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Orthotic Management of Scoliosis

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scoliosis - orthotics Vs Surgery

Up to Orthotic Management of Scoliosis
February 02. 2015
Anonymous

Hi

I’m after some information on what goes on at other centres regarding orthotic bracing in the management of scoliosis.  We don’t get allot of referrals here for scoliosis bracing as some of the surgeons are not keen on orthotics and the funding process is complex. Patients only tend to see us when they ask for a non-surgical approach.

Does anyone work closely with their spinal consultants and advise which candidates are suitable for bracing?

Do your centres brace most curves and if too much progression occurs then they go for surgery?

Do you have statistics for those who are braced and go for surgery at your centre?

Has anyone done an in centre study on orthotic bracing/surgery outcomes?

What it the optimum time for scoliosis correction surgery?

Thank you

A

February 03. 2015
Jonathan Bull

Hello Anon

What region do you practice, there are some variations throughout.

Typically in England with specialist commissioning and inclusion of Orthotic treatment written into Spinal Deformity, funding from CCGs is usually via block contract and the unbundling of such is usually down to the trust and local provision.  This could mean without clear guidance, referral is down to individual consultant preference.

It is recommended that the orthotist does work closely with consultants - International preference is that orthotists new to spinal deformity treatment work with experienced team members for 2 years to gain sufficient level of experience.

It is important that expectations are understood from onset of treatment, as we know, optimal curve treatment with bracing is 25-45 deg at risser 0-2. I would suggest that you look at the SOSORT website for comprehensive guidance in conservative treatment.  http://www.scoliosisjournal.com/content/7/1/3

Scoliosis correction surgery is dependant upon numerous factors, rate of progression, magnitude of curve, primary diagnosis, other medical factors.  The ideal is that if surgery is to be performed, it's carried out once without revision, this could be 13-15 in Adolescents.   In younger surgery candidates, there is a move towards the MaGec system.  Although more expensive per unit, the treatment is more cost effective long term as there is less need for revision surgery.  Nice have released some guidance here https://www.nice.org.uk/guidance/mtg18

February 09. 2015
Anonymous

Hi Jonathan

Thank you for your help I work in the Midlands. We will be meeting with the spinal surgeons soon to try and persuade them to use orthotics as a treatment option for suitable scoliosis patient's.  So it’s useful to have as much background information/evidence as possible to present to them which may influence the surgeons in their clinical decision and give the patient all the treatment/management options avaliable!.

Thank you

February 10. 2015
Jonathan Bull

Dear Anon

The Spinal Deformity Team in the Midlands do refer for scoliosis bracing, pm me if you'd like to discuss.

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