Sunday, 27 October 2013

Scoliosis Systems Highlights Research Showing Elastic Tension Bracing is as Effective as Hard Bracing

Scoliosis Systems, a specialist in the non-surgical treatment of scoliosis, offers patients a flexible, dynamic Spinecor tension brace that research has shown to be as effective in treating the curvature of the spine and traditional hard braces. This treatment approach is completely different to that of traditional three-point pressure rigid braces. It is the first and only true dynamic bracing system for idiopathic scoliosis.

Scoliosis Systems

Case Studies: Patient A<br />
26 year old, adolescent idiopathic scoliosis

This Spinecor uses a corrective movement principle which has been shown to help reduce the scoliosis curvature even after the brace has been removed. Through the use of elastic tension bands, Spinecor helps reeducate muscles and allows the force of gravity to permanently influence the growing spine. In adults, Spinecor can effectively reduce pain and fatigue, and improve postural control, thereby effectively reducing the degree of curvature even without affecting the shapes of the spinal bones.

The unique approach to treatment by global postural re-education has been shown to give progressive correction over time which, unlike any previous brace treatment, is extremely stable post brace weaning.

The dynamic tension brace option is also a more comfortable and less intrusive means of treating scoliosis. Spinecor allows patients to take the brace off for up to four hours a day, it offers total freedom of movement, can be well concealed by clothing and is cool to wear. Clinical experience to date also shows better compliance and cosmetic results.

To learn more about this effective scoliosis treatment and to find a doctor, visit www.scoliosissystems.com.

About Scoliosis Systems:

Dr. Lamantia, Dr. Deutchman and Dr. Brett Diaz are founding members of the International Society of Scoliosis Orthopedic Rehabilitation (SOSORT) and are the world's experts in alternative Scoliosis treatment for both children and adults. They make themselves available in 15 regional centers throughout the United States, seeing all scoliosis patients personally. They designed the S.T.A.R.T. Smart program to reduce and stabilize Scoliosis using a flexible dynamic brace, specially designed exercises and breathing techniques. Patients and families are given the tools and information necessary to live successfully with Scoliosis, while avoiding the need for rigid braces or surgery.

Source Prleap

Top Scoliosis Surgeon and Orthotics Technician Visit HMC

Top French orthopedic surgeon Dr. Michel Onimus from France recently visited Hamad Medical Corporation 's ( HMC ) Orthopedic Department, and is accompanied on the present visit by Orthotics Technician Mr. Francois Dubousset. Dr. Onimus has been regularly visiting HMC since 1999 as part of HMC 's efforts to provide local patients with top expertise and enable them to avoid the need to travel abroad for specialized care.

From left, Mr. Francois Dubousset and Dr. Michel Onimus

From left, Mr. Francois Dubousset and Dr. Michel Onimus


Hosting visiting physicians and surgeons such as Dr. Onimus also promotes exchange of expertise and continuing education for medical residents.

Currently Honorary Professor of Pediatric Orthopedic Surgery in Besancon University in France, Dr. Onimus visits HMC three or four times a year to conduct surgery and consult with patients on a fixed appointment basis. He is planning to return in February 2014. "Usually I come in June when we have many children who can then undergo surgery without it interfering with their school time," said Dr. Onimus, who in addition to routine cases of scoliosis in children, also performs surgery on complicated and rare cases.

Scoliosis is a condition in which a person's spine is curved from side to side. It can be congenital, idiopathic (of unknown cause), or caused by conditions such as cerebral palsy and muscular dystrophy. About 1-5 per 1,000 children worldwide have spinal deformities, said Dr. Onimus. Severe scoliosis can be disabling. "When we are treating spinal deformities especially in children, there is no easy surgery. The orthotic treatment, or treatment using braces, for scoliosis is a conservative treatment that is very important because in many cases especially in small children, braces can be sufficient to prevent the spinal curve from progressing, and to avoid the need for surgery," said Dr. Onimus, who added that Mr. Dubousset will provide his expertise to help develop the orthotics services at Hamad General Hospital.

