Can conservative treatment permanently reduce or eliminate AIS curves?

[Pooka1]

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
These are direct quotes of yours from months ago:

“As I recall, while most JIS cases entail progression, a fair number spontaneously correct. Anyone studying JIS and making claims abut JIS has to beat that background spontaneous correction. The other thing with JIS is that unlike AIS, braces seems to correct the curve at least in the short term. Are the chiros claiming the brace corrects AIS curves? That would be unheard of and almost certainly not true. In AIS, braces at best can prevent progression but never effect a permanent correction.”

“Not AIS cases. Braces don't correct AIS curves. You must be referring to JIS cases.”

"Nobody with any training will claim a brace can reduce an AIS curve. The only claim of all braces is that they can hope to prevent progression. The befores are controls for the afters. They will be in the running for the Nobel in physio or med if they can prove they are permanently reducing AIS curves outside the noise."
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

What is your point?

Permanent correction of AIS curves may not be happening on a large scale (if we keep saying it can't happen on sites like the National Scoliosis Foundation, we'll delay the large scale development needlessly),

You sound like a conspiracy theorist here. You have it exactly backwards. Experts say it because they are not seeing high quality studies with large populations whose AIS curves are permanently reduced absent PT the rest of their life. These are scientists. If there was good evidence of something they would study it for the sake of their patients if not their career.

[Pooka1]

, the bracing practitioners are not satisfied if they can not get 80-100% correction at initial bracing in those with mid-30s degree or less curves and low Risser. They then aim for 100-110% correction progressively down the line.

Sounds exquisitely painful.

[Pooka1]

They do where we go.

I asked our orthotist how many braces he made. He said about 300. I then asked him how many patients went on to surgery. He said 2. After that first visit and a subsequent one, we never returned. My daughter needed fusion. Does he know that? No way.

Do you see how this guy sounds high?

[LindaRacine]

Does it help to know that there have been a few efforts of orthopaedic spinal deformity specialists hooking up with chiropractors and orthotists, to attempt to understand if there's a benefit for these alternative treatments? The two I know about both fell apart. I'm guessing that's because they eventually couldn't agree on the data.

[Pooka1]

Does it help to know that there have been a few efforts of orthopaedic spinal deformity specialists hooking up with chiropractors and orthotists, to attempt to understand if there's a benefit for these alternative treatments? The two I know about both fell apart. I'm guessing that's because they eventually couldn't agree on the data.

You're not kidding.

[Concerneddad]

If you don't mind my asking, what kind of brace was used and where did you go? I can see why they were disappointed with the in-brace correction of only 30% or less. Of all the kids that I have got to know in the last year where we go, the bracing practitioners are not satisfied if they can not get 80-100% correction at initial bracing in those with mid-30s degree or less curves and low Risser. They then aim for 100-110% correction progressively down the line. They say right up front that if they can't get good in-brace correction, there won't be correction of curves in the long term, just a chance of stopped or slowed progression.

I definitely agree that if your practitioner's brace design only gets 30% initial in-brace correction, it did what it would be expected to do. That seems like an unacceptable in-brace correction as I understand it if it is a standard AIS Risser 1-2 case with curve in the mid 30s unless the patient's case was really out of the ordinary.

I'm not going to say where specifically. It's a standard Boston TLSO brace. After the in-brace scan the orthotist put extra pads in top and bottom so it may have gotten slightly more correction.

And any progression was under 5 degrees at a solid Risser 4 so the brace "worked." (I think much more likely is that she was already mature enough at diagnosis that she wasn't going to see major progression regardless, but whatever. Given the size of her curves if the brace even saved a couple of degrees of progression over that time period it probably bought her an extra several years on the back side.)

[Dustin76]

Does it help to know that there have been a few efforts of orthopaedic spinal deformity specialists hooking up with chiropractors and orthotists, to attempt to understand if there's a benefit for these alternative treatments? The two I know about both fell apart. I'm guessing that's because they eventually couldn't agree on the data.

I guess I don't consider bracing to be an alternative method, so I'm not following with what you are saying.

[Dustin76]

Sounds exquisitely painful.

