The history of scoliosis treatment is well documented over the past almost 500 years (1st metal brace was created in 1575) and dates back to the early writings of the Hippocrates himself (The Father of Medicine). For hundreds of years, if not thousands, scoliosis patients have been immobilized in various types and applications of scoliosis brace treatment without success, and the current clinical data appears the orthopedic community isn’t any closer to scoliosis brace treatment success even today. Dr. Stefano Negrini led a comprehensive review of scoliosis brace treatment and concluded “There is a very low quality of evidence in favor of using braces, making generalization very difficult.” 436 years of attempted scoliosis brace treatment experimentation and “very low quality of evidence” is the best they can come up with? Obviously, we need a better way.
The first scoliosis surgery was conducted (unsuccessfully) in 1865 and subsequently spurred on the first medical malpractice lawsuit in the orthopedic community shortly after. While scoliosis surgery techniques, hardware, and abilities have vastly improved since that time, the long-term negative complications of fusing multiple levels of freely move-able joints in a patient’s scoliosis spine still haunts the procedure; keeping in mind the wide spread agreement that the primary indication for scoliosis surgery is for improving one’s cosmetic appearance and not medical necessity.
The current state of scoliosis treatment appears to be scoliosis brace treatment is worthless and the scoliosis surgery procedure is worse than the condition itself in many cases.
The need for drastic change and over-haul to the scoliosis treatment system is clearly obvious, yet decade after decade, little to no progress is made other that “improvements” to the existing scoliosis brace protocols and scoliosis surgery procedures. The obvious question is simply, why? When the need is so glaringly evident and the technology and thought process is so clearly under-developed; why hasn’t the scoliosis treatment community rushed to meet the needs and demands of a world full of scoliosis patients? In my opinion it can be summed up in two words: Cobb angle.
Cobb angle first appeared on the scene in 1948 and has been adopted as the “common” (not necessarily “gold” standard) for scoliosis evaluation every since. Cobb’s angle is a completely obsolete system of analysis. Idiopathic scoliosis is a very complex condition and the more we learn about idiopathic scoliosis, the more complex it appears to be. Attempting to describe a condition as complex as idiopathic 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. There is so much more to this condition than just a Cobb angle.
The “prognostic” or “predictive” value of Cobb angle in curve progression is only slightly better than the odds of flipping a coin and ALL of the Cobb angle prognostic assumptions are based off a single study by Lonstein and Carlson in 1984, which has never been repeated or re-produced to this very day.
The current treatment schedule for scoliosis (10 degree diagnosis and then “watch and wait”, 25 degrees scoliosis brace treatment recommendation, 40 degrees scoliosis surgery recommendation) was accepted almost entirely on one article in 1977, by one doctor (Dr. William Kane), who openly admits the numbers are arbitrary and based on a cost based analysis to fit a particular healthcare system. It is not necessarily based off science, and more importantly, not necessarily based off the patient’s best interests.
Cobb angle has a generally accepted +/- 5 degree intra-examiner (same doctor measuring) “measurement error” between 2 separate x-rays and up to a 9.8 degree inter-examiner (different doctor) “measurement error” between 2 separate x-rays. This means a scoliosis brace treatment recommendation is essentially being made with an “acceptable” 20% error rate in scoliosis brace treatment recommendations for scoliosis cases of 25 degrees and scoliosis surgery recommendations are being made with a 12.5% error rate for scoliosis cases of 40 degrees. These measurement error rates are simply unacceptable when making recommendations for highly invasive procedures which have life-long lasting impacts (physically, emotionally, and psychologically) on those scoliosis patients unfortunate enough to be subjected to them.
Cobb angle is measured out of tradition, not an updated scientific understanding of idiopathic scoliosis.
So what is the link between an obsolete, un-reproducible, and un-reliable measurement system (Cobb angle) and the stagnant progress of scoliosis treatment (more useless scoliosis braces and more ways to induce spinal fusion through surgery)? All “mainstream” scoliosis treatment protocols (scoliosis brace treatment and scoliosis surgery) are entire predicated on Cobb angle. Remove Cobb angle from the equation and there is no indication for scoliosis brace or scoliosis surgery treatment. It’s really that simple. Cut off the head of the beast and the body dies.
Scoliscore genetic testing and Early Stage Scoliosis Intervention combine to create a new future for scoliosis treatment.
It has been said that one has to “replace” or “break” a current system, before the old one can be replaced. For example, email “broke” and “replaced” the fax machine. Almost overnight the fax machine became completely obsolete. Generally speaking it is easier to “break” the existing system than to “replace” it with something entirely brand new (which is really hard to do and needs to be invented first). In the case of over-hauling and replacing the current scoliosis treatment system it will need to be “broken” AND “replaced”.
Scoliscore genetic testing for idiopathic scoliosis will “break” the current scoliosis treatment system, because it “breaks” the use of Cobb angle as a predictive tool of curve progression. Idiopathic scoliosis a multi-factorial condition (aka: a combination of both genetic pre-disposition and environmental influences) and completely unique to every patient’s individual scoliosis case. No two cases of idiopathic scoliosis will ever have exactly the same genetic pre-disposition and/or environmental influences, so having a “known” variable like the patient’s genetic pre-disposition become invaluable in determining their true curve progression risk. In other words, a low genetic risk scoliosis case with a 20 degree Cobb angle looks exactly the same as a high genetic risk scoliosis case with a 20 degree Cobb angle on an x-ray; and under the current system to scoliosis treatment they would both receive the same scoliosis treatment recommendation (which in this case would be “observation only”).
