which brace is better for lower lumbar?

[Pooka1]

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.

There are great responses to this brace on this forum but mainly in the juvenile IS (JIS) crowd.

There are also great responses to other braces in the JIS crowd.

From these few testimonials, brace response in JIS appears to be different from that for AIS as a broad, general statement that may not be borne out over larger groups. It needs more study but I am not so sure bracing in JIS will be such a hot topic in the future if VBS pans out in a big way.

Good luck on Tuesday.

[JessicaNoVa]

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.

I do not believe our orthotist, Luke Stikeleather, makes any such claim.

[mariaf]

Hi Kerrifales,

I would definitely go with whatever your doctor recommends. It is really the only opinion that matters.

That said, I agree with those who said they doubt ANYTHING is effective 95% of the time.

One more point. While night braces (i.e., Providence, Charleston), and in fact all braces, are mostly used to treat moderate curves (meaning that they would not be prescribed for curves of 50 degrees, 60 degrees, etc.), I would not rule out a night time bending brace for a 38 degree curve.

Again, talk to your doctor - but I do know a few patients who were prescribed the Providence for curves of similar size as your daughter's and so far, so good.

Best of luck to you!

[mariaf]

There are great responses to this brace on this forum but mainly in the juvenile IS (JIS) crowd.

There are also great responses to other braces in the JIS crowd.

Great point, Sharon.

I believe that some patients (i.e., younger kids (JIS patients) with flexible spines and small to moderate curves) would be good candidates to respond to ANY treatment (Cheneau, TLSO, Providence, VBS, etc.).

While an older child (AIS) with a larger, stiffer curve might fail if any or all of the above were tried and go on to require fusion.

I have heard doctors even say they do not believe there is a huge difference among braces as long as they are well-fitting braces made by a trained orthotists. Or to put it another way 'a brace is a brace'.

[Ballet Mom]

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!

The Cheneau brace is a European brace, and the doctors in the US, for the most part, don't look to Europe for their information. It's unfortunate because in several areas, the US could benefit from doing so. I'm not talking about the Cheneau brace specifically, but studies in general and even the use of Accutane, a dangerous prescription drug and its dosage. US physicians are taught to be very aggressive in treatment and they don't want the patient to come back if at all possible. So you have surgery for scoliosis, and you have too high dosage of Accutane...too bad for the people who develop major complications.

Good luck, I hope you are prescribed the brace that is going to work best in your daughter's situation. None of us know what that is.

[Ballet Mom]

I do not believe our orthotist, Luke Stikeleather, makes any such claim.

Luke Stikeleather is a completely honest person. He told me not to fly out to visit him because my daughter's current brace had stopped the progression of her curve and was working.

[Ballet Mom]

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

I believe that was around the rate that lumbar curves were achieving with vertebral stapling also...so why aren't you saying that when discussing stapling? Why are they doing major spine surgery when watching and waiting could achieve those results? You're very selective in your criticisms.

[mariaf]

I'm not talking about the Cheneau brace specifically, but studies in general and even the use of Accutane, a dangerous prescription drug and its dosage. US physicians are taught to be very aggressive in treatment and they don't want the patient to come back if at all possible. So you have surgery for scoliosis, and you have too high dosage of Accutane...too bad for the people who develop major complications.

Just curious - what do you mean 'they don't want the patient to come back'?

When my daughter developed mild to moderate acne (I believe acne is what Accutane was originally developed for) her dermatologist was definitely not over aggressive. In fact, I had a teenage daughter asking me, on a daily basis "why can't he just fix this"?!!

We went back several times and finally he found a regiment (topical medicine, and some common sense suggestions to keep the skin as oil-free and clean as possible, etc.) that worked somewhat.

He also told us honestly that acne is a battle you fight to try to control it but hormones and other factors are involved and there is no magic pill or solution.

But let's get back to scoliosis :-)

[mariaf]

I believe that was around the rate that lumbar curves were achieving with vertebral stapling also...so why aren't you saying that when discussing stapling? Why are they doing major spine surgery when watching and waiting could achieve those results? You're very selective in your criticisms.

Not sure why everything has to be a confrontation, but please show me where 95% success is claimed with vertebral stapling of lumbar curves.

[Pooka1]

Why are they doing major spine surgery when watching and waiting could achieve those results?

This statement can only come from someone completely unfamiliar with this field. Because you are VERY familair with this field, I conclude you are arguing disingenuously.

That is not a personal comment... you are not your arguments. You can aspire to do better.

[mariaf]

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...

I hope so too.

I can only speak of our experience with the staff at Shriners in Philly and they are definitely not quick to push for surgery if they feel there is any way to avoid it.

In fact, unlike our former ortho, they are open to hearing a parent's views about treatment. Of course, if they feel something is detrimental to the patient they will advise against it, but they are very open to listening and involving the parent in the child's treatment.

For example, a while back I wanted to space David's x-rays out a bit more. I was concerned about radiation exposure and he had been stable for quite some time. Dr. Betz agreed to space out the x-rays as long as we came at regular intervals for exams so he could check him visually, with scoliometer, etc.

[Pooka1]

Here is a common fallacy that pops up from time to time.

That there is no convincing evidence bracing works and surgeons admitting that is NOT equivalent to "surgery all the way."

It's a variant on the "blood from a stone" fallacy.

ETA: Just because there are no conservative treatments with convincing evdience does not mean that surgeons only ever wanted to do surgery. I doubt any of them want to see a conservative measures fail so they can then do surgery. Thiis is an ad hom against surgeons.

[jrnyc]

just a note...i thought Accutane was taken off the market in America...it is a dangerous drug, i believe...

jess

[mariaf]

Yes, I believe it was pulled quite some time ago.

[Ballet Mom]

Yes, Accutane was taken off the market by Roche itself when it started losing lawsuits of significant dollar amounts. Accutane is actually isotretinoin and is made generically by about 11 other companies under different names, but I say Accutane because that's the name people recognize.

The thing about isotretinoin is that the harmful effects are dosage related. European doctors give acne patients much smaller dosages of the drug than some American doctors do and so don't get the kinds of side effects seen here in the US. And isotretinoin is supposed to be reserved for the most severe acne which causes kids faces to disfigure, which it often isn't.

It's really sad to see some of the pictures of these kids who have to deal with it. Lots of them really lose the will to live and some commit suicide. It's really quite tragic. It reminds me a lot of scoliosis in the sense that someone gets disfigured during puberty when they weren't before. So I don't think isotretinoin should be removed from the market, but I don't know why doctors think it's okay to give such high doses to kids here. The lower the dose given, the more people will get acne again, although usually not as severe. I don't understand why they need to risk the side-effects, just so the kid doesn't have to repeat a course like in Europe.

And isotretinoin is used to treat other diseases also such as cancer and ichthyosis.

I'm actually hoping the University of California at San Diego is close to developing a vaccine against acne that would protect kids from this acne curse. It would also save billions of dollars in medical costs.