which brace is better for lower lumbar?

[kerrifales]

My daughter will be meeting with the spine specialist in a few days for the first time. We know from meeting with the general doc in our town, that her curve is in the lower lumbar region and measures 38*, she is 13 years old. I have heard alot about the cheneau brace, but wasn't sure which one everyone thought was best for a curve in that region.Any info would be great...

[Pooka1]

My daughter will be meeting with the spine specialist in a few days for the first time. We know from meeting with the general doc in our town, that her curve is in the lower lumbar region and measures 38*, she is 13 years old. I have heard alot about the cheneau brace, but wasn't sure which one everyone thought was best for a curve in that region.Any info would be great...

The only info that will matter is what your surgeon says. Nobody here has any expertise to say which brace is best for lumbar curves.

That said, the Charleston night-time brace is supposed to work best on lumbar curves as opposed to other curves, not as opposed to other braces. I don't know what that translates into in terms of overall efficacy rate.

You might try getting that radiograph and bringing it to the surgeon. It may save him having to re-radiograph her if he is okay with the quality of it. He will likely do his own angle determination. Its worth a shot.

Good luck.

[Ballet Mom]

The night time braces do get very good results with lumbar curves. I think the Providence brace stops the progression in about 95% of patients with lumbar curves. Unfortunately, I believe both major night time braces (Providence and Charleston) are only recommended to curves up to 35 degrees maximum, as far as I know.

Therefore, you're probably looking at some sort of TLSO, such as the Boston brace. You can certainly bring up the Cheneau brace, but lots of doctors have never heard of it. I brought it up to one surgeon, and I got a lecture on the Copes brace and medical treatment in Mexico, lol.

[Pooka1]

I think the Providence brace stops the progression in about 95% of patients with lumbar curves.

Citation please.

Thanks in advance.

[Pooka1]

Could we take the discussion of the research back to the research section, please?

You are not allowed to limit the knowledge of others.

[Pooka1]

It's not knowledge that's being offered - it's just spin -

That's only your opinion. My "spin" is what the surgeons admit.

The reason I asked Pooka and Ballet Mom to take their discussion of the research to the research section is that their entrenched beliefs about bracing

I have no beliefs about bracing. You continually misunderstand this. The state of the evidence is what it is and doesn't require belief of any stripe. It requires acceptance of the state of affairs.

In support of these beliefs, each of them will post their pet research and dissect any conflicting research.

This is a lie w.r.t. me.

If you're interested, you can go down to the research sectionand get some sense of what researchers are saying. Basically, what you'll learn is that medical research is really crappy and almost no decisions that doctors make are based solely (or, in the case of scoliosis) even primarily on research studies. Hence the request that research discussions stay in the research section - because they don't have very much to do with how medical decisions are reached, and having the research spun up here in the parents forum just muddies the water.

Here's the spin.

[Pooka1]

Cross purposes

I spend much of my forum time trying to defend the concepts of science, evidence, skepticism, and intellectual honesty. These matter in ALL fora but the need to defend these things is most acute in the research section.

Hdugger has recently started advocating shunting the counterfactual claims to exactly where they don't belong... the research section.

Thus we are at cross purposes.

[jrnyc]

i am amazed at anything that works 95% of the time!
i would want to see proof of such a claim before i could believe it!
that goes for ANY claim of anything with a 95% success rate!

jess

[Pooka1]

i am amazed at anything that works 95% of the time!
i would want to see proof of such a claim before i could believe it!
that goes for ANY claim of anything with a 95% success rate!

jess

Yes exactly.

The obvious problem is that statement occurs in an area of the forum where people who are not necessarily familiar with the state of evidence read it and be mislead.

The other obvious problem is that some here don't give a hoot about innocent folks being mislead.

[Ballet Mom]

So am I allowed to answer questions on this forum or not? Sheesh.

[Pooka1]

Entrenched beliefs

I consider this an ad hom. Belief is only required when you want to claim something is true when there is no evidence.

I have not done that and therefore you have NO CALL to accuse me of that. I have no beliefs and it is an insult to accuse me of it.

I accept facts and reject claims provisionally until evidence is proffered.

I have not tried to insult you. If I have then I apologize. We are all in the same sandbox.

[Ballet Mom]

You're allowed to do anything.

I think the discussions about personal experience are always helpful, and the same way we deal with people coming in and talking about surgery. So, by all means, talk about your personal experience with bracing all you want.

I squawked when the discussion moved away from personal experience and into research. I think that's *always* dicey up in the general areas.

For a view of how it looks from here, imagine that someone came in saying that their doctor was planning on doing a fusion from the top to the bottom of their curve, and try to get 50% correction using pedicle screws, and I started dragging in research about how fusions should be longer then that, and how he should try to get more correction, and why wasn't he using hooks on the top. I think it would be pretty obvious to everyone that I had no place second-guessing their doctor about where exactly he was going to fuse, or how much correction he was trying to get, or whether he was using hooks or pedicle screws. I mean, what the hell do I know? How would I be qualified to interpret the research, or even understand what weight the research carries in the decision.

