spinecor

[mrf]

It's already been determined that rigid bracing is *ineffective* for a specific age group of adolescent curves because these *caring* doctors wait for the curve to progress beyond 30 degrees before starting treatment!!!! According to the studies - given your daughter's age and curve size she might be able to avoid surgery.....provided she wears her brace. I'm not even going to comment on the NIH "study" because it's just going to get me really REALLY upset Keep in mind that if you wait too long, the spinecor may not be an option and you won't have a choice but to continue with the TLSO.celia

Celia - you sound just like my wife who believes that the orthos are simply waiting for the curve to worsen with two things in mind: Surgery and $$$. While I am not as synical, I can't imagine all these kids are being braced simply as a place holder to allow them and us to feel as if we are doing something helpful until either their curves naturally progress or not. I'd like to hear your thoughts on the NIH study....

[cherylplinder]

Celia,
I also want to hear all your thoughts. I value what you think highly and don't know what these studies are proposing.
Tell us all about it!
Cheryl

[Celia]

I don’t want to be a cynic or a critic! I’m just trying to understand….is it greed??? Is the answer really that simple? Are our children’s lives dispensable because they have scoliosis? We have to question authority and not simply follow the dictates of doctors who may not have our children’s best interest in mind. Linda mentioned the study in a different thread and I’ll bring it up here:


[ Does bracing straighten a curved spine?

Decades-old treatment for scoliosis is supported by little scientific evidence

For decades, doctors have been prescribing braces for children with scoliosis -- a sideways curvature of the spine -- but there is actually little scientific evidence to support the practice. A team of Canadian and American researchers is hoping to change that.

Dr. James Wright, a co-investigator and surgeon-in-chief at the Hospital for Sick Children, says doctors aren't really sure braces reduce the risk of the curvature progressing to the point of requiring surgery. And wearing the uncomfortable and obtrusive device for several years could prove a heavy psychological burden for a teenager concerned about fitting in with her peers.

"I have to say to the family, I think they're probably effective, but I'm not absolutely certain," Wright says. "This is one of those things which is quite inconvenient, it's quite expensive and it has side-effects, which are what it does to the psyche of a growing adolescent."

Surgery, on the other hand, comes with "low but significant" risks for paralysis and blood transfusion, and could lead to long-term back problems as a result of the need to fuse the spine in a straightened position. "If we could reduce the risk of ultimate surgery, that would be a real benefit," Wright says.

Showing whether bracing actually works would also address a controversy over whether children should be checked for scoliosis at school or the doctor's office. Some medical organizations support this practice, while others recommend against it because of a lack of evidence for an effective treatment.

To determine whether bracing works, Dr. Wright and researchers at 19 other centres across North America are embarking on a five-year study in which they will randomly assign about 480 children (65 of them from Canada) to be fitted with a brace or simply observed. At the end of the study, they will see whether children who wore the brace were less likely to need corrective surgery.

The Canadian Institutes of Health Research and the Shriners hospital system have promised funding for seven centres involved in the $3.5-million US study, contingent on the U.S. National Institutes of Health picking up the rest of the tab.

The NIH turned down the group's initial request for funding but has given them permission to reapply this year.

I'm not sure where this guy gets his information, but the Scoliosis Research Society funded a study, published in 1997, that showed definitively that bracing is effective in specific populations:
Bone Joint Surg Am. 1997 May;79(5):664-74. Related Articles, Links

A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis.
Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D.
Kalamazoo Center for Medical Studies, Michigan 49008, USA. rowe@kcms.msu.edu

With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).[/COLOR]

[gerbo]

celia, just for the record, I can see you're angry. Is it because this is evidence that we (well, they) have been bracing for years without knowing whether it will do any good, or are you saying that there is no need for this study as there are enough other studies around answering this question (as good as it ever will be answered)??

[Celia]

No I'm just suffering from low caffeine right now Bracing does work for a specific group of children and it appalls me that doctors still take the "wait and watch" approach and once the curve is gets beyond a certain level then they say: "let's brace it now" knowing perfectly well it's not going to work. O.k….I'm a cynic, right??? I wasn't always this way and I did believe in the goodness of mankind - I know it's still there.

[gerbo]

so what do you exactly think of this study??

(ps, do share all your general cynisism)

[cherylplinder]

I thought that that was what you thought. "Watch and wait until it's too late" is a really bad policy that seems to be the current trend in bracing. Did they not just publish recommendations that raised the degree of curvature to brace to 30 degrees instead of 25?
I feel the same way that you do. When you wait until then, there is little room for correction and little hope of improvement. I also feel, and I can't wait til the stats back me up, that bracing with Spinecor in curves above 17 degrees, when curves are much more flexible and correctable, is the only sensible thing. Of course it will be difficult for the stats to back me up if they attribute the successes in Montreal to "marketing".
What would a new and innovative approach yeild?
I don't know if we'll ever know.

I face things every day of my life that require me to look beyond my circumstances to my blessings, move on, and make the best of it. I think the hogwash about the damage to teens self esteem is just that. Hogwash. Sorry if I offend anyone's ideas. We live in a society that focuses on the outside of a person. But the old adage still rings true.
Beauty is only skin deep. Character is to the bone, and with a close loving parental relationship, the hardships our children face will make them stronger and not scarred for life by the trauma of bracing.
I am not belittling our kids pain, only saying that it is an opportunity for a parent to help a child grow. God is bigger than the problems we face and brings good out of every trial.