Dr. Onimus sees between 80 and 100 patients in the clinics during each visit to HMC , and operates on several major and complicated cases of children with spinal deformities, according to Dr. Alaa Zakout, Spine Specialist at HMC . "Our collaboration with Dr. Onimus is part of our efforts to develop our department, particularly services for patients with spine problems. We are aiming for more specialization so we can continue to provide the best care possible for our patients."

Dr. Zakout said the department is now starting to do research on spine problems in adults. One of the research studies involves comparing fixation methods to treat spine fractures, and another study analyzes cases where patients went abroad and came back with complications. "People usually go abroad thinking they can get better service. However, many of these cases return with complications or their operations were not done properly, and so there is increased interest in developing spine surgery locally."

About HMC :

Hamad Medical Corporation ( HMC ) is the principal public healthcare provider for the State of Qatar. The Corporation manages eight hospitals along with further specialist clinical, educational and research facilities, and is growing in capacity each year around the diverse needs of the evolving population. HMC 's ambition is to become an academic health system; a world leading center of excellence in clinical care, medical education and research that transforms into significant clinical advancements.

HMC believes in excellence in healthcare, education and research with each supporting the other to provide world-class quality patient care in a safe and healing environment.

As well as four general hospitals situated in the most densely populated areas of Qatar, HMC also manages four specialist hospitals, looking after patients with the most prevalent conditions, including cancer, heart conditions, rehabilitation, and a hospital providing specialist treatment for women. HMC also operates the national Ambulance Service and a home healthcare service.

The Corporation was the first public healthcare system outside the United States to achieve Joint Commission International (JCI) accreditation for all hospitals simultaneously. JCI accreditation is based on quality and safety across all clinical and management functions.

HMC is also the first hospital system in the Middle East to achieve institutional accreditation from the Accreditation Council of Graduate Medical Education - International (ACGME-I), which demonstrates excellence in the way medical graduates are trained through residency, internship and fellowship programs.


For more information, please contact:
Joan Pauline Acevedo at jacevedo@hmc.org.qa
Corporate Communications Department
Hamad Medical Corporation

Source : Zawya , 20th October 2013

Scoliosis Can Hit Well Past Adolescence

On a family trip to the Grand Canyon three summers ago, my son Erik, who was hiking behind me, remarked, “Mom, your right hip is higher than your left.”

“I know,” I replied, promptly dismissing this observation. But it returned to haunt me many months later, when I had two related realizations: My left pant legs were now all too long, and I had shrunk another inch.

Diagnosis: Adult-onset scoliosis, an asymmetrical curvature of the spine that, if unchecked, could eventually leave me even shorter and more crooked, disabled by an entrapped spinal nerve, and dependent on a walker to maintain my balance.

Determined to minimize further shrinkage and to avoid pain and nerve damage, I consulted a physiatrist who, after reviewing X-rays of my misshapen spine, said the muscles on my right side, where the spinal protrusion is, were overdeveloped relative to the left. He prescribed a yoga exercise — a side plank — to strengthen the muscles on the left and exert enough of a tug on my spine to keep it from protruding farther to the right. He suggested that the exercise might even straighten the curve somewhat.

I’ve been doing this exercise, along with two others suggested by a physical therapist, every day for the last eight months. The therapist also told me to have heel lifts put in or on all my left shoes to help even out my hips and shoulders. While it is too soon to say whether there has been a significant reduction of my spinal curve, it has definitely not worsened and, unless my mirror lies, I look less lopsided.

Although scoliosis is generally thought of as a problem of adolescents, who often require bracing or surgery to correct the curvature, the condition is actually far more prevalent in older adults. In a study by orthopedists at Maimonides Medical Center in Brooklyn of 75 healthy volunteers older than age 60, fully 68 percent had spinal deformities that met the definition of scoliosis: a curvature deviating from the vertical by more than 10 degrees.

