Category: Blog

Spinal surgery for scoliosis and degenerative disc disease

Posted on September 21, 2019 by - Blog

Scoliosis, if left untreated, tends to progress in most cases – and where this progression is significant enough it can result in significant disability and reduction in quality of life. For this reason, scoliosis is a condition which the medical profession has been keen to treat and treat as early as possible in affected individuals. Stopping scoliosis is the primary objective of any surgical procedure, but unlike non-surgical approaches, there are known complications with surgical interventions. One of the most common is Degenerative Disc Disease (DDD).

 

Treatment options for scoliosis

Today, the treatment options for Adolescent Idiopathic scoliosis include observation, bracing, exercise approaches and surgery, and the general goal is to keep curves under 50° at maturity[1]. Observation, while still recommended by some medical practitioners not specially trained in scoliosis management, is not truly a treatment for scoliosis, and instead simply allows the condition to progress. Non-surgical options, such as bracing and exercise are fast becoming the treatment of choice, with surgery usually preferred as a last resort.

There are three main approaches to scoliosis surgery – these are posterior spinal fusion (PSF), anterior spinal fusion (ASF), or a combination of both. In each case, the goal is to fuse the affected vertebra into the correct position – this results in the targeted vertebra being unable to move, instead fusing into a single unit, but also eliminates scoliosis. PSF remains as the gold standard for the treatment of thoracic and double major curves, which make up most scoliosis cases. ASF is indicated for thoracolumbar and lumbar cases having a normal sagittal profile. A combination of ASF and PSF could also be used for the management of large curves (> 75°) or stiff curves, young age, and to prevent the “crankshaft phenomenon” – a condition in which the posterior fusion of the spine cases a secondary curvature to form as the bones grow.[2]

Although the safety and efficacy of both techniques have been demonstrated[3], many patients and surgeons are increasingly concerned about the long-term outcome of an extensive fusion in terms of spinal function, the development of degenerative disc disease and pain[4]. Weiss et al. reviewed the long-term risks of fusion spinal surgery with respect to scoliosis to enable establishing a cost/benefit relation of this intervention. According to their study, average rate of complications was as high as 44% in adolescent cases, ranging from 10 to 78%. They concluded that long-term complications have not yet been fully evaluated and further studies are needed to address this concern adequately[5].

 

Post-operative complications – new research

Corrective surgery of AIS can result in several benefits for the affected patients including improvements in aesthetics, quality of life, disability, back pain, psychological well-being, and breathing function. This is especially the case for patients whose scoliosis has progressed beyond the range likely to be positively impacted by non-surgical approaches, such as bracing.

These points notwithstanding, surgery is also associated with a variety of complications whose long-term impact is currently poorly understood – these may include  neurological damage, loss of normal spinal function, strain on unfused vertebrae, curvature progression, decompensation and increased sagittal deformity, increased torso deformity, delayed paraparesis, and pseudarthrosis.[6] Degenerative disc disease is however considered one of the most common results of surgery (although it is also associated with scoliosis progression)  and its association with the severity of pain has been reported.[7]

The most recent study looking at this connection was published in 2018[8] and followed a total of 42 AIS patients who underwent PSF surgery. The participants were examined for a range of post-operative complications. The mean age of the surgery was 14.4 ± 5.1 years. The mean follow-up of the patients was 5.6 ± 3.2 years.

On the positive side, the study confirmed that complete fusion of the vertebra was observed in all cases, and no cases of failure of surgical implants were noticed – in this sense, the patient’s scoliosis cases were therefore addressed and halted, which was of course the primary objective. However, according to the most recent study, degenerative disc disease had developed in 6 out of 37 (16%) of the patients. This finding was roughly in line with previous research, which has suggested rates on average of 7%, although rates varied by study.[9]

More concerning however, was the fact that the observed post-operative disability tended to increase over time, a similar study by Upasani et al. also showed an increased pain at 5 years compared with 2 years after AIS surgical treatment[10], and with this in mind the study investigators suggest that possible progression of DDD and associated increases in pain be carefully considered before opting for a surgical procedure.

 

Treating scoliosis without surgery

While it’s clear that for some patient’s surgical intervention may be the best option, even if there is a risk of postoperative complications, recent advances in non-surgical approaches to scoliosis treatment mean that other options exist for far larger numbers of patients then ever before. Scoliosis bracing, for example, is not associated with any long-term complications, save for the possibility of a loss of muscle strength, which is easily mitigated with targeted exercises. While such approaches are necessarily slower to show results than a surgical procedure, the most modern “over corrective” braces (such as the ScoliBrace we offer at the UK Scoliosis clinic) can nonetheless offer a substantial correction, typically over a period of 6 to 12 months.

 

 

[1] Janicki JA, Alman B. Scoliosis: review of diagnosis and treatment. Paediatr Child Health. 2007;12:771–6.

Tari SHV, Mahabadi EA, Ghandehari H, Nikouei F, Javaheri R, Safdari F. Spinopelvic sagittal alignment in patients with adolescent idiopathic scoliosis. Shafa Orthop J. 2015;2(3):e739.

[2] Hasan Ghandhari, Ebrahim Ameri, Farshad Nikouei, Milad Haji Agha Bozorgi, Shoeib Majdi & Mostafa Salehpour  ,Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis Scoliosis and Spinal Disordersvolume 13, Article number: 14 (2018)

[3] Wang Y, Fei Q, Qiu G, Lee CI, Shen J, Zhang J, Zhao H, Zhao Y, Wang H, Yuan S. Anterior spinal fusion versus posterior spinal fusion for moderate lumbar/thoracolumbar adolescent idiopathic scoliosis: a prospective study. Spine. 2008;33:2166–72.

[4] Bridwell KH, Shufflebarger HL, Lenke LG, Lowe TG, Betz RR, Bassett GS. Parents’ and patients’ preferences and concerns in idiopathic adolescent scoliosis: a cross-sectional preoperative analysis. Spine. 2000;25:2392–9.

[5] Weiss H-R, Goodall D. Rate of complications in scoliosis surgery—a systematic review of the Pub Med literature. Scoliosis. 2008;3:9.

[6] Weiss H-R, Goodall D. Rate of complications in scoliosis surgery—a systematic review of the Pub Med literature. Scoliosis. 2008;3:9.

[7] Buttermann GR, Mullin WJ. Pain and disability correlated with disc degeneration via magnetic resonance imaging in scoliosis patients. Euro Spine J. 2008;17:240–9.

