Scoliosis Specialists

[Nutty]

Can anyone here tell me who are
scoliosisspecialists.com?

I ask because they have spammed my blog (I can spot a spam post a mile off), and in the post they have used the above link so basically they have employed someone to write for them on blogs and get links, if anyone here knows them and can tell me if they are legit then I may allow the post, if not I will delete.

The comment on my blog was posted by "anonymous" and that rang alarm bells because why would a legitamate company offering help to people with Scoliosis post anonymously?

Thanks

Simone

[LindaRacine]

They are chiropractors.

[Nutty]

Hola

Thanks Linda, however, being a chiropractor doesn't make them bad people, we all have our opinions on chiropractors and mine isn't favourable I have to be honest but that doesn't mean I should shun them because they are.

I have deleted their post as I believe it to be misleading, had they not been anonymous I might have been more considerate.

Anyone here know anything else about them?

Thanks

Simone

[mbarnes]

My son sees Dr. Oulette in Georgia who is a Chiro. He does the Spinecor which is under the Scoliosis Specialists page I believe. In 3 mos. he has improved 3 deg. I have talked to people in his office from different states and they all have shown improvements. I don't know about anyone else but it s working for us.

[Pooka1]

Hola

Thanks Linda, however, being a chiropractor doesn't make them bad people, we all have our opinions on chiropractors and mine isn't favourable I have to be honest but that doesn't mean I should shun them because they are.

I haven't seen anyone suggest chiros should be shunned because they are bad people.

The correct reason to shun them is they are not trained to treat scoliosis and have no evidence (in about 100 years) of having successfully halted or decreased a curve outside of measurement error in controlled trials in the long run as far as I know.

Someone correct me if I'm wrong.

There is a reason why chiros are on Quackwatch (Chirobase).

[concerned dad]

The correct reason to shun them is they are not trained to treat scoliosis and have no evidence (in about 100 years) of having successfully halted or decreased a curve outside of measurement error in controlled trials in the long run as far as I know.

Someone correct me if I'm wrong.

There is a reason why chiros are on Quackwatch (Chirobase).

OK, first post, but I'll jump in here - you invited us to "correct me if I am wrong".
Apparently some Chiro's ARE trained to treat scoliosis. SpineCor trains SOME in the use of their brace. And, in much less than 100 years, their IS evidence of that brace "successfully halting or decreasing a curve" in SOME people.
My daughter will be treated by an orthopedic Dr using the SpineCor, but it could have just as easily turned out to be a Chiro treating her.
But I think you are referring to "traditional" chiropractic techniques as having no evidence in 100years of successfully treating scoliosis.

[Pooka1]

I certainly hope nobody waits for an invitation to correct statements! Evidence is always in order.

In re Spincor halting/correcting curves, I think I specified the long term. I don't think Spincor has been around long enough, nor are there enough controlled studies to my knowledge, to say that Spincor does either of those things as far as I know.

Rather, I think Rivard et al. are presently collecting data, no?

[LindaRacine]

We also need to wait and see if chiropractors are seeing the same results that Rivard et. al. have seen. My understanding is that early results aren't all that positive.

-Linda

[Pooka1]

Evidence is presently being gathered on the Spincor brace. We'll see what the future holds on that.

There is no evidence chiro minus a brace works to my knowledge. In over a hundred years.

[concerned dad]

We also need to wait and see if chiropractors are seeing the same results that Rivard et. al. have seen. My understanding is that early results aren't all that positive.

-Linda

Linda, I would be very interested to hear of any early results regarding Chiropractors and the SpineCor. Is there a specific study you can cite or is the understanding anecdotal? We are going to see Dr. Rivard however I would like to know about any other research out there. It seems logical that a chiropractor would be a valid avenue to offer the brace (If they have been trained and have sufficient experience). I am guessing most people who decide on the SpineCor do so only after an orthopedic Dr diagnoses the scoliosis and recommends bracing.

