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.