[8] Hasan Ghandhari, Ebrahim Ameri, Farshad Nikouei, Milad Haji Agha Bozorgi, Shoeib Majdi & Mostafa Salehpour  ,Long-term outcome of posterior spinal fusion for the correction of adolescent idiopathic scoliosis Scoliosis and Spinal Disordersvolume 13, Article number: 14 (2018)

[9] Jones M, Badreddine I, Mehta J, Ede MN, Gardner A, Spilsbury J, Marks D. The rate of disc degeneration on MRI in preoperative adolescent idiopathic scoliosis. Spine J. 2017;17:S332.

[10] Upasani VV, Caltoum C, Petcharaporn M, Bastrom TP, Pawelek JB, Betz RR, Clements DH, Lenke LG, Lowe TG, Newton PO. Adolescent idiopathic scoliosis patients report increased pain at five years compared with two years after surgical treatment. Spine. 2008;33:1107–12.

Does Degenerative Scoliosis cause pain?

Posted on August 7, 2019 by - Blog

Degenerative, or “De-novo” scoliosis is the name given to a scoliosis case which develops later in life and which has a known cause. Whereas the vast majority of scoliosis cases in younger people are classified as “idiopathic” scoliosis (that is to say, a condition without a clearly defined cause) de-novo scoliosis is understood to be the direct result of spinal degeneration – the term “de-novo” simply means “new”. Usually, de novo scoliosis develops as discs and facet joints (the hinge joints at the back of the spine) start to age – often in the lumbar spine (the lower part of the spine). When discs and facet joints age the vertebrae can slip out of place, which makes the spine curve – weakening of muscles and ligaments can also help to exacerbate the condition. Research suggests that de-novo scoliosis may affect as many as 30% of the over 60’s.[1]

 

Adult, or De-novo scoliosis?

Sometimes naming conventions are less than well thought through and scoliosis in adults is just such an example. There are, in fact, two main types of scoliosis in adults – these are de novo scoliosis and adult scoliosis. Adult scoliosis is the term which refers to a scoliosis case from adolescence, which has been carried into adulthood – and is also sometimes called adolescent scoliosis in adults (ASA). The difference matters since in adult scoliosis cases, curves that are 50 degrees or more in size after a person is fully grown are likely to increase by an average of 1 degree per year, whereas curves of less than 30 degrees rarely get significantly larger. De-novo scoliosis cases tend to increase in magnitude, but the progression is less predictable. Knowing as much as possible about a patients history is therefore critical to making the right diagnosis.

 

Is de-novo scoliosis painful?

There has been a long-running debate in the field of scoliosis treatment and research – does scoliosis cause pain? Since at least the 70’s there have been opposing views on both sides of the argument all of which have presented evidence to support their claims. In many instances, there have been limitations to the studies in both camps (with sample size being the most frequent issue) but it is also the case that adolescent scoliosis often receives more attention in research. In this regard, however, it does seem to be increasingly demonstrated that pain is correlated with scoliosis – and it’s not unreasonable to suggest the same is true in de-novo cases.

In the last 5 years or so, numerous studies have suggested that…

  • Spinal pain is, in fact, a frequent condition in AIS patients, further supporting the need for early detection and screening to minimise potential pain and suffering[2]
  • In patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[3]
  • In one study of 2400 patients with AIS, 23% reported back pain at their initial contact[4]
  • Scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back[5]
  • Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[6]
  • Patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[7]

In truth, whether or not scoliosis causes pain is less of an issue when it comes to adolescent scoliosis since most cases in young people are noticed either as a result of screening or due to visual symptoms. In adults, however, pain may well be a significant symptom which (since “back pain” is such a common condition today) many older people simply ignore.

Perhaps the link between de-novo scoliosis and pain was best summed up in a comment by Manuel Rigo, a scoliosis clinician with the Institut Elena Salvá in Barcelona, Spain, in a presentation to the 7th international conference on the conservative treatment of spinal deformities – according to Rigo (our emphasis added):

“Adult patients attending our institution – a scoliosis-specific rehabilitation centre – could be divided into two main groups: Group I: Patients attending the clinic with a clear self-conscience of belonging to the scoliosis population because they were mostly diagnosed during childhood or during adolescence – treated or not treated-; Group II: Patients belonging to the back pain population referred to us by their doctors, mostly because they showed a bad response to general rehabilitation and such a bad response was related to a non-previously diagnosed scoliosis condition. Generally speaking, we could identify patients with idiopathic, congenital and secondary scoliosis in Group I while most of the patients in Group II have developed de novo degenerative scoliosis or scoliosis secondary to any pelvic or lower limbs biomechanical disturbance.”

Degenerative or “De-Novo” scoliosis

Therefore, while it is unclear exactly how well de-novo scoliosis and pain are correlated – pain is well worth considering as a possible symptom in older individuals. Indeed, many of our patients presenting with de-novo scoliosis do initially complain of pain. Indeed, the UK Scoliosis association now also recognises that patients with degenerative scoliosis will often also have back pain and muscle fatigue and that people with degenerative scoliosis sometimes also have back stiffness and leg symptoms, including pain, numbness, and weakness.

The positive message overall though, is that research does show that conservative approaches, such as part-time bracing can have a positive effect in reducing it where it does exist.[8] One such approach is our latest generation brace, the ScoliBrace. Unlike many scoliosis braces, ScoliBrace is a fully customised, 3D designed, CAD/CAM manufactured brace which is low profile, comfortable and easy to use, alongside specialist scoliosis exercises, part-time bracing with ScoliBrace can provide a significant improvement in quality of life for those suffering from De-novo scoliosis.

 

 

[1] ‘Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

[2] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)

[3] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[4] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[5] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[6] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[7] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[8] Scoliosis bracing and exercise for pain management in adults—a case report Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

 

Think Scoliosis Just effects children? Think again!

Posted on July 17, 2019 by - Blog

While it’s true that Scoliosis is a major issue for younger people, the fact that scoliosis only affects them, or even primarily affects them isn’t quite correct. Today, for example, we know that at least one child in every school class will develop scoliosis – bud did you know that as many as 1 in 3 people over the age of 60 also suffer from scoliosis ? This means that scoliosis, while often more serious in younger people due to the high risk of progression, is actually far more frequently seen in older individuals.

 

The overs 60’s get scoliosis?

