Another New Brace

[rohrer01]

I think it's two different things.

If you're doing surgery, you're going to include the most tilted curve in the fusion, so it wouldn't make sense to measure the curve afterwards from the now-most-tilted vertebrae. You just want to measure the curve in exactly the area you fused.

But, in an unfused spine, you *do* want to measure the most tilted vertebrae, in order to best track the curve. My very experienced surgeon/SRS specialist doctor definatley changed the vertebrae he used to measure the curve between visits depending on which one appeared most tilted. I even asked him about it, and that's the explanation he gave.

So, it's the correct procedure for measuring an unfused spine, according to my expert.

WAYYY better than I said it. ;-)

[rohrer01]

Yes absolutely but I am talking about assessing the claims that braces and PT hold or reduce (primary) curves. Talking about that is not to say there aren't other issues.



As they can do in untreated curves (see collapsed spine cases I posted where some folks now need fusion to the pelvis when they wouldn't otherwise need that).

It is not an open question whether surgery reduces curves, in most cases for at least decades.

It IS an open question whether bracing or PT reduces or stabilizes curves for at least decades. Even for the folks who don't progress, it is impossible to show the treatment was needed in the first place. Recall we have at least a few cases where curves made it to the 50* range and hung there all by themselves, in one case for about two decades.

I was referring to Linda's comment about fused vs. nonfused endpoint choices.

You need not remind me of collapsing spines, since I have one. Hopefully it quits collapsing, but doesn't look that way as last year's x-ray showed progression in the "compensatory" curve AGAIN.

I agree that it is not known whether bracing or PT can hold a curve. It's almost impossible to get "controls" due to the nature of the deformities and possible genetic causes (they could be different from individual to individual) which would basically null the untreated controls.

I think the thing for most folks is that "watch and wait" is a very uncomfortable position to be in. They want to DO something. So they feel that even if the treatment protocol holds off surgery for a little while, they have won the battle.

I don't necessarily share this opinion, only because of my own circumstance. Had I known that my lumbar would eventually be involved, I may have wanted surgery as a teen and my mom would probably have pushed for it, too. With that said, I am STILL in the "watch and wait" category and I'M NOT COMFORTABLE in it...But, sadly there's not a darn thing I can do about it.

[Pooka1]

I think the thing for most folks is that "watch and wait" is a very uncomfortable position to be in. They want to DO something. So they feel that even if the treatment protocol holds off surgery for a little while, they have won the battle.

I'm going to disagree with you a little bit. I doubt many parents or any patients would wear a (23 hour/day hard) brace if they thought it might only just delay surgery. It's too hard a treatment. I suggest everyone one of those folks goes into brace treatment with the hope of avoiding surgery for life. I think surgeons know or suspect bracing might only delay surgery but I question whether any one of them ever told a parent or patient that suspicion. I guess it would be covered under the "no guarantees" statement about bracing but it's slightly dishonest because some folks will not progress (due to bracing or just natural history) and think they are out of the woods. We have several cases here who are now way into surgical territory (and have had surgery) who were told that after "successful" bracing.

I don't necessarily share this opinion, only because of my own circumstance. Had I known that my lumbar would eventually be involved, I may have wanted surgery as a teen and my mom would probably have pushed for it, too. With that said, I am STILL in the "watch and wait" category and I'M NOT COMFORTABLE in it...But, sadly there's not a darn thing I can do about it.

You are a good example. I think it is bordering on malpractice to tell a kid with a T, even a subsurgical one, or a parent not to keep track of both curves. It must be the mother of all kicks in the teeth to start with a only structural T curve and then find out you need a fusion to the pelvis even if the T curve doesn't progress. Hopefully that is rare but I am betting that one woman with the trashed (formerly compensatory) lumbar wished she had the T curve fused earlier.