The Early Stage Scoliosis Intervention program will “replace” the current scoliosis treatment model when used in combination with the genetic predisposition information provided by the Scoliscore test. Again, based on the new understanding that idiopathic scoliosis is a multi-factorial condition with both genetic predisposition and environmental influences resulting in the development of a spinal curvature; the current scoliosis brace and scoliosis surgery treatment protocol only attempts to deal with the end result (the spinal curvature) rather than treating and preventing the spinal curvature from developing by reducing/eliminating the environmental factors (the only variable we can currently control at this time). However, the Early Stage Scoliosis Intervention program is solely targeted towards reduction of the environmental influences and is centered around a neuro-muscular rehabilitation program the specifically targets the automatic postural control centers in the hind brain, which many researchers feel is genetically predisposed to being “under-developed” in idiopathic scoliosis patients.
This “one, two” punch of accurately determining which patients are most genetically predisposed to developing a severe idiopathic scoliosis curvature with Scoliscore genetic testing and immediately implementing an Early Stage Scoliosis Intervention program which re-trains the under-developed postural control centers in the brain, while simultaneously reducing environmental influences for idiopathic scoliosis is the most scientifically advanced approach to scoliosis spine treatment to date.
The current state of scoliosis treatment is deplorable. The Cobb angle system of scoliosis evaluation is antiquated (and thanks to Scoliscore genetic testing, now obsolete as well), and the scoliosis treatment system (scoliosis brace and scoliosis surgery treatment) employed under its (Cobb angle) direction is equally antiquated. In order to “turn the page” to a new day in scoliosis treatment, the scoliosis treatment community will need to embrace Scoliscore genetic testing as a way to “break” the hold Cobb angle has on scoliosis treatment protocols and adopt an Early Stage Scoliosis Intervention program to “replace” the current observation, scoliosis brace treatment, and scoliosis surgery treatment methodology in favor or a more pro-active strategy which prevents the spinal curvature (hence eliminating the need for scoliosis brace and scoliosis surgery treatment) and re-trains the neuro-muscular under-developmental cause of idiopathic scoliosis.
Tuesday, March 29, 2011
Thursday, March 24, 2011
Spinal bracing for Adolescent Idiopathic Scoliosis has NO effect on Adolescent Idiopathic Scoliosis
Scoliosis brace treated patients actually are worse off than un-treated patients when compared in a genetic pre-disposition study!!!!
Spinal bracing for Adolescent Idiopathic Scoliosis has NO effect on Adolescent Idiopathic Scoliosis
Spinal bracing for Adolescent Idiopathic Scoliosis has NO effect on Adolescent Idiopathic Scoliosis
Scoliosis Treatment Begins in the Brain, Not in the spine.
“Idiopathic scoliosis” is term that has been present in recorded human history for almost 3,500 years, but the mystery of its “unknown cause” is slowly being discovered. As many experts have suspected for decades, breakthroughs in scoliosis genetic testing (Scoliscore) and the scoliosis blood test have uncovered sequences of genetic code that leave an individual “genetically pre-disposed” to the development of severe idiopathic scoliosis. However, since the condition doesn’t appear until adolescence in the vast majority of patients, the search for environmental influences that are connected to un-coordinated growth spurts is on-going.
Virtually all current idiopathic scoliosis research is pointing towards a neurological deficit/under-development in the automatic postural control centers of the brain stem as the root cause of the condition, but the factors that cause severe progression requiring scoliosis brace treatment and /or scoliosis surgery appear to be primarily environmental (bio-mechanical, bio-chemical, and specific activity related) driven.
Previous attempts in scoliosis treatment have entirely centered on treating the scoliosis spine itself and have almost entirely ignored the obvious neurological component of idiopathic scoliosis. Scoliosis brace treatment is a relatively simple minded approach to “guided growth” in which the spine is essentially forced into a straighter position (in the front view dimension only). The scoliosis spine growth mal-adapts to alter the bio-mechanical loading patterns provided by the scoliosis brace in an attempt to “out-smart” the developing pattern of the scoliosis spine. Unfortunately, this well-studied scoliosis brace treatment approach has been found very ineffective due to the inability for idiopathic scoliosis patients to comply with the 23 hour a day, 7 day a week, 365 day a year scoliosis brace treatment protocol and those whom do comply experience significant muscle atrophy (muscle weakening) and scoliosis brace dependency in which they need to be “weaned” out of the scoliosis brace over the course of weeks or months. In addition to not addressing the primary neurological cause of idiopathic scoliosis, recent research at the University of Vermont conducted on rat tails under simulated scoliosis brace conditions, suggests that scoliosis brace treatment may actually be causing permanent deformity to the scoliosis spine discs that could lead to further curve progression during adolescences or adulthood.