De-Novo Scoliosis

The over 60’s are certainly at a high risk of scoliosis, but you’d be forgiven for being unaware of this fact. Over the last 10 years, there has been much more interest in the treatment of adolescent and juvenile scoliosis – prominent cases such as that of Princess Eugene have certainly contributed to this attention as have numerous other celebrities who have openly discussed their childhood scoliosis. What’s been much less discussed is scoliosis in adults – a condition which primarily affects the over 60’s.
Unlike scoliosis in juveniles and adolescents (the exact cause of which is still unclear) we do know that De novo (or “new”) scoliosis is caused by wear and tear to the spine. Adults scoliosis is also worsened by wear and tear but is primarily the development of existing scoliosis, rather than an entirely new occurrence. Although the cause might be different, the symptoms are the same – scoliosis sufferers often notice undesirable physical symptoms, such as the Rib cage sticking out on one side, hips or waist sticking out and being unable to stand up straight easily. Scoliosis is also frequently the cause of back pain and discomfort, ranging from moderate to acute. Many suffers also have to live with pain in the legs or pins and needles due to nerve root pressure. That annoying back pain might, in fact, be the early signs of De-Novo scoliosis.

 

Does scoliosis in adults matter?

De-Novo scoliosis

Just as with children, the key issue is the degree of scoliosis. A very small curve may present with few if any symptoms, but, if left untreated, scoliosis can progress to such an extent that normal physical function can be impaired – first making walking and moving about difficult, and then eventually even affecting breathing.
Many adults simply accept aches and pains as part of “getting older” – but no matter the case this isn’t a smart approach. The first reason for this is that small, but persistent, aches and pains can be the first sign of a more serious problem which requires treatment. The second and more important reason is that you do not need to live your life in pain! Pain itself, while once thought not to be correlated with scoliosis is now believed to have at least some link to the condition.
Where scoliosis isn’t painful, it may also cause difficulties with movement or a noticeable postural or physical deformation of the spine which for some people can be embarrassing and stressful. The overall result for most older adults is a reduction in their ability or desire to socialise, exercise and get about day to day. This is especially problematic given that research is increasingly showing that keeping fit and active is the key to ageing gracefully and enjoying a long and healthy life.

 

Can scoliosis in adults be treated?

The good news is that through the same treatment approaches which are being used to treat adolescent scoliosis today, its also possible to treat adult scoliosis. Historically, it was thought that only surgical treatment was effective in correcting scoliosis – so with many people unwilling to go under the knife, scoliosis has become a life-limiting factor for many of us. Today, however, conservative methods such as bracing and specialist exercise programs are a time, cost and risk effective way to treat the condition.
For smaller curves, a scoliosis-specific exercise program can be an ideal intervention but by far the best option is a customised scoliosis brace, designed to gently guide the spine back into the proper alignment. Far from the braces used many years ago, our cutting edge ScoliBrace is a low profile, comfortable brace which looks more like a piece of sports equipment than a medical device. Best of all, bracing has been shown to effectively reduce scoliosis and its symptoms, and in some instances can have a noticeable impact in a matter of weeks. Pain especially seems to be reduced through part-time bracing in older adults.

 

How can I get treatment for scoliosis?

While your GP might be the first stop for most conditions (and its certainly worth a visit to rule out anything more serious) there’s a limited amount that your GP can do for you through the NHS. Instead, speak with a spinal specialist, such as a Scoliosis Clinician. At the UK Scoliosis clinic, many of our patients are adult scoliosis sufferers – so if you suspect you may be suffering from adult scoliosis, why not give us a call today and arrange a consultation?

A scoliosis Journey – Week 3

Posted on July 8, 2019 by - Blog

This week, we round out our journey with Patient X – having correctly diagnosed scoliosis and chosen an appropriate treatment methodology, it’s now time to explore her progress and eventual results using the Scolibrace system.

 

5. Treating scoliosis with scolibrace – the results

As you will remember from previous instalments of this series, there are two main categories of scoliosis brace – active correction and “passive” braces. Active correction braces are the type now used by most scoliosis specialist clinics, and have been shown to be highly effective in treating scoliosis.[1] While scolibrace is certainly not the only active correction brace on the market, we firmly believe it is the best available today.

There are two main reasons we believe this – firstly, scolibrace is highly user-friendly. Unlike some braces, scolibrace can be put on and taken off by the wearer without any assistance, it’s also easy to secure, requiring just a couple of Velcro straps to hold it in place. Scolibrace also has a low form factor, meaning it can be worn under clothes without being visible in most cases – and a wide variety of colour choices goes to make this even easier. Being made from the latest materials, and fabricated using CAD/CAM technology scolibrace is also lightweight and so easy to move in that many wearers even leave their brace on to participate in sports activities. Taken as a whole this makes life during bracing very much more comfortable (and far preferable to surgery!).

Perhaps more important in the long term, however, are scolibrace’s results. In the case of patient X (who began treatment with a 33-degree Cobb angle), a one-month in-brace x-ray showed that the curve had reduced to 13 degrees. At the 3 month out of brace x-ray, the curve had reduced to 26 degrees. In just three months the out of brace curve had reduced by 7 degrees.

At this point, the flexibility of the scolibrace design was once again important since, where other systems may require a whole new brace, scolibrace allows extra corrective padding to easily be added to the brace to increase the 3-dimensional corrective action and keep up the progress. At the 12-month mark, an out-of-brace x-ray was taken – The results of which showed that the spine was down to just 11 degrees without using the brace – a reduction of 22 degrees which brought patient X within one degree of “normal” measurement.

The final x-ray for patient X was taken 22 months after the start of treatment after a period of weaning off the brace. This x-ray was an out-of-brace x-ray where the patient was required to be out of the brace for at least 6 hours. The results of the final X-ray showed her spine to have a 6-degree curvature, which according to definition (greater then 10 degrees cobb) cannot be classified as a scoliosis.

The combination with scoliosis specific exercise assisted in speeding the correction of the Cobb angle[2], but also made a substantial contribution to the overall postural correction which scoliosis treatment also provides. Postural assessments showed continuous improvement of her posture with her body showing good balance after 4 months of treatment, with improvements continuing so that she was visually symmetrical by the 12-month mark. The postural improvements were then maintained throughout the treatment period.

One potential risk of scoliosis bracing which has been highlighted is the potential for loss of mobility or deterioration of fitness, however the incorporation of exercises in the program also assisted in this regard[3], such that a functional assessment of fatigue ability and strength of her core muscles, together with the flexibility of her spine showed no deterioration of strength, endurance or flexibility at the end of treatment.