[Celia]

Cheryl,

OMG...they're making it official that it's 30 degrees before bracing???! UGHHHHH!!!!! Well no wonder bracing doesn't work! I guess surgery is the only option. I *loved* your last paragraph!!!


Gerbo,

It really sounds like you're egging me on. Surely you must have your own opinions and we'd love to hear them

[cherylplinder]

Celia,
I can't remember where I read that recommendation. I remember thinking that I thought 25 was too high, and that it should be lowered not raised. I'll have to look for it again. I thought you might know.

P.S. As long as there are real doctors, like Dr. Rivard and Dr. Coillard out there, more interested in making a difference in children's lives than in their pocketbooks, all is not lost. There will always be great men and women in our society. They have always been rare.


Gerbo,
Yeah! What are your thoughts?

Cheryl

[gerbo]

It really sounds like you're egging me on.

Celia, it looks, unintentionally, a bit as if i am egging you on. Where i said "do share all your general cynisism", it meaned to say "I do share etc. etc. Sorry for the misunderstanding.

All i was asking was what you meaned when you said earlier

I'm not even going to comment on the NIH "study" because it's just going to get me really REALLY upset

I am happy to give thoughts on anything you want, but not sure what you want thoughts on though, i.e. bracing, consultant attitudes, nih study, global warming or Jim Carrey's performance as The Grinch in "how the grinch stole christmas" which is the most fantastic and funny satire and parabel on the theme of christmas and christmas associated greed and indulgence I have seen.

In all fairness, over the past 1000+ replies to the original question in this thread, i think it has become clear that we share very similar thoughts and frustrations on these issues, and none of us would be in the current position if we would just have followed advice given by our (initial) doctors and "done as we were told".

[LindaRacine]

Please understand that this study is Canadian. I believe it does not reflect the usual American standards in terms of bracing, but I guess that would depend on the individual doctor.

In addition to individual physician beliefs, there is no set of single variables that represent when a child should be braced. It depends on their Cobb angle, curve type, and skeletal age.

--Linda

[Celia]

Linda,

Maybe you’re privy to information the rest of us don’t have but nowhere in the article does it state that Dr. Wright is the ring leader for this study nor does it state that it’s specifically a Canadian study…. further since the majority of patients are in the U.S. one would assume that it’s an American doctor who initiated the study and is heading it. When I criticize doctors in general, I'm referring to American doctors and not Canadian since I have the highest regard for the two Canadian doctors that have/are treating my daughter and have literally saved her life.

Gerbo,

You missed your calling in politics because you’ve managed to talk about Jim Carey and every thing else under the sun instead of answering the question at hand.... i.e., your views on the NIH study LOL !!!!

[LindaRacine]

Celia...

Is this not the study to which you referred?

http://www.macleans.ca/topstories/he...19_100836_5800

I believe that James Wright is, indeed, Canadian.

--Linda

[Celia]

....Dr. James Wright, a co-investigator and surgeon-in-chief at the Hospital for Sick Children....The Canadian Institutes of Health Research and the Shriners hospital system have promised funding for seven centres involved in the $3.5-million US study, contingent on the U.S. National Institutes of Health picking up the rest of the tab.

Yes we are reading the same article! It states that Dr. Wright is a co-investigator and that the Canadian Institute of Health Research and the Shriner's Hospital System have promised funding for the 3.5 Million U.S. Study

[LindaRacine]

Sorry, I should not have stated the "study" was Canadian. The article that you referred to was, however, focusing on Dr. Wright who is Canadian.

In that article, Dr. Wright is credited with stating "For decades, doctors have been prescribing braces for children with scoliosis -- a sideways curvature of the spine -- but there is actually little scientific evidence to support the practice."

I believe that statement is incorrect in that there is plenty of evidence that bracing works. In my original post, I included this study:

Bone Joint Surg Am. 1997 May;79(5):664-74. Related Articles, Links

A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis.
Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner-Bonneau D.
Kalamazoo Center for Medical Studies, Michigan 49008, USA. rowe@kcms.msu.edu

With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).

Unfortunately, PubMed does not have the abstract for the big bracing study funded by the SRS (Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg Am 1995 Jun;77(6):815-22). In that large, multi-center study, they found that "The end point of failure of treatment was defined as an increase in the curve of at least 6 degrees, from the time of the first roentgenogram, or two consecutive roentgenograms. As determined with use of this end point, treatment with a brace [defined as "an underarm plastic brace"] failed in 17 of the 111 patients; observation only, in 58 of the 129 patients; and electrical stimulation, in 22 of the 46 patients. According to survivorship analysis, treatment with a brace was associated with a success rate of 74% (95% confidence interval, 16 to 49); and electrical stimulation, with a success rate of 33% (95% confidence interval, 12 to 60).

So, I think there is plenty of evidence that bracing works, at least until skeletal maturity. Now, someone needs to do some very long-term followup, to know what happens to these patients in 30-40 years.

--Linda