Scoliosis surgery is a “brute force” approach to scoliosis treatment and has under gone many advancements since its inception in 1865, but even to this day the scoliosis treatment goal remains the same…..complete multi-level spinal fusion. While most orthopedic surgeons make substantial efforts to limit the number of vertebral segments fused during scoliosis surgery, it generally includes at least 5-6 segments out of a total 24 moveable spinal vertebrae which completely immobilizes an approximately 25% portion of the patients entire spinal column. The long-terms (15-20 years post scoliosis surgery) are very poor in terms of chronic pain and quality of life measures. Dr. Robert Saulter of the Toronto Hospital for Sick Children summed up the relationship between chronic dysfunction and chronic pain with is famous quote, “Restoration of function is more important than the relief of pain”. Unfortunately for the idiopathic scoliosis patients whom undergo scoliosis surgery the chronic dysfunction (multiple level spinal fusion)will almost certainly lead to severe chronic pain at some point in their lifetime. This may be considered an acceptable trade off if the scoliosis surgery was a “life-saving” procedure, but the research conducted on the effects of scoliosis surgery has concluded the procedures is primarily indicated for cosmetic purposes and is not medically necessary. This is a generally accepted fact with in the scoliosis treatment community, because scoliosis surgery does not improve cardiac function, pulmonary function, eliminate pain, or improve the adolescent idiopathic scoliosis patient’s quality of life in the long-term follow up studies. It should be noted, that a fused scoliosis spine from scoliosis surgery is every bit (or more) dysfunctional that an un-treated scoliosis spine. Perhaps most importantly, scoliosis surgery is not and will not lead to a cure for scoliosis since it still fails to address the underlying neurological deficit/ under-development that is the root cause of idiopathic scoliosis.
The concept of re-training the automatic postural control centers of the brain stem actually dates back several hundred years (if not much further back) to a time when young girls aspiring to become debutants practiced good posture by walking around balancing books on top of their heads (which is not a suggested scoliosis treatment). By making the head (temporarily) artificially heavier with the book, they essentially changed where their body neurologically perceived the center mass of their skull and caused their “body schema” (the neurological “set point” for normal spinal posture) to react to the perceived postural change. Over time the repeated re-training of the young girl’s automatic postural control centers in her brain stem resulted in a permanent change in the “body schema” and the improved posture simply, became “the new normal”. These very same principles (in a much more effective and advanced application) can be applied to scoliosis treatment and permanently alter the natural course of the idiopathic scoliosis condition by treating the root cause of the condition. The future of scoliosis treatment will be found in treating the scoliosis spine, by treating the automatic postural control centers in the brain stem first.
Virtually all current idiopathic scoliosis research is pointing towards a neurological deficit/under-development in the automatic postural control centers of the brain stem as the root cause of the condition, but the factors that cause severe progression requiring scoliosis brace treatment and /or scoliosis surgery appear to be primarily environmental (bio-mechanical, bio-chemical, and specific activity related) driven.
Previous attempts in scoliosis treatment have entirely centered on treating the scoliosis spine itself and have almost entirely ignored the obvious neurological component of idiopathic scoliosis. Scoliosis brace treatment is a relatively simple minded approach to “guided growth” in which the spine is essentially forced into a straighter position (in the front view dimension only). The scoliosis spine growth mal-adapts to alter the bio-mechanical loading patterns provided by the scoliosis brace in an attempt to “out-smart” the developing pattern of the scoliosis spine. Unfortunately, this well-studied scoliosis brace treatment approach has been found very ineffective due to the inability for idiopathic scoliosis patients to comply with the 23 hour a day, 7 day a week, 365 day a year scoliosis brace treatment protocol and those whom do comply experience significant muscle atrophy (muscle weakening) and scoliosis brace dependency in which they need to be “weaned” out of the scoliosis brace over the course of weeks or months. In addition to not addressing the primary neurological cause of idiopathic scoliosis, recent research at the University of Vermont conducted on rat tails under simulated scoliosis brace conditions, suggests that scoliosis brace treatment may actually be causing permanent deformity to the scoliosis spine discs that could lead to further curve progression during adolescences or adulthood.
Scoliosis surgery is a “brute force” approach to scoliosis treatment and has under gone many advancements since its inception in 1865, but even to this day the scoliosis treatment goal remains the same…..complete multi-level spinal fusion. While most orthopedic surgeons make substantial efforts to limit the number of vertebral segments fused during scoliosis surgery, it generally includes at least 5-6 segments out of a total 24 moveable spinal vertebrae which completely immobilizes an approximately 25% portion of the patients entire spinal column. The long-terms (15-20 years post scoliosis surgery) are very poor in terms of chronic pain and quality of life measures. Dr. Robert Saulter of the Toronto Hospital for Sick Children summed up the relationship between chronic dysfunction and chronic pain with is famous quote, “Restoration of function is more important than the relief of pain”. Unfortunately for the idiopathic scoliosis patients whom undergo scoliosis surgery the chronic dysfunction (multiple level spinal fusion)will almost certainly lead to severe chronic pain at some point in their lifetime. This may be considered an acceptable trade off if the scoliosis surgery was a “life-saving” procedure, but the research conducted on the effects of scoliosis surgery has concluded the procedures is primarily indicated for cosmetic purposes and is not medically necessary. This is a generally accepted fact with in the scoliosis treatment community, because scoliosis surgery does not improve cardiac function, pulmonary function, eliminate pain, or improve the adolescent idiopathic scoliosis patient’s quality of life in the long-term follow up studies. It should be noted, that a fused scoliosis spine from scoliosis surgery is every bit (or more) dysfunctional that an un-treated scoliosis spine. Perhaps most importantly, scoliosis surgery is not and will not lead to a cure for scoliosis since it still fails to address the underlying neurological deficit/ under-development that is the root cause of idiopathic scoliosis.
