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  #1  
Old 19th September 2013, 04:43 PM
hduggan hduggan is offline
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Default Randomized study on bracing shows effectiveness

My son was diagnosed too old to be offered bracing, so I never had to go through trying to get a teen to wear a brace. But I've followed the (so far) very muddy research on bracing, and was left with the sense that it was effective even though the research wasn't very clear.

The problem with the research was that patients weren't randomized. Basically, that means that it was possible that people who wouldn't progress were over-represented in the bracing group, and that bracing then just seemed more effective because of this.

So they did the first big randomized study of bracing in the US and the results were so conclusive that that had to end the study because, ethically, they couldn't continue to assign patients to the non-bracing group.

Here's a link to the research plus a New York Times article

The results are:

In the bracing group, 72% didn't progress to surgical range while in the non-bracing group only 48% didn't progress. The numbers got better the longer the brace was worn, with 90% of the kids wearing a brace more than 13 hours a day not progressing to surgery - almost twice the rate of the non-braced kids.

This still leaves lots of issues open - like, how many of the braced kids will need surgery as adults, and are there other downsides of bracing, and what's the trade off in psychological cost of bracing.

Bracing is a very individual choice, and some kids just aren't going to be able to do it. There's lots of things to balance. But I think this will make it easier for parents whose kids are bracing to feel like there's some point to encouraging their kids to weather it through.
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Old 20th September 2013, 08:03 PM
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tonibunny tonibunny is offline
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Default Re: Randomized study on bracing shows effectiveness

Thanks very much for posting this, Hduggan! I know that bracing can be a controversial subject as some patients worry that there is little research to support its efficacy. This is a very interesting study and it's good to see some research is now being done.
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37 years old, diagnosed with infantile idiopathic scoliosis at 6 months old with curves of 62(T) and 40(L) degrees. Casting and Milwaukee braces until surgery at 10 - ant release/pos fusion T1-T12, halo traction. Post op cast and then TLSO. Further surgery at 18 (ant release/pos fusion extended to L3 to include lumbar curve, costoplasty) and 25 (another costoplasty). Fusion extended to L4 at 33 (XLIF with 4 pedicle screws and two short rods). Pre-op curves: 76(T) and 70(L). Post-op curves: 45(T) and 35(L). Diagnosed with Ehlers-Danlos Syndrome aged 34; scoliosis almost certainly due to this rather than being idiopathic.
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Old 20th September 2013, 08:36 PM
hduggan hduggan is offline
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Default Re: Randomized study on bracing shows effectiveness

I can't imagine what it's like to convince a kid to wear a brace - mine was never asked to. I could hardly get him to brush his teeth

But it's good to see some light at the end of that tunnel for kids who are trying to brace.

Looking at the numbers, it still seems like there's a bunch of over-bracing. Almost half of the non-braced group didn't progress to surgical range, so, presumably, half of the braced kids wouldn't have progressed either even if they hadn't worn the brace. Hopefully they can figure out how to better identify the kids who will benefit from bracing.

One thing I didn't love about this study is that they only had one end point - either the kid hit 50 degrees or they didn't. That's not really the only important question. A kid who's braced at 35 degrees and doesn't advance at all is very different from a kid who's braced at 35 degrees and advances to 49 degrees. I wish they'd gathered (or published) that data, since they will never be able to repeat this experiment (because they won't be allowed to have a non-braced control group). That's really unfortunate.
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Old 25th September 2013, 12:50 PM
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nerak nerak is offline
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Default Re: Randomized study on bracing shows effectiveness

Hi,

thanks for posting this! For a variety of reasons I couldn't have surgery even though my curves are large. Bracing was the only other option available so we went for it! I wore a brace for about 18months between the ages of 13-15. It wasn't a pleasant experience and I was bullied both by children and teachers at my school because of it.

However, it did stop the progression of my curves almost immediately and for that I am grateful. We persevered with the brace and now I dread to think what could have happened to my spine if we hadn't gone done the bracing route.

