Early Stage Scoliosis Intervention

Once an individual has been diagnosed with scoliosis, no treatment is initially prescribed, and no action is immediately taken, until the Cobb angle has progressed to 25 degrees (which is an arbitrary figure. There is no clinical significance to this number). At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic surgeon, where full-spine x-rays are taken consistently to gauge the progress of the patient's condition.

A wise man once said, "when in doubt, do something, because doing something isn't doing nothing, which isn't doing something......it's just doing nothing."

Quote from the NSF website.

"The data collected by orthopedists shows that without any form of treatment, 4 out of 5 minor curvatures will not progress beyond 20 degrees. For this reason, orthopedists no longer treat such minor curvatures but they do recommend periodic observation, especially in growing children."

Kind of sucks to be part of that 20% of patients whom the orthos are willing to throw under the bus huh? Anyway, the advent of genetic testing indicates that 25% (not 20%) of patient's diagnosed with Adolescent Idiopathic Scoliosis (AIS) are pre-disposed to developing a severe curvature (>40*).....Which isn't to say that the other 75* of geneticly low risk patients can't or won't still experience significant curve progression that often leads to moderate to severe impact on their quality of life in adulthood.

Adult Scoliosis: A health assessment analysis by SF-36
SPINE 2003; 28(6): 602-606

"adult scoliosis patients with spinal curves 10 degree or greater scored significantly lower in 7 out of 8 categories including physical functioning, general health, social functioning, and body pain when compared to the general population. In fact the researchers concluded "It is our conclusion that adult scoliosis is becoming a medical condition of significant impact, affecting the fastest growing segment of our society to a previously unrecognized degree."

38,000 spinal fusion surgeries (many of which with terrible long-term outcomes) are being performed and 30,000 children are being needlessly stuffed into braces (which often cause life long self esteem, depression, and other psychological disorders in addition to being generally ineffective) each year, because the conventional wisdom of yesterday has decided to take a 're-active' approach to treating rapidly progressing curvatures, rather than a 'pro-active' approach to stabilizing and reducing them BEFORE they become increasing, progressive curvatures.

Don't let a lifetime be defined by scoliosis. Be pro-active, be assertive, be informed, and when in doubt do something!!!

Dr. Ian Stokes (Head of orthopedic research at the U. of Vermont, developer of the widely adopted "vicious cycle of scoliosis" model, and all around class act person) approached the podium at 8:50am on May 22nd at the 2010 SOSORT conference in Montreal and dropped an absolute bomb shell. The amazing thing is that I don't believe anyone else (other than perhaps me and a few "like minded" colleagues sitting around me) even heard it go off. I guess the difference between what one hears vs comprehends is largely due to pre-disposed perspective.

Excerpts from Dr. Ian Stokes 2010 SOSORT presentation on the effects of immobilization (AKA: scoliosis brace treatment) on spinal discs in scoliosis.

"Both vertebral and disc deformity contribute to the idiopathic scoliosis deformity, but the cobb angle measures both without distinguishing their relative magnitudes, which is approximately equal. (The disc deformity is greater in the lumbar region than in the thoracic) [Author's note: Doesn't that make them not equal and places greater emphasis on the disc deformity than the verterbal wedging?]. Most attention has been given to the vertebral deformity, which apparently develops because of growth disturbance, and some subsequent remodelling. [Author's note: vertebral deformity is a secondary result of asymmetrical loading as a result of the scoliosis spine, not a primary cause of the condition] Conversely, discs do not grow in height while adolescent deformity is progressing. It appears from a few studies that progression of scoliosis occurs initially in the discs and subsequently in the vertebrae. Nutritional compromise has been implicated premature disc degeneration on the concave (inside) side in scoliosis. Our rat tail model in which a curvature is imposed along with compression develops a 'structural' [Aka: permanent] disc deformity with tissue remodeling after 5 weeks, and we are studying the underlying mechanisms.