The concept of re-training the automatic postural control centers of the brain stem actually dates back several hundred years (if not much further back) to a time when young girls aspiring to become debutants practiced good posture by walking around balancing books on top of their heads (which is not a suggested scoliosis treatment). By making the head (temporarily) artificially heavier with the book, they essentially changed where their body neurologically perceived the center mass of their skull and caused their “body schema” (the neurological “set point” for normal spinal posture) to react to the perceived postural change. Over time the repeated re-training of the young girl’s automatic postural control centers in her brain stem resulted in a permanent change in the “body schema” and the improved posture simply, became “the new normal”. These very same principles (in a much more effective and advanced application) can be applied to scoliosis treatment and permanently alter the natural course of the idiopathic scoliosis condition by treating the root cause of the condition. The future of scoliosis treatment will be found in treating the scoliosis spine, by treating the automatic postural control centers in the brain stem first.
Tuesday, March 22, 2011
Idiopathic Scoliosis Hubpages!!!
Idiopathic Scoliosis Hubpages!!!
Discover the new thinking in idiopathic scoliosis cause, treatment, and a possible path towards a cure?
Discover the new thinking in idiopathic scoliosis cause, treatment, and a possible path towards a cure?
Friday, March 18, 2011
Specific scoliosis exercise is required.
Idiopathic scoliosis is primarily a neurological condition that has its primary effect on the spine, rather than "just a spine condition". With that in mind, it is no wonder scoliosis brace treatment and scoliosis surgery are becoming obsolete rather quickly. The advent of break through prognostic technologies like Scoliscore (genetic testing) and the soon-to-be-released scoliosis blood test are only going to increase the push for early stage scoliosis intervention scoliosis treatment technology as well. Fortunately, we are already well on our way towards prevention of the condition and hope to prove we can alter the natural course of the condition in even high risk genetically predisposed patients soon.
Wednesday, March 16, 2011
The scoliosis treatment process matters.
Idiopathic scoliosis of spine is a unique and rather confusing condition. Adolescent children (mainly girls) whom appear to have perfectly normal and healthy spines all of a sudden develop an unexplained scoliosis spine; often in only a few months. They didn't start to do anything differently, they didn't start eating anything differently, and perhaps most the weird part is that despite their scoliosis spine being crooked, they are still generally healthy.
Of course, not "knowing" the cause of the condition certainly makes the task of scoliosis treatment quite challenging; especially when one considers that researchers have yet to find anything actually broken or wrong with the scoliosis spine itself ......it's simply just crooked. In the early stage idiopathic scoliosis patients the discs appear to normal, the muscles appear to be normal, the vertebrae appear to be normal, the ligaments appear to be normal; the scoliosis spine just is crooked for no apparent reason.
This lack of evidence is what has lead to most idiopathic scoliosis researchers to begin looking for a neurological cause for scoliosis of spine, and they are collected a lot of compelling data/evidence to support a neurological under-development in the postural control centers of the brain stem as a root cause component (a combination of genetic and environmental influences) of the scoliosis of spine condition.
Armed with this knowledge, it is pretty easy to see why "mainstream" scoliosis treatment (scoliosis brace treatment and scoliosis surgery) have very poor outcomes and are basically obsolete at this point. As it turns out, process matters in scoliosis treatment.
I always like to use the "making bread" analogy when discussing the Mix/Fix/Set protocol developed by the CLEAR Institute. Throw eggs, flour, yeast, oil, ect into a bowl and toss it in the oven and you won't get bread.....you'll get warm goo. However, if you knead the ingredients into dough, let it rise in the fridge, cook it in a pre-heated oven for the prescribed amount of time you will most likely get bread. Same ingredients, different protocols, dramatically different outcomes.
The successful scoliosis treatment programs for scoliosis of spine in the future will primarily focus on the neuro-muscular component of the scoliosis spine and not just the curvature itself. It will begin as a pro-active scoliosis spine rehab program in the earliest stages of idiopathic scoliosis. And perhaps most importantly, it will focus on the elimination of the environmental influences that combine with the genetic pre-disposition that actually causes scoliosis of spine and will (hopefully) lead to a cure for idiopathic scoliosis.
Of course, not "knowing" the cause of the condition certainly makes the task of scoliosis treatment quite challenging; especially when one considers that researchers have yet to find anything actually broken or wrong with the scoliosis spine itself ......it's simply just crooked. In the early stage idiopathic scoliosis patients the discs appear to normal, the muscles appear to be normal, the vertebrae appear to be normal, the ligaments appear to be normal; the scoliosis spine just is crooked for no apparent reason.