 

6. After scoliosis

After just 22 months of treatment, patient X no longer suffered from scoliosis – an unmitigated success for scolibrace, but what about in the future, could scoliosis reoccur?

While a patient is continuing to grow, there is always the chance that scoliosis could begin to develop again – scoliosis patients should, therefore, be monitored until they have reached adulthood and their skeleton has finished growth. Having said this, recent research has indicated that continuing with some targeted scoliosis specific exercises after bracing can be effective in preventing any loss of correction[4].

So what now for patient X? Having completed her treatment and with a handful of ongoing exercise to keep her on track she’s free to get on with the rest of her life, scoliosis free!

 

scoliosis braces

Scoliosis braces have come a long way!

Could ScoliBrace be right for you?

We hope that this series of articles has been informative and has given you an outline as to the path that a typical non-surgical scoliosis treatment can take. If you have concerns about scoliosis, or would like to find out if ScoliBrace might be right for you, why not get in touch today, and arrange a one to one consultation with our specialists.

 

 

 

 

 

 

[1] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘
Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

 

[2] Negrini S, Negrini A, Romano M, Verzini N, Parzini S: A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis. Stud Health Technol Inform 2006, 123:519-522.

 

[3] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys 2005, 41(2):183-201

[4] Fabio Zaina et al. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT’s 2008 Award for Best Clinical Paper,  Scoliosis 2009, 4:8

 

A Scoliosis Journey: Week 2

Posted on June 22, 2019 by - Blog

Last week we began to explore the case of Patient X – a scoliosis patient who, after successful treatment with a ScoliBrace, avoided the need for corrective surgery and now lives scoliosis free.  This week, we learn about her treatment prescription. If you missed week one, we suggest reading it here first.

 

3. The best treatment?

Having confirmed a scoliosis case and with that case being below the surgical threshold, it was possible to move forward with a non-surgical approach for patient x – but which is the best treatment methodology on offer?

In dealing with any scoliosis case, there are at least three elements to treatment which need to be considered – firstly, the Cobb angle (that is to say, the angle of the scoliotic curvature) needs to be reduced. Secondly the angle of trunk rotation (rib hump) and thirdly, muscular imbalances which have developed alongside the scoliosis, need to be addressed and balanced.

In terms of Cobb angle reduction, Scoliosis braces are the most effective non-surgical approach.[1] There are many different kinds of scoliosis brace and many work slightly differently. Broadly speaking braces can be classified as either active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position). Passive braces which are typically provided by hospitals, once the only option available, obviously do nothing to reduce cobb angle – so bracing with an active correction brace is the recommended approach.

The angle of trunk rotation or the “rib hump” is best addressed by a active scoliosis brace such as Scolibrace which addresses the scoliosis in a 3-dimensional manner, helping to de-rotate the spine to reduce rib hump progression, whilst preserving the spines natural curves in the low and mid-back.

The best approach to correcting the muscular and postural imbalances associated with scoliosis are specialised exercise methodologies which have been designed for scoliosis treatment. There are two main approaches to consider. The first is SEAS or the “Scientific Exercise Approach to Scoliosis”. SEAS consists of an individualised exercise program adapted for the purpose of treating an individual’s scoliosis. Different exercises are used to correct different types and elements of scoliosis, so by combining them in the correct way, an ideal exercise plan can be produced.

SEAS treatment is often used as a stand-alone approach when treating smaller curves and as a compliment to bracing with large curves and where there is a significant risk of progression.

The other main exercised based method, Schroth therapy, is a well-established and easy to use treatment methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis.[2]  As an independent treatment, some studies have shown a reduction of Cobb angle of 10-15 degrees over the course of a year[3] – however, Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly than either approach alone.[4]

Patient x’s scoliosis, being 33 degrees cobb, was already beyond the point where exercise alone would have been an ideal treatment. As the patient was still growing and the curve was already greater than 30 degrees, she was also considered a high risk for her scoliosis to worsen. While this specific combination of factors meant that hers was a high-risk case overall, she was an ideal candidate for correction with a highly advanced scoliosis brace – the ScoliBrace. (This is the brace we offer at the UK Scoliosis Clinic)

In this case, scoliosis specific rehabilitation exercises and use of a scoliosis orthotic device, a Scolibrace, were therefore recommended.

 

4. Treatment with ScoliBrace

ScoliBrace, unlike many braces, is a totally customised, 3D designed, rigid active correction brace. ScoliBrace isn’t just customised for your scoliosis case, you can also choose a colour or pattern which suits your style – or opt for something which matches your skin tone to blend in well.

A ScoliBrace is not like most braces which use 3 point pressure. It uses a 3D inverse correction of the spine ie it shifts the spine into the opposite direction by moving the spine towards the correct position

For Patient X, the scoliosis brace was initially to be worn full-time. This is 23 hours per day with up to a maximum of 4 hours out of the brace if the patient was actively participating in sports during those out of brace hours. Brace wear was started at 2 hours on the first day, followed by adding another 2 hours every subsequent day until the required full-time hours were attained. Time in brace is often adjusted throughout scoliosis treatment period -but is generally high at the start in order to arrest the curve development and begin to reduce it as soon as possible.

Patient X was also given a program of scoliosis specific exercises, which were initially taught in the clinic as twice a week for 3 weeks, followed by once per month. The patient was required to complete the exercises each day out of the brace, but this was easy to do at home and it was included as brace time wear.  A  ScoliRoll (scoliosis orthotic device) was also used daily for 20 minutes to stretch the spine into the opposite direction of the curve, to help improve the spines mobility back to a normal position.

Next week, we’ll focus on Patient X’s progress with ScoliBrace!

 

 

[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine (2018) [Publish Ahead of Print]

[2] Steffan K, Physical therapy for idiopathic scoliosis,  Der Orthopäde, 44: 852-858; (2015)

[3] Kuru T, et al. The efficacy of three-dimensional Schroth  exercises  in   adolescent idiopathic scoliosis: A randomised controlled clinical trial, Clinical  Rehabilitation,  30(108); (2015)

[4] Marinela, Rață;Bogdan, Antohe, Efficiency  of the Schroth and Vojta Therapies in Adolescents with Idiopathic Scoliosis. Gymnasium, Scientific Journal of Education, Sports, and Health Vol. XVIII, Issue 1/2017

A Scoliosis Journey: Week 1

Posted on June 12, 2019 by - Blog

Welcome to this special series of articles from the UK scoliosis clinic. This month is scoliosis awareness month, and throughout June we will be covering a representational example of a scoliosis case, all the way from discovery to diagnosis, treatment to conclusion.  While this series necessarily presents a generalised view of scoliosis treatment as a whole, we hope it will provide a good overview of the treatment process, which will be similar for most cases.