Wearing a brace as a teenager isn't a great experience but it did help me in the long term.

love Karenxxx
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Old 1st October 2013, 11:06 AM
Smartie Smartie is offline
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Default Re: Randomized study on bracing shows effectiveness

My son William is 2 years old and has congenital scoliosis. He will need surgery, but they are hoping to wait until he's at least 4 years old. Meanwhile he is wearing a brace 23 hours a day. We have been told that his top curve which is 48 degrees and is a rigid curve, will not improve with bracing, but will hopefully stop it getting worse before surgery is needed. His bottom curve is flexible and we are hoping for a 50% improvement with wearing the brace. He has only been wearing it since May and we can see the difference already as his rib hump doesn't look so prominent and he is standing up straighter. As before, he looked like he was bending forward. As he is very young, we have had no problems getting him to wear it, actually he tries to put it back on when we give him an hour break from it!!! Plus it has lovely pictures of cars and tractors and trucks, so he loves wearing it. Reading your experiences and also perhaps knowing that bracing can help, is really what any parent wants to know. I know from also having teenage daughters, that bracing wouldn't be a great journey for everyone as William has made life a lot easier with how he is adapting to it all being so young.
Sue x
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Old 18th October 2013, 07:26 PM
hduggan hduggan is offline
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Default Re: Randomized study on bracing shows effectiveness

Quote:
Originally Posted by Smartie View Post
I know from also having teenage daughters, that bracing wouldn't be a great journey for everyone as William has made life a lot easier with how he is adapting to it all being so young.
I'm glad to hear you son is adjusting so well to the brace. I had a friend who had polio quite young, and she talked about how happy she was when she got crutches made for her. And, how surprised she was at older kids who would throw their crutches against the wall. For her, the crutches were an improvement over life without them. But for them, they were a sign that they were losing something.

My son also has congenital scoliosis/kyphosis - although it didn't become noticeable until he was a teenager - and his top curve is also really stiff. Because he was so old at diagnosis, he sort of missed the normal surgery window, but fortunately his curve seems stable so he has time to figure out how he wants to proceed.

Best to you and your son.
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Old 18th October 2013, 07:16 PM
hduggan hduggan is offline
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Default Re: Randomized study on bracing shows effectiveness

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Originally Posted by nerak View Post
However, it did stop the progression of my curves almost immediately and for that I am grateful. We persevered with the brace and now I dread to think what could have happened to my spine if we hadn't gone done the bracing route.
That's really the hope - that bracing will sort of freeze your curve where it was at diagnosis. If your curve is smallish, hopefully this will mean that you won't ever require surgery.

I saw some report recently on a totally soft brace - it looked like it was just some kind of fabric material - but it didn't link to any research that I could find. If they could manage to find a brace that wasn't awful to wear and that actually held a curve, they could maybe keep even more kids from surgery.
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Old 18th October 2013, 07:20 PM
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tonibunny tonibunny is offline
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Default Re: Randomized study on bracing shows effectiveness

That sounds like the Spinecor brace. I think it's a little difficult to find independent peer-reviewed studies about this brace though, as a lot of the info about it comes from the designers/stakeholders. I've heard mixed reports about its success, but most people do agree it's a lot more comfy to wear than a hard plastic TLSO.
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37 years old, diagnosed with infantile idiopathic scoliosis at 6 months old with curves of 62(T) and 40(L) degrees. Casting and Milwaukee braces until surgery at 10 - ant release/pos fusion T1-T12, halo traction. Post op cast and then TLSO. Further surgery at 18 (ant release/pos fusion extended to L3 to include lumbar curve, costoplasty) and 25 (another costoplasty). Fusion extended to L4 at 33 (XLIF with 4 pedicle screws and two short rods). Pre-op curves: 76(T) and 70(L). Post-op curves: 45(T) and 35(L). Diagnosed with Ehlers-Danlos Syndrome aged 34; scoliosis almost certainly due to this rather than being idiopathic.
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