Previous studies had reported a prevalence of scoliosis in older adults of up to 32 percent. These reviews may have included adults who were younger than those in the Brooklyn study, whose average age was 70.5 and who had no pain or impairment related to their spinal condition.

Whichever is the real rate, the prevalence of scoliosis in adults is high and expected to increase as the population ages. The most common underlying cause of spinal deformities arising in midlife or later is the degeneration of the discs between vertebrae and sometimes of the vertebrae themselves.

Unlike scoliosis in youth, which afflicts many more girls than boys, adult-onset scoliosis affects men and women in roughly equal proportions. Some had scoliosis as children; it had stabilized, only to progress again gradually as advancing age took its toll on the spine. But the vast majority of adults with scoliosis had normal spines in their youth.

A misshapen body is the least serious consequence of scoliosis. It can result in disabling pain in the buttocks, back or legs, and neuropathy, a disruption of feeling and function when a spinal nerve is compressed between vertebrae. Neuropathy must be treated without delay to prevent nerve death and a permanent loss of function.

While there are no surefire ways to prevent all cases of adult scoliosis, certain conditions that are preventable increase the chances it will develop. One is being overweight or obese, and another is smoking. A third cause is a lack of physical fitness, resulting in weak core muscles of the trunk.

Other risk factors include the wear-and-tear of osteoarthritis and osteoporosis, a thinning and weakening of the bones that can cause the vertebrae to break down and compress unevenly. People who undergo spinal surgery to remove tissue pressing on nerves sometimes develop spinal imbalance. A spinal injury that deforms vertebrae can also lead to scoliosis.

Typically, adults don’t seek treatment for scoliosis until they develop symptoms, the most common of which are lower back pain, stiffness and numbness, cramping or shooting pain in the legs. Those affected often lean forward to try to relieve the pressure on affected nerves.

Others with scoliosis may lean forward because they lose the natural curve in their lower back. This compensating posture, in turn, can strain the muscles in the lower back and legs, causing undue fatigue and difficulty performing routine tasks.

Exercises that strengthen core muscles — those of the abdomen, back and pelvis — help to support the spine and can reduce the risk of developing scoliosis, as well as prevent or minimize its symptoms.

Demonstrations of core exercises that can be done at home, with or without an exercise ball, are easily found online.

As many of you know, I am a swimmer, and my physical therapist insisted that I add the backstroke to my daily workout in the water, both to further strengthen my core and to develop upper back and shoulder muscles that will keep me from becoming bent forward as I age.

I soon discovered that the backstroke is more challenging than freestyle, and in doing it for half of my 40-minute swim, I’ve lost weight as well as gotten stronger.

Most people who develop symptoms of scoliosis can be treated effectively with over-the-counter pain medication and exercises to increase strength and flexibility. Bracing is not recommended for adult scoliosis because it can further weaken core muscles.

Surgical treatment is reserved for those with disabling symptoms not relieved by noninvasive remedies. Surgery often involves spinal fusion to relieve pressure on the affected nerves. It is riskier in adults than in adolescents with scoliosis; complication rates are higher and recovery is slower, according to the Scoliosis Research Society.

But progress is being made in developing less invasive measures, including the use of biologic substances that stimulate bone growth in degenerated vertebrae.

Source : The New York Times ( Well Blogs ) , 21st October 2013

Monday, 14 October 2013

Are Pedicle Screws Best for Scoliosis Surgery?

A study published in the October issue of Spine evaluates whether adolescent idiopathic scoliosis patients treated with pedicle screws have fewer readmissions when compared with patients who receive hybrid constructs.

The study examined 627 patients in a prospective multi-center database that was retrospectively queried to identify consecutive patients who underwent posterior spinal fusion for AIS.  The researchers found:

•    Reoperation rate among pedicle screw patients was 3.5 percent, compared with 12.6 percent in the hybrid group.

•    Early return to the OR was 2 percent among the pedicle screw group versus 9.2 percent among the hybrid group.

•    Longer operating time was an independent risk factor for an unplanned return to the operating room among pedicle screw patients.

