spinecor

[gerbo]

I think we've had this discussion before, but there is plenty of evidence that TLSO braces do, in fact, work for the majority of patients. Here are just a few:

sorry Linda, I agree, but must be more specific, I agree that the evidence is that if well applied and consistently worn, a TSLO is often succesful in stopping a curve from getting worse, but doesn't tend to give much improvement from the starting position. The available evidence from the spinecor suggest that with the spinecor the initially achieved correction is maintained after finishing wearing the brace,

I do know that there is only one big spinecorstudy, which is a weakness. However, in practice, on this and other forums, I must say that ihardly ever hear a TLSO succes story, whilst I do hear of spinecorsuccesses, which could suggest that spinecor results are easier repeated in "real life", whilst outside controlled studies TLSO-succes is harder to achieve. Could this be because a good, well correcting, TLSO is actually quite hard to manufacture, and because in practice many young people are unwilling to put in the wearing time required???

[LindaRacine]

Gerbo...

Anecdotal evidence is fine, but doesn't really tell the story. The scoliosis specialists that I've worked with here in the U.S. tell parents that if they don't get at least 50% initial in-brace correction, there is not great evidence that the brace will work long term. Of all of the kids I've known to be braced, I can only think of handful that didn't get at least 50% in-brace correction.

I can almost guarantee that, over time, the Spinecor will be found to get the same or worse results than a TLSO, which usually means that the curves return to within 10 degrees of the initial measurement before bracing. The only thing that might improve Spinecor results over TLSOs is compliance (which I agree is a huge issue).

I am definitely not anti-Spinecor. I think it's a great innovation, and hope that results can be duplicated outside of Canada, and that the results hold up over time. The only concern I have (other than the lack of too little data) is that letting chiropractors prescribe these braces will actually destroy the reputation of the brace, resulting in insurance companies not allowing reimbursement for it. I'd also like to see the price drop some. I'm thinking that the margin has to be huge.

As with any new treatment, it would be malpractice for all scoliosis specialists to jump on the bandwagon before more studies have been published and results can be duplicated in other centers. Until then, specialists are going to stick with what they know to work.

--Linda

[cherylplinder]

Linda,
Rachel was seen by Dr. Sanders at Erie in April. Diagnosed at 7 with an 18T/17L curve, she remained stable until last year, at which time her thoracic curve progressed to 38 degrees. In April, when Dr. Sanders saw her, she was 10 with a 38T/27L curve. Her adolescent growth spurt had not even begun. He said that she had a 100% chance of surgery with ANY brace. Celia recently posted an article on juvenile supported his opinion.
Nonetheless, Rachel has grown about 3 inches since being put in the Spinecor in January, and her curve contines to diminish with each visit. They don't give me any guarantees, but if this continues, her prognosis is excellent. I hope our success continues. At some point her curve, instead of continuing to diminish, will probably just stabilize. And that, I know, is if we are really blessed.
She was unable to function normally before this brace, in frequent pain. From the time she was put in the brace, her pain stopped. At first she still hurt when she was out of brace. Now she doesn't.
Had she been brace at 18T/17L, I don't think she would have a curve at all. The success stories on this forum alone are impressive.
It's food for thought.
With the cost of one surgery at anywhere from 100,000 to 250,000 dollars, even in terms of dollars and cents, using our healthcare dollars wisely, is there really a place for observation of a juvenile curve or risser 0 adolescent curve that is progressing rapidly or has reached 17 degrees, I think the minimum for Spinecor in AIS?
Even in terms of dollars and cents, it doesn't make sense to me.
Bracing at that time gives some room and time for observation in brace. There would be little liability in that. The brace is FDA approved. I firmly believe a more proactive approach is in order.

[Celia]

The scoliosis specialists that I've worked with here in the U.S. tell parents that if they don't get at least 50% initial in-brace correction, there is not great evidence that the brace will work long term. Of all of the kids I've known to be braced, I can only think of handful that didn't get at least 50% in-brace correction.

Linda,

Sorry to cut in, I know this was addressed to Gerbo Even if these children get 50% in-brace correction with rigid bracing, the post brace curve will not be much different than what it started out with. In fact, I read a study which showed that children who achieved *some* correction after many years of bracing ended up with the same curve they started out with - is this what you mean by success??? The study didn't even touch upon what happened to these children as they aged - most likely their curves continued to deteriorate.

Considering that most doctors don't start bracing curves until they're past 30 degrees, it stands to reason that most of them will end up with surgery anyway. I agree with your views on chiropractors and I find it puzzling why the results at Ste. Justine can't be duplicated in the U.S. but everywhere else in the world.

Who is the ideal bracing candidate ? Give me your views on curve size and age.

