Monday, February 28, 2011
Posterior Fusion Scoliosis Surgery video#post2877
Posterior Fusion Scoliosis Surgery video#post2877
This can be a tough one to watch. Squeemish eyes should not view this video. Scoliosis surgery is a risky procedure with poor long-term chronic pain outcomes. It is not medically necessary and only indicated for cosmetic reasons.
This can be a tough one to watch. Squeemish eyes should not view this video. Scoliosis surgery is a risky procedure with poor long-term chronic pain outcomes. It is not medically necessary and only indicated for cosmetic reasons.
Scoliosis of spine: Scoliosis brace treatment
The first scoliosis brace attempts date back to as early as 400 A.D. and have been applied in every conceivable manner (without success) since then. The first metal scoliosis brace we constructed by Ambrose Pare in 1575 and again, didn’t work. Since then scoliosis brace makers have continued to innovate without success. Hard scoliosis brace, soft scoliosis brace, night time scoliosis brace, flexible scoliosis brace, rotational scoliosis brace, traction scoliosis brace; in the end each attempt has prove to be as feeble as the last (not due to lack of effort, application, or funding).
The main problem with scoliosis brace treatment isn’t application, but rather process. As it turns out, treating a condition that is primarily a neurological condition like it is primarily a skeletal spine problem doesn’t work too well (shocking….sarcasm). This very simple understanding of idiopathic scoliosis makes almost 3500 years of scoliosis brace treatment completely obsolete and practically worthless.
In fact, Axial Bio-Tech (developers of the Scoliscore genetic test) did a comparison study of brace treated and un-treated scoliosis patients and found absolutely no difference between the two groups long-term treatment outcomes, even when compared genetically. Scoliosis brace treatment has absolutely no effect on the natural course of the idiopathic scoliosis condition. Essentially scoliosis brace treatment and doing nothing have exactly the same effect….None.
So why do orthopedic doctors and some mis-guided chiropractors continue to prescribe a worthless and obsolete protocol like scoliosis brace treatment. Well the long answer is “this is the way we do things around here” syndrome and the short answer is financial gain.
Thousands of academic reputations and careers are based on the faulty logic that scoliosis brace treatment works and is effective, so to do an about face and reverse one’s position on the topic (even in the face of over-whelming evidence) would be career suicide for most.
The other motivation (financial gain) is a less complicated explanation, but probably more compelling. Scoliosis brace treatment generate hundreds of millions of dollars worldwide every year and you know what they stay about not finding the solution, when there is good money in prolonging the problem.
So how do we break out of this never-ending cycle of scoliosis brace treatment failure? Well, the good news is that we probably don’t have to; prognostic idiopathic scoliosis technology (Scoliscore genetic testing for idiopathic scoliosis, the scoliosis blood test, ect) will probably spell the death of scoliosis brace treatment all by itself.
These new technologies will provide a “heads up” to parents and patients in regards to their child’s idiopathic scoliosis condition and long before scoliosis brace treatment is indicated, so the scoliosis treatment market will naturally move towards more pro-active scoliosis treatment solutions like the Early Stage Scoliosis Intervention program we feature on this website. In fact, preliminary flowcharts and treatment models that focus on Scoliscore genetic testing for idiopathic scoliosis that completely eliminate scoliosis brace treatment and scoliosis surgery have already been developed and are being tested as you read this right now.
Scoliosis surgery: Friend or Foe?
There is no medically necessary reason for scoliosis surgery. Sounds crazy right? I mean, how could a scoliosis spine that is twisted and wrapped around itself not crush the lungs, heart, intestines, liver, and/or every other organ in one’s body? Well, the medical facts are clear that is somehow doesn’t and won’t pose a life threatening risk to the patient if the severe scoliosis of spine developed after the age of 5 years old (the lungs are fully mature by the age of 5 and thus the risk of developing an actual life threatening condition called “cor pulmonale” is eliminated). Believe it or not this isn’t even new information. It has been common knowledge that scoliosis surgery isn’t medically necessary among orthopedic surgeons for decades. Only recently has a respected scoliosis spine researcher, Dr. Has Rudolf Weiss, come forward and published an comprehensive review of the medical necessity for scoliosis surgery. Here were his findings from this 2008 scoliosis surgery study published in the Journal of Disability and rehabilitation.