•    The majority of returns to the operating room among the pedicle screw group were in less than 60 days, while the hybrid group had most of the returns 60 days after surgery.

Source : Becker's Spine Review , 30th September 2013

5 Findings on XLIF for Scoliosis Surgery

In a recent study published in the journal Spine, researchers set out to examine extreme lateral interbody fusion as a treatment for adult degenerative scoliosis.

The prospective, multicenter, single-arm study was conducted through evaluation of clinical and radiographical results of 107 patients undergoing the XLIF procedure. On average, there were three levels treated per patient.

The study found:

•    85 percent of patients were satisfied with the procedure and would choose it again.

•    The complication rate for XLIF was found to be overall lower than that of traditional surgical approaches to degenerative scoliosis.

•     All clinical outcome measures showed significant improvement at 24 months.

•    Overall Cobb angle was corrected from 20.9 degrees to 15.2 degrees.

•    The greatest Cobb angle correction was observed in patients supplemented with bilateral pedicle screws.

The study provides supporting evidence that the XLIF procedure leads to good clinical and radiographical outcomes, without the high complication rate often associated with traditional surgical treatment of degenerative scoliosis.

The researchers included Frank Phillips, MD, Robert Isaacs, MD, William Blake Rodgers, MD, Kaveh Khajavi, MD, Antoine Tohmeh, MD, Vedat Deviren, MD, Mark Peterson, MD, Jonathan Hyde, MD, and Mark Kurd, MD.

Source : Becker's Spine Review , 30th September 2013

Sunday, 13 October 2013

Study finds braces twice as effective in preventing corrective surgery for scoliosis

Childhood infections

In the first large-scale test of whether wearing a brace helps to prevent an already-curved childhood spine from twisting further, bracing was nearly twice as effective as a watch-and-wait approach at preventing kids from needing corrective surgery.

But the study also found that too many children with scoliosis are being given a brace when they don't need one. Data from the new research may help doctors identify which children need to wear the brace and when it is better to just keep tabs on the child.

The study "really answers the question that parents raise - 'If you're going to prescribe a brace for my child, does it work?'" said Dr. Stuart Weinstein, lead author of the study, which was published online by the New England Journal Medicine and reported Thursday at the Scoliosis Research Society's annual meeting in Lyon, France. "The answer is that braces have a very high success rate," he told Reuters Health.

"We also found that the longer the child wore the brace, the more likely you were to achieve success," he said. "Children who wore it more than 13 hours a day had a 90 percent to 93 percent chance of success for avoiding having the curve progressing to a surgical threshold."

The results were so pronounced, the test of 242 youngsters in the U.S. and Canada was halted early.

"It certainly reinforces our present approach to bracing in these at-risk adolescents," Dr. Allan Beebe, an orthopedic specialist at Nationwide Children's Hospital in Columbus, Ohio, who was not connected with the research, told Reuters Health in an email. "This study appears to be better science" than the previous research on bracing.

About 2 to 3 percent of children have some degree of spine curvature, but only 0.3 to 0.5 percent have progressively worsening curves that make them candidates for treatment aimed at avoiding the need for surgery.

Once the spinal curve gets beyond 50 degrees, there's a high risk it will continue worsening into adulthood unless corrected surgically. So treating the problem early is preferable, and less expensive.

Weinstein and his colleagues point out in their report that there were more than 3,600 spinal surgeries to correct adolescent scoliosis in the U.S. in 2009. At a total cost of $514 million, the procedure "ranked second only to appendicitis" for children 10 to 17 years old.

"Bracing has been the standard method of trying to protect patients from needing surgery ever since a brace was developed in the 1940s, said Weinstein, of the University of Iowa. "But it was never really proven if it was effective. There was never a randomized trial where some children were braced and some weren't. The data were inconsistent."

The original plan for the study was to randomly assign some children to a brace and to simply watch others to see whether the curve of the spine became too severe. In either case, progression of the curve to 50 degrees or more indicated that the assigned treatment had not worked.