It is scoliosis? It’s not always easy to tell without an x-ray

 

1 . Is that scoliosis?

Most people have never heard of scoliosis, although it’s much more common than you might think. Scoliosis affects about 3 or 4 per cent of children (about one in each class at school) and as many as 40% of the over 60s. Scoliosis is a condition of the spine which causes it to curve away from its natural (fairly) straight alignment when viewed from behind. When viewed from the side the spine does curve gently forwards and backwards – these curves are known as Kyphosis, and Lordosis, and are a normal and important part of the way your spine works. A small bend in the spine, less than 10 degrees is considered normal and not a cause for concern – but in cases which need treatment, curves can often exceed as much as 50 degrees, 5 times that “normal” figure.

While this is all great information, we can’t usually see our spines or our children’s spines – and unless you’ve had cause to have a chest x-ray or similar taken its unlikely that you ever would have, so how can we recognise scoliosis in the first place?

In many countries around the world, Scoliosis is a condition for which there is a national screening program. In the same way that many of our children receive immunisations through their school, if you happen to be born in the right country, you’ll also get a Scoliosis screening. Screening allows scoliosis to be spotted very early and therefore treated most effectively. In the UK however, there is no such program, so here most scoliosis cases are spotted by family members, friends, or (often in the case of teenagers) by the sufferer themselves.

Take our case here, patient X. Patient X is a 16-year-old female, who initially complained about what appeared to be poor posture. The ‘x’s marked on her back show exactly where each of her vertebrate is, but you can imagine that without these markings, it simply looks as if she is standing awkwardly, or, like many teenagers, has awful posture! As you can see from the X-ray on the right, however, this is, in fact, a fairly well-advanced scoliosis case.

 

So how do we spot scoliosis? The main points to ask yourself are –

  • Are the shoulder’s level or uneven?
  • Is the waist even on each side? Or is one side straighter and the other more rounded or prominent?
  • Does one side look like it’s folded down or have a large skin crease?
  • Are the shoulder blades level? Does one stick out more than the other?
  • With straight legs, bending forward from the waist and with the hands between the knees is one side of the rib cage higher than the other, or is the lower back more prominent than the other, if yes, this indicates scoliosis.

 

It wasn’t a scoliosis screening which highlighted this example – In-Patient X’s case, it was this poor posture, and some mild back pain which brought her in for a scoliosis screening – importantly, she also participated in ballet (research shows that ballet dancers have a higher incidence of scoliosis) and had a family history of scoliosis. While these facts probably didn’t seem relevant to her at the time, they sounded all too common to the scoliosis professionals. According to the patients’ mum, she had no major issues growing up and all major growth milestones passed without incident – but for the back pain and the fact that she noticed the poor posture, this case would have continued to progress. It’s hard to say when the case actually began, but it’s entirely possible it had been developing for several years, and early screening could have detected this.

 

2. So, its Scoliosis.

A scoliometer, which helps us to measure and understand a Scoliosis case

Thankfully, patient X was seen at a scoliosis clinic within just weeks of her initial diagnosis. A simple scoliosis screening, coupled with a measurement from a device known as a scoliometer revealed the presence of all the warning signs, and at her follow up appointment the above x-ray confirmed the presence of scoliosis.

But when we say “scoliosis” – what do we really mean? This is a complex question since each and every scoliosis case is different and occurs in 3D. While we typically define scoliosis as a curvature of the spine when viewed from the rear, the condition is always more complex than this explanation makes it sound. In addition to the curvature, the vertebra will usually be rotated to some extent and may also be subject to damage or malformations as a result, or even as a cause of the Scoliosis. Scoliosis cases can curve in different directions and the vertebra which is most displaced from the centreline will also vary. Some scoliosis cases consist of a single curve, whereas others consist of a major curve and an opposite “compensatory” or secondary curve.  Scoliotic curves can also develop in different regions of the spine, or more than one region.

Therefore, receiving the diagnosis of “scoliosis” is only the first step. Using a variety of sophisticated imaging technologies, it was possible to classify and understand patient x’s scoliosis – hers was a 33 degree, left thoracolumbar scoliosis with significant rotation of the vertebra in the lumbar spine, the condition was causing poor posture and had also become painful. There’s no question that this is a complex diagnosis and one which only 10 years ago would almost certainly have ended in surgery, but thanks to the advanced research in the field of scoliosis correction, it’s the kind of case that today we can successfully treat non-surgically.

What’s critical to appreciate, however, is the complexity of this and the vast majority of scoliosis cases. Patient X (as we will see in coming segments) was treated with great success, without surgery, and no longer suffers from scoliosis – but this result has been almost entirely attributable to the highly individualised, customised treatment plan she received. More about that, next week.

 

Scoliosis awareness month 2019 – Special events at the UK Scoliosis clinic

Posted on June 3, 2019 by - Blog

A year has almost gone by already, and its nearly time for scoliosis awareness month 2019.

Scoliosis awareness month was originally set up by the National Scoliosis Foundation in the US, and has since been endorsed by the Scoliosis Research Society and the Society On Scoliosis Orthopaedic Rehabilitation and Treatment (SOSORT), meaning that many of the most important organisations in the world of scoliosis treatment now support this special month. This year, as always, we are aiming to:

 

  • Highlight the importance of early detection and the effectiveness of bracing as an effective form of non-surgical treatment for scoliosis.
  • To have every state, district and commonwealth to officially declare by proclamation their observance of National Scoliosis Awareness Month during the month of June.
  • Increase public awareness of scoliosis and related spinal deformities through educational and advocacy campaigns of local activities, and community events during the month of June and throughout the year
  • Unite scoliosis patients, families, physicians, and clinicians in a collaborative partnership that educate, and advocate, for patient care, patient screening, patient privacy, and patient protection
  • Build networks of community collaborations and alliances to help sustain and grow the campaign

 

Originally a one-off event, scoliosis awareness month is now held in June each year, and it’s a prime opportunity to raise awareness and create the opportunity for those in the community to access screening and treatment. The fact that the event has now gone yearly is a fantastic indication that the message about scoliosis is getting out there, but with so many people requiring surgeries which could have been avoided each year, there’s still more work to do!

 

What is the UK Scoliosis clinic doing in June 2019?

At the UK scoliosis clinic, we have several special events confirmed for this year:

Free screening days

This year, we will be running at least one (but perhaps more, subject to demand) free scoliosis screening days. At a free screening, it will be possible for members of the public to be professionally evaluated for scoliosis by our scoliosis professionals. Screening is a fantastic idea for anyone who is at a high risk of scoliosis but can also be used to rule out scoliosis as an underlying or causal factor in another complaint.

We will be running a free screening day at the clinic on June 15th – if you would like to attend please grab yourself a slot on our Eventbrite page and if you’re on Facebook, sign up to our event page to get the latest updates here.

Screening takes about 15 minutes and will be performed in privately with our scoliosis clinicians. Screening is suitable for individuals of any age, but keep in mind the risk is greatest in children aged approximately 10-18.

Early detection of scoliosis is one of the most important factors in ensuring a positive outcome for each case, and gives the greatest possible latitude for conservative, non-surgical treatment so succeed – don’t miss this free opportunity!

 

Special Initial consultation offer

Throughout June, those who already suspect they have scoliosis or have had a positive screening result will be able to book an initial consultation at the reduced price of just £45. At your initial consultation, a suspected or confirmed scoliosis case will be thoroughly investigated, and a detailed case history will be taken to assess your risk of progression and the best treatment options available. If you do not already have X-rays for your case, these will be available for a small additional fee, on-site, at your consultation.

 

Special blog series

During June, we’ll also be running a special blog series which will give step by step instructions for parents and guardians who are concerned about children with scoliosis – we’ll be starting at initial diagnosis and working all the way through to the end of treatment to give you a good overview of the whole process.

 

Free X-ray review

If you have X-rays already and would like an initial (or second opinion) please feel free to take advantage of our free x-ray review service. While this service isn’t a standalone diagnostic tool (an initial consultation is needed to confirm and characterise the presence of scoliosis) it is an excellent way to determine whether a case warrants further investigation.

 

Scoliosis awareness – what can I do?

While scoliosis is now becoming easier than ever to treat, at least when spotted early, one of the biggest issues we face today is the fact that most people are still unaware of it. Although scoliosis affects approximately 3 or 4 percent of children, and as much as 40% of the over 60’s many people have never even heard of the condition.

This lack of awareness means that parents, friends and carers – with the best will in the world – just don’t know the signs or what to do if they have concerns. There have been well-organised campaigns to make the public aware of potentially serious conditions, such as meningitis, in children and adolescents, but almost nothing on scoliosis.

Simply talking to friends and family about scoliosis can, therefore, make a massive impact. Using tools like ScoliScreen, its easy to estimate your risk profile and to find out how to seek help, but raising initial awareness depends upon conscientious members of the public highlighting the issue – during June, speak to friends and loved ones about scoliosis, and point them to our free resources, working together we can prevent hundreds, if not thousands of unnecessary surgeries this year!

 

 

At what age am I at the greatest risk of scoliosis?

Posted on May 17, 2019 by - Blog

Scoliosis, like many conditions, is most common in certain age groups – and as a consequence, we recommend that these individuals be the most careful when checking for symptoms. The simplest answer to the question is that young adults are generally considered to be at the highest overall risk – but in fact, this question is a complicated one which is worth some discussion.

 

Scoliosis and age of diagnosis

Scoliosis is a difficult condition to diagnose – in large part, this is due to the complex nature of the condition and the fact it causes an individualised, three-dimensional shift in the spine. The rate at which scoliosis develops also varies, and is usually associated with growth spurts, rather than being steady.

One major challenge with scoliosis cases is estimating exactly when the condition began. Because scoliosis is very hard to detect (unless an individual is properly screened) until it has become large enough to cause visual distortions to the patient’s body, a diagnosis is often not made until the condition has existed for some time. Ideally, we would like to know when scoliosis began, as this has an impact on future prognosis – but in most cases, scoliosis is simply classified by the time it is diagnosed, not necessarily when it actually began.

 

Scoliosis in children is typically grouped into one of three types:

Infantile scoliosis – diagnosed in children from 0 -3 years old

Juvenile scoliosis – diagnosed in children from 4 – 10 years old

Adolescent scoliosis– Diagnosed in children and young people from 10 – 18 years old

 

Scoliosis first diagnosed in individuals older than 18 is classified as adult scoliosis and could be either a case of scoliosis which has progressed undetected throughout childhood (common in younger individuals) or a case caused by degeneration of the spine and supporting structures, known as de-novo scoliosis. (Very common in the over 60’s)

 

Which age group is most at risk?

While much of the literature on scoliosis focuses on scoliosis in younger people, the statistics are clear – the most affected group is actually the over 60’s, mainly from De-Novo scoliosis. While about 3 or 4 % of young people suffer from scoliosis, nearly 40% of the over 60’s have the condition.

Statically, Infantile scoliosis is the least common of all and comprises only about 1% of all idiopathic scoliosis in children. Unlike most forms of Scoliosis infantile scoliosis is more common in males – about 60% of patients are boys.

Juvenile scoliosis is less common than adolescent scoliosis but more common than infantile scoliosis – Juvenile scoliosis comprises approximately 10-15% of idiopathic scoliosis cases and is slightly more common in younger males and older females within this age range.

Adolescent scoliosis makes up the majority of cases in young people, somewhere between 80 and 85%. Whereas infantile and younger Juvenile scoliosis cases are more common on boys, 80% of all adolescent cases are girls. The very highest point for diagnosis is around 11-12 years of age in girls and slightly later in boys.

 

Risk of progression and severity – the key factors

If it’s actually older people who are most likely to suffer from scoliosis, why does most scoliosis treatment focus on the young? It’s an important question which goes to the heart of scoliosis itself and its treatment.

Scoliosis can vary hugely in its severity and its speed of progression – but in all cases, once scoliosis has started to develop, it generally does not stop until a young person has reached skeletal maturity. This means that the younger a scoliosis patient, the longer the condition has to develop to the point at which it becomes debilitating or requires major surgery to correct.  What’s more, scoliosis is closely linked to growth spurts – often worsening substantially over just a few months during a growth phase. Since younger children have much growth ahead of them, the risk of progression is significant.

It’s this risk of progression and the initial degree of the curvature which means cases in younger people are often considered as more serious – De-novo scoliosis, the form most commonly found in older adults, while a problematic condition, tends to be much less substantial in magnitude and much slower in progression. Addressing the problem can lead to a significant improvement in quality of life, but urgency is less of a factor.

By contrast, some research has demonstrated that Juvenile scoliosis greater than 30 degrees almost always increases rapidly and presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[i]

Today, with modern bracing technology, it has been demonstrated that timely conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis – and research has suggested drastically different outcomes. In one recent study of Juvenile 113 patients treated with bracing, the vast majority achieved a complete curve correction, and only 4.9% of patients eventually needed surgery.[ii]

While cases detected in adolescents do have less time to develop, they are often more severe once detected (they may well have began as a Juvenile anyway) and the high volume of cases in this age range means that this group are considered to be at the most risk. It’s thought that the changes which occur during puberty may be linked to the onset or progression of scoliosis, which may account for the spike in cases in this age range. If 3 or 4% of young people in this age bracket will develop scoliosis, that’s about one in each class at school and in most cases,  there will still be enough time for scoliosis to progress to the surgical threshold or at least cause significant disability.

 

So, who is at the greatest risk?

The answer to this question is simply that everyone should be aware of scoliosis, and take the simple steps needed to screen for the condition and address it early on. Our ScoliScreen tool is a great place to start.

Scoliosis in infants is certainly rare, but obviously presents the greatest possible opportunity for the condition to worsen over time. Juvenile scoliosis is also fairly uncommon, but the prognosis is not good if the condition is not treated early on. Most younger scoliosis patients are diagnosed as adolescents, meaning that children from 11-15, in particular, should be screened regularly.

Older individuals, while likely to develop a less severe form of scoliosis, have about a 4 in 10 chance of developing the condition over the age of 60.

If you are concerned about scoliosis, why not try out ScoliScreen tool, or get in touch today to arrange a professional consultation.

 

 

[i] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[ii] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

I have Scoliosis – will my children have Scoliosis?

Posted on May 3, 2019 by - Blog

One of the questions which scoliosis sufferers often ask is as to whether they would be likely to pass scoliosis on to any children they may have. This is a good question since research does suggest that scoliosis (like most conditions) can run in families. Having said this, much more research is required before we can give a definitive answer, but here’s an overview of the latest thinking.

 

Is scoliosis genetic?

Before answering this question its important to remember that in children at least, 80% of all scoliosis cases are still considered idiopathic  – this literally means “without known cause” – so while we can make some useful observations on this topic, science is yet to form a complete conclusion, and that should be kept in mind.

It’s also important to be clear about the kind of scoliosis which is being discussed here – the causes of some forms of scoliosis are known. For example, de novo scoliosis in the over 60’s is caused by degeneration of the spine, while other genetic and neurological disorders (which certainly can be communicated to children) can also cause scoliosis. Here, we’ll be discussing the 80% of cases which are currently considered “idiopathic”.

One thing certainly has been established with clarity – results show that no ethnic group seems to be invulnerable to scoliosis, as is the case with some genetic conditions. Research suggests that whatever your heritage, scoliosis could be a risk.[1]

 

Scoliosis in twin studies

Perhaps the best way to study the importance of genetics in the inheritance of a certain condition is through the conduct of twin studies. Because of the unique relationship which twins have, they help researchers to examine the overall role of genes in the development of a trait or disorder.  Comparisons between monozygotic (MZ or identical) twins and dizygotic (DZ or fraternal) twins are conducted to evaluate the degree of genetic and environmental influence on a specific trait.  MZ twins are the same sex and share 100% of their genes.  DZ twins can be the same- or opposite-sex and share, on average, about 50% of their genes.

If MZ twins show more similarity on a given trait compared to DZ twins, this provides evidence that genes significantly influence that trait.  However, if MZ and DZ twins share a trait to an equal extent, it is likely that the environment influences the trait more than genetic factors.

So what do twin studies say about scoliosis? Such an approach has suggested that scoliosis may have a familial link since at least as early as 1922[2] and since then reports of multiple twin sets and twin series have consistently shown higher concordance (that is to say, similarity)  in monozygotic (MZ) compared to dizygotic (DZ) twins[3] – indicating a strong genetic link.  A meta-analysis of these clinical twin studies revealed 73% MZ compared to 36% DZ concordances[4]. Interestingly, in this series, there was a significant correlation with curve severity in monozygous twins but not dizygous twins. No correlation with curve pattern was found either, suggesting the importance of genetic factors in controlling susceptibility and disease course, but not necessarily disease pattern.

 

Will I pass scoliosis on to my children?

If research clearly shows that there may well be a genetic link, what are your chances of passing on scoliosis? One study[5] has tried to estimate the approximate chances, by comparing scoliosis prevalence with other common genetic diseases such as rheumatoid arthritis (RA), Crohn’s disease (CD), type 1 diabetes (T1D), or psoriasis vs the general population. The following table illustrates the findings and provides at least some broad context.

 

Calculated Sibling Risk Ratios for IS are Comparable to Other Well-Studied Complex Genetic Diseases

 

Disease Prevalence Risk ratio  
RA .01 2-17
CD .001 10
T1D .007 15
Psoriasis .02 4-11.5
IS (≥10°) .03 8
IS (≥20°) .005 23

 

The main message here is therefore that the more severe your scoliosis, the more likely you are to pass scoliosis on to your children – however, rheumatoid arthritis (RA), Crohn’s disease (CD), type 1 diabetes (T1D), or psoriasis are all more likely to be passed on than scoliosis resulting in a small curve, and scoliosis with a large curve is only fractionally more likely to be passed on than rheumatoid arthritis.

Therefore, research certainly suggests that if you have scoliosis, you do have a risk of passing it on to your children. Given the advances in treatment technologies however, this should not be a reason to put off having children in this day and age. Parents with scoliosis should of course be diligent with screening and monitoring for scoliosis, but in all fairness the same should go for all parents – not just scoliosis sufferers.

 

 

 

[1] Herring JA. Tachdjian’s Pediatric Orthopaedics. Philadelphia: WB Saunders; 2002. Scoliosis; p. 213.

[2] Staub HA. Eine skoliotikerfamilie.Ein Beitrag zur Frage der kongenitalen Skoliose und der Hereditat der Skoliosen. Z. Orthop. Chir. 1922;43:1

[3] Horton D. Common skeletal deformities. In: Rimoin DL, Conner MJ, Pyeritz RE, Korf BR, editors. Emery & Rimoins Principles and Practices of Medical Genetics. Amsterdam: Churchill Livingstone Elsevier; 2002. pp. 4236–4244

[4] Kesling KL, Reinker KA. Scoliosis in twins. A meta-analysis of the literature and report of six cases. Spine. 1997;22:2009–2014.