“The study found "no evidence has been found in terms of prospective controlled studies to support surgical intervention from the medical point of view...... Until such evidence exists, there can be no medical indication for surgery. The indications for scoliosis surgery are limited for cosmetic reasons in severe cases and only if the parent and family agree with this."
The indications for scoliosis surgery are limited for cosmetic reasons in severe cases (which is a whole other debate) and ONLY if the parents and family agree with this; which in my experience they don’t, because they are generally under the assumption the scoliosis surgery is medically necessary to save the patient’s life; Which it isn’t in cases of adolescent idiopathic scoliosis.
So how did all of this get started anyway? Well the first scoliosis surgery was performed in 1865 (yes, that’s right, the same year the civil war ended!) and it didn’t go well. The post-operative results were terrible, which lead to what many experts consider to be the first recorded instance of medical surgeons disputing in print & in court, and ending in one of the most famous orthopedic lawsuits in history: Guerin vs. Malgaigne. This defamation trial ended in Malgaigne's favor (the anti- scoliosis surgery doctor).
The first American doctors performed scoliosis surgery in 1914 and the procedure was becoming relatively routine by 1941. Dr. Paul Harrington came to fame with the “Harrington Rod” scoliosis surgery in 1950’s and 1960’s. The blood loss from this 8-12 hour marathon scoliosis surgery has huge and death of the patient was a real concern. Unfortunately the rods kept breaking and by the 1970’s scoliosis surgery used 2 Harrington rods instead of one.
By the 1980’s a new hook and pedical screw system has been developed that dramatically increased the amount of correction a scoliosis surgery could achieve, but it also dramatically increased the amount and severity of complications associated with scoliosis surgery.
Some of the complications of scoliosis surgery include…
“Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while pneumonia, mild pleural effusion, UTI, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications.”
Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation, Scoliosis. 2009 May 7;4:11.
The poor long-term results of scoliosis surgery, coupled with the significant risks of scoliosis surgery prompted a top scoliosis surgery researcher to state:
“Scoliosis surgery… is a major undertaking with significant risks, and rather than reinstituting normality, replaces one abnormality (a flexible, curved spine) with another (a rigid, straighter spine).” Goldberg et al in 2001.
Saturday, February 26, 2011
The Current System of Scoliosis Management in the United States is Not Supported by EBM
A "guest blog" by Dr. Josh Woggon.
Evidence-based medicine (EBM) or evidence-based practices (EBP) are poorly understand by the general public and also by many members of the healthcare profession. They are often misinterpreted to mean that only interventions with published research can be considered part of EBM; this is untrue. EBM began in Ontario, Canada, at McMaster's University, as a way of closing the gap between clinical practice and clinical research. David Sackett, one of the originators, describes EBM as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. [emphasis added]"
It is also important to note that it is the patient who has the final say in accepting, rejecting, or modifying care. For example, if surgery is found to be the best intervention through research and the clinical expertise of the doctor, but the patient either does not want surgery or there are reasons why that individual patient might be at a greater risk in having the surgery performed, the published research & doctor's expertise play only a secondary role to the free will of the patient.
The triad of EBM is thus; the patient's preferences, combined with the doctor's clinical expertise, and the best available research evidence.
The difficulties arise when no high-quality evidence is available on a specific intervention. In these cases, it is appropriate to apply lower levels of evidence, such as observational studies and case reports. According to a study published in the British Medical Journal in 2007, 15% of the interventions evaluated so far have been proven to be beneficial; 22% are likely to be beneficial; 2% appear to be a "trade-off" between potential risks & benefits; 5% are unlikely to be beneficial; and, 4% have been shown to be likely to harm. The remainder of interventions, 47%, do not have sufficient evidence to make a decision either way.