But many parents had strong feelings about how they wanted their child treated and declined to allow a treatment to be randomly selected for them. So the research team let those parents choose a treatment; 70 percent chose a brace.

"The interesting fact was that when you looked at both the randomized children and those who chose their preference, bracing produced an overwhelming 72 percent success rate when it came to preventing the need for surgery," Weinstein said. The success rate in the observation group was 48 percent.

The success rate among children randomly assigned to bracing was even higher, at 78 percent.

A temperature sensor logged the amount of time the child wore the brace.

"The study provided pretty overwhelming evidence that braces are effective," Weinstein said.

But it was also clear from the results that many bracing treatments are unnecessary.

Nearly half of the participants in the watch-and-wait group during the trial did not have curve progression to the point of needing surgery. The same was true for 41 percent of kids in the bracing group who actually spent very little time wearing their braces.

"We're unnecessarily bracing two patients to get the one patient who actually needs it. We are still overtreating patients," Weinstein said.

A further analysis of the data might prevent some of that unnecessary treatment, he said.

"We will probably, in the next year or so, be analyzing all the factors so we can hone down better who the ideal candidate for bracing is," Weinstein said.

Source : Medcitynews , 23rd September 2013

10 Pivotal Cost-Effectiveness Studies on Spine Surgery to Know

Here are 10 studies published and presented in the past five years on cost-effectiveness of spine surgery.

Operating Room

Spinal Deformity: Dr. Richard Hostin.
Published in May 2013, this article in Spine Deformity: The Official Journal of the Scoliosis Research Society includes several co-authors and the International Spine Study Group. The authors aimed to calculate the cost of improvement in health-related quality of life by examining consecutive patients with adult spinal deformity in a single center over a five year period: 2005 to 2010. They collected costs from hospital data on total costs incurred during the episode of care and found that cost-effectiveness ranged from an average of $5,658 per 1-point improvement in the SRS Self-image to an average cost of $25,918 per 1-point improvement in the SF-36 Physical Component Score. There were 164 patients examined in the study with an average of 3.2 years follow-up. Authors concluded surgical treatment for adult spinal deformity could be more cost effective for select proposes like pain reduction and less cost-effective for other purposes, such as improved functional activity.

Intervertebral disc herniation: SPORT. Jon D. Lurie, MD, Gunnar B. Andersson, MD, Sigurd Berven, MD, James Weinstein, DO, were co-authors on this article. As part of the Spine Patient Outcomes Research Trial, these surgeons and research partners examined the cost-effectiveness of surgical versus nonoperative treatment for lumbar disc herniation over a two-year period. The researchers examined 775 patients who underwent surgery and 416 who underwent nonoperative treatment for intervertebral disc herniation and found the average difference in QALYs over the two-years after treatment was 0.21 in favor of surgery. Surgery was more costly than nonoperative care — $14,137 more expensive for adult surgery and $34,355 for Medicare populations. The estimated economic value of surgery varied considerably, according to the study authors, but overall found surgery moderately cost-effective.

Spinal stenosis: SPORT. Published in a 2011 Issue of Spine and reported in Medscape, this article examined cost-effectiveness of spinal stenosis and two other disorders as part of the Spine Patient Outcome Research Trial. The patients were followed for two years and researchers calculated cost per quality-adjusted life year gained in 2004 US dollars, comparing that number to nonoperative care using a societal perspective with costs and QALYs discounted at 3 percent per year. Surgery was performed initially or over a four-year period for 414 of the 634 patients for spinal stenosis. QALY gained for spinal stenosis patients was 0.22 and costs per QALY gained decreased for spinal stenosis from $77,600 at two years to $59,400 at four years. The study authors include Jon D. Lurie, MD, Gunnar B. Andersson, MD, Sigurd Berven, MD, James Weinstein, DO, Harry Herkowitz, MD, Todd Albert, MD, Keith Bridwell, MD, and other non-physician authors.