Pooka1, If by 'controlled studies' you mean SpineCor braced vs non braced (or other brace) then the only paper I've been able to find is a recent paper in Spine (Wong et al May 08). Wong had very poor results w/SpineCor relative to the Boston. However, Rivard published a letter in Spine just 2 weeks ago (Dec 1) basically saying Wong didnt know what he was doing. He finished his letter to the Journal editor by saying "For SpineCor to be applied by insufficiently trained providers is negligent and for these same providers to conducted a study on its efficacy is unethical."
If by 'controlled studies' you mean technical papers published in refereed journals, well then , yes there are a few. I havent been able to find one though that could be called truly independent.
Personally, I like a good scientific debate. I just wish my daughters health wasnt in the balance. Never the less, after researching the info I could find I decided to go see Dr. Rivard for the SpineCor.

And Pooka1, I agree 100% w/what you said about Chiro minus a brace.
And Simone, I agree that Spamming like you experienced rings alarm bells.

[Pooka1]

Pooka1, If by 'controlled studies' you mean SpineCor braced vs non braced (or other brace) then the only paper I've been able to find is a recent paper in Spine (Wong et al. May 08). Wong had very poor results w/SpineCor relative to the Boston. However, Rivard published a letter in Spine just 2 weeks ago (Dec 1) basically saying Wong didn't know what he was doing. He finished his letter to the Journal editor by saying "For SpineCor to be applied by insufficiently trained providers is negligent and for these same providers to conducted a study on its efficacy is unethical."

Yes this is what I mean by controlled. The lack of a control unbraced group for the first several years of bracing studies has made those studies worthless. For example, because some smaller curves will not progress absent bracing, anyone who was braced and didn't progress was counted as a success in the bracing column. Clearly garbage research that is now recognized as such. As a scientist, I question the peer review on journals who published these uncontrolled studies. It's research 101 that you learn (or better learn) in your first year of grad school.

Personally, I like a good scientific debate. I just wish my daughters health wasn't in the balance. Never the less, after researching the info I could find I decided to go see Dr. Rivard for the SpineCor.

Well I wish you and your daughter luck. Spinecor seems promising.

sharon

[concerned dad]

...... The lack of a control unbraced group for the first several years of bracing studies has made those studies worthless. ...... Clearly garbage research that is now recognized as such. As a scientist, I question the peer review on journals who published these uncontrolled studies. It's research 101 that you learn (or better learn) in your first year of grad school.
sharon

Sharon, I suggest you google "Declaration of Helsinki" to understand the grave error in your statement above.

This is perhaps the main difference between physical sciences and biological sciences. What you said holds true for the physical sciences. Ethics trumps research 101 when live people are involved. This is why medical research often moves ahead so slowly. This is also why SRS came up with a set of guidelines to use for brace evaluation studies.

[Pooka1]

Not bracing is certainly not unethical!!! I chose that route for one of my daughters and would have chosen it for the other if she hadn't decided she wanted to give it a go. Choosing to watch and wait is not out to lunch.

Plenty of surgeons/researchers doubt the efficacy of bracing. Until the nighttime brace came out, our surgeon rarely if ever braced nor did the previous surgeon we consulted. These folks still have their medical licenses.

There are any number of cases of failed bracing that requires fusion.

From the NSF page... http://www.scoliosis.org/resources/m...entbracing.php

"In 1985, the Scoliosis Research Society (SRS) initiated a study to investigate the effectiveness of bracing as a treatment for scoliosis. Many previous studies of full time bracing showed that braces stop about 80% of curves. All of these studies, however, were "uncontrolled" which means there were no simultaneous groups of untreated, unbraced patients for comparison. Therefore, there was some doubt that brace treatment of scoliosis was effective, and concern that bracing may be no different than "natural history" or what happens when no treatment is undertaken."

Now it goes on to cite some studies that were controlled and did show efficacy of bracing over natural history but yet some orthopods still eschew bracing.

But the point is that NOW folks are indeed doing controlled studies with unbraced groups. And I would certainly hope no uncontrolled study is ever published again. An uncontrolled study is the very definition of garbage science.

