rahmouni results

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gerbo
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rahmouni results

Beitrag von gerbo »

Dear All

Rahmouni results with regards to correction in brace look very good.

However, the "perceived wisdom" (or published evidence) is that with hardbraces, the curve tends to go back to the point where it was before bracing started.

Is there anything known about how patients do after they finished their treatment with their rahmouni braces?

thanks

gerbo
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BZebra
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Re: rahmouni results

Beitrag von BZebra »

Hi Gerbo,

nice hearing from you again! :)
gerbo hat geschrieben:However, the "perceived wisdom" (or published evidence) is that with hardbraces, the curve tends to go back to the point where it was before bracing started.
What do you mean with hard braces? Braces that do correct a lot?
Is there a study about a brace type, which achieved very high corrections?

Landauer has published long term results about his brace treated patients (Unfortunately I don't know which publication it was. He has published a series over the years; one of them.).

He distinguishes between three groups.
  • Those whose scoliosis could be corrected or kept under 30 degrees - they stay stable,
  • those who ended up with a scoliosis of more than 30 degrees - at average they slowly got worse over the years according to the normal rate of progression within adults,
  • and those whose scoliosis could not be corrected or kept from progression - surgery.
So basically, the outcome of his study is, that the progression rate after brace treatment depends mainly on the remaining degree and behaves like untreated scoliosis of the same degree.
gerbo
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Beitrag von gerbo »

i knew you would be quick with your reply, you always are.

what i meaned is this; the list of achieved initial correction by rahmouni is indeed very impressive. However, it isn't this initial correction anybody should be interested in, it is whether this actually achieves a change in the natural history of the curve, with other words, does it make a difference in the eventual outcome??

the only information available in the english literature is with regards to TLSO and boston braces (hard braces) and the spinecor brace (soft brace). I won't go into the spinecor, as there is only one study, but many studies with regards to hardbraces suggest that the best you can expect as an eventual outcome is stabilisation of the curve at the pre-treatment level, with the best chance of this kind of outcome if the initial correction is more than 50% and the brace is worn more than 20 hours a day.

Even that view is not shared by everybody and many consultants will say, a curve will get worse, whatever you do about it and bracing does not make any difference in the long term.

so, they keyquestion is; with all that correction initially achieved, once patients stop using their rahmouni brace, once they finished growing, are they any better off than before they started? And if so, are these improvements permanent??

thanks for considering these questions

gerbo
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BZebra
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Beitrag von BZebra »

gerbo hat geschrieben:so, they keyquestion is; with all that correction initially achieved, once patients stop using their rahmouni brace, once they finished growing, are they any better off than before they started? And if so, are these improvements permanent??
In Landauer's case, yes! He has a group of patients which achieved a correction after brace weaning. It could either be hold if the degree was under 30 (these scoliosis generally don't tend to progress during adulthood) or it worsened slowly according to natural history, not faster.

The average initial correction in brace in the Landauer's group was 50%.

But I can give you a very clear example which doesn't leave any room for discussion of the sort you mentioned.

With a hard brace, it is possible to correct the scoliosis in the other direction. If that happens during growth, it stays that way after brace weaning. Any progression would than be into the opposite direction, and this way it is quite unlikely that you would anytime soon reach the same degree as before bracing.

As to the question if this "over correction" is permanent: It can even be overdone. Over 15 years ago Rahmouni corrected a girl to 16 degrees in the other direction. After brace weaning it was exactly this then.

Somehow it is always quite funny how people tend to generalise without even considering (or being capable of considering) the hole range of possibilities. ;)
Dateianhänge
Ausschulungsbefund nach 3-jähriger Behandlung:
<br />leichte Überkorrektur
Ausschulungsbefund nach 3-jähriger Behandlung:
leichte Überkorrektur
Skoliose3-1b.jpg (10.94 KiB) 22054 mal betrachtet
Anfangsbefund: 
<br />45° thorakal, 42° lumbal
Anfangsbefund:
45° thorakal, 42° lumbal
Skoliose3-1a.jpg (10.26 KiB) 22054 mal betrachtet
gerbo
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Beitrag von gerbo »

the central unanswered question remains; what is known of the postbrace/ longterm outcomes of young people who had a rahmouni brace fitted. Did they go back to their pre-treatment levels, (as the literature on hardbracing suggest) or did they stay at their corrected levels? Or somewhere in between? Do you know whether he ever has published an overview of his results???

bzebra, from my point of view, this is not a pure theoretical question, as you know, i have a daughter wirth scoliosis, and in the next few months i might have to reconsider our current approach, and her question, rightfully is, if i go in "that brace" (which she will hate) will it make any difference??
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Beitrag von BZebra »

Well, Rahmouni did not publish any results. I don't even believe that there has been conducted a long term study with Rahmouni's patients.
Usually patients don't return to their orthopedists after brace weaning. There is no reason to, nothing our health securities would pay for. You don't have to forget, he is not a doctor, just a talented manufacturer of scoliosis braces.