I haven't run into kids/parents describing it that way. I'm sure it's pretty uncomfortable initially, but more and more comfortable as the curves stretch out and become more stable. Our kids, 100% corrected initially (from worst curves of 20 and 26 degrees), were sleeping through the night uninterrupted within a couple days. Don't get me wrong, they don't love their braces, but they don't complain of pain most of the time.

[Dustin76]

What is your point?



You sound like a conspiracy theorist here. You have it exactly backwards. Experts say it because they are not seeing high quality studies with large populations whose AIS curves are permanently reduced absent PT the rest of their life. These are scientists. If there was good evidence of something they would study it for the sake of their patients if not their career.

My point is that you said a few comments ago that you didn't exactly say that AIS curve reduction is impossible, but you did. I put up with a lot of condescension from you the last time around, but no more. I'll stay respectful, but I won't put up with it. I think you are the one who has it backwards. If we just stick to the "if there is good evidence for it, then we study it" stance, then there is no progress. There is enough preliminary evidence for those who have asked the question regarding AIS curve reduction, to continue study and to take what respected orthotists are reporting (AIS curve reduction) seriously. It actually seems more like you are the conspiracy theorist, like one chiropractor and a bunch of Cheneau Riggo type bracing specialist got together and all decided to claim that they are reducing AIS curves.

You may have noticed that I never asked you of your medical background. That is because any given person can bring up valid points related to what I have presented. Any intelligent person can read and self-educate - as you have a lot I can tell. Your formal education does not negate the fact that you bring up a lot of valid points whether you work at McDonalds or have an extensive medical background. Well, I employ the same "give them the benefit of the doubt" approach to those medical providers proposing a bracing plan for our kids. Many ground breaking innovators have not had the exact formal education that many have thought should be required. I just don't go with your theory that a chiropractor couldn't, using his/her base knowledge of anatomy/physiology/biomechanics and continuing self study, make some modifications to already standard bracing protocol and come up with something effective. I'm not saying don't be skeptical of chiropractic. Of course chiropractic manipulations do nothing for scoliosis and for lots of other things, but this won't stop me from even considering a method developed by a chiropractor, especially when they are fundamentally doing what is standard - with some fine tuning and much more time per kid spent to be precise brace construction and adjustment.

[Dustin76]

I'm not going to say where specifically. It's a standard Boston TLSO brace. After the in-brace scan the orthotist put extra pads in top and bottom so it may have gotten slightly more correction.

And any progression was under 5 degrees at a solid Risser 4 so the brace "worked." (I think much more likely is that she was already mature enough at diagnosis that she wasn't going to see major progression regardless, but whatever. Given the size of her curves if the brace even saved a couple of degrees of progression over that time period it probably bought her an extra several years on the back side.)

Thanks for the information. I am hearing a lot of similar reports from parents that I am talking to.

[Pooka1]

My point is that you said a few comments ago that you didn't exactly say that AIS curve reduction is impossible, but you did.

I deny that and stand on the record you posted.

[Dustin76]

In this recent study presented at SOSORT in 2017, AIS curve improvement is almost assumed and expected since the point of the study is to see how well the AIS curve improvements hold up over time.....and they held up really well. Mean curve improvement was 10-15 degrees in AIS cases. Curve improvements only regressed 2-4 degrees over 15 years of post-brace living. I'm sure they could be accused of selecting the most favorable cases, but that does not appear to be the situation. I guess SOSORT thinks it is a good study. See abstract below but the full text is free online.

------------------------------------------------------------------------------------------------------------------------------------------------------
Curve progression after long-term brace treatment in adolescent idiopathic scoliosis: comparative results between over and under 30 Cobb degrees - SOSORT 2017 award winner

Angelo G. Aulisa,corresponding author1 Vincenzo Guzzanti,1,2 Francesco Falciglia,1 Marco Galli,3 Paolo Pizzetti,1 and Lorenzo Aulisa3

Abstract

Background
The factors influencing curve behavior following bracing are incompletely understood and there is no agreement if scoliotic curves stop progressing with skeletal maturity. The aim of this study was to evaluate the loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.