[LindaRacine]

Celia...

It remains to be seen that Spinecor patients will remain permanently corrected. I personally don't believe that is the case. The reason that curves return to their original severity in most cases is that the vertebrae and discs are wedged. Spinecor does nothing to change that.

I don't pretend to be a medical professional, but I do read all the research. If you want to know who the ideal brace candidate is, you should address your question to a real professional.

I did not mean to start another debate. I just wanted those reading this forum to understand that there has been considerable success using TLSO braces.

--Linda

[scoliocolorado]

I am glad that I read this message about the possibility that the spinecor brace patients may not have permanent correction in the spine. I was looking into this brace, but now that I read about this, I don't know if I should even pursue it.

[LindaRacine]

I am glad that I read this message about the possibility that the spinecor brace patients may not have permanent correction in the spine. I was looking into this brace, but now that I read about this, I don't know if I should even pursue it.

You should discuss this with your scoliosis specialist.

[Celia]

I don't pretend to be a medical professional, but I do read all the research. If you want to know who the ideal brace candidate is, you should address your question to a real professional.

I seem to recall a previous discussion where you stated curves shouldn't be braced until they're past 30 degrees and that bracing *all* children with mild scoliosis would put an enormous strain on the health care system and bankrupt insurances.

We all have to choose our own path. I'm glad for the choices.

[gerbo]

Anecdotal evidence is fine, but doesn't really tell the story

, but neither does "research" necessarily, personally I feel that the combination of the two gives a better indication than either on their own.

The scoliosis specialists that I've worked with here in the U.S. tell parents that if they don't get at least 50% initial in-brace correction, there is not great evidence that the brace will work long term.

i wrote to a few american specialists early on (john emans, marc asher) and this was exactly the message i got. Based on this I did not worry toomuch about switching to the spinecor, as we were only getting 25% correction with the TLSO, and our specialists were not particularly bothered about it. If we would have been close to our 50 % correction I am not sure what i would have done

I can almost guarantee that, over time, the Spinecor will be found to get the same or worse results than a TLSO, which usually means that the curves return to within 10 degrees of the initial measurement before bracing

The current available evidence (including still to be published long term outcomes) suggest otherwise.

The only concern I have (other than the lack of too little data) is that letting chiropractors prescribe these braces will actually destroy the reputation of the brace

,

agree fully (but we do have to be carefull not to blindly equate chiropracter with bad practice)

The reason that curves return to their original severity in most cases is that the vertebrae and discs are wedged. Spinecor does nothing to change that.

although that must be true for longstanding curves, i believe that specially initially most of the curve is determined by the behaviour of muscles, ligaments and the effect of gravity and posture, if you correct at that earlier stage before wedging etc has taken place, you might have a good chance of some permanent correction

did not mean to start another debate

do start a debate as it is good to look at the different angles now and again, and your views and opinions (and knowledge of research) are always very helpful

[cherylplinder]

Dr. Rivard did tell me that remodeling of the vertebrae can occur. I asked him specifically at our initial fitting.

[mrf]

Cheryl,

Can you expound on what remodeling of the vertebrae is and what Dr. Rivard told you?

Thanks.

[mrf]

I can almost guarantee that, over time, the Spinecor will be found to get the same or worse results than a TLSO, which usually means that the curves return to within 10 degrees of the initial measurement before bracing.

--Linda

Linda,

What makes you so sure of this? On what are you basing your "guarantee"?

[cherylplinder]

Well, the technical terminology involves osteoclasts and osteoblasts. These are types of cells in bone. The osteoclasts are constantly breaking down bone and the osteoblasts are constantly building bone, if I understand correctly. This is one reason growth can be a corrective force in scoliosis. I asked Dr. Rivard if it was possible, because of the activity of these cells, for the bone to remodel and the structural deformity of the bone to be corrected. He said yes.
He may have said more, but I can't remember if he did. I remember how encouraging I found his answer. I remember that I specifically said what I stated above.
It makes sense. There is a case study on the spinecorporation website of a 10 year old boy with a 30 degree curve that was corrected to 0 degrees.

[LindaRacine]

Hi...

If Cheryl is correct, than there probably isn't any difference between the Spinecor brace and a TLSO (or, for that matter, other braces) if all were applied early enough. Unfortunately, as I've stated before, I'm definitely partial to socially responsible medicine. And, because of that, could not support putting every child with a 10-20 degree curve into a brace, at least one paid for by insurance or by the government.

Doctors are hopefully close to knowing which curves will progress and which won't, which would make this a moot debate.

Regards,
Linda

[MATJESNIC]

We just got our appt. at St. Justine's. We're going on Dec 13th. Anyone else going around this time?


Melissa