My son has a 32 degree curve and I am wondering if surgery is necessary or if bracing could help the curve. Our doctor is recommending surgery and I am nervous.
Please, please go to another doctor for a second opinion. Surgery for a 32 degree curve, especially if it is not progressing rapidly, is definitely open for debate.
If you express say to your current doctor, "I'm concerned about surgery becuase someone on the web thought surgery sounded unusual" your doctor will rightly say they are the expert, adn what does the person on the web know?! However, it is perfectly legiitmate for you to say to the doctor, "I know you're an expert at this, but surgery would be a big step, and as a concerned parent, I'd like to visit one other surgeon for a second opinion". The doctor shoudl be very comfortable with thtat request (if he's not, you should be concerned).
If you're not sure who to go to for a second opinion, try one of the following:
1. Visit the Scoliosis Research Society on the web (you can find it by a Google search). Their members are teh top surgeons for scoliosis. Look through their membership for a doctor in your area, and contact them.
2. Or, if you live close to a big city, contact the Children's Hospital in your city adn ask to ttalk to the Orthopaedic Dept. Tehn ask for an appointment with one of the doctors who specializes in a scoliosis.
3. Ultimatdly, what you're looking for is an expereinced orthopaedic spine surgeon who specializes in peditric spinal deformity, or a pediatric surgeon who specializes in spinal deformity.
Your current doctor might be right....maybe surgery is needed. But there is NO harm in taking a month or two to get a second opinion.
To Owen's mommy,
I see that it is over a month since you posted this comment, but I made an account just so I could reply to you. PLEASE seek a second opinion. My daughter is 11 and was diagnosed with congenital scoliosis when she was an infant. Her doctor watched and waited for about 7 years. She was in a brace at times and out at others, but he never recommended surgery until her curve was over 40 degrees. We always knew, of course, that surgery may become necessary--he was very open about that. But until her curve was over 40 and bracing wasn't helping stabilize her, he said we could wait on surgery. By the way, her surgeon was a doctor with over 30 years of experience and was chief of surgery at an all children's all orthopedic hospital.
I am NO doctor, just a mom with 11 years of experience with this topic. My understanding is that 40 degrees is the guideline most doctors use, along with what the rate of progression is. I don't know if your son's diagnosis is new, but I would think if it is, a doctor will want to wait at least a little, maybe a few months, then recheck to see if the curve is stable or progressing. I also know that those degrees are not exact numbers...there is a margin of error of plus or minus 5 degrees. So your son may be at 32, or he may be closer to 37...but he may be at more like 27!
My daughter just went through her third back surgery last month. My heart goes out to you and I hope you find great medical care. I also hope your son doesn't have to have surgery, but I will tell you that my daughter has been such a trooper through it all and all 3 surgeries have gone perfectly with no complications.
Hope to get an update!
Hi Owensmommy. Our son was diagnosed with infantile scoliosis at the age of 3. There is a fairly popular misconception that bracing prevents surgery. Bracing is used as a conservative treatment for scoliosis to slow down the rate at which the curve deteriorates. It doesn't 'cure' it. The most crucial period is at puberty. It is at that time, as your child's growth accelerates, that so too does the deterioration in the spinal curve. The bracing, in most cases, merely 'buys' time to allow your child to grow to a reasonable height before surgery, if necessary, is undertaken. Once the spine is fused it stops growing. To date I haven't personally come across a case where a brace actually prevented surgery but I'm sure there are, particularly where a minor curve was evident.
My son wore a plaster cast brace for 12 years (364 days per year). He ultimately had to have surgery - which we knew he had to have - at the age of 15. Today, he is 25, a healthy young man and living an absolutely normal life! Back when he was 3, the leading specialist in the field of scoliosis worldwide was a Miss Mehta - who suffered herself from severe scoliosis - who was based at the Royal National Orthopaedic Hospital in London UK. She was absolutely fantastic! We live in Australia and used to fly him over regularly for treatment/assessment, and then ultimately for his surgery.
I hope this is of some help (and comfort!) to you
I am not a physician but what I know is bracing does not work for everyone and every curve. If it's a very large curve or one that does not stop getting worse with a brace, his doctor will probably recommend surgery. There are different types of surgery. Some may be better for specific curve than other types. The main purpose of scoliosis surgery is to fuse (join together) the bones of your curve. The fusion keeps your spine straight. Your surgeon will talk to you about your options, the different types of surgery, and the different types of implants available. Implants are devices that are inserted during surgery. They remain in your back after surgery and help keep your spine straight.