One of the most interesting facts about EBM is that it itself fails its own test! The process of EBP has not been rigorously tested according to its own standards, so we do not know for certain if it actually results in improved health. (Straus & McAlister 2000) This does not mean that EBP has been proven to be ineffective; it means, quite simply, we do not know enough to decide either way. "No evidence of effect is not the same as evidence of no effect." (Tarnow-Mordi & Healy 1999)
When the standards of EBM are applied to scoliosis brace treatment (Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review, Dolan & Weinstein, Spine 2007), the conclusion is, "Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in adolescent idiopathic scoliosis. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by 'troublingly inconsistent or inconclusive studies of any level.'"
When EBM is applied to surgery, "a medical indication for this treatment cannot be established in view of the lack of evidence." (Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the literature, Scoliosis 2008)
Interestingly enough, exercises have been shown to have the most evidence to support their use in the scoliosis treatment, yet there are no medical scoliosis centers in the United States that currently utilize these methods.
"A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults." (The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature, Hawes 2003)
"Contrary to current dogma, the condition may be corrected with this therapy." (Mooney et al, Exercise for managing adolescent idiopathic scoliosis, Journal of Musculoskeletal Medicine, 2007, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain)
"Results show that in literature there is proof of level 1b on exercises." (Negrini et al, Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies, Europa Medicophysica-SIMFER 2007 Award Winner, Eur J Phys Rehabil Med 2008)
On the topic of chiropractic and scoliosis, preliminary evidence appears to indicate that manual therapy alone (e.g., chiropractic adjustments performed in the absence of any other modalities) does not alter the natural history of scoliosis (Negrini et al, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review, Scoliosis 2008). However, a growing body of case reports have reported positive results when manual therapy is combined with other rehabilitation approaches (Brooks 2009, Chen 2008, Brooks 2007, Morningstar 2004 & 2006). According to the standards of EBM, case reports and case series are considered level 3 evidence - above expert opinion, but below case-control studies, RCT's & systematic reviews. This places the level of evidence in support of the CLEAR Institute treatment approach as equal to the level of evidence in favor of bracing. All it will take is one well-conducted case-control study to place the level of evidence in favor of CLEAR above the level of evidence in favor of bracing(and believe me, I'm working overtime and donating all of my time to make that happen!).
Warm Regards,
Josh Woggon DC
Director of Research, CLEAR Institute
jwoggon@clear-institute.org
Evidence-based medicine (EBM) or evidence-based practices (EBP) are poorly understand by the general public and also by many members of the healthcare profession. They are often misinterpreted to mean that only interventions with published research can be considered part of EBM; this is untrue. EBM began in Ontario, Canada, at McMaster's University, as a way of closing the gap between clinical practice and clinical research. David Sackett, one of the originators, describes EBM as: "the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of EBM means integrating individual clinical expertise with the best available external clinical evidence from systematic research. [emphasis added]"
It is also important to note that it is the patient who has the final say in accepting, rejecting, or modifying care. For example, if surgery is found to be the best intervention through research and the clinical expertise of the doctor, but the patient either does not want surgery or there are reasons why that individual patient might be at a greater risk in having the surgery performed, the published research & doctor's expertise play only a secondary role to the free will of the patient.
The triad of EBM is thus; the patient's preferences, combined with the doctor's clinical expertise, and the best available research evidence.
The difficulties arise when no high-quality evidence is available on a specific intervention. In these cases, it is appropriate to apply lower levels of evidence, such as observational studies and case reports. According to a study published in the British Medical Journal in 2007, 15% of the interventions evaluated so far have been proven to be beneficial; 22% are likely to be beneficial; 2% appear to be a "trade-off" between potential risks & benefits; 5% are unlikely to be beneficial; and, 4% have been shown to be likely to harm. The remainder of interventions, 47%, do not have sufficient evidence to make a decision either way.