This lack of evidence is what has lead to most idiopathic scoliosis researchers to begin looking for a neurological cause for scoliosis of spine, and they are collected a lot of compelling data/evidence to support a neurological under-development in the postural control centers of the brain stem as a root cause component (a combination of genetic and environmental influences) of the scoliosis of spine condition.
Armed with this knowledge, it is pretty easy to see why "mainstream" scoliosis treatment (scoliosis brace treatment and scoliosis surgery) have very poor outcomes and are basically obsolete at this point. As it turns out, process matters in scoliosis treatment.
I always like to use the "making bread" analogy when discussing the Mix/Fix/Set protocol developed by the CLEAR Institute. Throw eggs, flour, yeast, oil, ect into a bowl and toss it in the oven and you won't get bread.....you'll get warm goo. However, if you knead the ingredients into dough, let it rise in the fridge, cook it in a pre-heated oven for the prescribed amount of time you will most likely get bread. Same ingredients, different protocols, dramatically different outcomes.
The successful scoliosis treatment programs for scoliosis of spine in the future will primarily focus on the neuro-muscular component of the scoliosis spine and not just the curvature itself. It will begin as a pro-active scoliosis spine rehab program in the earliest stages of idiopathic scoliosis. And perhaps most importantly, it will focus on the elimination of the environmental influences that combine with the genetic pre-disposition that actually causes scoliosis of spine and will (hopefully) lead to a cure for idiopathic scoliosis.
Tuesday, March 15, 2011
Do the scoliosis treatment "ends" justify the scoliosis brace/ scoliosis surgery "means"?
"The ends justify the means" is a common statement in our everyday society and when applied to the greater or long-term good of the individual, organization, or humanity it is generally accepted. Unfortunately, this can not be said in regards to the current state of scoliosis treatment. For the last 3500 years of recorded human history (and the last 450 in particular) idiopathic scoliosis patients have been poked, stretched, cut, squashed, and even tied to various apparatuses and procedures in an attempt to alter the natural course of idiopathic scoliosis under the guise of "the ends justify the means".
Scoliosis brace treatment first appeared in recorded human history around 650AD and has taken virtually every form and approach the a human mind could conceive, yet when compared to the expected genetically predicted natural course of idiopathic scoliosis, the scoliosis brace treatment data shows absolutely NO effect. None! In addition, in 2007 Drs. Weinstein and Dorlan reviewed 15 comprehensive scoliosis brace studies (using virtually every kind of scoliosis brace on the market) and found that scoliosis surgery rates among the scoliosis brace study participants were exactly the same as the untreated idiopathic scoliosis patients. Finally, rat tail research being conducted at the University of Vermont is discovering that simulated scoliosis brace conditions on the rat tail (which is practically structurally identical to a human spine) actually makes the permanent deformity of the disc worse and probably increases the risk of curve progression in scoliosis adult patients.
Scoliosis surgery has been performed since 1865 and has changed both in procedure and intent since that time. The original scoliosis surgery was in hopes of halting progression of the curvature and that mindset held true all the way until the 1950's and 1960's when Paul Herrington introduced the "Herrington rod" scoliosis surgery. The pedicle screw system developed by Cotrel & Dubousset was the next (and still currently used) scoliosis surgery technique to be employed. While it allowed for much better correction of the idiopathic scoliosis deformity, it also came with a lot more complications and very poor long-term quality of life results. In fact, one study found that 40% of post scoliosis surgery treated patients were legally defined as "severely handicapped" only 16.9 years after the scoliosis surgery.
While both of these scoliosis treatment methodologies (scoliosis brace treatment and scoliosis surgery) are and were created with the best of intensions, it cannot be said that the means justify the end. In fact, a 50 year follow up study of untreated idiopathic scoliosis patient found they had a quality of life the exceeded the scoliosis surgery treated patients and one could only assume that the untreated idiopathic scoliosis patient's quality of life was at least equal to that of the scoliosis brace treated patients since scoliosis brace treatment doesn't seem to have any positive effect on idiopathic scoliosis anyway.
So where does that leave the idiopathic scoliosis patient in terms of scoliosis treatment? From my perspective, between a rock and a hard spot, but help is one the way. Scoliosis treatment is undergoing a revolution for the first time since scoliosis surgery was first performed. Early stage prognostic testing for idiopathic scoliosis is allowing us to determine which patients are at an elevated risk for severe scoliosis and which need extensive early stage scoliosis treatment to prevent the onset of a spinal deformity.
Scoliosis brace treatment first appeared in recorded human history around 650AD and has taken virtually every form and approach the a human mind could conceive, yet when compared to the expected genetically predicted natural course of idiopathic scoliosis, the scoliosis brace treatment data shows absolutely NO effect. None! In addition, in 2007 Drs. Weinstein and Dorlan reviewed 15 comprehensive scoliosis brace studies (using virtually every kind of scoliosis brace on the market) and found that scoliosis surgery rates among the scoliosis brace study participants were exactly the same as the untreated idiopathic scoliosis patients. Finally, rat tail research being conducted at the University of Vermont is discovering that simulated scoliosis brace conditions on the rat tail (which is practically structurally identical to a human spine) actually makes the permanent deformity of the disc worse and probably increases the risk of curve progression in scoliosis adult patients.
