Category: Blog

The UK Scoliosis Clinic is in this week’s OK magazine

Posted on October 27, 2018 by - Blog

If you pick up a copy of OK magazine this week you’ll find some great info form our own Dr Paul Irvine in the health section. We’re really excited to be getting this message out about scoliosis and how to spot it, since early detection makes such a huge difference.  This week, let’s review some of the key symptoms to look out for.

Scoliosis : what to look out for

We’re in this week’s OK!

Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but as we pointed out in OK, it’s about one per class at school.  Among adults over 50, the rate is as high as 40% – this means that you almost certainly know at least a few people with scoliosis.

Scoliosis is a complex condition and can affect individuals in different ways. In fact, scoliosis is often difficult to detect early on, which is why screening is so important.

When scoliosis has first started to develop, visual symptoms are often the main issue – uneven shoulders, hips, or a rib hump are commonly noticed. While these symptoms don’t necessarily pose a significant health risk on their own, they are strongly associated with psychological problems, such as low self-esteem, anxiety and depression.

Once scoliosis develops and becomes more pronounced it can have an impact on everyday life as well as being more obvious visually. Symptoms might include:

  • Changes with walking. When the spine abnormally twists and bends during walking, it can cause the hips to be out of alignment which changes a person’s gait or how they walk. You might also notice you get tired quickly when walking.
  • Reduced range of motion. You might notice a reduced flexibility, or even pain and stiffness when moving.
  • Trouble breathing. If the spine rotates enough and diverges from its normal position enough, the rib cage can twist and tighten the space available for the lungs.
  • Cardiovascular problems. Similarly, if the rib cage twists enough, reduced spacing for the heart can hamper its ability to pump blood.
  • Many scoliosis patients report back pain ranging from moderate to severe. More research is required to determine if scoliosis is the main cause of the pain or if the pain is associated with issues, such as muscle tightness, which come with scoliosis, but pain is nonetheless often the symptom which causes people to seek treatment.

 

How can I screen for scoliosis?

Screening for scoliosis is easy and takes about 5 minutes – you can learn more about how to screen for scoliosis here, or use our ScoliScreen tool, which will guide you through the process.

 

Spot scoliosis early and improve your prognosis!

Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery[1]

In the 2015 study, it was shown that curve correction was accomplished in 88 patients (77.8%) and stabilization was obtained in 18 patients (15.9%). Only 7 of the patients (6.19%) had progression of their scoliosis, and only 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early.[2]

 

Have questions about scoliosis?

If you have questions about scoliosis, feel free to get in touch with us by phone or email – or upload your x-rays for a free scoliosis assessment.

 

 

[1] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner‘ and 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] Ibid.

Scoliosis FAQ with Dr Paul Irvine

Posted on September 30, 2018 by - Blog

This week, we take some of the most frequently asked questions we have here at the clinic and put them to our founder, Dr Paul Irvine. While these quick FAQ’s are a good starting point, please keep in mind that scoliosis is a complex, 3D condition which requires a personal treatment plan designed by a scoliosis professional to treat properly.

As always, if you have you own questions, just get in touch.

 

What causes scoliosis, can anyone get Scoliosis?

Paul with Tony Betts at the 2018 SOSORT conference

There are two types of scoliosis – scoliosis in adults, which is sometimes known as “degenerative”  scoliosis and scoliosis in children.

Degenerative scoliosis is just that – the product of degeneration of the spine with age. Degenerative (also called de-novo) scoliosis is actually much more common than many people think, nearly 40% of adults over 50 will experience it.

The other main type of scoliosis is childhood scoliosis – the truth  is that we aren’t 100% sure what causes childhood scoliosis. While about 20% of cases can be attributed to an underlying condition, spinal deformity or a neurological or congenital cause, 80% of scoliosis cases are classified as “Idiopathic” scoliosis. Idiopathic literally means “without known cause”.

Having said that, researchers believe there are some common threads which may raise your risk of scoliosis.  Firstly, some studies have suggested that certain activities, such as ballet, gymnastics and dancing might predispose someone to scoliosis – One study has suggested that gymnasts are as much as 12 times more likely to develop scoliosis, for example.

Secondly, having a family member with scoliosis does seem to predispose someone to developing the condition.

 

Do genes play a part in scoliosis?

We know that individuals with a family history of scoliosis are more likely to develop scoliosis than those without – this strongly suggests that there may be a genetic cause (or contributor) to the development of scoliosis. There is research being carried out in this area at the moment, but at this time there is still insufficient evidence to make a definite conclusion.