One of the most interesting facts about EBM is that it itself fails its own test! The process of EBP has not been rigorously tested according to its own standards, so we do not know for certain if it actually results in improved health. (Straus & McAlister 2000) This does not mean that EBP has been proven to be ineffective; it means, quite simply, we do not know enough to decide either way. "No evidence of effect is not the same as evidence of no effect." (Tarnow-Mordi & Healy 1999)
When the standards of EBM are applied to scoliosis brace treatment (Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review, Dolan & Weinstein, Spine 2007), the conclusion is, "Comparing the pooled rates for these two interventions shows no clear advantage of either approach. Based on the evidence presented here, one cannot recommend one approach over the other to prevent the need for surgery in adolescent idiopathic scoliosis. This recommendation carries a grade of D, indicating that the use of bracing relative to observation is supported by 'troublingly inconsistent or inconclusive studies of any level.'"
When EBM is applied to surgery, "a medical indication for this treatment cannot be established in view of the lack of evidence." (Weiss & Goodall, Rate of complications in scoliosis surgery - a systematic review of the literature, Scoliosis 2008)
Interestingly enough, exercises have been shown to have the most evidence to support their use in the scoliosis treatment, yet there are no medical scoliosis centers in the United States that currently utilize these methods.
"A growing body of evidence from independent sources is consistent with the hypothesis that exercise-based approaches can be used effectively to reverse the signs and symptoms of spinal deformity and to prevent progression in children and adults." (The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature, Hawes 2003)
"Contrary to current dogma, the condition may be corrected with this therapy." (Mooney et al, Exercise for managing adolescent idiopathic scoliosis, Journal of Musculoskeletal Medicine, 2007, 6th Interdisciplinary World Congress on Low Back & Pelvic Pain)
"Results show that in literature there is proof of level 1b on exercises." (Negrini et al, Rehabilitation of adolescent idiopathic scoliosis: results of exercises and bracing from a series of clinical studies, Europa Medicophysica-SIMFER 2007 Award Winner, Eur J Phys Rehabil Med 2008)
On the topic of chiropractic and scoliosis, preliminary evidence appears to indicate that manual therapy alone (e.g., chiropractic adjustments performed in the absence of any other modalities) does not alter the natural history of scoliosis (Negrini et al, Manual therapy as a conservative treatment for adolescent idiopathic scoliosis: a systematic review, Scoliosis 2008). However, a growing body of case reports have reported positive results when manual therapy is combined with other rehabilitation approaches (Brooks 2009, Chen 2008, Brooks 2007, Morningstar 2004 & 2006). According to the standards of EBM, case reports and case series are considered level 3 evidence - above expert opinion, but below case-control studies, RCT's & systematic reviews. This places the level of evidence in support of the CLEAR Institute treatment approach as equal to the level of evidence in favor of bracing. All it will take is one well-conducted case-control study to place the level of evidence in favor of CLEAR above the level of evidence in favor of bracing(and believe me, I'm working overtime and donating all of my time to make that happen!).
Warm Regards,
Josh Woggon DC
Director of Research, CLEAR Institute
jwoggon@clear-institute.org
Friday, February 25, 2011
The case against surgical intervention for scoliosis in adolescent patients.
The case against surgical intervention for scoliosis in adolescent patients.
Scoliosis surgery in adolescent idiopathic scoliosis patients isn't medically necessary and has proven poor long-term outcomes. In fact, a 50 year follow up study showed the majority of untreated patients had a higher quality of life than scoliosis surgery patients just 16.9 years after the procedure. Not good.
We need a better way. Work is under way to develop a neuro-muscular rehab based scoliosis spine treatment that is out-performing every single scoliosis brace in existance and will eventually eliminate the "need" for scoliosis surgery in the future. The CLEAR Institute is leading the way and combined with the advent of genetic testing for scoliosis (Scoliscore) can actually start working towards a cure for the condition by eliminating environmental factors in patients with an elevated genetic predisposition.
Exciting new work in the field of eipgenetics is also providing promise of being able to "turn off" active scoliosis genes that will hopefully result in reducing the elevated genetic predisposition for future generations.
Scoliosis surgery in adolescent idiopathic scoliosis patients isn't medically necessary and has proven poor long-term outcomes. In fact, a 50 year follow up study showed the majority of untreated patients had a higher quality of life than scoliosis surgery patients just 16.9 years after the procedure. Not good.