Methods
We reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination. The population was divided into two groups based on Cobb degrees (< 30° and > 30°). Statistical analysis was performed to test the efficacy of our hypothesis.


Results
The patients underwent a long-term follow-up at a mean age of 184.1 months (±72.60) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long term follow-up period (p = 0.105). The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.

The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.

There was no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up.


Conclusions
Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups. These results are in contrast with the history of this pathology that normally shows a progressive and lowly increment of the curve at skeletal maturity. Bracing is an effective treatment method characterized by positive long-term outcomes, including for patients demonstrating moderate curves.

[LindaRacine]

We should have no issues with people who stick to posting their own or their kids' experience. It is grossly irresponsible to encourage others to seek specific treatment, regardless of what that treatment is.

[Dustin76]

We should have no issues with people who stick to posting their own or their kids' experience. It is grossly irresponsible to encourage others to seek specific treatment, regardless of what that treatment is.

I'm not sure exactly what you mean. I have only posted things relating to my kid's experiences and my experiences in trying to give my kid's the best possible care I can find. Since I am a medical professional myself, that means digging deep in the literature, talking to bracing professionals, and talking to parents/kid's who are in the midst of the battle right now. It also means seeking out those who have been out of brace for month/years/decades to hear their stories and see how they are holding up. I am asking some very specific questions of the literature and of the bracing professionals and of those in the midst of their own experiences.

Are you saying I can't post my literature reviews? Are you saying I can't post studies? What in your mind is a specific treatment? Bracing is a specific treatment that many have discussed, even naming their bracing specialist or the orthopedic surgeon that they are dealing with. There would be a lot of moderator deleting to do if all past discussions of specific treatments were deleted. I have already deleted all references to where we go specifically from months ago.


As far as experiences of my kids, the pediatric orthopedic surgeon that we had them see at UCSF, who the director of the scoliosis center said was the best one to see, was surprised by our kid's braces. He said that he would definitely be bracing both of our kids given their situations. He said that their bracing team would be striving for the spine positions in which they were already braced. He was also really impressed with monitoring the curves via MRI instead of x-ray. He said that he saw no problems with the current bracing plans for our kids. He agreed to give primary oversight for their care and we will follow up every 6 months. I plan to go into great detail about each of our kids experiences in upcoming threads. Last time I started to do that, the title of my thread was changed from "Early Onset Scoliosis" to "JIS...." - that was inaccurate, so I deleted that thread.

[LindaRacine]

I'm not sure exactly what you mean. I have only posted things relating to my kid's experiences and my experiences in trying to give my kid's the best possible care I can find. Since I am a medical professional myself, that means digging deep in the literature, talking to bracing professionals, and talking to parents/kid's who are in the midst of the battle right now. It also means seeking out those who have been out of brace for month/years/decades to hear their stories and see how they are holding up. I am asking some very specific questions of the literature and of the bracing professionals and of those in the midst of their own experiences.

Are you saying I can't post my literature reviews? Are you saying I can't post studies? What in your mind is a specific treatment? Bracing is a specific treatment that many have discussed, even naming their bracing specialist or the orthopedic surgeon that they are dealing with. There would be a lot of moderator deleting to do if all past discussions of specific treatments were deleted. I have already deleted all references to where we go specifically from months ago.


As far as experiences of my kids, the pediatric orthopedic surgeon that we had them see at UCSF, who the director of the scoliosis center said was the best one to see, was surprised by our kid's braces. He said that he would definitely be bracing both of our kids given their situations. He said that their bracing team would be striving for the spine positions in which they were already braced. He was also really impressed with monitoring the curves via MRI instead of x-ray. He said that he saw no problems with the current bracing plans for our kids. He agreed to give primary oversight for their care and we will follow up every 6 months. I plan to go into great detail about each of our kids experiences in upcoming threads. Last time I started to do that, the title of my thread was changed from "Early Onset Scoliosis" to "JIS...." - that was inaccurate, so I deleted that thread.

If you post your children's experiences, no one will have any issues with your posts. Same goes for everyone.