"The disc wedging structural changes in human scoliosis may result from reduced mobility" [Author's note: As seen and caused by scoliosis brace treatment]

"Disc deformity is a significant contributor to scoliosis, not specifically measured relative to vertebral deformity by cobb angle. Prevention of progressive disc deformity may require maintenance of mobility as well as reversal of loading asymmetry."

So there you have it. Scoliosis brace treatment causes permanent structural disc wedging deformity in as little as 5 weeks, which is a significant contributor to progression of idiopathic scoliosis. In other words, scoliosis brace treatment is making scoliosis patients worse and causing their scoliosis to become more progressive both in adolescents and adult patients.

The continued usage of scoliosis brace treatment needs to end immediately. It is clear that it does not alter the natural course of the condition, it impairs lung development, it does not have any effect on preventing the need for scoliosis surgery, and now we learn it permanently creates disc wedging that leads to increased risk of curve progression in adolescent and adult scoliosis patients.

Muscles Testing and Function with Posture and Pain
Fifth Edition by Kendall. Written in 2005.

"IMPORTANCE OF EARLY INTERVENTION

Instead of waiting to see if a curve gets worse before deciding to do something about it, why not treat the problem to help prevent the curve from getting worse?

Doing something in the very early stages of a lateral curve does not mean getting involved in a vigorous, active program of exercises. Rather, it means prescribing a few carefully selected exercises that help establish a kinesthetic sense of good alignment. It means providing good instruction to the patient and the parents in how to avoid habitual positions or activities that clearly are conducive to increasing the curvature.

It may mean taking a picture of the child's back in the usual sitting or standing position, and then another in a corrected position, so that the child can see the effect of the exercise on posture. It also means providing incentives to help keep the person interested and cooperative,
because achieving correction is an ongoing project.

For those in whom the curve has become more advanced, in many instances it is necessary and advisable to provide some kind of a support to help maintain the improvement in alignment that has been gained through an exercise program."

Early Stage Scoliosis Intervention is the best opportunity for a scoliosis patient to overcome and successfully manage their condition. This will require a completely new treatment schedule and system of treatment process.

"The treatment goals for an early stage scoliosis intervention program should be to hold the curvature under 20 degrees during the growing years and have the curvature measure no more than 25 degrees by the time the patient reaches skeletal maturity"

While there is still no cure for adolescent idiopathic scoliosis, theories abstracted from current research suggests the natural course of the condition can be altered with an active rehabilitation program that targets the involuntary postural control centers in the patient's brain.
For many early stage scoliosis patients, treatment will be a necessary and ongoing process until they reach skeletal maturity (16-17 for females and 18-20 for males), and some patients will require ongoing treatment throughout life. However, the risk of progression significant curve progression in skeletally immature patients and skeletally mature patients can greatly reduced by developing a "20/25 vision" ongoing treatment plan during their "growing years" and before skeletal maturity.

Current research has found that younger patients with spinal curvatures that measure 0-19 degrees have a 14%-22% risk of further progression while they are growing, but the risk increases more than 3 fold (68%) for the same patients if their increases to the 20-29 degree range (1). Therefore, it is vitally important to halt or reduce the curvature below the 20 degree mark in order to reduce the adolescent patient's risk of progression by up to 46%.

Long-term research has discovered that idiopathic adolescent scoliosis patients whom have spinal curvatures that measure greater than 25 degrees have a 68% risk of continued progression in their scoliotic curvature throughout adulthood that will cause severe pain and disability, however scoliosis patients who whose curvatures measured 25 degrees or less only experienced further curve progression 8% of the time throughout adulthood.(2)

(1) Lonstein et el, The prediction of curve progression in untreated idiopathic scoliosis. J Bone Joint Surg AM.1984,661061-1071

(2) Curve Progression in Idiopathic Scoliosis - Follow up study to skeletal maturity
Ken-Jin Tan, et al.
SPINE.2009.vol34(7).697-700