 

How common is Scoliosis? 

Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  Among adults over 50, the rate is as high as 40% – this means that you almost certainly know at least a few people with scoliosis.

 

Will Scoliosis go away on its own?

On this issue research is clear – scoliosis almost never resolves on its own, whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction. The exception to this rule is infantile scoliosis, which does sometimes resolve on its own – however if you suspect infantile scoliosis you should seek a professional consultation as soon as possible.

 

Does scoliosis affect males and females equally?

No. While both boys and girls can and do develop scoliosis, but 70% of cases are girls (with ballet dancers and gymnasts being 12 times more likely to be affected). My professional experience at the clinic backs this up – the majority of cases we see are females. That being said, its possible that scoliosis might be more prevalent in boys than we yet know.  Since girls are far more likely to be involved in sports such as ballet and gymnastics (where coaches now often look for scoliosis) the figures might be slightly skewed in their favour simply because scoliosis in girls is more often noticed.

 

Is scoliosis most common in young people, whose spines are still developing?

As we already mentioned, scoliosis is common in both adults and children. The cause in adults is usually spinal degeneration and is better understood.  Scoliosis in children usually starts to develop between 10 and 15, but the rate of scoliosis development increases rapidly form age 11 to 14.

 

How serious does scoliosis need to be before surgery is the only option?

When we talk about the severity of scoliosis, we consider a measurement known as cobb angle – cobb angle is simply the degree of curvature of the spine away from the normal position.

As a general rule, a cobb angle over 45 degrees will often be considered an indicator for surgery, however some braces (such as our ScoliBrace) have been shown to be effective in reducing the progression of scoliosis and improving the curve in patients up to 60 degrees cobb.

At our clinic we often combine bracing with exercise-based approaches to scoliosis treatment, such as SEAS and the Schroth method. These approaches teach patients to actively correct their scoliosis using physical therapy exercises and can be effective for treating small curves (less than 20 degrees) as a standalone treatment. That being said, many parents prefer part time, or night time bracing in these situations as exercise must be performed correctly and routinely to have a chance of success.

The latest generation of scoliosis braces are far more effective than older versions. There has been a great deal of research in the field over the last 10 years, so that today the majority of patients who wear a brace will see significant curve correction, and there is an excellent chance of complete correction of the scoliosis – especially when spotted early.

 

What is the prognosis for people with scoliosis? Can it be completely cured?

This depends mainly upon age and the severity of scoliosis. If curves are spotted early and treated before they reach 30 degrees, there is an excellent chance of avoiding surgery and it is highly likely that a complete or near complete curve correction can be achieved.

To give some numbers, studies show that 30-50% of scoliosis cases which are left untreated progress to the surgical threshold – whereas when bracing is used 70-90% will not progress and can be improved. Roughly 10% of cases will progress to surgery despite bracing.

Without a doubt, some cases will always progress even with bracing, however a significant number of the 10% of cases which do not respond to bracing will be as a result of the patient not wearing the brace for the allotted time.

In cases where bracing is not successful, surgery remains an option. At our clinic we strongly encourage people to try modern non-surgical approaches before taking the considerable step of undergoing a surgical procedure, as this comes with many risks and complications – but there is no doubt that orthopaedic surgeons can do fantastic work in treating scoliosis in cases where non-surgical approaches are not successful.

 

Does poor posture cause Scoliosis?

While many people with scoliosis might report poor posture, it is not thought that poor posture causes scoliosis. The main known factors are heredity and participation in some sporting activities, as mentioned above. There has been a small amount of research which has suggested that factors such as diet may have an impact, but far more research is needed before anything authoritative can be said in that regard.

 

Is there anything I can do to avoid scoliosis?

The best way to reduce your risk of having your life limited by scoliosis is to regularly screen for scoliosis in the first place. Scoliosis which is spotted early is much easier to treat and can almost always be prevented from developing.

There is no research which clearly indicates any positive action will reduce the chance of scoliosis developing – although avoiding ballet, gymnastics etc. might reduce risk.

Since that isn’t much fun – especially for young girls – Scoliosis screening is the best thing to do. Screening is easy to do (we even have an online screening tool people can use) with their friends or family at home – self screening takes about 5 minutes!

A great deal of research recommends screening in schools as a method for spotting scoliosis early – and most researchers agree that screening is an effective way to reduce the number of patients eventually requiring surgery. In the UK scoliosis screening is not implemented in schools, although some sports clubs (particularly ballet) do perform screening.  By contrasting example, Hong Kong offers scoliosis screening to all students.

 

Can I check if my child has scoliosis?

You certainly can, and it’s easy to do. We have an online tool called scoliscreen which you can use to perform a screening at home (try here) or you can simply follow the simple screening guidelines on this page. If you do suspect scoliosis, be sure to get a professional consultation from a scoliosis practitioner sooner rather than later. Most reputable clinics should offer this service for free.

 

Will scoliosis go away on its own?

Posted on September 22, 2018 by - Blog

When you or a loved one are first diagnosed with scoliosis its natural for your first thoughts to be about the best treatment available – and perhaps whether treatment is even necessary. Indeed, many medical professionals today still believe that a “wait and see” approach is the best way forward in most scoliosis cases. Despite this view, research is clear – scoliosis almost never resolves on its own whereas proactive treatment carries a very high success rate. Left untreated, scoliosis can be a life limiting condition, whereas the majority of patients treated with non-surgical methods today can live a totally normal life and often experience total curve correction.

 

What’s wrong with wait and see?

“Wait and see” is never the best approach

The “wait and see” approach (often called observation) means simply watching and waiting to see if a scoliosis case gets worse. This approach is based upon the (now outdated) view that surgery is the only effective option for scoliosis treatment. If your doctor or medical professional has recommended “wait and see” this does not mean they are being negligent however – historically surgery was thought to be the only effective treatment for scoliosis but today there are a wide variety of effective non-surgical options.

Non-surgical treatment for scoliosis has been shown to be successful up to 60 degrees cobb angle (cobb angle is the measure of scoliosis curvature), but the best results can be achieved when scoliosis is treated early.  Since the objective of observation is simply to see if the scoliosis progresses to a significant enough curve to require surgery (typically 40 degrees plus) patients are often told to simply keep “waiting and watching” while their opportunity to maximise non-surgical approaches sadly slips away.

It can not be stressed enough that if you have been diagnosed with scoliosis and have been advised to “wait and see” you should contact a scoliosis clinic and schedule a consultation as soon as possible.

 

What happens if scoliosis is left untreated?

If scoliosis is left untreated, or a policy of “observation” is employed, scoliosis is overwhelmingly likely to continue to progress. In the very small number of cases where scoliosis does not progress it will certainly not reduce – meaning that (at best) the patient spends the rest of their life with symptoms associated with scoliosis.

Research has demonstrated that cases of Juvenile scoliosis greater than 30 degrees tend to progress quickly – studies suggest that 100% of these patients will progress to the surgical threshold. Juveniles with curves from 21 to 30 degrees are more difficult to predict in terms of progression but can frequently end up requiring surgery, or at least are left living with significant disability.[1]

In cases which do not progress to the surgical threshold there are still many common symptoms which scoliosis sufferers will experience throughout their life without treatment. Some of the most common include pain, physical deformity, limited mobility and difficulty breathing during exercise.[2] Some recent research has also suggested that even a small cobb angle can have a significant negative impact upon a person’s ability to be active and keep fit and healthy.[3] Since we understand how important staying fit and active is to long term health, it is also fair to say that left untreated scoliosis could be a predictor for longer term health problems.

 

How can scoliosis be treated?

Today (while surgery remains and option for severe cases) most scoliosis patients can be treated non-surgically, although the sooner treatment is sought the better the prognosis and the simpler the treatment program required. Whereas “wait and see” can result in as much as 100% of patients progressing to the surgical threshold, through modern bracing technology it has been demonstrated that conservative treatment with a brace can reduce the number of patients requiring surgery to as low as 4.9% – in addition the vast majority of patients can active complete curve correction.[4]

 

 

[1] 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.

[2] Sperandio EF, Alexandre AS, Yi LC, et al. Functional aerobic exercise capacity limitation in adolescent idio- pathic scoliosis. Spine J. 2014;14(10):2366–72. PubMed doi:10.1016/j.spinee.2014.01.041

[3]  SARAIVA, BA; et al. “Impact of Scoliosis Severity on Functional Capacity in Patients With Adolescent Idiopathic Scoliosis”. Pediatric Exercise Science. 30, 2, 243-250, May 2018

[4] ‘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

My child has Scoliosis: Top 10 things to do right away

Posted on September 11, 2018 by - Blog

 

If you have recently discovered that your child has scoliosis, or you suspect that scoliosis might be an issue it can often be a stressful and confusing time. There is a great deal of new information to consider and often it can seem there simply isn’t enough time.

To help out with this, here’s out top 10 list of things that you should do when first considering scoliosis treatment.  Get these 10 done, and you’ll be well on your way!

 

 

1 – Screen for scoliosis at home

If you have already had your child screened for scoliosis, either at home or by a professional you can skip this step. If you have not yet performed a scoliosis screening however, begin here.

Scoliosis screening is easy to do at home using our ScoliScreen tool. ScoliScreen was developed in Australia by our partner ScoliCare, who spent years researching and designing the easiest home screening tool available. Screening with ScoliScreen takes about 10 minutes – you don’t have to take any pictures or upload any information, just follow the steps on screen and note down your results. ScoliScreen isn’t an alternative to a professional consultation, but it’s a highly effective tool to use as a starting point.

 

2 – Get a professional consultation

Screening and consultations are always available at the UK Scoliosis Clinic

We can’t stress enough that getting a professional consultation with a scoliosis specialist is a must. Many parent’s natural reaction is to take their child to see their GP about their concerns– but this isn’t always the best step.

There are a few reasons for this – Firstly, while no question that GP’s do fantastic work, with so many different conditions to recognise and treat most GP’s simply don’t have time to research the latest options for scoliosis treatment. Years ago, it was thought that surgery was the only effective option for treating scoliosis, so many medial professionals were simply taught that the best approach to scoliosis is to “wait and see” if the curve becomes bad enough for treatment. The problem is that scoliosis almost never resolves on its own[1] so “wait and see” is never a good option. If your GP tells you to “wait and see” please bear in mind they aren’t trying to be dismissive, they just aren’t experts on the non-surgical options which are available today (but scoliosis clinicians are!).

Secondly, properly diagnosing scoliosis requires taking X-rays to fully understand the position of the spine – since GP’s have to justify any referral it can be difficult to argue for x-rays to be taken when “wait and see” is the standard recommendation.

Finally, scoliosis has often been a condition which hasn’t received the attention it really should, so many people think that the GP is their only option. One child in each class at school will develop scoliosis[2], so a significant number of people are affected, but most people are unaware of the condition. If you are reading this blog as a first port of call, please know there are numerous specialist clinics out there waiting to help!

At the UK Scoliosis Clinic, scoliosis screening as well as consultations for those with scoliosis are always available.

 

3- Get X-rays

Scoliosis is a complex Three Dimensional condition which can be successfully treated only with a thorough understanding of the condition of the spine. X-rays are the best way to properly establish the situation and also to rule out any other underlying conditions which might be causing or contributing to scoliosis. At the UK Scoliosis clinic, we have a brand-new state of the art digital X-ray machine on site for instant results – other clinics might refer you to another provider to get X-rays taken in advance of your consultation.

Some clinics offer what is often marketed as “radiation free imaging” – this simply means they do not provide X-rays and use an alternative, less effective imaging method. In real terms, this means that practitioners simply cannot get as good a picture of what is going on with the spine, which increases the risk of treatment failure, misdiagnosis or even injury from inappropriate treatment.

Are X-rays dangerous? The short answer is a handful of X-rays are far less risky than requiring major spinal surgery due to failed scoliosis treatment. The longer answer is that in fact, we are all exposed to a small amount of background radiation everyday without ill effect. For context, an average lumbar X-ray exposes you to only about as much radiation as 2 months of normal background radiation in the UK. An average airline pilot is exposed to about an eighth as much radiation as an x-ray on each transatlantic flight, meaning that most pilots are exposed to about the same amount of radiation as found in your x-ray every other week.

 

4 – Understand your treatment options

Scoliosis SEAS treatment

Specialist exercises can reduce Scoliosis

Today the non-surgical scoliosis treatment field is growing fast and there are many different approaches which can be utilised, these include treatments backed up by extensive research, such as Schroth and SEAS exercise methodologies and bracing as well as some emerging approaches which might or might not be effective, but currently lack enough research – such as chiropractic approaches.

Many clinics, like the UK Scoliosis Clinic offer a range of treatments and will tailor your treatment options based upon your needs, but some clinics only offer one approach. In this case, be sure that the treatment being offered is actually the right one for your case – and get a second opinion if you feel unsure.

 

5 – Chose a clinic which conforms to the SOSORT guidelines

Like all professions, the scoliosis treatment field has a guiding body – for us it’s the International Society on Scoliosis Orthopaedic and Rehabilitation Treatment, otherwise known as SOSORT. SOSORT is an International organisation that guides health professionals on the most up to date, evidence-based recommendations in relation to the conservative treatment of idiopathic scoliosis. SOSORT’s ongoing mission is to constantly evaluate new treatment methodologies and to publish guidelines for best practice for patient outcomes[3].

Reputable clinics are run by clinicians who follow the SOSORT guidelines and stay in touch with the latest research – check that your clinician is keeping up to date by attending the yearly conference or contributing to the journal for example.

 

6 – Get the best brace

In many cases, bracing is going to be the most effective, fastest and easiest way to correct scoliosis. However, not all braces are created equal – be sure to quiz your scoliosis care provider about the braces they offer and the features they provide. Many braces (including those available in some areas through the NHS) are designed to hold the spine in its already scoliotic position. This kind of brace might stop the scoliosis progressing, but it wont help to improve it.

At the UK Scoliosis Clinic, we recommend ScoliBrace – a totally custom brace designed with 3D imaging and computer aided design. The ScoliBrace is an active correction brace – meaning it actually guides the spine back into the correct position, rather than just holding it still.

 

7 – Consider mental health

While everyone’s scoliosis experience is varied and depends much upon personality, some research has shown that children and young adults are more at risk of stress and even depression as a result of scoliosis. At the UK Scoliosis clinic, we provide a private one to one environment, and welcome as many relatives or friends that your child would like to have around them. Research has shown that having a calming and private environment to discuss and perform treatment can actually lead to better clinical outcomes[4].

When considering bracing, try to also take into account the impact wearing a brace could have on a young person’s life. This is one of the reasons we are so confident in our ScoliBrace – unlike many braces ScoliBrace is low profile and is easily hidden under normal clothes. Additionally, ScoliBrace does not impede a child’s ability to participate in sports and physical activities and was designed specifically with maximising mobility in mind. ScoliBrace is also customisable in a range of colours and patterns to suit your tastes!

 

8 – Ask questions

Dr Paul Irvine and Dr Jeb MacAviny at the SOSORT conference 2018

Ask questions, ask lots of questions – and encourage your child to ask questions. A scoliosis consultation appointment is a great opportunity to do this, but feel free to phone our clinic for more information. Scoliosis treatment is a fast-moving field in which new research is always being published, so as scoliosis clinicians we spend much of our time asking questions and keeping up with research too. Avoid a clinic who can’t (or wont) answer your queries and opt for one that shows they are up to date with the latest information.

Whenever you speak with a scoliosis practitioner, consider making a list of things you would like to know and make sure you get answers! Reputable clinics will be able to answer any queries you may have, and back these answers up with the latest published scientific research papers.

 

9 – Consider the cost of treatment carefully

When considering the cost of scoliosis treatment, its important to remember that a scoliosis treatment program is not a “quick fix” – time is required to initially correct scoliosis, and then further maintenance treatment of some kind is then required to keep the spine properly aligned until the end of growth. This means that parents need to ensure that the treatment options they choose represent a sensible choice over the long term.  To give an example, this might mean that a more expensive scoliosis brace, which is adjustable to last for a long period of time may be more cost effective than two or three cheaper braces. Similarly, for small curves a ScoliNight brace might be a better long-term investment than continued scoliosis specific exercise sessions.

This decision depends to a great extent upon your own preferences and your child’s– but keep the long term in mind.

 

10 – Get on with your life!

Scoliosis does not need to be an impediment to life – and if treated properly and early on can usually be corrected without any serious impact on the young person concerned. If properly treated and corrected scoliosis will not affect your child’s life going forward, so plan for tomorrow!

 

[1] Angelo G Aulisa et al. ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies – SOSORT award 2013 winner, Scoliosis 2014 9:3

[2] Gutknecht S, Lonstein J & Novacheck T ‘Adolescent Idiopathic Scoliosis: Screening, Treatment and Referral’ 2009, A Pediatric Perspective, vol. 18, no. 4, pp. 1-6.

[3] Information about SOSORT and their guidelines can be found at http://www.sosort.mobi/index.php/en/

[4] Elisabetta D’Agata et al. Introversion, the prevalent trait of adolescents with idiopathic scoliosis: an observational study Scoliosis and Spinal Disorders (2017) 12:27

Does scoliosis cause back pain? Research update

Posted on September 3, 2018 by - Blog

For some time, it has been thought that adolescent idiopathic scoliosis (AIS) does not necessarily cause back pain – however research is now beginning to indicate that in fact, scoliosis does most likely cause pain especially in patients with larger curves.

 

Scoliosis and back pain, current opinion

scoliosis back pain

Research is unclear, but many believe scoliosis causes back pain

For some time, it has been suggested that scoliosis might be responsible for back pain. Although the issue has been debated, some evidence suggests there is a link – A recent study of almost 2000 patients less than 21 years-old referred for a spine evaluation reported that when an underlying condition was identified as the cause of the pain, the most frequent diagnosis was scoliosis (1439/1953), followed by Scheuermann’s kyphosis.[1]

Although this evidence suggests there may be a link, other studies which have considered the issue have produced mixed results. On the one hand, Ramirez et al. reported on more than 2400 subjects with AIS. Of these, 23 % reported back pain at the time of diagnosis – a substantial number. An additional 9%, initially free of pain and managed with observation alone, developed pain during follow-up[2].

Sato et al. examined more than 30,000 adolescents with various spinal issues and concluded that the subgroup with scoliosis had an approximately 3 to 5 fold increased risk of back pain in the upper and middle right part of the back[3].

On the other hand, Lonner et al. compared three groups of adolescents including 894 with AIS and 31 control individuals without, when considering pain score using the SRS pain score method, they found that the differences between the AIS and control group were not significant. [4]

With this mixed picture in mind, one 2016 review concluded that while back pain in adolescents is quite common, especially in girls – pain does not seem to be a major problem for the vast majority of adolescents with an idiopathic form of scoliosis.[5] This is the view which tends to prevail amongst most scoliosis practitioners today.

Despite this conclusion, however, there have been a number of studies which have suggested much more strongly that back pain is a common issue amongst scoliosis sufferers. Research has indicated that chronic nonspecific back pain (CNSBP) is frequently associated with AIS, with a greater reported prevalence (59%) than the one seen in adolescents without scoliosis (33%)[6]. Furthermore, Clark et al. reported that participants who were diagnosed with AIS at age 15 were 42% more likely to report back pain at age 18.[7]

 

New evidence

The regions of the spine

The most recent research is a Canadian study by Théroux et al.  It considered 500  patients from the orthopedic scoliosis outpatient clinic from the CHU Ste-Justine Centre, a university-teaching paediatric hospital with a view to exploring the relationship between scoliosis and back pain more accurately.

The conclusions from this study were of great interest. The study showed that spinal pain was a frequent problem for the AIS sufferers included in the study.  Overall, 68% of the participants reported pain. Furthermore, pain intensity increased with scoliosis severity in the main thoracic and lumbar regions – the degree of disability caused by pain was also positively associated with scoliosis severity in the proximal thoracic, main thoracic and lumbar regions.[8]

Perhaps of most interest for us as a clinic, the results showed that spinal bracing was associated with lower spinal pain intensity in the thoracic and lumbar regions. Bracing was also related with lower disability for all spinal areas. [9]

 

Does scoliosis cause back pain?

More research will be needed before a definitive answer can be provided to this question – however it seems reasonable to suggest that back pain is associated with scoliosis in a good number of cases, given our own experience and the foregoing evidence, we would suggest a repetitive figure for the risk of back pain associated with scoliosis is likely to be  40 – 50% , with factors such as curve location being key factors.

Thankfully research and our own experience clearly indicates that proactive scoliosis treatment, whether with bracing or (ideally) a combined bracing and exercise program can be highly effective in reducing back pain in scoliosis cases.

 

 

 

 

 

[1] 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.

[2] 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.

[3] 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.

[4] Lonner B, Yoo A, Terran JS, Sponseller P, Samdani A, Betz R, et al. Effect of spinal deformity on adolescent quality of life: comparison of operative scheuermann kyphosis, adolescent idiopathic scoliosis, and normal controls. Spine (Phila Pa 1976). 2013;38:1049–55.

[5] Ibid.

[6] Cited in 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] Ibid

[9] Ibid

Scoliosis specific exercise prevents loss of correction after bracing

Posted on August 21, 2018 by - Blog

When we think about scoliosis treatment we tend to focus on there here and now – normally this means concentrating on getting the correct diagnosis and making sure the right treatment program is put in place. What’s often less discussed however, are plans for going forward after you have completed your treatment.  This is especially the case when bracing – we know that bracing can offer a significant reduction in cobb angle, but what happens when it’s time to stop wearing the brace?

 

Does the end of bracing mean the return of scoliosis?

At our clinic we often encounter clients who wonder whether the end of bracing means a reversal in the correction achieved – will scoliosis start to develop again after bracing?  It’s a fair question – but thankfully research shows that a scoliosis specific exercise program – exactly the same kind of program which is usually used to support bracing – can actually be highly effective in reducing loss of correction after bracing.[1] The results of the study suggest that simply continuing with a scoliosis specific exercise program can, in fact, prevent any loss of correction.

Scoliosis specific exercises are already recommended not only as a compliment to bracing, but also as a means to avoid some of the pitfalls associated with wearing a brace – the most common issues being muscular stiffness loss of strength.[2] In fact, it’s common to use scoliosis specific exercises for a period before beginning bracing – as some research suggests this may promote a quicker correction.[3]

It’s therefore not surprising that exercises may have a valuable role to play during the weaning phase of treatment too. Brace weaning itself is a critical phase of treatment which can vary in both its nature and duration according to the patient. In some instances, clinicians reduce the daily hours of brace in a somewhat rapid way, shifting from full-time wearing (18 or more hours per day) to the point that the patient is totally free from the brace within a period of six to 12 months. Others progressively and slowly reduce the hours of brace use, with a mean reduction of two to three hours every six months.[4]  Researchers currently believe that a failure to properly support and train the trunk muscles during this period may be responsible for the loss of correction which sometimes accompanies the end of treatment – however, scoliosis specific exercises can be used to address this specific problem.

 

What does the research say?

Scoliosis SEAS treatment

SEAS exercises can reduce loss of correction in scoliosis cases

The results of one of the few studies on this specific issue were certainly encouraging– in the 2008 study, sixty-eight patients were monitored throughout their process of brace weaning. The patients were divided into two groups according to whether or not exercises were performed during the weaning period. The exercise group included 39 patients and was further divided into two sub-groups: a SEAS group, who performed SEAS exercise programs, and an “other” group – who performed a variety of other forms of scoliosis specific exercise.  29 patients were placed in the non- exercise group.

The study followed the patients for 2.7 years – at the end of treatment, Cobb angle had increased  in the non-exercise group (by approximately 3.5 degrees) – however both the SEAS and other exercise groups saw their cobb angles remain stable – no change was detected.

 

So does the end of bracing mean the return of scoliosis?

In short, it certainly does not have to! From a patient’s perspective it’s important to find a clinic which also provides a solid aftercare plan however. At the UK Scoliosis clinic, we take great care to plan a course of treatment which includes appropriate brace weaning support, so that maximum correction can be maintained. As new research becomes available in this regard, we’ll apply it to our programs wherever appropriate.

 

 

 

[1] 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

[2] 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

[3] 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.

[4] Negrini S: The Evidence-Based ISICO Approach to Spinal Deformities. 1st edition. Milan, Boston: ISICO; 2007.

Why choose ScoliBrace?

Posted on August 11, 2018 by - Blog

When thinking about the right scoliosis treatment there are many options to consider. This is what you would expect since scoliosis itself is a complex and often highly variable condition which requires a treatment plan specifically designed for each patient.

The two main approaches used in non-surgical scoliosis treatment are scoliosis specific exercise methodologies and bracing. Of the two, bracing is probably the more effective, although a scoliosis specific exercise program can sometimes be sufficient. In some instances, patients might prefer bracing over exercise due to the improved results which can be obtained without conscious efforts.

At the UK Scoliosis clinic, we often use both approaches to achieve the best possible outcome for patients – but today let’s consider bracing.

 

Why is bracing so popular?

Today, scoliosis patients can benefit from the latest and most technologically advanced braces available through our clinic. Unlike some older brace designs, modern braces present a high likelihood of a successful non-surgical outcome.

To take just a few points, recent research has shown that…

  1. Specialised scoliosis bracing when prescribed for high-risk patients, can prevent the need for surgery in most cases[1]
  2. Patients who wear scoliosis braces get better results the longer they wear the brace each day[2]
  3. Part-time bracing in adults significantly reduces progression of curvatures and improves quality of life[3]
  4. Conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, with most patients reaching a complete curve correction[4]
  5. Bracing is an effective treatment method for AIS cases, characterized by positive long-term outcomes[5]

Today, research is therefore clear – scoliosis bracing is an effective, affordable and safe alternative to surgery. But which brace should you choose? With the growth in interest in non-surgical scoliosis treatment, various brace designs have become popular – while each have their own benefits, here at the UK Scoliosis Clinic, we offer the ScoliBrace active correction brace – which we believe to be the most modern an effective brace on the market. Let’s see why:

 

Why choose ScoliBrace?

