TSRH research shows that bracing IS effective!

[Ballet Mom]

I haven't loved that study (I complained in the past that they seemed to be monkeying with some of the requirements), but I have to defend my fellow MPh's and state that they're not *trying* to change the standard of care. They're trying to figure out if the standard of care is effective. That's always a reasonable thing to do, and this kind of research has been tremendously helpful in showing, for example, that physical therapy is just as good as surgery for most common back problems.

BTW, I'm not actually entirely in favor of bracing, personally. But I'd never recommend that someone else's child not be braced if that's what their doctor recommends. If people want to make their own counter-doctor decisions for their own child - well, that's what being a parent is all about. But recommending that *other* children ignore doctor's advice is out of our realm of expertise.

I'll give them the benefit of the doubt...and if they ever manage to get enough people to participate, they may surprise themselves to discover that bracing works...obviously not for everybody.

The incessant anti-bracing, pro-surgery cheering squad on this site has obviously influenced my opinion of the study. And others have stated that the study has been designed to disprove bracing effectiveness, so it will be interesting to take apart their study when they're done. It better be unimpeachable.

And there certainly are people who want to restrict other people's decisions about scoliosis treatment to certain surgical procedures. Just like they want to shut down the research section and "control" the proper information flow.

And really, I don't care that all of you don't like bracing. No one forced your kids to brace, and none of you braced. I don't "like" bracing either...just as I wouldn't "like" to have a colostomy bag or a wheelchair, but the bracing has been successful. And I'm glad I made that decision and wouldn't have made any other. And I question why bracers are always being challenged on their decisions, like we love to torture our kids and the challengers don't.

[hdugger]

And really, I don't care that all of you don't like bracing. No one forced your kids to brace, and none of you braced. I don't "like" bracing either...just as I wouldn't "like" to have a colostomy bag or a wheelchair, but the bracing has been successful. And I'm glad I made that decision and wouldn't have made any other. And I question why bracers are always being challenged on their decisions, like we love to torture our kids and the challengers don't.

My reasons for being suspicious of it are entirely unsupported - because I think the muscles play a large role, I'd be hesitant about doing anything that would weaken them. But, that's purely conjecture (the exercise experts don't even agree with it), and I suspect that if any surgeon had actually strongly recommended (or recommended at all) that my son brace, we would have done it. I just would have gone into it with mixed feelings.

But, you did something that was difficult, and your daughter has avoided surgery. Even if there's no way to prove that those two things are cause and effect, you have every reason to be proud of how you protected your child.

[Ballet Mom]

My reasons for being suspicious of it are entirely unsupported - because I think the muscles play a large role, I'd be hesitant about doing anything that would weaken them. But, that's purely conjecture (the exercise experts don't even agree with it), and I suspect that if any surgeon had actually strongly recommended (or recommended at all) that my son brace, we would have done it. I just would have gone into it with mixed feelings.

But, you did something that was difficult, and your daughter has avoided surgery. Even if there's no way to prove that those two things are cause and effect, you have every reason to be proud of how you protected your child.

Thank you for the kind words of support. There is very little support on this site for people who are bracing their children, unfortunately.

[Ballet Mom]

Oh, and with my daughter diagnosed with a 35 degree quickly progressing curve at age 12, Risser 0, one year pre-menarchal, and four or five inches of follow-on growth I think I can pretty safely say the brace stopped her curve.

With absolute 100% certainty that would satisfy Pooka? No, but with what most doctors and researchers would realize probably had close to zero chance of stopping its progression on its own.

[Sherie]

I'll give them the benefit of the doubt...and if they ever manage to get enough people to participate, they may surprise themselves to discover that bracing works...obviously not for everybody.

The incessant anti-bracing, pro-surgery cheering squad on this site has obviously influenced my opinion of the study. And others have stated that the study has been designed to disprove bracing effectiveness, so it will be interesting to take apart their study when they're done. It better be unimpeachable.

And there certainly are people who want to restrict other people's decisions about scoliosis treatment to certain surgical procedures. Just like they want to shut down the research section and "control" the proper information flow.

And really, I don't care that all of you don't like bracing. No one forced your kids to brace, and none of you braced. I don't "like" bracing either...just as I wouldn't "like" to have a colostomy bag or a wheelchair, but the bracing has been successful. And I'm glad I made that decision and wouldn't have made any other. And I question why bracers are always being challenged on their decisions, like we love to torture our kids and the challengers don't.

Agree with you 100%. Speaking from experience, I believe strongly that parents need to have options. How many are going to be satisfied just sitting by waiting to see if they're kid progresses to surgery? At the very least, you can say you tried and it failed, better than not trying at all. I took my daughter into surgery knowing that I did the best I could, no regrets. And my daughter knows that too.

Good luck to your daughter for continued success.

[skevimc]

And really, I don't care that all of you don't like bracing. No one forced your kids to brace, and none of you braced. I don't "like" bracing either...just as I wouldn't "like" to have a colostomy bag or a wheelchair, but the bracing has been successful. And I'm glad I made that decision and wouldn't have made any other. And I question why bracers are always being challenged on their decisions, like we love to torture our kids and the challengers don't.

Just to clarify my own point and reason for saying I don't like bracing. I was primarily saying it to show my impartiality to the presented study. I come from the exercise side of the argument and for decades bracing studies would start their articles with "It has been shown that exercise does not affect the natural history of the curve". And while that's technically true, the studies they quote were horrible studies yet this influenced clinical dogma. So a chunk of my grad school time was spent looking at bracing studies and looking at the claim of how effective bracing really is. We never genuinely doubted that bracing was effective, but it certainly wasn't the open and shut case that was presented. As well, we were trying to design a better, more acceptable alternative to bracing, i.e. strength training.

So all of that to say that I think the TSRH study shows fairly clearly the effectiveness of bracing.

Oh, and with my daughter diagnosed with a 35 degree quickly progressing curve at age 12, Risser 0, one year pre-menarchal, and four or five inches of follow-on growth I think I can pretty safely say the brace stopped her curve.

I would agree completely.

[Pooka1]

Another (short) commentary

http://www.orthosupersite.com/view.aspx?rid=65842

[PNUTTRO]

I think the overall point is that 60% of patients were on the down slope of their height velocity. So they still had growth (because <1cm of growth in 6 months was an endpoint), but they weren't in their major growth spurt which is usually 6-13 cm/yr.

I think that this is the real problem. A patient isn't a patient until there are symptoms. And likely a lot of kids have had their major growth spurt before the scoliosis is diagnosed. It probably takes a parent who really notices their kid's body changes to detect it early.

[Pooka1]

I think that this is the real problem. A patient isn't a patient until there are symptoms. And likely a lot of kids have had their major growth spurt before the scoliosis is diagnosed. It probably takes a parent who really notices their kid's body changes to detect it early.

Yes.

That one commentator thought measurement error was a potential Achilles heel.

I think another is that these results may largely of not only apply to kids with double majors who are beyond their growth spurt and wearing Boston braces. And even then there is a small effect buried under a sea of variability. I would like to see if and how surgeons will change their treatment based on this paper.

I also wonder if these results have much if any applicability to lumbar curves. I think because of the lower propensity to progress, there the risk of over-treating is larger than in double majors and I don't know if this study was designed to ferret out how many patients would not have progressed anyway no matter what they did or didn't do.

And the $64,000 question of what happens in the out years (35 is a key age per Linda) still looms. I hope someone follows this cohort out.

Last, we have seen victory claimed before only to be shot down as in the case inadvertent stacking of curve types in other studies. Nobody saw that coming and perhaps nobody will see other things coming that affect interpretation of these results. Scientific results like these are tentative by their nature, especially when the results are not clean. These results may stand but we will have to wait and see if they do and if there is enough here to change treatment regimes.

[bas2101]

"And it is unfortunate, there are many young children who are at great risk of curve progression, who are following the advice of their doctor or some other scoliosis practitoner, who will never know of any other treatment, because his/her doctor does not believe in it, or is not familiar with it. "

Michael,

This is what is so frustrating. I read your post, and can't help thinking "what if," even though it is futile now years later. Like your daughter, at 8 years old my daughter was at 40 degrees. At that time, we saw 3 pediatric orthopedists specializing in scoliosis. We were told by one doctor to get growing rods that would need adjustment (something like every 6 months if I remember correctly), and that she would most likely need surgery in the end anyway. The other two doctors said to brace, that she would have to wear the brace for about 8-10 years during which time she would NOT get a reduction and may still need surgery in the end anyway. With this kind of prognosis, we said forget it to both options. These were the only two options we were ever told of by the surgeons. At the time, we figured if she is very likely to have surgery in the end anyway (we were told she had a 90% chance of progression), let's at least try other options, many of which were also futile. But, what I have learned from other JIS parents over the years, some of these kids are having amazing results with reduction from bracing, oftentimes in combination with PT, like your daughter. You just never know, and can't wait around for studies to "prove" everything. Since my daughter's 68 degree curve (at 12 1/2 years old) reduced to 60 degrees (by 14 years old) with bracing and PT, I only imagine she would have had much more success if she had started this back when she was 8 when she was more flexible and had a lower curve, if only we knew more and weren't given such a bleak prognosis based on I am not sure what. I hope your daughter has continued success.

Ballet Mom,

My daughter also reduced her curve through bracing/PT (albeit very late in the game and certainly not ideal), 68 to 60. She was pre-menarche, Riser 0, and has now grown 5 1/4 inches. Without the bracing she would absolutely have continued progressing with all of that growth. Obviously I do not know what the future holds, but it is an example of reduction while bracing, something too many doctors claim won't happen. I hope this will change in the future, especially for the JIS kids, some of whom seem to grow out of their curves while braced.

Brooke

[Ballet Mom]

I think that this is the real problem. A patient isn't a patient until there are symptoms. And likely a lot of kids have had their major growth spurt before the scoliosis is diagnosed. It probably takes a parent who really notices their kid's body changes to detect it early.

Especially since the majority of curves in this study are double majors. They are apparently the most likely to not be noticed until they're big because they are typically well-balanced and less likely to show.