Wednesday, November 7, 2012

Second Opinions for Scoliosis Bracing, and Including Your Child / Adolescent In The Decision Process.

We do quite a few second opinions for scoliosis and other spine surgeries at Hey Clinic, many of whom travel from out of state to come in for a visit.  It makes sense -- scoliosis surgery is a big deal, and can be helpful to learn more, and consider whether surgery is really best option, and/or what techniques and surgical team's approach and experience might be best fit for you or your loved one.

7:30 yesterday morning,  my nurse practitioner Brittaney and I  did a second opinion for a very nice family whose 14 yo daughter has adolescent idiopathic scoliosis (AIS) measuring about 38 degrees.

The family had seen a pediatric orthopaedic surgeon just recently for a few minutes, who quickly wrote a prescription for a scoliosis brace, and sent them down the hall to get the brace made.

The mom described how they were in a state of shock, and did as they were told, and ordered the brace.

After going home, they started to think about it a bit more, and decided to come in to see us for another opinion, and a friend recommended coming in to see us at Hey Clinic.

When we saw this young lady, we took a careful history, remeasured all her films, and then spent some time exploring the benefits vs. the "costs" of bracing.   We actually took out a Boston Brace and showed it to the patient and family ---- this was the first time they actually saw a real brace!  Yikes!  How can you expect a young lady to decide whether she is willing to wear the brace if she's never even seen one!  The young lady's eyes got quite wide.  We drilled down on specific growth parameters for this young lady that allowed us to risk stratify the potential benefit of bracing and risk of progression for her.  We explained the prospective bracing literature which has shown that bracing may decrease the rate of scoliosis surgery by as much as 50% at the time of skeletal maturity.  We also explained, however, that the brace does not straighten the curve, or improve her posture / appearance, and it is no guarantee that she will not need surgery in the future.   We explained that bracing for scoliosis was different than bracing for your teeth, where you don't have the option of taking your braces off, and braces typically make your teeth straight!  (This young lady messed up my story though.... because she told me that her teeth went crooked when her braces came off!  :)  )

Not unlike surgery, scoliosis bracing is a big commitment, and there is usually no medical emergency to get your child or adolescent in a brace within the next week or two.  Take your time, collect information, feel out your child a bit, and then decide.  Bracing in some ways is a  BIGGER commitment because it requires the compliance of the teenager to wear the brace for at least 18 hours a day, usually over several years.  At Hey Clinic, we spend time, quite a bit of time, engaging the teen as well as his or her parents in the decision-making process, pulling up special growth remaining and other tables and literature to help families make an educated decision.  For the younger children we see with Early Onset Scoliosis (EOS), the issue of bracing is not as traumatic --- the younger kids actually don't mind the brace as much, and actually like to decorate it with stickers, etc.  Bracing in the EOS group also has some big advantages as we seek to at least slow the curve while their bodies are gaining crucial size.

We do brace quite a few children and adolescents at Hey Clinic, but always have a good dialogue first and let the patient and the parents make the final decision on an individualized basis.    Let's face it: as a parent, you have to pick your battles when you are trying to mold a teen into a successful, independent adult!

So, if you feel like you just got whisked down the hall to the brace shop with your son or daughter's new scoliosis diagnosis, it may make sense to slow the doctor or other provider down and ask some more questions, and then, most importantly, talk to your son or daughter about the decision and include them in the process.  This can make it a very positive journey, and build trust.

This particular family left my office yesterday morning really glad that they made the trip, and were going to go home as a family and have that dialogue!  That is time well spent.  An extra hour for a second opinion, or going back to see your pediatric orthopedic surgeon before having your son or daughter wear a brace for 6,500 hours per year for 2-5 years is probably a good investment!  In general, a more holistic, developmental approach that fully engages the adolescent or child in the process is the way to go. That is what I would want for my teen, which is why that's the way we do it this way at Hey Clinic.

If you are looking for a good place to get a second opinion for scoliosis bracing, the Scoliosis Research Society ( is a great resource.  They also have all sorts of great references online, including their new eText site which you can sign up for....

Dr. Lloyd Hey

No comments: