when should bracing be done?

[LindaRacine]

Celia...

I totally agree that kids who have a significant chance of having surgery should be braced if caught in time. A 14 year old girl with curves < 25 degrees, who has had her period for 7 months, and for whom progression has not been documented, is VERY unlikely to ever need surgery. I am NOT against bracing. I wish my curves had been caught in time so I could have possibly avoided surgery.

I'm hopeful that someone with the appropriate statistics will see this thread and post about the actual cost to society for bracing kids who have little or no chance of ever needing surgery.

--Linda

[Celia]

Linda,

I think worrier should get a second opinion as to whether the cobb angle calculations are correct, I doubt they are. I hate to quote this but here it is: an ounce of prevention is worth a pound of cure.

[worrier]

I'm sorry, I didn't mean to set people off! She is due to go back to the doc in 4 months for more xrays. My husband wants to get a 2nd opinion in about 2 months. So, I guess I will just have to wait and see. I'll keep you posted. One last question...to those of you that are waiting....do you look at your child's back in between visits to note any changes? If so, how often? I am trying to downplay this with my kid.

Thanks, this is a great forum.

[worrier]

Whoops.... Meant to put a about this being a good forum

[marmyte]

Marmyte...

In my opinion, if the excessive healthcare of some causes millions of others to have no access to healthcare, then the greater good should be considered.

--Linda

bracing is by no means "excessive", like celia has already said, it has prevented many surgeries and if used correctly it will prevent many more. no it doesn't always work, but if you have a CHANCE of avoiding the emotional and physical trauma for the patient, then it's worth trying

[Celia]

Worrier,

Nobody is angry, sometimes we enjoy having heated discussions I came across another thread yesterday, in the "new posts" section and I can't remember the exact details but again the surgeon is recommending waiting until the curve progresses to 50 degrees before bracing. I understand that bracing can be a traumatic event for a teenager, but major invasive spinal surgery with is WAY more traumatic for the child. Consider the life long pain and complications from surgery that the poor child will have to live with - let's face it spinal surgery is no where near perfect AND it's VERY VERY expensive ( $200,000 ?). There is definitely something sinister and wrong with the current system. Becky (Marmyte) has recently undergone spinal fusion, and she's here to tell you that if you can prevent it - GO FOR IT !!!!!!

[marmyte]

$200,000 are you serious?!?! wow my surgery was a lot less than that. i said in another thread recently that if you figure it out and think about it - how much time in relative terms will your child spend in a brace? a few years, which have the potential to prevent major surgery. i can't understand why doctors wait until a curve is at 50* before bracing

[Celia]

Becky,

These surgeries are incredibly expensive, I've heard of some surgeries costing $250,000. If you consider the Titanium rib many of these young children will require surgeries throughout their growing years and I can't even imagine the total cost at the end of it all - somewhere in the millions for each child! I don't like to talk dollars and cents when the life of a child is in question, but if you look at this from another angle something has to be done to prevent the necessity for subjecting these poor children to endless surgeries. Many of these children are in constant pain, and it breaks my heart

[cloggerx3]

I do

I'm worrier's daughter

I'm glad yall care about me

[scoligirl2025]

do yall mind if a teen butts in here?

about surgery~ i'm not really sure how much it costs, but i think it's $100,000-$150,000. and i know kids who've had surgery, and they are absolutely pain free now.

worrier~ i have a situation very similair to your daughter's. (sorry this might take a while) i am 13 (14 in 3 months) and was diagnosed in june with two 20* curves. i was told to wait for 4 months, so i went back at the end of september. my thoracic (top) curve stayed the same at 20* but because i only grew in one leg, the lumbar (bottom) curve went up to 25*. my dr. said that since the only reason i got worse was cuz i'm growing weird, he couldn't justify bracing me. i am currently wearing a shoelift and praying it works. if i get any worse, i will be braced. i have had my period for like 7 months, and am a risser 2. (i think i heard that that means i have the skeletal maturity of a 10-year old child)
my dr. said that 20* is closer to normal than it is abnormal, and i really don't think bracing is required at 19* and 17*. that is totally unnecessary! just take it day by day.

cloggerx3 (worrier's daughter)~ you might wanna join www.spinekids.com too! it's a great forum for scoli kids, and you get sooooo much support!

[Attie]

Dear Worrier, I understand your worries! My daughter (now 14) was diagnosed at 11 with a double curve of 17 degrees which stayed put for a year and then jumped to 24 at which time she started wearing a TLSO brace. She's had her brace (on her 3rd one) since Aug. 2003. Just last Jan (2005) she began her period. We are still looking at about another year and a half before she's done with it all, we hope.

Before you worry too much right now I think you need some additional information. Ask your doctor where she is on the Risser scale...very important to know! The fact that she's 14 and just got her period several months ago only means that she can still grow for up to 2 years after she started her cycle. (This is what I have been told by her orthopedist as well as my gyn.) My daughter's doctor has watched her growth plate in her hip...when that is closed (she'll be at a Risser 5 then) and her height remains stable then she'll be done growing. It's so hard to predict how long that will take, though. I recently learned that the 6 months prior to the beginning of menstruation and the 6 months following that can be times of significant growth spurts.

In my daughter's case, her curves had responded well to the brace (18 hours/day) and had stayed at 18/20 until this past summer when they jumped to 29/24. Basically, she outgrew her brace and unfortunately it was in between her checkups. So, she got a new brace...recently she broke her leg and has actually gotten tons of time in her brace.