Degenerative spondylolisthesis: SPORT. Published in a 2011 Issue of Spine and reported in Medscape, this article examined cost-effectiveness of surgical treatment for degenerative spondylolisthesis and two other disorders as part of the Spine Patient Outcome Research Trial. The patients were followed for two years and researchers calculated cost per quality-adjusted life year gained in 2004 US dollars, comparing that number to nonoperative care using a societal perspective, with costs and QALYs discounted at 3 percent per year. Surgery was performed initially or over a four-year period for 391 of the 601 patients for degenerative spondylolisthesis. QALY gained for degenerative spondylolisthesis patients was 0.34 and costs per QALY gained decreased for degenerative spondylolisthesis from $115,600 at two years to $64,300 at four years. The study authors include Jon D. Lurie, MD, Gunnar B. Andersson, MD, Sigurd Berven, MD, James Weinstein, DO, Harry Herkowitz, MD, Todd Albert, MD, Keith Bridwell, MD, and other non-physician authors.

Outpatient cervical disc arthroplasty: Dr. Richard Wohns. Richard Wohns, MD, founder of NeoSpine in the Puget Sound Area, Wash., published an article describing the cost-effectiveness of outpatient cervical disc arthroplasty in Surgical Neurology International in 2010. The article reviewed 26 patients who underwent outpatient cervical disc arthroplasty and found 100 percent of patients improved after the surgery and no postoperative complications. The cost of outpatient single-level cervical disc arthroplasty was 62 percent less than outpatient single-level cervical anterior discectomy with fusion using allograft and plate. The arthroplasty procedure cost 84 percent less than inpatient single-level cervical disc arthroplasty.

Posterior spinal fusion compared to hip and knee arthroplasty: Sonoran Spine Research and Education Foundation. In 2012, researchers and surgeons at the Sonoran Spine Research and Education Foundation in Mesa, Ariz., published an article online examining the cost-effectiveness and outcomes for spinal fusion and joint replacement patients. The study used a Markov model of 1,000 patients for the three cohorts: spinal fusion, knee replacement and hip replacement. The cost of revision surgery was neglected. Researchers found the total hip arthroplasty group had a cost of $27,450.93 per change in QALY and the total knee arthroplasty group had a cost of $59,165.40 per change in QALY. The posterior spinal fusion group reported a cost of $34,110.03 per change in QALY. The cost of the index procedure was more expensive for the spinal surgery, but when adjusting for the improvements in quality of life, the spine surgery had similar costs to the total hip and knee arthroplasty.

Image-guided spine surgery: Dr. Robert G. Watkins IV. Robert G. Watkins IV, MD, teamed with Robert G. Watkins III, MD, and Akash Gupta, MD, to examine the cost-effectiveness of image-guided spine surgery in this study. The surgeons examined 100 patients undergoing thoracolumbar pedicle screw instrumentation using image guidance and compared them to a retrospective group of 100 patients who underwent screw placement prior to the use of image guidance. Revision reduced from 3 percent to 0 percent when the image guidance was used, and the cost-savings for the placement of pedicle screws as $71,286 per 100 cases. The time required to place screws with image guidance was 20 minutes for two screws, 29 minutes for four screws, 38 minutes for six screws and 50 minutes for eight screws. The researchers calculated cost-savings for the time spent placing pedicle screws with image guidance by subtracting the time required with the current non-guidance techniques from the averages with guidance and multiplying that number by $93 per minute. The article was published in The Open Orthopaedic Journal in 2010.

Spinal fusion surgery: The Ohio State University.
Surgeons from the department of orthopedics at The Ohio State University published this 2012 article in the Journal of Bone and Joint Surgery examining the most cost-effective graft option for spinal fusion to treat L4-L5 degenerative spondylolisthesis. They used a Markov decision model to identify the cost and effectiveness of spinal fusion surgery and revision surgery associated with each graft option. The incremental cost-effectiveness ratio for each graft option when compared with living with chronic back pain was $21,308 per QALY for iliac crest bone graft; $16,595 per QALY for rhBMP-2; $21,204 per QALY for local bone alone; $21,287 per QALY for demineralized bone matrix with local bone; and $28,153 per QALY for corticocancellous allograft chips.