If people want to discuss research in the research section, that's fine. If they want to explore alternative treatments in the non-surgical section, that's fine. But don't start dragging poorly-understood research up into the general section and presenting it as if it's known fact.

Personally, I'd like to see a thread actually stay on topic instead of going off on these ridiculous rants. What exactly have you added to the OP's original question? That'll teach anyone to ask a simple question and expect different people to add their knowledge and experience. If the OP wanted to wait until the doctor gave his prescription, she would have waited and not asked the question to us. I'm not going to self-censor to make you happy.

And Pooka is capable of finding the data very simply if she was interested. I'm not here to provide her with studies backing up every single thing I say. Is anyone else expected to provide data for every single thing they say on this forum? No, I didn't think so.

[kerrifales]

I wanted to thank everyone for their opinion... that is why I posted the question, I was hoping to hear from several people and get their opinions. I appreciate everyones response, of course I know the people that respond to me are not doctors, that really is why I wanted to post the question to people with personal experiences in this situation. I am one that fully believes docs do not know everything, and thru the years of other medical issues with my daughter, and my father I have always been very proactive and done my own research. So, just wanted to say I value everyones response, and personal opinions...that is exactly what I wanted. Back to the cheneau brace--- does anyone know why it is not used alot or heard of by some docs? I have read several personal stories with kids whose curves seem similar to my daughters, and that brace was used with some great response. I assumed that we would not be able to just use the night time brace with my daughters curve as severe as it is, but that would be great for her. My daughter has a school friend that just also was diagnosed with scoliosis, went to the same spine spec. we will be using , and was told she was going straight to surgery, with no try of a brace. Of course, her curve measured 50* I think. Just hoping I don't end up with one of those surgeons, that are "surgery" all the way, and really are not open to trying some bracing... Well again thank you, I really enjoy reading everyones "different" opinions and personal experiences. Keeping my fingers crossed we get some good news tuesday, will keep u all posted!

[Pooka1]

And Pooka is capable of finding the data very simply if she was interested. I'm not here to provide her with studies backing up every single thing I say. Is anyone else expected to provide data for every single thing they say on this forum? No, I didn't think so.

You have no evidence for the statement that the Providence brace is effective 95% of the time. NONE.

Watching and waiting could have a 95% success rate with lumbar curves. That statistic you stated is likely all false positives.

If you had evidence for that statement then there should be no lumbar curves in the BrAIST study with surgeons at no less than 26 hospitals agreeing it is ethical to randomize half the kids to a "no brace" group. I recall nothing in the protocol about excluding lumbar curves.

If you had evidence for that statement then Sponseller, experienced pediatric orthopedic surgeon who thinks bracing is worth a try, doesn't know about it. It's your own "private" evidence. Again.

[Pooka1]

I wanted to thank everyone for their opinion... that is why I posted the question, I was hoping to hear from several people and get their opinions. I appreciate everyones response, of course I know the people that respond to me are not doctors, that really is why I wanted to post the question to people with personal experiences in this situation. I am one that fully believes docs do not know everything, and thru the years of other medical issues with my daughter, and my father I have always been very proactive and done my own research. So, just wanted to say I value everyones response, and personal opinions...that is exactly what I wanted. Back to the cheneau brace--- does anyone know why it is not used alot or heard of by some docs? I have read several personal stories with kids whose curves seem similar to my daughters, and that brace was used with some great response. I assumed that we would not be able to just use the night time brace with my daughters curve as severe as it is, but that would be great for her. My daughter has a school friend that just also was diagnosed with scoliosis, went to the same spine spec. we will be using , and was told she was going straight to surgery, with no try of a brace. Of course, her curve measured 50* I think. Just hoping I don't end up with one of those surgeons, that are "surgery" all the way, and really are not open to trying some bracing... Well again thank you, I really enjoy reading everyones "different" opinions and personal experiences. Keeping my fingers crossed we get some good news tuesday, will keep u all posted!

I think you know the score. Most players do or eventually come up to speed. Some never do.

In re the Charleston and curve magnitude, my kid was in the low 30*s when she got the brace. But her case is not going to be generally applicable because she has some type of connective tissue disorder and there is some evidence no brace will work in those cases.

In re the Cheneau, it was developed in Europe and there are only a relatively few othotists in the US who fit the brace. The claims are very large for this brace though there is not much published data.

There a LOL aspect to the Cheneau orthotists in the US... if you believe some of the testimonials, some if not all of these guys claim they are the only ONE certified orthotist here to fit the brace. Heh.