In addition to watching the treatment of my daughter, I have had the opportunity to manage over 3000 scoliosis cases. As a Medical Doctor and an Orthotist, I'm familiar with the benefits and drawbacks of both bracing and surgical approaches. I think, in some ways, effective orthotic treatment can be more demanding and more difficult for the patient than surgery. For the patient, surgery is a very passive procedure. The surgeon plans his or her approach and after 4 to 8 hours, it is done. Orthotic treatment demands more from the patient, the patient's family, and their entire medical team. It is a sacrifice because it is a long, long treatment that requires daily, active participation of the patient.

With regard to the conservative treatment of idiopathic scoliosis, there are well known studies that demonstrate that orthotic treatment and surgery are the only two ways to change the natural history of curve progression. If the curve can be prevented from progressing beyond the initial Cobb angle measurement, then that criteria has been met. There are several studies that have demonstrated the ability of bracing to do that. However, I think there is more to it.

Each curve needs to be considered individually and the expectations of treatment adjusted accordingly. How flexible and correctable is/are the curve(s) of the patient? How mature is the patient? How much will that particular deformity be able to be controlled? With some patients, I don't feel bad if we don't reduce the curve; simply preventing it from progressing further is a great outcome. For other patients, it is reasonable to expect a permanent reduction between 10 to 25% of the initial curve. Each case has to be monitored individually.

Bad braces can be as dangerous as bad surgeries. Unfortunately there is no turning back, once the spine loses its flexibility. Like I say, "Flexibility will be our best player or our worse enemy. It depends how we use it!"

Also, there is more to it than Cobb angles. The patient should be well-balanced and stable. It is actually fine to have curves if they are not to large and well compensated on the spine. It is necessary to re-educate new generations of doctors, orthotists and physical therapists to understand this.

Please contact us. We will be happy to respond to you. We can consult with you, give you our recommendations and provide your patients with the individualized brace best suited for them.

GOS "Gomez Orthotic Systems" is directly affiliated with Laboratorio Gilete from Bogota, Colombia. (www.laboratorio-gilete.com)

Sincerelly
José Miguel Gómez T. MD LO

Mail: jmgomezmd@gorthoticsystems.com