Hope this is a little help.
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Hi, My daughter is 11 and has been wearing a boston brace for 2 years.She had though a 49 degree curve. It has progressed to 58 so she needs surgery. My doc, Joseph Krajbech at Shriners in Portland said at the time" curves less than 50 degrees tend to stop curving once a child has stopped growing. If we can keep it halted with a brace so that it doesn't go over 50, that's the goal. if it goes over 50,research shows it typically gets worse about a degree a year after growth maturation. At Shriners they usually don't recommend surgery until you are over 50 degrees, but not sure in every case. Could also depend on if there are other factors involved.
My personal opinion of a mom with a child of this disorder. 32 degrees is at a point where probably bracing should be tried first. I haven't heard of many kids needing surgery with that # of curve, unless he has other issues. He should be braced to try and halt progression. A good pediatriac orthopedic surgeon will know what type is best. compliance is a major problem. My daughter cried and was very uncooperative, and she normally is the most cooperative child out there. Her curve though was much greater. If you can get him to wear it the 20+hours a day, you'll have the best chances later of not needing the surgery.
I suggest you get to a local Shriners, even if you have to fly. They are free of charge and he surely would be a candidate. Get his xrays and have them sent there. Online there is an application to fill out. See if they'll accept him. the bracing then, etc would be free of charge. you'd have to go in a few times a year for corrections to the brace, etc but it's worth it. Shriners does excellent work. They are all over the country. My doc in Portland was outstanding, name above. Another great surgeon is Dr. Lawrence Lenke (president of the Scoliosis Research Society). he teaches at Washington University in St. Louis and performs surgeries at Shriners in St. Louis. He has a website/own practice. He's one of the best out there and maybe a visit or phone consult would be worth every cent.
At any rate a 2nd and 3rd opinion are warranted. I've even gotten them, knowing what I know. Ask your pediatrician for a referral.
I can certainly understand the orthopedic docs concern, but scoliosis brace treatment simply doesn't have any effect on the spinal curvature.
A 2007 study published in SPINE (which was a review of 18 separate studies) by Drs. Dolan and Weinstein concluded that observation only (no treatment) or scoliosis bracing showed no clear advantage of either approach. Furthermore one can not recommend one approach over another to prevent (scoliosis) surgery. They gave the recommendation for bracing a grade "D" relative to observation only because of "troublingly inconsistent or inconclusive studies on any level."
In fact, there is reason to believe it may even be harmful....
Excerpts from Dr. Ian Stokes 2010 SOSORT presentation on the possible effects of immobilization (AKA: scoliosis brace treatment) on spinal discs in scoliosis based off his rat tail research.
"Both vertebral and disc deformity contribute to the idiopathic scoliosis deformity, but the cobb angle measures both without distinguishing their relative magnitudes, which is approximately equal. Conversely, discs do not grow in height while adolescent deformity is progressing. It appears from a few studies that progression of scoliosis occurs initially in the discs and subsequently in the vertebrae. Nutritional compromise has been implicated premature disc degeneration on the concave (inside) side in scoliosis. Our rat tail model in which a curvature is imposed along with compression develops a 'structural' [Aka: permanent] disc deformity with tissue remodeling after 5 weeks, and we are studying the underlying mechanisms."
"The disc wedging structural changes in human scoliosis may result from reduced mobility"
"Disc deformity is a significant contributor to scoliosis, not specifically measured relative to vertebral deformity by cobb angle. Prevention of progressive disc deformity may require maintenance of mobility as well as reversal of loading asymmetry."
The developers of the Scoliscore™ genetic pre-disposition test did a comparison study of scoliosis brace treated patients vs. non-treated scoliosis patients and “genetically risk stratified” each group according to their Scoliscore™; which is to say they compared patients with low genetic risk to low genetic risk, and high genetic risk to high genetic risk. This allows for a more accurate “apples to apples” scoliosis treatment comparison.
You can view 3-D in and out of scoliosis brace CAT scans that show how braces can actually increase the amount of spinal deformity.http://www.treatingscoliosis.com/scoliosis-brace.html