Early intervention
This is my son and I was given his permission to post this comparison. First image is pre-bracing. Second image is 24 hours out of brace.
In the earlier picture, he was 11 years old. His scoliosis was (averaging who measured) 18 degrees, 21 degrees, and 12 degrees from proximal curve, mid-thoracic and lumbar respectively. He was 63” tall.
He’s now 15.5 years old and 73.6” tall. His curves are currently from top to bottom 28, 15, and effectively 0 - there is no discernible lumbar curve now.
As of yesterday he is Sanders 8 in a bone age test and the next stage is a slow wean off the brace. There is a protocol to this as well, in full consideration that we monitor and give appropriate time for his muscles to take over for what the brace has been doing, offering that postural support.
Over the course of bracing, he had about 7 braces, I lost count. Every 2.5 inches of growth or 15 lbs in weight, we would get refit, fundamentally chasing the curves.
Why did the top curve get worse? Double majors are quite difficult to manage and there is a fulcrum effect on the upper curve and you see this in any treatment, operative or non-operative.
This needs a critical eye, and a balance must be struck between how much corrective force is applied to the mid-thoracic curve in relation to the upper (proximal) curve. Consider that the other factor is that this area cannot be addressed by the brace because of anatomical constraints - it is impossible to access. It can only be managed and is very difficult to treat with physiotherapy optimally as well, given the rigidity of that region and those short levers. My son has the most difficult curve type to manage. It is not considered a conventional curve.
Overall we are quite grateful we landed under 30 degrees. We continue to do a targeted physiotherapy routine for that upper curve.
I’ve watched my son for years walk around with a plastic tube wrapped around him. And I am happy to report, he’s a happy well-adjusted (literally) kid who has friends, hopes, dreams, strength and empathy for others.
The hardest part of the parent side of it for me was dealing with some of the providers of various sorts. I am indebted for his success, and at the same time, I can say that getting people to hear your concerns can be very hard and overwhelming. I have aged, but I am still here.
I want to end on the title of the post here, early intervention. This is just not discussed enough. Parents get blind-sided and treatment often comes later than earlier. So I thought it would be important to show that early intervention with bracing can offer growth guided correction/ what is referred to as growth modulation - to steer the spine into a more aligned state. This typically happens in younger patients who have growth ahead. And it can mean the difference between using the growth to your advantage or progression.