Artificial disc replacement: Dr. Richard Delamarter. Richard Delamarter, MD, co-director of the Cedars-Sinai Spine Center, reported a 2011 study in which he found that artificial disc replacement for patients with degenerative disc disease had a more positive economic impact than spinal fusions. The study examined 209 patients with damaged cervical spine discs who underwent either cervical disc replacement or spinal fusion. Four years after the surgery, the fusion patients were four times more likely to need additional surgery and half of those operations were necessary because of new disc complications occurring at levels adjacent to the fusion. Another study focused on patients suffering from three-level lower back disc disease, comparing the cost of care between disc replacement and fusion. The total hospital costs for the disc replacement patients were, on average, 49 percent lower than fusion patients.

Transforaminal lumbar interbody fusion: Dr. Matthew J. McGirt, MD. Dr. McGirt partnered with Alexandra Paul, MD, Brandon Davis, MD, Oran Aaronson, MD, Clint Devon, MD, and Joseph Cheng, MD, and non-physician researchers to conduct this study into the cost-effectiveness of transforaminal lumbar interbody fusion. The study was presented at the American Association of Neurological Surgeons annual meeting in April 2011, which discussed the economic benefits for patients with leg and back pain associated with grade 1 degenerative spondylolisthesis to receive TLIF. Researchers followed patients for two years to see where the postoperative economic impact lay:

•    Patients reported less disability and improved quality of life according to questionnaires they were given.

•    The mean two-year direct medical cost was $25,251.

•    The mean surgical cost was $21,311±2,086, and the mean outpatient resource cost was $3,940±2,720.

•    The average total two-year cost of TLIF was $36,835±11,800.

•    The average reported annual income prior to surgery was $50,000. Patients missed an average of 60 work days, representing a two-year societal cost of $11,584.

•    At two years after surgery, the total cost per Quality Adjusted Life Years gained of TLIF was $42,854, well below the accepted $50,000 cost-effective threshold.

Source : Becker's Spine Review , 4th October 2013

Back bracing for scoliosis needs work, studies show : NEW YORK

Bracing for scoliosis has been so controversial that until now, one recognized medical group advised against it. But braces have been used for years to prevent spine surgery for the problem, and now a report in the prestigious New England Journal of Medicine racks up scientific evidence that braces do indeed need work.

You can see the scoliosis, curvature of the spine, as 12-year-old Shannon White bends forward. It started when she was very young.

"I was going to my doctor and she noticed that my shoulders weren't even, and I was about 5 or 6 at that time," said Shannon.

She went to a pediatric orthopedist.

"He started bracing me and hope that as I grew, it would decrease the curvature," said Shannon.

The new report backs up the idea of wearing a brace like this for 13 to 18 hours a day.

The report compared kids Shannon's age to see if bracing versus no bracing prevented progression of spine curvature. The results favored bracing so much that the study was stopped so all the kids could use the braces.

It's very flexible as well. Shannon has been wearing it for the hours that she sleeps, and for several hours after school.

"At sleep overs it's a little uncomfortable on the ground or in a sleeping bag," said Shannon.

But she told me she's now used to it, and she's able to take it off for sports, including gymnastics. She's had it two years. She'll wear it another year until her spine and the rest of her bones stop growing. She's had no progression of the curvature in the years she's worn the brace.

"That was our number one goal, to prevent the need for surgery on her back, and the brace has accomplished that," said Shannon's mom, Valerie White.

Scoliosis has a big genetic factor, Shannon's father had the problem. Because of that, she had a one in five chance of getting it too. In the pipeline is some DNA research that may help doctors figure out which patients will go on to progression of spine curvature, and which kids won't.

Dr. David Konigsberg THE VALLEY HOSPITAL

Source : ABC Local , 4th October 2013