Scoliosis surgery has been performed since 1865 and has changed both in procedure and intent since that time. The original scoliosis surgery was in hopes of halting progression of the curvature and that mindset held true all the way until the 1950's and 1960's when Paul Herrington introduced the "Herrington rod" scoliosis surgery. The pedicle screw system developed by Cotrel & Dubousset was the next (and still currently used) scoliosis surgery technique to be employed. While it allowed for much better correction of the idiopathic scoliosis deformity, it also came with a lot more complications and very poor long-term quality of life results. In fact, one study found that 40% of post scoliosis surgery treated patients were legally defined as "severely handicapped" only 16.9 years after the scoliosis surgery.
While both of these scoliosis treatment methodologies (scoliosis brace treatment and scoliosis surgery) are and were created with the best of intensions, it cannot be said that the means justify the end. In fact, a 50 year follow up study of untreated idiopathic scoliosis patient found they had a quality of life the exceeded the scoliosis surgery treated patients and one could only assume that the untreated idiopathic scoliosis patient's quality of life was at least equal to that of the scoliosis brace treated patients since scoliosis brace treatment doesn't seem to have any positive effect on idiopathic scoliosis anyway.
So where does that leave the idiopathic scoliosis patient in terms of scoliosis treatment? From my perspective, between a rock and a hard spot, but help is one the way. Scoliosis treatment is undergoing a revolution for the first time since scoliosis surgery was first performed. Early stage prognostic testing for idiopathic scoliosis is allowing us to determine which patients are at an elevated risk for severe scoliosis and which need extensive early stage scoliosis treatment to prevent the onset of a spinal deformity.
Thursday, March 10, 2011
Cause of Scoliosis - Initiating and progressive factors
Cause of Scoliosis - Initiating and progressive factors
Idiopathic scoliosis is a complex multi-factorial condition........This thread on causes and curve progression driving factors is not. Understanding Idiopathic scoliosis made easy...and quick too.
Idiopathic scoliosis is a complex multi-factorial condition........This thread on causes and curve progression driving factors is not. Understanding Idiopathic scoliosis made easy...and quick too.
Wednesday, March 9, 2011
SpineCor vs rigid Scoliosis Brace
SpineCor vs rigid Scoliosis Brace
Hmmm, which brace should we use....the worthless rigid brace or the even more worthless spine cor brace? How about NO Scoliosis brace!!!!!
Hmmm, which brace should we use....the worthless rigid brace or the even more worthless spine cor brace? How about NO Scoliosis brace!!!!!
Monday, March 7, 2011
Is the cure of scoliosis surgery worse than the condition itself?
It is not my intention to condemn the efforts of sincere and caring medical professionals who have spent their lives to helping individuals with idiopatic scoliosis. However, I like to add to the current list of scoliosis treatment options and empower these individuals to make their own decision regarding their own scoliosis spine, and their own life.
Scoliosis surgery has been a part of the scoliosis treatment landscape since 1865 (yep, the same year the civil war ended) and while the techniques and surgical hardward have vastly improved, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many short and long term consquences to the highly invasive procedure.
Scoliosis surgery is Generally recommended of curvatures 40-50 degrees and larger. This number is rather arbitary and will vary greating from surgeon to surgeon.
Those patients for whom fail scoliosis brace treatment, they are often told scoliosis surgery is their only option. While the idea of having a metal rod fused to their spine that will impair their daily activities and in many cases leads to chronic pain may not appeal to most scoliosis patients, they often feel as though they have no other choice. In addition many are told the scoliosis surgery will reduce the rib hump and improve the cosmetic appearance of the condition. Unfortunately, current research has consistently shown that scoliosis surgery does little to address the rotation of the scolisis spine (and hence the rib hump) and will actually cause the rib hump to increase in time. (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).
Scoliosis surgery is highly invasive and carries with it a risk of death. Although death rates of less than 1% are reported, no one completely eliminate this possibility. There is also significant risk of injury to the nerves, resulting in the loss of movement to the arms & legs. This has become a greater concern in recent years, as surgeons strive for greater corrections in their patients, and place more stress upon the nerves running through the spinal column.
Surgical Hardware failure is virtually 100% over the course of a scoliosis patient's lifetime. It may occur immediately after the scoliosis surgery or several years later, but one or more components of the hardware placed inside the body is highly likely to fail or break. The author of one study stated, "One would expect that if the patient lives long enough, rod breakage will be a virtual certainty". Another study found that out of 74 patients who underwent the scoliosis surgery, failed fusion occurred in 27% of patients within a few years after the procedure.
Scoliosis of spine is an neurological condition primarily affecting the spine, which involves much more than merely a sideways curve. Yet the "success" of scoliosis surgery is measured only by how much it can reduce the Cobb angle (lateral deviation) through the application of artificial correction, and a scoliosis surgery treated spine is every bit as abnormal and dysfunctional as an untreated scoliosis spine.
“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, 2001.
Risks and complications of scoliosis surgery.
One study (Scoliosis. 2009 May 7;4:11.) found that 68% of patients experienced minor or major severe complications, including two deaths (out of 50 patients):
“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 surgery has been a part of the scoliosis treatment landscape since 1865 (yep, the same year the civil war ended) and while the techniques and surgical hardward have vastly improved, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many short and long term consquences to the highly invasive procedure.
