Friday, May 11, 2012

Scoliosis Bracing - Genetic Information Needed To Evaluate Effectiveness

Idiopathic scoliosis is a lateral deviation of the spine when viewed from the front or back of greater than ten degrees. It primarily develops in adolescent female's ages nine to thirteen. It is standard medical treatment to prescribe a rigid spinal brace if the scoliosis advances to greater than twenty degrees and growth still remains. The thought behind a scoliosis brace is that by using aggressive pressure to the pelvis and ribcage the spine can be held in a straighter position while your child grows which will somehow decrease the chance that your child's scoliosis will advance to a surgical level of greater than 40 degrees.
Statistical data varies greatly in the literature in regards to scoliosis bracing efficacy and type of brace used. The majority of authorities agree that in brace correction should be greater than 50 percent in order to have a better chance of stopping progression of the scoliosis. The normal prescription time for spinal bracing is twenty three hours daily in the brace until your child reaches skeletal maturity which on average is sixteen years of age in females. Generally radiographic measurements of your child's spine are performed every six months to evaluate progression and stability. Since only a smaller percentage of scoliosis curves progress to surgical levels it is difficult to determine bracing success and even harder considering success is defined as not progressing to more than 5 degrees of the pre treatment measurement.
This type of statistical data is quite frustrating because if for instance 60 percent were not genetically predisposed to get worse but yet all 60 percent wore a scoliosis brace the research would demonstrate a much higher percent success rate because none of that group would have the genetic predisposition to reach severe deformity levels. On the other hand if 40 percent were genetically predisposed to progress to severe scoliosis deformity levels and all of them wore the scoliosis brace then the study would demonstrate an extremely low success rate.
The only logical way to determine success from rigid spinal orthosis or other modalities designed to stop progression would be to only perform data collection on those patients who were genetically risk stratified. If a child was predisposed to progression and the brace or treatment prevented it then there would be more reason to believe that scoliosis treatment works. This may seem complicated and somewhat trivial, but this approach would certainly eliminate scoliosis bracing or at least significantly reduce the time requirements for those patients who were at low risk of reaching severe deformity.
By determining genetic risk when performing clinical trials when scoliosis bracing is being evaluated we would be able to isolate specific cases that in fact may or may not have responded to treatment and therefore eliminate a very invasive and psychologically damaging prescription. The current system involves a blanket approach for cases that reach bracing thresholds with growth remaining and tens of thousands of children are likely being prescribed something that doesn't have much of an effect on their condition as originally thought.

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