We need a better way. Work is under way to develop a neuro-muscular rehab based scoliosis spine treatment that is out-performing every single scoliosis brace in existance and will eventually eliminate the "need" for scoliosis surgery in the future. The CLEAR Institute is leading the way and combined with the advent of genetic testing for scoliosis (Scoliscore) can actually start working towards a cure for the condition by eliminating environmental factors in patients with an elevated genetic predisposition.
Exciting new work in the field of eipgenetics is also providing promise of being able to "turn off" active scoliosis genes that will hopefully result in reducing the elevated genetic predisposition for future generations.
Thursday, February 24, 2011
Would current treatment even pass evidence based medicine standards?#post2857
Would current treatment even pass evidence based medicine standards?#post2857
Scoliosis brace treatment has been around since the dawn of man and the first scoliosis surgery was performed in 1865, so both treatments pre-date the era of "Evidence Based Medicine". Which makes one wonder, based on the current research data for bracing and surgery, would they even pass the basic standards of care for scoliosis treatment today?
Scoliosis brace treatment has been around since the dawn of man and the first scoliosis surgery was performed in 1865, so both treatments pre-date the era of "Evidence Based Medicine". Which makes one wonder, based on the current research data for bracing and surgery, would they even pass the basic standards of care for scoliosis treatment today?
Scoliosis surgery is an elective cosmetic procedure
Scoliosis surgery is an elective cosmetic procedure?
Current research suggests scoliosis surgery isn't medically necessary.
Current research suggests scoliosis surgery isn't medically necessary.
We need a better way for scoliosis spine treatment.......
We need a better way for scoliosis spine treatment....... The current treatment system is too broken and too obselete to fix....It needs to be replaced.
Wednesday, February 23, 2011
Scoliosis of spine treatment: Where are we now and where are we going?
There is very little doubt that it is possible (or needed) to reduce the need for surgery in the scoliosis spine treatment.
It also should not and cannot be argued against that there is a need for the advancement of research into manners by which a mild scoliosis can be prevented from progressing into a serious spinal deformity.
If the current stardard of treatment attempts (bracing and surgery) were successful and effective ways of treating scoliosis, there would not be a need for advancement into new treatment methods. Necessity is the mother of all invention. Also, there is increased need for physicians of all specialties to collaborate in the realm of scoliosis treatment.
Many scoliosis doctors part fulfilling these needs by attending conferences of international scoliosis experts (SOSORT), working with recognized scoliosis specialists in all fields of healthcare, participating in debates about the future of scoliosis treatment, and providing more options to people living with scoliosis. More collaboration among the best, brightest, and most motivated physicians needed now more than ever.
Here is a "state of the union address" of the current standard of care for scoliosis treatment.....
~ The current system of scoliosis detection, evaluation, early intervention, treatment protocols, and treatment methods need to be completely re-invented. The current system is too patch-worked and broken to be fixed......It needs to be replaced.......and here is how and why.
~ "The too late test" (the bending over and looking for rib cage asymmetry test) isn't sensitive enough to detect scoliosis in its early stages....it is usually referred to as Adam's positions in the medical books.
~ Cobb's angle was developed in 1948 and is a completely obsolete system of analysis. It is nothing more than a measurement of lateral bending in the spine, which is one of the least important treatment outcomes of scoliosis treatment. Attempting to describe a condition as complex as scoliosis purely by the means radiographic lateral flexion is the equivalent to attempting to describe all the features of your new luxury car by only its color. I feel that the continued use of cobb's angle as the sole system of idiopathic scoliosis analysis in the United States is the single greatest obstacle blocking further understanding of the true nature of scoliosis. There is so much more to this condition than just a cobb angle.
~ The current treatment schedule for scoliosis (10 degree diagnosis, 25 degree bracing, 40 degree surgery) is obselete. It was accepted entirely on one article in 1977, by one doctor who openly admits the numbers are arbitrary. It is not based off science or the patient's best interests.