Scoliosis surgery is Generally recommended of curvatures 40-50 degrees and larger. This number is rather arbitary and will vary greating from surgeon to surgeon.
Those patients for whom fail scoliosis brace treatment, they are often told scoliosis surgery is their only option. While the idea of having a metal rod fused to their spine that will impair their daily activities and in many cases leads to chronic pain may not appeal to most scoliosis patients, they often feel as though they have no other choice. In addition many are told the scoliosis surgery will reduce the rib hump and improve the cosmetic appearance of the condition. Unfortunately, current research has consistently shown that scoliosis surgery does little to address the rotation of the scolisis spine (and hence the rib hump) and will actually cause the rib hump to increase in time. (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).
Scoliosis surgery is highly invasive and carries with it a risk of death. Although death rates of less than 1% are reported, no one completely eliminate this possibility. There is also significant risk of injury to the nerves, resulting in the loss of movement to the arms & legs. This has become a greater concern in recent years, as surgeons strive for greater corrections in their patients, and place more stress upon the nerves running through the spinal column.
Surgical Hardware failure is virtually 100% over the course of a scoliosis patient's lifetime. It may occur immediately after the scoliosis surgery or several years later, but one or more components of the hardware placed inside the body is highly likely to fail or break. The author of one study stated, "One would expect that if the patient lives long enough, rod breakage will be a virtual certainty". Another study found that out of 74 patients who underwent the scoliosis surgery, failed fusion occurred in 27% of patients within a few years after the procedure.
Scoliosis of spine is an neurological condition primarily affecting the spine, which involves much more than merely a sideways curve. Yet the "success" of scoliosis surgery is measured only by how much it can reduce the Cobb angle (lateral deviation) through the application of artificial correction, and a scoliosis surgery treated spine is every bit as abnormal and dysfunctional as an untreated scoliosis spine.
“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, 2001.
Risks and complications of scoliosis surgery.
One study (Scoliosis. 2009 May 7;4:11.) found that 68% of patients experienced minor or major severe complications, including two deaths (out of 50 patients):
“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."
Where is the accountability in scoliosis treatment?
The treatment record for idiopathic scoliosis over the past 3500 years of human history is terrible. An utter failure really. Failed scoliosis brace treatments of every kind and variety. Scoliosis surgery procedures that leave many of the patients (research suggest as much as 40% or higher) worse off 17 years post-op then idiopathic scoliosis patients 50 years post diagnosis that had absolutely no treatment at all. In the immortal words of the late, great Vince Lombardi, "what in the hell is going on out there!".
We need a better way.....a much better way. A completely, utterly, and drastically better way. The kind of better way in which the entire system is turned on top of it's head and shaken to its very core. The search for a better way will tarnish academic reputations and shatter several thousand years worth of conventional wisdom, and it all comes down to making one small change that seems so insignificant that one would probably gloss right over it if they were reading it in a magazine or a book. So what is this revolution that is going to uproot the scoliosis treatment world? Here it comes......
Scoliosis is primarily a neurological condition that has it's primary affects (symptoms) on the spinal alignment.
Duh, no kidding right? Ok, so the idea is pretty well established, but for some reason it doesn't seem to carry over into the realm of scoliosis treatment. I mean, scoliosis brace treatment and scoliosis surgery are in no way making any attempt to actually treat the primary neurological deficits that are undoubtedly the root cause of the condition. This is a kin to taking cough medicine for tuberculosis. Sure, it will quite the cough temporarily, but the overall condition goes unaddressed.......resulting in significant long-term consequences.
So what can be done about this obvious blunder of logic. Well, we can start by treating this neurological condition like it is indeed a neurological condition. Here is one example.
Guest blogger: Dr. Brian Dovorany.
"The role of scoliosis exercise.
There are many schools of thought regarding scoliosis, exercises, and the overall relationship between the two. Muscle fiber type dictates how a muscle responds to force/load principles. There are different fiber types in skeletal muscle not to mention many layers of muscles in the spine and pelvis. The deeper we go into the spinal column and evaluate the muscle structure it becomes obvious that the muscle length gets shorter and the fiber type becomes more populated with TYPE 1 non fatige-able antigravity musculature. This means that deep muscle groupings like the mutifidi serve to support the body relative to gravity and also have the largest ability to alter the structural position of a single vertebrae. Since scoliosis has apical vertebrae(the vertebrae at the apex of the scoliosis curve) which appear on both dissection and on radiographic evaluation to be grossly displaced relative to what is considered normal anatomical position it would be logical to assume that these deep muscles would be strong on one side and weak on the other. Unfortunately this assumption is false. Neurologically the brain controls the on-off switch for antigravity musculature and is in direct response to several sensory systems including the joint and muscle receptors of our feet, pelvis, trunk, and neck, our inner ears, and our eyes. These create receptors feed input to the brain , the brain then sends a motor signal to these muscles telling them to turn on or off.
