How tight should a night time brace be?

[hdugger]

What you can find and what is out there are two different things. As usual..

Well, I'll tell you what I did, because I was genuinely interested in finding out. I first thing I found was the most recent (July 2013) Blue Cross statement on scoliosis treatment and this was their summary on vertebral stapling:

"A search of the MEDLINE database in 2010 and updated in 2011 identified a total of five
publications on vertebral stapling; all from Betz et al. The most recent (2010 and 2011)
publication reported on 29 patients with juvenile or adolescent idiopathic scoliosis who met the
study inclusion criteria (out of a database of 93 patients). The reasons for excluding 69% of the
patients from the database were not specifically described but included a change in the type of
staple in 2002."
https://www.bcbsal.org/providers/policies/final/464.pdf

So that got me up to 2011, then I went to PubMed and searched on Betz's name and stapling and I came up with one more article, but it was exclusively about children under 10.

So, I stated what I'd found with the caveat that it was "what I could find" so that Maria or Gayle could update me with anything more recent. And here we are.

I'll add, again, that the "As usual" is sort of unpleasantly zingy. If you have better data, just post it. There's no need to insult me - just post something newer/more comprehensive.

So, anyway, to the best of my knowledge, Betz is including just 29 patients in his published studies. Which is roughly equivalent to the number of kids in the torso rotation studies. Hence my statement that it's all based on very few data points and that parents really have to guide themselves on glimmers.

growth spurt..

You're losing me with the growth spurt numbers. I have no idea how you'd pull that out of any of the published research on any of this stuff. How many of the kids in Betz' study are in their growth spurt? I don't know. Given that we simply don't have that data, we'd have to invent (as it seems you are doing below) and then compare the invented numbers, and I don't know of any statistical test that would make sense out of that. Why not just stick to the actual data?

Does it matter

Around 35 patients total, I think. You can't pull the growth spurt kids out as a separate study.

Sure, yes, it matters. What Mooney did was classic good science (IMO). He had a theory about something that might work, and he ran a pilot study and it looked like there was something there. Then Kevin followed up with a study which appeared to replicate the results. Is it a huge number? No, and I doubt it ever will be. There's just no one with deep pockets who could follow up. You'd need a surgeon, like Dr. Mehta, who is willing to enroll their own patients to get the necessary numbers. But, as I recall, the results were partly measured against natural history - you had a couple of AIS kids who reduced their curve - something which doesn't happen with natural history.

So, yes, it matters. That's why people were interested in it. And they're interested in Betz' work, even though his most recent published research (caveat: that I can find) only concerns 29 patients.

When the choices are bracing/fusion, then people are willing to take a chance on methods with even very small numbers. Totally reasonable, in my book.

If there is another scoliosis treatment that is seriously considered with less patients, I'd like to know what it is.

Yes, tethering. Seriously considered and casually recommended to parents new to the forum.

[hdugger]

Then we are even

I'm not trying to be *even* - it's not a blood vendetta. I'm trying to correct statements in your posts which are not supported by fact and to call out the ad hominems which are distracting from the discussion. I am pointing out that casting aspersions on researchers' as a way of discounting their research is not a clear-eyed reading of the research. It is, by definition, an ad hominem attack - "argumentum ad hominem, is a general category of fallacies in which a claim or argument is rejected on the basis of some irrelevant fact about the author of or the person presenting the claim or argument."

So, suggesting that Mooney would *lie* about how many kids in his study were in their growth spurts is way, way outside the bounds of a clear-eyed reading of research. It adds nothing, whatsoever, to the facts at hand - it doesn't clarify, inform, or otherwise.

Is there some reason why you cannot stick with just the research instead of making attacks against Mooney's character, my character, and the character of anyone who might have a different opinion?

[Added correction - 12/29] Upon locating the Mooney paper in question, I discovered that the repeated reference to his dishonesty in double publishing is wholly unsupported by the facts. Mooney clearly states in his 2003 paper that he is using data from his earlier study, how many patients came from both studies, and that the table shows combined results. There is no question of an ethical violation of any kind. This renders moot the entire discussion about the ethics of this event, since it turns out that the said event never happened. I will add this correction to all of my posts concerning Mooney's research to reflect this better information

[Pooka1]

Yes, tethering.

I meant one that has been around as long as torso rotation. There are probably no more than a dozen kids in the growth spurt among those 35 patients.

I would bet more than 12 kids have been tethered by now and they are all in the growth spurt and tethering is FAR newer than torso rotation.

[Pooka1]

I'm trying to correct statements in your posts which are not supported by fact

Are you as sure I'm wrong as you are that my comments and McIntire's in re BrAISt are different?

[Pooka1]

I'm not trying to be *even* - it's not a blood vendetta. I'm trying to correct statements in your posts which are not supported by fact and to call out the ad hominems which are distracting from the discussion. I am pointing out that casting aspersions on researchers' as a way of discounting their research is not a clear-eyed reading of the research. It is, by definition, an ad hominem attack - "argumentum ad hominem, is a general category of fallacies in which a claim or argument is rejected on the basis of some irrelevant fact about the author of or the person presenting the claim or argument."

