How tight should a night time brace be?

[Pooka1]

Oh, for heavens sake. If you want to emphasize the point that you just don't like the cut of my jib, could you just add it to your tagline instead of adding a no-content post re-re-restating that opinion each time I post?

Really, we *all* get the point.

Good for you. Have fun with that.

[hdugger]

The point is .

Oh, for heavens sake. If you want to emphasize the point that you just don't like the cut of my jib, could you just add it to your tagline instead of adding a no-content post re-re-restating that opinion each time I post?

Really, we *all* get the point.

[Pooka1]

Yes, it is. Thank you for taking the time to make all this clear.

The point is that you were banging on merrily before it was clear to you.

[hdugger]

Hope this is helpful.

Yes, it is. Thank you for taking the time to make all this clear.

[mariaf]

And tethering, at least according to this - http://www.vertebralstapling.com/upl...NG_May2012.pdf - is targeted at 10 and over (to avoid the risk of over-correction).

I'm not sure what the JIS kids with curves over 35 degrees are doing.

See my comments above which pertain to this point as well.

(I didn't know how to reference both in my response above).

[mariaf]

I don't know that VBS is available for the kids Maria is talking about - those JIS patients presenting with 35 to 40 degree curves. Betz (at least) is not offering VBS above 35 degrees. Perhaps other centers are.

Virtually every child with a curve under, say, 50 degrees or so falls into either the VBS or VBT (tethering) category AS LONG AS they have enough growth remaining.

It's not completely cut and dry. You mentioned that tethering is aimed mainly at kids 10 and up. Yes and no. The majority of tethering patients are 10 or older. However, let's say that a 9 year-old child presented with a 38 degree curve and was not overly flexible upon bending x-ray, they might very well be accepted as a tethering patient. If they were extremely flexible, then perhaps they'd be considered for VBS.

I've really never heard of anyone being told that they were not a candidate for either procedure unless they were either too skeletally mature OR they had a very large curve. But absent those factors, the doctors take everything into consideration and decide which procedure is best.

Hope this is helpful.

[Pooka1]

I don't know that VBS is available for the kids Maria is talking about - those JIS patients presenting with 35 to 40 degree curves. Betz (at least) is not offering VBS above 35 degrees. Perhaps other centers are.

I wasn't addressing that.

[hdugger]

I don't know that VBS is available for the kids Maria is talking about - those JIS patients presenting with 35 to 40 degree curves. Betz (at least) is not offering VBS above 35 degrees. Perhaps other centers are.

And tethering, at least according to this - http://www.vertebralstapling.com/upl...NG_May2012.pdf - is targeted at 10 and over (to avoid the risk of over-correction).

I'm not sure what the JIS kids with curves over 35 degrees are doing.

[hdugger]

VBS and tethering are the best hopes for these kids in my own opinion.

I don't know that VBS is available for the kids Maria is talking about - those JIS patients presenting with 35 to 40 degree curves. Betz (at least) is not offering VBS above 35 degrees. Perhaps other centers are.

[Pooka1]

If you asked me my personal opinion of what I believe after a decade of being around JIS, I would say that all you are trying to do is slow them down.

I know a lot of parents who were told by various, well-respected orthos that their child (who presented with, say, a 35 or 40 degree curve) was going to almost certainly need fusion at some point. I would agree with this. Again, just my personal view - but I find it hard to picture it turning out differently. Assuming that the brace can at best maintain the curve (and I have seen no proof to the contrary with regard to curves of this magnitude), where does that leave the patient? Also, this is assuming LONG-TERM, FULL COMPLIANCE with wearing the brace. Having raised 3 kids who are now 25, 22 and 15, I can tell you that is an assumption of enormous proportion.

That's my sense, also.

Over-treatment, while a HUGE problem in AIS, never really seems to be an issue in JIS either because you simply have to try to slow the bigger curves ahead of a definitive fusion or because VBS and bracing can decrease smaller JIS curves and avoid definitive fusion. I seriously doubt anyone thinks in terms of "over-treatment" with JIS. It's a game of finding the least burdensome treatment for the best outcome.

VBS and tethering are the best hopes for these kids in my own opinion.

[hdugger]

If you asked me my personal opinion of what I believe after a decade of being around JIS, I would say that all you are trying to do is slow them down. .

Thanks, Maria. As always, your experience in this area is invaluable.

[mariaf]

But Gayle's comment about most kids in braces still needing surgery makes it sound as if bracing works very differently in this population. Is the general thinking that JIS kids over a certain degree (30 or 35) just are going to progress to surgery in braces and all you're trying to do is slow them down? that is, is bracing considered ineffective in halting progression in this population (although it might slow it somewhat)?

If you asked me my personal opinion of what I believe after a decade of being around JIS, I would say that all you are trying to do is slow them down.

I know a lot of parents who were told by various, well-respected orthos that their child (who presented with, say, a 35 or 40 degree curve) was going to almost certainly need fusion at some point. I would agree with this. Again, just my personal view - but I find it hard to picture it turning out differently. Assuming that the brace can at best maintain the curve (and I have seen no proof to the contrary with regard to curves of this magnitude), where does that leave the patient? Also, this is assuming LONG-TERM, FULL COMPLIANCE with wearing the brace. Having raised 3 kids who are now 25, 22 and 15, I can tell you that is an assumption of enormous proportion.

[hdugger]

I just don't think the two are related (any potential long-term risks and the surgeons' care not to overtreat with VBS).

The latter is simply because (as has been stated above) no surgeon should perform unnecessary (or in this case, unsuccessful) surgery. There's nothing more to it than that.

Thanks Maria. I wanted to clear up one thing in my earlier posts about bracing and JIS. I'm much more familiar with the AIS literature on this topic. So, when the research article I found reported similar success rates in JIS kids (assuming you controlled for compliance), it jibed with what I knew. But Gayle's comment about most kids in braces still needing surgery makes it sound as if bracing works very differently in this population. Is the general thinking that JIS kids over a certain degree (30 or 35) just are going to progress to surgery in braces and all you're trying to do is slow them down? that is, is bracing considered ineffective in halting progression in this population (although it might slow it somewhat)? I feel as if I'm hearing both things (that it holds curves and that it doesn't) and I'm trying to figure out what the general understanding is.

[mariaf]

Likewise, because the long-term risks of VBS are unknown, it appears that the surgeons are being very careful not to overtreat (by making the curve range very narrow). Again, it may not be a huge number of cases that they'd needlessly operate on if they loosened their protocol, but it appears to be something they're keeping in mind.

I just don't think the two are related (any potential long-term risks and the surgeons' care not to overtreat with VBS).

The latter is simply because (as has been stated above) no surgeon should perform unnecessary (or in this case, unsuccessful) surgery. There's nothing more to it than that.

[mariaf]

You and your partners in the VBS site have really made a difference for a lot of kids. It's something to be very proud of!



As we have seen, there is no escaping conspiracy theorists.

Thanks, Sharon. There are so many people trying to get the word out so that parents are aware of all the options available to them (parents, medical professionals who gladly answer our many questions, etc.) - I may just be the most visible :-)

And, yes, my daughter went through a phase where you could not bring up anything without her connecting it to some conspiracy theory - thankfully, that phase has passed for the most part - LOL!