But as I said, Landauer has conducted a study, and this is the same type of brace as Rahmouni does them, a chêneau and "hard" as you call it. So in principle there should be no differences despite a higher initial correction at average in the chêneau braces made by Rahmouni.
gerbo hat geschrieben:Did they go back to their pre-treatment levels, (as the literature on hardbracing suggest) or did they stay at their corrected levels? Or somewhere in between?
The long term results from Landauer are a comparison from 6 months after brace weaning and many years later.

Very often doctors use faulty results. They x-ray directly after the brace has been taken off, but you don't loose your correction so quickly. So you have to make sure, that the brace has not been worn for preferably at least a few months, to ensure that there is no residue effect from the brace.

And then you also have to ask, if the braces they are talking about, did correct sufficiently? There are very few studies which include the initial correction in the brace. A brace which corrects less than 25% does have no effect whatsoever, and the minimum correction for just holding the curve is 40-50%. The question is, if there is a study with braces that corrected significantly more than 50% at average?

Given the number of brace makers in German, who are capable of doing this (which is minimal), I would guess, that not a single long term study has ever been conducted with braces that ever had a chance of a significant permanent correction after brace weaning.

If you don't even try a thing in the first place, it is little wonder if you don't succeed.
gerbo hat geschrieben:and in the next few months i might have to reconsider our current approach, and her question, rightfully is, if i go in "that brace" (which she will hate) will it make any difference??
Why do you have to reconsider? Did it get worse?
gerbo
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Beitrag von gerbo »

appreciate the fact that no studies have been published, however doesn't that leave you with the problem that you recommend a certain treatment, (and you recommend rahmouni a lot) which is very involved and physically and emotionally very difficult to cope with potentially, without knowing whether "it is worth it" / "makes a difference" etc etc.

what has happened to all those people which have been put on the list with their initial corrections?? Have they disappeared, have they written on the forum how they are doing or have they stopped the treatment, or did they get worrse after all??

I am not intending to sound aggressive about it, but these are the question I will get when suggesting "lets take the plane and go to germany" for a rahmouni brace.

do you understand where i am coming from???
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BZebra
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Beitrag von BZebra »

gerbo hat geschrieben:doesn't that leave you with the problem that you recommend a certain treatment, (and you recommend rahmouni a lot) which is very involved and physically and emotionally very difficult to cope with potentially, without knowing whether "it is worth it" / "makes a difference" etc etc.
First of all there are many studies, which come to the conclusion, that a minimum correction of 50% is necessary to ensure that there is no further progression. I guess we can agree that this is quite sure then.

Rahmouni provides this correction in most cases, so if you get used to your brace in a reasonable amount of time and wear it, it practically is an insurance against further progression. That alone is already worth it, since without brace there would be an enormous progression and in the end surgery. Alas, if the brace improves the curve or not matters little, the main goal is to avoid surgery.

Secondly, since I was a patient of Rahmouni with a brace that corrected from 58 degrees to 18 degrees, I know from my own experience, that while I was wearing my brace, there was absolutely no chance of any progression. When I took off my brace, I was still straight, up to 2 1/2 centimeter higher than I am now.
How would a progression be able to take place, if your spine never even gets remotely near to the initial degree of curvature. There I don't see any possibility.

And lastly, since I know the magnitude of the effect a well correcting brace of Rahmouni's can have and the quality difference to other braces which hardly correct at all, it seems no wonder that they don't achieve any correction. If they did with so little initial correction, I would have to be absolutely straight right now, given how much my brace corrected - von nichts kommt nichts!

Well, for most of us it is quite an easy decision. Rahmouni is one of the best. You can't do anything wrong if you just take the best, that applies everywhere in life. If you are unsure, you just take what seems best to you.
gerbo hat geschrieben:which is very involved and physically and emotionally very difficult to cope with
And concerning this point of view, gerbo, I am a patient. I hardly ever regard things out of the eyes of third person like a parent or doctor, deciding over someone else.

