For those who have followed the Bracing vs. Not Bracing controversy in this research section:
Here is a video of the lecture presented at the latest 2010 POSNA meeting by John A. Herring, MD of Texas Scottish Rite Hospital for Children.
It shows that bracing is effective if worn for enough hours each day and has some very interesting insights including:
Success Rates (progession <6 degrees):
>12 hours of wear per day - 82%
7-12 hours per day - 61%
<7 hours per day - 32%
Flexibility of the curve did not seem to alter the success rate or the frequency with which the brace was worn!
72 patients did not have surgery, average wear 8.1 hours per day!
28 patients had surgery, average wear of 4.3 hours per day.
Whether the patients were told to wear the brace 23 hours per day or 16 hours per day didn't matter, both groups ended up wearing the brace the same average total number of hours! There was no difference between the number of hours of brace wear of boys and girls.
Most important slide in my opinion:
Results vs. Natural History
Lonstein, Carlson results (Risser 0,1 Curves 20-29 degrees) i.e. the natural history:
68% progressed
Katz, Herring et al (this study) (Risser 0,1 Curves 25-45 degrees) curves larger and therefore more likely to progress:
Brace > 12 hours 18% progressed
Brace < 7 hours 69% progressed (back to the natural history)
Therefore, bracing alters the natural history!!
http://posna.gmetonline.com/Presenta...onpackageid=44
Click on the link for Scientific Program Day 3, and then the sixth presentation at 9:04 a.m.
One item of concern for me:
Brace treatment was discontinued at Risser 4, 18 months post menarche in the girls, boys until growth ceased. This is very interesting because my daughter is already two years post menarche and is at Risser 4 and she will continue to wear her brace until her growth has ceased completely. She had 3/4 of an inch of growth in the last six months. I ran across a study recently that showed that Risser 5 isn't even an exact measure of completion of growth as growth has occurred in some patients even after reaching Risser 5.
Unfortunately, I am unable to come up with the right search terms to find that paper again. It seems to me girls should also stop bracing when growth has ceased. It seems a shame to stop bracing too early in some cases, after all the effort, and have the unintended consequences of continued progression.
Here is a video of the lecture presented at the latest 2010 POSNA meeting by John A. Herring, MD of Texas Scottish Rite Hospital for Children.
It shows that bracing is effective if worn for enough hours each day and has some very interesting insights including:
Success Rates (progession <6 degrees):
>12 hours of wear per day - 82%
7-12 hours per day - 61%
<7 hours per day - 32%
Flexibility of the curve did not seem to alter the success rate or the frequency with which the brace was worn!
72 patients did not have surgery, average wear 8.1 hours per day!
28 patients had surgery, average wear of 4.3 hours per day.
Whether the patients were told to wear the brace 23 hours per day or 16 hours per day didn't matter, both groups ended up wearing the brace the same average total number of hours! There was no difference between the number of hours of brace wear of boys and girls.
Most important slide in my opinion:
Results vs. Natural History
Lonstein, Carlson results (Risser 0,1 Curves 20-29 degrees) i.e. the natural history:
68% progressed
Katz, Herring et al (this study) (Risser 0,1 Curves 25-45 degrees) curves larger and therefore more likely to progress:
Brace > 12 hours 18% progressed
Brace < 7 hours 69% progressed (back to the natural history)
Therefore, bracing alters the natural history!!
http://posna.gmetonline.com/Presenta...onpackageid=44
Click on the link for Scientific Program Day 3, and then the sixth presentation at 9:04 a.m.
One item of concern for me:
Brace treatment was discontinued at Risser 4, 18 months post menarche in the girls, boys until growth ceased. This is very interesting because my daughter is already two years post menarche and is at Risser 4 and she will continue to wear her brace until her growth has ceased completely. She had 3/4 of an inch of growth in the last six months. I ran across a study recently that showed that Risser 5 isn't even an exact measure of completion of growth as growth has occurred in some patients even after reaching Risser 5.
Unfortunately, I am unable to come up with the right search terms to find that paper again. It seems to me girls should also stop bracing when growth has ceased. It seems a shame to stop bracing too early in some cases, after all the effort, and have the unintended consequences of continued progression.
Comment