I'm telling you all of this to let you know that yes you should be concerned but I think you need more specific information, especially in regards to where she falls on that Risser scale. Treating with the brace can be effective if used as prescribed but it can be difficult emotionally. The fact that you can "see" the scoliosis is a concern ... it might be a good idea to get a second opinion. It seems like there is a wide range of opinion/course of treatment throughout the world, but here in our little corner (Philadelphia area) the general consensus is to brace at 25 degrees and anything under is a watch and wait. Unfortunately there is no crystal ball ... some curves don't increase beyond a certain point. But, I have been told that the higher the curve goes the more chance it will continue to increase.

I think the important thing is to trust your own instincts and intuition. If you're not comfortable with the current situation, then get another opinion but be sure to ask very specific questions. (I know in the beginning it's hard to know what these are.) I hope this helps a bit...my prayers are with you and your daughter. -Attie

[cloggerx3]

i dont know if anybody will still read this thread, but::

I am worrier's daughter, the 14 year old. We ended up getting me a SpineCor brace. I have had it for a week, and it is already working wonders Sorry for the "heated discussion" this situation has caused lol. I definitely would recomend this brace @ low curves (or degrees or whatever).

[Joe's Mom]

I have worked in health care for over 30 years now. I started working in the days when the only thing insurance covered were major surgeries and overnight hospital stays. They didn't cover things like braces or outpatient services then. People paid for these things themselves.

Now 30 years later, all sorts of things are covered by insurance and copayments.

I suspect this pendulum is starting to swing back again to less insurance coverage and more private pay. But the providers have not readjusted yet.

I will say that when insurance coverage is not/was not available the COST of goods and services was/is less than when 3rd party coverage is available. I know that when insurance began covering therapy services in the late 1970's our director was instructed to inflate/increase fees by 20% as the insurance was only paying 80% of what was charged. That way, the 80% collected was in fact the "real" amount of the service, for a short while anyhow! Fees inflated dramatically soon thereafter. And the fees have continued to increase all along.

It is really difficult to determine exactly what a health care service or product really costs these days. What is charged is often NOT the same amount that is paid by 3rd party payors. The amount(s) paid are often quite different depending upon the contract each company has with the health care institutions and they are almost never what is listed as the "cost" by the facility. The last hospital I worked for charged almost $200 an hour for therapy services. In reality, they collected around $75-100 max per hour from any 3rd party payor, but there were individuals who privated paid for therapy . . some were actually charged the full fee, some were given a "discount" of 10-15% if they paid up front ($20-30.00 off a $200 fee is still WAY more than the insurance companies were charged/paid). And the real amount collected was often a closely guarded secret!

Personally, I don't think providing braces to kids with spinal curves who may/will benefit from them will bankrupt any insurance company or health care system. Utilization of health care services and goods isn't the problem . . . run away "costs" and indeterminant "costs" and "costs" that are driven upwards to support hosts of mid level management, TV commercials, inflated CEO salaries, and the like . . now that may be something to look at.

Cost benefit analysis is a very challenging task . . . and sometimes the cost of doing nothing in the long run can be quite high.

[marmyte]

Cost benefit analysis is a very challenging task . . . and sometimes the cost of doing nothing in the long run can be quite high.

right there you've hit the nail on the head unfortunately i know several people with scoliosis who can support this statement and i feel very lucky that i'm not one of them

[nikyergen]

Worrier--I am so sorry you have had to go through all these heated discussions. I have three daughters, all with scoliosis. My 17 yo had surgery for hers last March, 2005. She was in extreme pain before surgery and does say that she still hurts, but not like she used to. She does more activities than she used to. My 15 year old daughter was a wait and watch. That is exactly what we did. She saw the doctor on the 27th of October and was told that nothing is progressing or changing. My 13 year old daughter wears a brace. By the time she gets out of it, she will have spent two years in it. But, it has payed off. The doctor is really seeing a lot of improvement in her back. So, to have a brace, wait and watch, or surgery. I can't tell you what to do, as I have all three scenarios at my house, but if you aren't comfortable with things, get a second opinion. Have you checked out Shriners Hospital. Incredible hospital and doctors. They are all over the country. Be sure that your second opinion comes from a doctor that is a pediatric orthopedic surgeon that specializes in spinal deformaties.

To your wonderful daughter--Keep you chin up and wear that brace like you are supposed to. My 17 year old would of loved to of had a chance at a brace before directly going to surgery. Her curve was at 88 degrees when she was diagnosed, so a brace was never an option. She is an athlete and is sitting out of her favorite sport, Basketball, her junior year in high school. She says she is okay with it, but I am sure it hurts to see her team out there practicing and playing and she can't participate.

To both Worrier and her wonderful daughter--Don't wrap yourself in bubble wrap. Keep up any normal activities. None of them need to be cut out. All three of my girls play post positions in Basketball, the middle one also does track and field, and the youngest one plays volleyball, and their backs haven't slowed them down. This is in addition to having the life of being a Rancher's daughter and livestock and rodeo as a very important part of their lives. Stay active and stay in shape. Keep your muscles toned up.

I hope this encourages you.

Again, I am so sorry you got caught up in a heated discussion. You just really need some reassurances and I hope I could enlighten you a little bit.

God Bless You Both,

Nikki