~ "Watch and wait" (Observation) is not scoliosis treatment.....it is simply doing nothing and hoping the problem doesn't get worse (denile isn't just a river in Africa you know)....an aggressive, non-invasive early stage scoliosis intervention program should be employed during this time. An adolescent child's best hope of beating scoliosis is reduction and stabilization of the curvature while it is still flexible and before it gets a biomechanical advantage. Any medical professional whom doesn't instill a frank sense of urgency in a parent's mind when their child is diagnosed with scoliosis is doing them a dis-service.
~ Scoliosis brace treatment should be discontinued. It has no clinical value and only serves to psychologically scar our children whom already have enough hurdles to overcome. Newer research now suggests that long-term spinal immobilization from bracing may actually increase the amount of permanent spinal deformity.
~ Scoliosis surgery has been proven and accepted to provide NO clinical value to the patient in terms of organic health measures (pulmonary function, cardiac output, elimination of pain, ect). The research on this is clear, the vast majority of orthopedic doctors agree on the subject, and may patients assume it is "medically necessary" and don't even ask. Given the high rate of complications, long recovery, and poor long-term outcomes. I feel asking a desperate parent and/or patient to trade deformity for dysfunction is unfair.
Now here is the good news.....
We are entering a golden age in Adolescent Idiopathic Scoliosis (AIS) treatment, yet most people and doctors don't see it yet.
The development of new prognostic technologies like the Scoliscore genetic testing and the much anticipated Scoliosis blood test are going to be a significant boosts to the field of scoliosis treatment, but only if we scurry to close the ever growing divide between the rapid advanacement of prognositic scoliosis technology and treatment protocols that are able to take advantage of the opportunity this technology creates. The new mantra of scoliosis treatment will be....."stay ahead of the curve".
Bracing is intended to halt the progression of spinal curvatures (which research is showing it doesn't really do anyway), not prevent them, or reduce them. It is not, and will not take advantage of the prognostic technology currently being developed and will gradually be phased out due in favor of pro-active, rehab based treatment approaches.
Scoliosis surgery is never the preferred treatment choice due to the invasive nature of the procedure and poor long-term outcomes. Recent research on spinal fusions in younger patients are showing very poor long term results. Preventative spinal fusion for scoliosis should not, become the path paved by scoliosis prognostic technology.
So what technologies are currently being developed for AIS that will allow us to close the gap between prognostic tests that tell us the worse is coming?
A general picture of adolescent idiopathic scoliosis is emerging and it seems to be breaking down into a multi-factorial equation that looks something like this.
Genetic pre-disposition + Environmental Factors = Adolscent Idiopathic Scoliosis (AIS)
Therefore.... the only possible way and treatment technology that could take full advantage of the new AIS prognostic testing abilities would be one that focuses on the reduction/elimination of the Evironmental Factors (Bio-mechanical, Bio-Chemical, and Activity related) that co-create the condition.
In the future, Early Stage Scoliosis Intervention will be defined as a partnership btw prognostic testing technologies and "pro-active", environmental factor reducing treatment approaches while "after-the-fact" treatment approaches like bracing and surgery will disappear into the past.
The CLEAR Institute approach to scoliosis treatment is currently the only scoliosis treatment attempting to alter the natural course of the condition and prevent scoliosis through environmental factor reduction.
Treat the cause, NOT just the curve.
It also should not and cannot be argued against that there is a need for the advancement of research into manners by which a mild scoliosis can be prevented from progressing into a serious spinal deformity.
If the current stardard of treatment attempts (bracing and surgery) were successful and effective ways of treating scoliosis, there would not be a need for advancement into new treatment methods. Necessity is the mother of all invention. Also, there is increased need for physicians of all specialties to collaborate in the realm of scoliosis treatment.
Many scoliosis doctors part fulfilling these needs by attending conferences of international scoliosis experts (SOSORT), working with recognized scoliosis specialists in all fields of healthcare, participating in debates about the future of scoliosis treatment, and providing more options to people living with scoliosis. More collaboration among the best, brightest, and most motivated physicians needed now more than ever.
Here is a "state of the union address" of the current standard of care for scoliosis treatment.....
~ The current system of scoliosis detection, evaluation, early intervention, treatment protocols, and treatment methods need to be completely re-invented. The current system is too patch-worked and broken to be fixed......It needs to be replaced.......and here is how and why.
