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.