So, suggesting that Mooney would *lie* about how many kids in his study were in their growth spurts is way, way outside the bounds of a clear-eyed reading of research. It adds nothing, whatsoever, to the facts at hand - it doesn't clarify, inform, or otherwise.

Is there some reason why you cannot stick with just the research instead of making attacks against Mooney's character, my character, and the character of anyone who might have a different opinion?

The record is Mooney was not being straight on a number of issues, not the least of which is double publishing without saying he was double publishing. You are free to ignore reality and to not understand the gravity of this.

[hdugger]

I meant one that has been around as long as torso rotation..

I don't think the time frame is helpful in making sense of the data. Doctors who are performing tethering are doing it as part of their main line of business, so they can easily enroll patients. Kevin talked about the difficulty of enrolling patients in PT studies - you have to work with a doctor, they have to help you enroll patients, your work is a financial drain, so you need to get funding, and so on and so on.

So, there's nothing useful to be gained from time frame - it will take a much longer time and likely a good deal of funding for another torso rotation study. You can't even really compare on number of patients because the total number of *patients* for tethering is knowable (there are only a handful of surgeons doing it.) The number of people doing torso rotation is unknowable. We have a bunch in this forum. Other surgeons might be recommending it without anyone knowing. Etc. We have no idea what the number of patients for torso rotation is.

The only thing you can compare is published studies. Torso rotation: 35, VBS: 29; Tethering: 0

I'm not going to compare numbers of children in growth spurt because those numbers are not known across the three. There's no reasonable way to make that comparison.

[hdugger]

The record is .

No, the "not being honest" is your extrapolation. The information is that Mooney published two studies with the same patients. I have no idea how common that it is this field, or whether there's any ethical judgment about it at all. It looked as if Betz' 2010 and 2011 study were also just the same 29 patients, as were several other studies I've run across.

So, none of that in any way affects the central finding of the study, which was replicated by another researcher. And none of it is vital to know in interpreting the data.

I will note, again, that the only researchers who you feel it necessary to examine their character you also happen to disagree with.

I will also note that this: "free to ignore reality and to not understand the gravity of this" likewise is straying away from the discussion in order to examine *my* character. It really is not necessary to insult me at every turn. Just state your case.

[Added correction - 12/29] Upon locating the Mooney paper in question, I discovered that the repeated reference to his dishonesty in double publishing is wholly unsupported by the facts. Mooney clearly states in his 2003 paper that he is using data from his earlier study, how many patients came from both studies, and that the table shows combined results. There is no question of an ethical violation of any kind. This renders moot the entire discussion about the ethics of this event, since it turns out that the said event never happened. I will add this correction to all of my posts concerning Mooney's research to reflect this better information

[Pooka1]

It looked as if Betz' 2010 and 2011 study were also just the same 29 patients,

Does Betz admit it is the same patient population?

You are not grasping that magnitude of the dishonesty with the two Mooney pubs.

There is a reason surgeons discount the Spinecor pubs and that is a FAR less dishonest reason than the Mooney situation.

[hdugger]

not grasping that magnitude of the dishonesty .

I don't think I'm alone in that.

Without any easy way of measuring how this is perceived in the medical field, I looked through Kevin's posts on Mooney's two studies. I certainly don't get any sense from them that he's discussing a huge ethical issue. He describes the second paper as thin, says repeating data is a no-no, and that says that he was disappointed in the missed opportunity (to publish some follow up data). In the following post he talks about how much respect the surgeon he worked with (Asher) had for Mooney.

So, again, I don't get the sense that it's a big ethical issue in the field. The only place where it's described as a huge issue - so large that it calls Mooney's veracity into question - is in your posts.

I think we can drop the discussion of Mooney's character. I find the topic very unpleasant - the man did some good work on his own dime and now he is dead - and I find nothing to support your notion that his character is in question in any way.

He published some data, and that really is the only thing that need be considered here.

[Added correction - 12/29] Upon locating the Mooney paper in question, I discovered that the repeated reference to his dishonesty in double publishing is wholly unsupported by the facts. Mooney clearly states in his 2003 paper that he is using data from his earlier study, how many patients came from both studies, and that the table shows combined results. There is no question of an ethical violation of any kind. This renders moot the entire discussion about the ethics of this event, since it turns out that the said event never happened. I will add this correction to all of my posts concerning Mooney's research to reflect this better information

[Pooka1]

I think we can drop the discussion of Mooney's character.

Good for you. Have fun with that.

[flerc]

The record is Mooney was not being straight on a number of issues, not the least of which is double publishing without saying he was double publishing. You are free to ignore reality and to not understand the gravity of this.

Is not Dr. Mooney a surgeon? Did you forget how you used to say that all surgeons are the most honest and right people of the world? Do you believe is coherent with what you are saying now?

[leahdragonfly]

research articles about VBS

Hdugger,

I am really reluctant to post OT on FAHSAI's thread because I think it is rude, so I am going to keep my comments brief. BTW nobody asked me, but I think you two should move your discussion onto it's own thread, since FAHSAI's thread has been massively hijacked. I am pleasantly surprised to see he is still hanging in here, despite 16 pages of arguments that do not pertain to his daughter's situation. Enough said.

Here is my hasty summary of the currently published data on VBS, gleaned from PubMed:

1.
Vertebral body stapling in children younger than 10 years with idiopathic scoliosis with curve magnitude of 30° to 39°.
Theologis AA, Cahill P, Auriemma M, Betz R, Diab M.
Spine (Phila Pa 1976). 2013 Dec 1;38(25):E1583-8. doi: 10.1097/BRS.0b013e3182a8280d.

(2. removed, it is an early animal model study)

3.
Thoracoscopic vertebral body stapling for treatment of scoliosis in young children.
Laituri CA, Schwend RM, Holcomb GW 3rd.
J Laparoendosc Adv Surg Tech A. 2012 Oct;22(8):830-3. doi: 10.1089/lap.2011.0289.

4.
Vertebral body stapling as an alternative in the treatment of idiopathic scoliosis.
Trobisch PD, Samdani A, Cahill P, Betz RR.
Oper Orthop Traumatol. 2011 Jul;23(3):227-31. doi: 10.1007/s00064-011-0032-z.

5.
Clinical outcomes of nitinol staples for preventing curve progression in idiopathic scoliosis.
Lavelle WF, Samdani AF, Cahill PJ, Betz RR.
J Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S107-13. doi: 10.1097/BPO.0b013e3181ff9a4d. Review.

6.
Vertebral body stapling: a fusionless treatment option for a growing child with moderate idiopathic scoliosis.
Betz RR, Ranade A, Samdani AF, Chafetz R, D'Andrea LP, Gaughan JP, Asghar J, Grewal H, Mulcahey MJ.
Spine (Phila Pa 1976). 2010 Jan 15;35(2):169-76. doi: 10.1097/BRS.0b013e3181c6dff5.

7.
Growth modulation in the management of growing spine deformities.
Akel I, Yazici M.
J Child Orthop. 2009 Feb;3(1):1-9. doi: 10.1007/s11832-008-0145-6. Epub 2008 Nov 20.

8.
[Results of treatment of progressive scoliosis with SMA staples].
Stücker R.
Orthopade. 2009 Feb;38(2):176-80. doi: 10.1007/s00132-008-1364-8. German.

9.
Finite element modeling of vertebral body stapling applied for the correction of idiopathic scoliosis: preliminary results.
Lalonde NM, Aubin CE, Pannetier R, Villemure I.
Stud Health Technol Inform. 2008;140:111-5.

10.
Newer technologies for the treatment of scoliosis in the growing spine.
Torre-Healy A, Samdani AF.
Neurosurg Clin N Am. 2007 Oct;18(4):697-705. Review.

11.
Fusionless treatment of scoliosis.
Guille JT, D'Andrea LP, Betz RR.
Orthop Clin North Am. 2007 Oct;38(4):541-5, vii. Review.

Several of these are published by other well-known pediatric surgeons such as Samdani, Schwend, and Diab. I don't have time to review all of these full articles, although I have in the past. The list of references is priceless in some of these articles and includes literature reviews of the topic. There have also been some very informative conference presentations about VBS over the last 5 years at POSNA (Pediatric Orthopedic Scoiety of North America). Tethering has been presented at least once at POSNA, also, and Lenke published a single case study of an early tethering case.

[Pooka1]

BTW nobody asked me, but I think you two should move your discussion onto it's own thread, since FAHSAI's thread has been massively hijacked. I am pleasantly surprised to see he is still hanging in here, despite 16 pages of arguments that do not pertain to his daughter's situation. Enough said.

Gayle, you are correct.

I just reached my limit with hdugger. I am done.

I apologize to fahsai for the wasted space in this thread.

[flerc]

You can stop with all the bracing and PT if she has little to no growth remaining.

You are saying there is not any reason to believe it may work, right? You must to justify why are you saying that. Well, you should if you would be honest of course.. but you know moderator will always allows you to do what you want here. Good team!

[flerc]

BTW nobody asked me, but I think you two should move your discussion onto it's own thread, since FAHSAI's thread has been massively hijacked. I am pleasantly surprised to see he is still hanging in here, despite 16 pages of arguments that do not pertain to his daughter's situation. Enough said.

Of course!, it's the Pooka1's unmoral work. She is doing it in the non surgical sections since many years ago. Is she agreeing now to not hijack this thread any more? I cannot believe it, she cannot stop to do her work, is something impossible, except some action would be taken from outside.