~ "The too late test" (the bending over and looking for rib cage asymmetry test) isn't sensitive enough to detect scoliosis in its early stages....it is usually referred to as Adam's positions in the medical books.
~ Cobb's angle was developed in 1948 and is a completely obsolete system of analysis. It is nothing more than a measurement of lateral bending in the spine, which is one of the least important treatment outcomes of scoliosis treatment. Attempting to describe a condition as complex as scoliosis purely by the means radiographic lateral flexion is the equivalent to attempting to describe all the features of your new luxury car by only its color. I feel that the continued use of cobb's angle as the sole system of idiopathic scoliosis analysis in the United States is the single greatest obstacle blocking further understanding of the true nature of scoliosis. There is so much more to this condition than just a cobb angle.
~ The current treatment schedule for scoliosis (10 degree diagnosis, 25 degree bracing, 40 degree surgery) is obselete. It was accepted entirely on one article in 1977, by one doctor who openly admits the numbers are arbitrary. It is not based off science or the patient's best interests.
~ "Watch and wait" (Observation) is not scoliosis treatment.....it is simply doing nothing and hoping the problem doesn't get worse (denile isn't just a river in Africa you know)....an aggressive, non-invasive early stage scoliosis intervention program should be employed during this time. An adolescent child's best hope of beating scoliosis is reduction and stabilization of the curvature while it is still flexible and before it gets a biomechanical advantage. Any medical professional whom doesn't instill a frank sense of urgency in a parent's mind when their child is diagnosed with scoliosis is doing them a dis-service.
~ Scoliosis brace treatment should be discontinued. It has no clinical value and only serves to psychologically scar our children whom already have enough hurdles to overcome. Newer research now suggests that long-term spinal immobilization from bracing may actually increase the amount of permanent spinal deformity.
~ Scoliosis surgery has been proven and accepted to provide NO clinical value to the patient in terms of organic health measures (pulmonary function, cardiac output, elimination of pain, ect). The research on this is clear, the vast majority of orthopedic doctors agree on the subject, and may patients assume it is "medically necessary" and don't even ask. Given the high rate of complications, long recovery, and poor long-term outcomes. I feel asking a desperate parent and/or patient to trade deformity for dysfunction is unfair.
Now here is the good news.....
We are entering a golden age in Adolescent Idiopathic Scoliosis (AIS) treatment, yet most people and doctors don't see it yet.
The development of new prognostic technologies like the Scoliscore genetic testing and the much anticipated Scoliosis blood test are going to be a significant boosts to the field of scoliosis treatment, but only if we scurry to close the ever growing divide between the rapid advanacement of prognositic scoliosis technology and treatment protocols that are able to take advantage of the opportunity this technology creates. The new mantra of scoliosis treatment will be....."stay ahead of the curve".
Bracing is intended to halt the progression of spinal curvatures (which research is showing it doesn't really do anyway), not prevent them, or reduce them. It is not, and will not take advantage of the prognostic technology currently being developed and will gradually be phased out due in favor of pro-active, rehab based treatment approaches.
Scoliosis surgery is never the preferred treatment choice due to the invasive nature of the procedure and poor long-term outcomes. Recent research on spinal fusions in younger patients are showing very poor long term results. Preventative spinal fusion for scoliosis should not, become the path paved by scoliosis prognostic technology.
So what technologies are currently being developed for AIS that will allow us to close the gap between prognostic tests that tell us the worse is coming?
A general picture of adolescent idiopathic scoliosis is emerging and it seems to be breaking down into a multi-factorial equation that looks something like this.
Genetic pre-disposition + Environmental Factors = Adolscent Idiopathic Scoliosis (AIS)
Therefore.... the only possible way and treatment technology that could take full advantage of the new AIS prognostic testing abilities would be one that focuses on the reduction/elimination of the Evironmental Factors (Bio-mechanical, Bio-Chemical, and Activity related) that co-create the condition.
In the future, Early Stage Scoliosis Intervention will be defined as a partnership btw prognostic testing technologies and "pro-active", environmental factor reducing treatment approaches while "after-the-fact" treatment approaches like bracing and surgery will disappear into the past.