[5] ‘Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’

Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

Does Scoliosis cause Neck pain?

Posted on April 15, 2019 by - Blog

For some time, it has been thought that common problems such as back and neck aches and pains were not a symptom of scoliosis. Even many scoliosis specialists did not necessarily consider pain to be an important indicator of a problem – however, over the last few years, various studies have demonstrated that back pain at least is correlated with scoliosis, and new research now also suggests that neck problems are a common issue.

 

Back pain and Scoliosis.

While it was once thought that back pain was not necessarily correlated with scoliosis (since scoliosis certainly can exist without pain) it has become increasingly clear that there is a link.

Indeed, research from the last few years has sown that spinal pain is, in fact, a frequent condition in scoliosis patients, further supporting the need for early detection and screening to minimise potential pain and suffering[1]. Furthermore, in one study of patients under 21 treated for back pain, scoliosis was the most common underlying condition (1439/1953 patients)[2] and in another of 2400 patients with AIS, 23% reported back pain at their initial contact[3].  Chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than seen in adolescents without scoliosis (33%)[4], while patients diagnosed with AIS at age 15 are 42% more likely to report back pain at age 18.[5]

We also now know that part-time bracing in adult scoliosis cases can improve chronic pain[6] and that taken as a whole Scoliosis patients have between a 3 and 5 fold increased risk of back pain in the upper and middle right part of the back.[7]

At the very least, this evidence suggests we should reevaluate our view of the relationship between Scoliosis, and pain.

 

Scoliosis and neck pain.

Perhaps the most obvious common features of the studies just discussed is their focus on back pain. This certainly sensible, after all, scoliosis primarily affects the thoracic and lumbar spine – but this does beg the question – what about neck pain?

Studies examining scoliosis and neck pain are much more sparse, however, at least one 2017 study[8]does provide some useful insight.

The large scale study, conducted across the Karolinska University Hospital, Stockholm; the Skåne University Hospital, Malmö; the Sundsvall and Härnösand County Hospital, Sundsvall, and Sahlgrenska University Hospital, Gothenburg, sought to understand what if any correlation existed between scoliosis and neck problems.

One thousand sixty-nine adults with a mean age of 40 years, diagnosed with idiopathic scoliosis in youth, answered a questionnaire on neck and back problems. Eight hundred seventy of these answered the same questionnaire on a the second occasion in a mean of 4 years later. Comparisons were made with a cross-sectional population-based survey of 158 individuals. Statistical analyses were made with logistic regression or analysis of variance, adjusted for age, smoking status, and sex.

The results were telling – Individuals with scoliosis (either treated or untreated) had a higher prevalence of neck problems –  42% compared to 20% of the control group (non-scoliosis patients). Interestingly, the study also showed that there was no correlation between the methodology used to address the scoliosis, or by the age of onset of scoliosis; juvenile or adolescent – which suggests the risk is the same regardless of how you approach scoliosis treatment.

Given the prior interest in back pain and scoliosis, this study also provided some interesting information on the two as a combined issue  – if neck and back problems were taken together, then the percentage of scoliosis patients experiencing problems increased to 72% , while the control group rose to 37%.  Of the individuals with scoliosis having neck problems, 81% also reported back problems, compared to 59% of the individuals in the control group.

 

Conclusions

Given the research which has already taken place on back pain and with this 2017 study in mind, it seems fair to suggest that neck problems are more prevalent, and more often coexist with back problems in individuals with idiopathic scoliosis than in non-scoliosis patients – and indeed, many scoliosis patients seem to suffer from both of these issues.

For us as a clinic, this stands out as an area for further study and research – it perhaps telling that the current version of the widely used and validated Scoliosis Research Society (SRS)-questionnaire (at the time of writing) does not even include questions on neck pain.

At the UK scoliosis clinic, we do take pain into consideration when diagnosing and treating scoliosis – and as a broad-based clinic dealing with multiple complex postural issues, we have other screening tools on hand to assess and monitor neck pain, however, going forward it may well benefit the field for neck and back pain, to be considered with greater weight when diagnosing scoliosis.

 

[1] ‘Back Pain and Adolescent Idiopathic Scoliosis: A Descriptive, Correlation Study’,
Theroux Jean, Le May Sylvie, Labelle Hubert [University of Montreal, Quebec, Canada; Murdoch University, Perth, WA, Australia], Spine Society of Australia 27th Annual Scientific Meeting (8-10 April 2016)

‘Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis A Cross-sectional Study’
Jean Theroux, DC, MSc, PhD, Sylvie Le May, RN, PhD, Jeffrey J. Hebert, DC, PhD,and Hubert Labelle, MD : SPINE 153607

[2] Dimar 2nd JR, Glassman SD, Carreon LY. Juvenile degenerative disc disease: a report of 76 cases identified by magnetic resonance imaging. Spine J. 2007;7:332–7.

[3] Ramirez N, Johnston CE, Browne RH. The prevalence of back pain in children who have idiopathic scoliosis. J Bone Joint Surg Am. 1997;79:364–8

[4] Jean Theroux et al. Back Pain Prevalence Is Associated With Curve-type and Severity in Adolescents With Idiopathic Scoliosis Spine: August 1, 2017 – Volume 42 – Issue 15

[5] Clark EM, Tobias JH, Fairbank J. The impact of small spinal curves in adolescents that have not presented to secondary care: a population- based cohort study. Spine (Phila Pa 1976) 2016; 41:E611–7.

[6] Scoliosis bracing and exercise for pain management in adults—a case report
Weiss et al, J Phys Ther Sci. 2016 Aug; 28(8): 2404–2407.

[7] Sato T, Hirano T, Ito T, Morita O, Kikuchi R, Endo N, et al. Back pain in adolescents with idiopathic scoliosis: epidemiological study for 43,630 pupils in Niigata City. Japan Eur Spine J. 2011;20:274–9

[8] Christos Topalis, Anna Grauers, Elias Diarbakerli, Aina Danielsson and Paul Gerdhem, Neck and back problems in adults with idiopathic scoliosis diagnosed in youth: an observational study of prevalence, change over a mean four year time period and comparison with a control group Scoliosis and Spinal Disorders 2017 12:20