I cannot imagine that anyone would want a low quality treatment if the risk of an unwanted surgery is involved. The moment you understand this, there are no physical or emotional problems anymore. It is the price you are glad to be able to pay.
I never had any problems of that sort, because I wanted that brace and I was so lucky that I got it. The majority of people who write here are teenage patients as well. So if they go to Rahmouni, it is there own decision.
what has happened to all those people which have been put on the list with their initial corrections?? Have they disappeared, have they written on the forum how they are doing or have they stopped the treatment, or did they get worse after all??
Well you have to read in the forum. There is a link to each person's profile, many of them have written how their story went on.
I am not intending to sound aggressive about it, but these are the question I will get when suggesting "lets take the plane and go to germany" for a rahmouni brace.
Well, unless your daughter has more than 50 or 60 degrees, I am not suggesting that you should go to Rahmouni. I would recommend Nahr in Berlin. Flights from London to Berlin are not so expensive, the braces in general a bit smaller than Rahmouni's. The only question is if your health security covers a brace from Germany. But Austrian and Swiss health insurers do, so they might.
gerbo
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Beitrag von gerbo »

bzebra, I am a bit confused here

first of all, you appear a bit irritated and i don't know why, or am i just oversensitive?

your experience and outcome are without doubt fantastic, if you would have lived in the UK or the USA you would have been operated on, no doubt. I was trying to work out how some of the 12-13 year old have done, who are on the list, but somehow none of them seem to be giving any real feedback on how they are doing at the moment, with some not posting at all after their initial few posts, so I am struggling there and little indication whther young people started with a rahmouni brace get any longterm benefit from it, or whether they stick with it or give up on it after a while. You obviously have the benefit of virtually seeing every post on this forum over the years (and being able to read them!!) and therefore having a better impression then i can get from the info available.

really confusing is that you are recommending klaus nahr, although there really seems to be no information at all about him, not even about initial correction rates and the only reason you recommend him because nobody has ever complained about him. Or is there something I have overlooked here?

best wishes

gerbo :) :)
lego

Beitrag von lego »

Gerbo,
To reassure you about Nahr: There's a publication in the journal "Der Orthopäde": J. Matussek et al. (from the Orthopedic University Clinic (Orthopädische Universitätsklinik) Berlin/Oskar-Helene-Heim; one of the authors is K. Nahr): Zwei- und dreidimensionale Korrektur von Skoliosen durch Korsettbehandlung. Optimierte konservative Therapie der idiopathischen Skoliose durch ein weiterentwickeltes Cheneau-Korsett. Orthopäde (2000) 29: 490-499.

This article describes the efficiency of a Cheneau brace of the newest generation, a brace with a three-dimensional corrective effect.
The conclusion is that these braces can not only stop scoliosis but also lead to permanent improvement of the curvature!
Precondition is a high correction (more than 50%; if possible, overcorrection) in the brace.
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BZebra
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Beitrag von BZebra »

gerbo hat geschrieben:you appear a bit irritated
Well, what am I supposed to say if you come up with all these studies about braces which didn't even deserve the name. If you find one about braces which corrected properly, then you also have your address to go to.

We are talking here about people who just did research about how it is not being done! They can't do it!
but somehow none of them seem to be giving any real feedback on how they are doing at the moment, with some not posting at all after their initial few posts
Everybody who posted his or her results somewhere here in the forum is on the list. It is to make sure that the results are not being selected, that it is a representative sample.

People who have posted information about how things went on are:
qtstar, Anchetcheprure, schloesd, Finomina, *so delicious*, Birgit007, Sabi, Ulli, Emmalou, lisabet, sweety1, Padde, florentina, optimist, laura14, Mama41, Loewin16, tennis lilli, Wolf, Tulear, BZebra, Fiara, DerMensch, Tabea, Daniela, Mutter, Kathy_Lindner, Simone, Tulipana, Elfi, Katjes, Tippi, *Honey-Boney_Betze*, NettiAngel and Soj_83 / Fine.

Isn't that enough?
really confusing is that you are recommending klaus nahr, although there really seems to be no information at all about him, not even about initial correction rates and the only reason you recommend him because nobody has ever complained about him. Or is there something I have overlooked here?
Well I know Rahmouni better. So I (me personally) trust him more if it comes to difficult cases.

Nahr recently worked together with Chêneau (that is Rahmouni's teacher as well) and was recommended by him. The published results in the study mentioned are good, the internally conducted quality control shows equally good results and he is being listed on our linklist for some time now, and no insufficient results were being reported on this forum by now.

Furthermore, it is quite easy to correct small curves, even though most people will fail to do this none the less :rolleyes:. It isn't such a difficult thing to do if we are talking about scoliosis between 20 and 40-45 degrees and you are also successfully correct stronger scoliosis.
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