The CLEAR Institute approach to scoliosis treatment is currently the only scoliosis treatment attempting to alter the natural course of the condition and prevent scoliosis through environmental factor reduction.
Treat the cause, NOT just the curve.
Tuesday, February 22, 2011
Scoliosis spine treatment: Don't let a lifetime be defined by scoliosis
1.
Now that genetic pre-disposition testing for idiopathic scoliosis progression risk is available; An Early Stage Intervention Program has also been developed to provide scoliosis patients a non-bracing, non-surgical treatment option that allows them to take immediate action in the prevention of the next stage of the standard treatment process.
While it is not the intention of CLEAR Institute to condemn the efforts of sincere and caring medical professionals who have dedicated their lives to helping individuals with scoliosis. We would, however, like to add to the current list of options; to educate those who are personally involved with scoliosis about what the research says; and, to empower these individuals to make their own decision regarding their own spine, and their own life.
The three medically-sanctioned methods of scoliosis treatment - observation, bracing, and surgery - have been around for decades. A great deal of research has been done on the risks & benefits of each option. However, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many conflicts and inadequacies present in the current model.
Observation Only or the “watch & wait” stage
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. At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic.
Scoliosis brace treatment (Generally recommended for curvatures 25 degrees and larger)
If there ever was a time when a patient could benefit most greatly from chiropractic, therapeutic exercise, or non-surgical intervention, it would undoubtedly be during the mild stages of the disease - before the muscles & tissues of the body have been deformed by months or even years of compensating for the abnormal twisting & bending of the spine.
Bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces in use, ranging from the venerable and bulky Milwaukee brace, to the traditional TLSO braces such as the Boston and the Wilmington brace. There are "part-time" braces, designed to be worn at night: the Providence brace, and the Charleston brace. There are also "dynamic corrective braces" (SpinCor) which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis.
While it is not the intention of CLEAR Institute to condemn the efforts of sincere and caring medical professionals who have dedicated their lives to helping individuals with scoliosis. We would, however, like to add to the current list of options; to educate those who are personally involved with scoliosis about what the research says; and, to empower these individuals to make their own decision regarding their own spine, and their own life.
The three medically-sanctioned methods of scoliosis treatment - observation, bracing, and surgery - have been around for decades. A great deal of research has been done on the risks & benefits of each option. However, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many conflicts and inadequacies present in the current model.
Observation Only or the “watch & wait” stage
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. At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic.
Scoliosis brace treatment (Generally recommended for curvatures 25 degrees and larger)
If there ever was a time when a patient could benefit most greatly from chiropractic, therapeutic exercise, or non-surgical intervention, it would undoubtedly be during the mild stages of the disease - before the muscles & tissues of the body have been deformed by months or even years of compensating for the abnormal twisting & bending of the spine.
Bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces in use, ranging from the venerable and bulky Milwaukee brace, to the traditional TLSO braces such as the Boston and the Wilmington brace. There are "part-time" braces, designed to be worn at night: the Providence brace, and the Charleston brace. There are also "dynamic corrective braces" (SpinCor) which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis.
This dizzying variety is further complicated by the fact that not every doctor prescribes the braces to be used in the same manner, and not every patient may follow their doctor's recommendations to the same extent. As a result, research is often conflicting in regard to the true effectiveness of bracing in scoliosis treatment. Some studies have shown very little difference between patients who wore the brace for the prescribed time. In every case, all corrective benefit is lost very quickly once the patient stops wearing the brace.
Scoliosis surgery (Generally recommended of curvatures 40 degrees and larger)
Those patients for whom bracing fails to prevent the progression of their scoliosis are left with only one option: surgery. Those who are confronted with this choice may be told that having a metal rod fused to their spine will not impair their daily activities, and will reduce the rib arch & improve their cosmetic appearance. However, research has consistently shown that surgery - which primarily focuses upon the sideways bending, and does little to address the rotation of the spine (and hence the rib protrusion) - will actually cause the rib arch to worsen (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).
Subscribe to:
Posts (Atom)