[concerned dad]

First, apologies to Simone for hijacking this thread.

Sharon, I never meant to imply that a parent choosing the option of non bracing was unethical. That is an informed decision that the patient (or parent) makes.

Where we differ though is in the scientific study issues, the value of those studies and the merits of the researchers.

It sounds like you would like to see all brace studies done with randomized trials of braced vs non braced patients. I don’t know how this could be ethically accomplished (I’m not saying it cant be done, I just don’t understand how it can be done). You say that one is ongoing right now, I would like to see the protocol for the study. If you could provide a link or reference I would be very interested to read it.
It seems to me that once a parent decides to not brace a child, that child would not make a good candidate for the unbraced cohort. The decision removes the randomness. Again, I could be wrong, but it seems to me a higher percentage of parents who have children with small curves (or high Risser) would be more likely to choose the non brace option. Wouldn’t this bias the analysis and invalidate the results?

Regarding the value of existing research without unbraced cohorts, I don’t see how you can negate their value. There is information to be gained from them. What is important is to understand the limitations of the results. But, simply because there are limitations does not negate the scientific value.

Finally, my strongest disagreement with your comments relates to the merits of the researchers.

An uncontrolled study is the very definition of garbage science......Yes this is what I mean by controlled. The lack of a control unbraced group for the first several years of bracing studies has made those studies worthless.

“Worthless” and “Garbage science” are pretty strong words. I think you are wrong. They are simply doing the best they can while maintaining ethical standards. I draw your attention again to the Declaration of Helsinki (a set of ethical principles for the medical community regarding human experimentation.) (emphasis added is mine)

32. The benefits, risks, burdens and effectiveness of a new intervention must be tested
against those of the best current proven intervention, except in the following
circumstances:
• The use of placebo, or no treatment, is acceptable in studies where no current
proven intervention exists; or
• Where for compelling and scientifically sound methodological reasons the use of
placebo is necessary to determine the efficacy or safety of an intervention and the
patients who receive placebo or no treatment will not be subject to any risk of
serious or irreversible harm. Extreme care must be taken to avoid abuse of this
option.

I think you are wrong to scorn the previous and current researchers working on studies that lack non-braced cohorts.

[Pooka1]

1. In re conducting research on scoliosis, apparently three of the best approaches are randomized trials, controlled studies, retrospective studies. For example...

http://www.physicaltherapyonline.org...act/85/12/1329

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

The second one is a 2007 article that uses newer, stricter criteria for selecting patients and crunching data that produces results that are less optimistic about the efficacy of bracing. This points up the very real case that previous bracing studies potentially suffered severe flaws. Last, there was an analysis recently that shows that most of the published results, even in top-shelf journals, are false forvarious reasons.

2. It is unethical to put a kid in a brace without knowing it is better than no action. Before the controlled studies, there was NO evidence that bracing decreased the need for fusion. There would be no way to say that any bracing is better than the natural history. When you consider putting kids in 23 hour a day hard braces, sometimes for years with the attendant issues, you can start to understand why there are several orthopods out there who rarely, if ever brace and are not sued for malpractice. The very fact that these guys are out there and aren't being sued out of existence is independent evidence that the verdict on bracing is STILL out.

3. In re the Helsinki accords you posted,

32. The benefits, risks, burdens and effectiveness of a new intervention must be tested
against those of the best current proven intervention, except in the following

sharon -> The best proven intervention for scoliosis is surgery. But that isn't an option for sub-surgical Cobb angles.

circumstances:
• The use of placebo, or no treatment, is acceptable in studies where no current
proven intervention exists; or

sharon -> The only proven intervention is surgery. That's why an unbraced control group in a bracing study is required and is the only ethical way forward.

• Where for compelling and scientifically sound methodological reasons the use of
placebo is necessary to determine the efficacy or safety of an intervention and the
patients who receive placebo or no treatment will not be subject to any risk of
serious or irreversible harm. Extreme care must be taken to avoid abuse of this
option.

sharon-> There is little evidence that no treatment represents higher risk or harm than bracing.