearly states in his 2003 paper that he is using data from his earlier study, how many patients came from both studies, and that the table shows combined results. There is no question of an ethical violation of any kind. This renders moot the entire discussion about the ethics of this event, since it turns out that the said event never happened. I will add this correction to all of my posts concerning Mooney's research to reflect this better information

[Pooka1]

It looked as if Betz' 2010 and 2011 study were also just the same 29 patients,

Does Betz admit it is the same patient population?

You are not grasping that magnitude of the dishonesty with the two Mooney pubs.

There is a reason surgeons discount the Spinecor pubs and that is a FAR less dishonest reason than the Mooney situation.

[hdugger]

The record is .

No, the "not being honest" is your extrapolation. The information is that Mooney published two studies with the same patients. I have no idea how common that it is this field, or whether there's any ethical judgment about it at all. It looked as if Betz' 2010 and 2011 study were also just the same 29 patients, as were several other studies I've run across.

So, none of that in any way affects the central finding of the study, which was replicated by another researcher. And none of it is vital to know in interpreting the data.

I will note, again, that the only researchers who you feel it necessary to examine their character you also happen to disagree with.

I will also note that this: "free to ignore reality and to not understand the gravity of this" likewise is straying away from the discussion in order to examine *my* character. It really is not necessary to insult me at every turn. Just state your case.

[Added correction - 12/29] Upon locating the Mooney paper in question, I discovered that the repeated reference to his dishonesty in double publishing is wholly unsupported by the facts. Mooney clearly states in his 2003 paper that he is using data from his earlier study, how many patients came from both studies, and that the table shows combined results. There is no question of an ethical violation of any kind. This renders moot the entire discussion about the ethics of this event, since it turns out that the said event never happened. I will add this correction to all of my posts concerning Mooney's research to reflect this better information

[hdugger]

I meant one that has been around as long as torso rotation..

I don't think the time frame is helpful in making sense of the data. Doctors who are performing tethering are doing it as part of their main line of business, so they can easily enroll patients. Kevin talked about the difficulty of enrolling patients in PT studies - you have to work with a doctor, they have to help you enroll patients, your work is a financial drain, so you need to get funding, and so on and so on.

So, there's nothing useful to be gained from time frame - it will take a much longer time and likely a good deal of funding for another torso rotation study. You can't even really compare on number of patients because the total number of *patients* for tethering is knowable (there are only a handful of surgeons doing it.) The number of people doing torso rotation is unknowable. We have a bunch in this forum. Other surgeons might be recommending it without anyone knowing. Etc. We have no idea what the number of patients for torso rotation is.

The only thing you can compare is published studies. Torso rotation: 35, VBS: 29; Tethering: 0

I'm not going to compare numbers of children in growth spurt because those numbers are not known across the three. There's no reasonable way to make that comparison.