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.