Sherrington's law of reciprocal innervation (neurological stuff) dictates that an agonist and antagonist muscle group has a neurological system that allows the agonist(mover) to contract while the antagonist automatically will not contract to allow the movement to occur. In the tonic antigravity system since movement is not the primary function of these muscles. These deep muscles contain a very complex system that actually allows for shortening and lengthening reactions to control the center mass of the body in gravity so we don’t fall over. What happens is small changes in the environment are sensed and the tonic muscles adapt instantly through millions of shortening and lengthening responses to stabilize."
Now, I know that explanation maybe a little "out in the weeds" for most readers, but it certainly provides more hope and logical than stuffing a kid into a brace like they are a small tree staked to the ground in the backyard in hopes of "making" the scoliosis of spine grow straight and the scoliosis surgery is just the same principle applied more invasively and well, internally.
Scoliosis treatment has been the victim of under diagnosis and lack of creating thinking long enough. It is time to start holding the "experts" accountable and demanding more, much more.
Demand a better understanding of each patients actual condition other than just jumping into "one size fits all" treatment and hoping for the best. Demand more treatment options, less invasive once that are based on new principles, not more of the same old tired and failed ones of the past. Demand an updated outcome assessment system that reflects the true nature of the condition, not just one minor aspect (the magnitude of the curve's lateral bending as measured by Cobb angle).
Scoliosis patients (and parents of).......Demand more, expect better, and don't quit until you get it, because the level of understanding and treatment do exist, but will aways be shoved aside in favor of conventional wisdom until the public demands accountability and progress.
We need a better way.....a much better way. A completely, utterly, and drastically better way. The kind of better way in which the entire system is turned on top of it's head and shaken to its very core. The search for a better way will tarnish academic reputations and shatter several thousand years worth of conventional wisdom, and it all comes down to making one small change that seems so insignificant that one would probably gloss right over it if they were reading it in a magazine or a book. So what is this revolution that is going to uproot the scoliosis treatment world? Here it comes......
Scoliosis is primarily a neurological condition that has it's primary affects (symptoms) on the spinal alignment.
Duh, no kidding right? Ok, so the idea is pretty well established, but for some reason it doesn't seem to carry over into the realm of scoliosis treatment. I mean, scoliosis brace treatment and scoliosis surgery are in no way making any attempt to actually treat the primary neurological deficits that are undoubtedly the root cause of the condition. This is a kin to taking cough medicine for tuberculosis. Sure, it will quite the cough temporarily, but the overall condition goes unaddressed.......resulting in significant long-term consequences.
So what can be done about this obvious blunder of logic. Well, we can start by treating this neurological condition like it is indeed a neurological condition. Here is one example.
Guest blogger: Dr. Brian Dovorany.
"The role of scoliosis exercise.
There are many schools of thought regarding scoliosis, exercises, and the overall relationship between the two. Muscle fiber type dictates how a muscle responds to force/load principles. There are different fiber types in skeletal muscle not to mention many layers of muscles in the spine and pelvis. The deeper we go into the spinal column and evaluate the muscle structure it becomes obvious that the muscle length gets shorter and the fiber type becomes more populated with TYPE 1 non fatige-able antigravity musculature. This means that deep muscle groupings like the mutifidi serve to support the body relative to gravity and also have the largest ability to alter the structural position of a single vertebrae. Since scoliosis has apical vertebrae(the vertebrae at the apex of the scoliosis curve) which appear on both dissection and on radiographic evaluation to be grossly displaced relative to what is considered normal anatomical position it would be logical to assume that these deep muscles would be strong on one side and weak on the other. Unfortunately this assumption is false. Neurologically the brain controls the on-off switch for antigravity musculature and is in direct response to several sensory systems including the joint and muscle receptors of our feet, pelvis, trunk, and neck, our inner ears, and our eyes. These create receptors feed input to the brain , the brain then sends a motor signal to these muscles telling them to turn on or off.
Sherrington's law of reciprocal innervation (neurological stuff) dictates that an agonist and antagonist muscle group has a neurological system that allows the agonist(mover) to contract while the antagonist automatically will not contract to allow the movement to occur. In the tonic antigravity system since movement is not the primary function of these muscles. These deep muscles contain a very complex system that actually allows for shortening and lengthening reactions to control the center mass of the body in gravity so we don’t fall over. What happens is small changes in the environment are sensed and the tonic muscles adapt instantly through millions of shortening and lengthening responses to stabilize."
Now, I know that explanation maybe a little "out in the weeds" for most readers, but it certainly provides more hope and logical than stuffing a kid into a brace like they are a small tree staked to the ground in the backyard in hopes of "making" the scoliosis of spine grow straight and the scoliosis surgery is just the same principle applied more invasively and well, internally.
Scoliosis treatment has been the victim of under diagnosis and lack of creating thinking long enough. It is time to start holding the "experts" accountable and demanding more, much more.
Demand a better understanding of each patients actual condition other than just jumping into "one size fits all" treatment and hoping for the best. Demand more treatment options, less invasive once that are based on new principles, not more of the same old tired and failed ones of the past. Demand an updated outcome assessment system that reflects the true nature of the condition, not just one minor aspect (the magnitude of the curve's lateral bending as measured by Cobb angle).
Scoliosis patients (and parents of).......Demand more, expect better, and don't quit until you get it, because the level of understanding and treatment do exist, but will aways be shoved aside in favor of conventional wisdom until the public demands accountability and progress.
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