Scolibrace

ScoliBrace is comfortable, low profile and easy to use!

When choosing a new treatment option for our clinic, our scoliosis specialists scrutinise each aspect of a candidate product, both from a clinical and patient comfort perspective. To date, ScoliBrace is (in our opinion) the best scoliosis braces we have seen, that’s why it’s our go-to treatment in many cases. Originally developed in Australia we are one of only a handful of internationally approved ScoliBrace providers.

ScoliBrace improves upon many previous braces, and avoids some of the most common pitfalls – it is:

 

Highly effective

A ScoliBrace is an over-corrective brace – unlike braces which simply try to halt the progression of scoliosis, ScoliBrace works by guiding the body and spine into a posture that is the opposite of how the scoliosis is shaped. This means that all the time you are wearing a ScoliBrace, you are treating your scoliosis – not just slowing it down. A ScoliBrace can also help to improve the overall appearance of the body.

 

Comfortable

Most Scoliosis braces are quite tricky to get into and can sometimes have a less than optimal construction for your body shape. ScoliBrace opens and closes at the front making it easy to wear and remove without assistance. Thanks to our advanced manufacturing process, your brace will be custom made to fit you like a glove.

 

Stylish

Unlike most braces which are only available in white, ScoliBrace is available in a variety of colours and patterns which allow you to personalise the look of your brace. We can offer exciting patterns for younger children (featuring everything from dinosaurs to football, and butterflies to love hearts) as well as stylised looks from a Demin pattern to Zebra print!  ScoliBrace is also available in a wide variety of natural skin tones, to match your own completion if you prefer.

 

Adjustable

Many scoliosis braces are manufactured to a single size and shape, meaning that over the course of treatment some patients may require three or even four individual braces. ScoliBrace has a wide range of adjustment, meaning that in most cases patients require no more than two braces during treatment – which can save a great deal of money in the long term.

 

Low profile

ScoliBrace has been designed with everyday people living everyday lives in mind – this means the brace is as unobtrusive as possible and can even be worn during sports and other physical activities. ScoliBrace is intentionally low profile, so that it can be worn almost invisibly under even light clothing.

 

Totally customised

Many scoliosis braces today claim to be a custom design – but ScoliBrace braces take this principle a step further. ScoliBrace braces are planned out using brace Scan technology, which combines 3D full-body laser scanning, x-rays and posture photographs.  Each brace is then custom designed for the individual with Computer Aided design (CAD) and then created with Computer Aided Manufacture (CAM) to create a brace which is perfect both in terms of fit and correction. Thanks to this process our measuring and manufacturing tolerances are as low as 0.5mm.

 

scolibrace

Modern scoliosis braces like ScoliBrace are highly effective

 

 

 

[1]   ‘Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements’
Negrini S, Negrini F, and Zaina F, 2011, Spine J. 2011 May;11(5):369-80. doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’   [Results of the BrAIST Clinical Trial]
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[2] ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

[3] ‘Effects of Bracing in Adult With Scoliosis: A Retrospective Study‘
Palazzo C, Montigny JP, Barbot F, Bussel B, Vaugier I, Fort D, Courtois I, Marty-Poumarat C, Arch Phys Med Rehabil. 2016 Jun 22. pii: S0003-9993(16)30256-8. doi: 10.1016/j.apmr.2016.05.019

[4] ‘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

[5] Curve progression after long-term brace treatment in adolescent idiopathic scoliosis: comparative results between over and under 30 Cobb degrees
Aulisa et al,  Scoliosis and Spinal Disorders 2017 12:36 https://doi.org/10.1186/s13013-017-0142-y

Scoliosis Treatment – Scoliosis exercise Vs. Bracing, which is best?

Posted on August 3, 2018 by - Blog

Today the two main methodologies involved in the non-surgical treatment of scoliosis are Bracing, and Specialist exercise methodologies. In most cases we use both approaches throughout the course of treatment with our patients since both approaches have their strengths. We are however, often asked which treatment methodology is best – so let’s consider the latest research on this question.

 

Bracing vs Exercise – New research

The first thing to realise when comparing scoliosis treatment is that while many patients often want to know “which is best”, this question is often less explored in the scientific literature. For the most part, scoliosis practitioners want to focus their time and attention towards improving their methodologies of choice, rather than on making comparisons with other approaches. Because of this, few studies have tried to directly compare bracing and exercise approaches – although a recent 2017 study has done just this[1].

In the study conducted in China, 53 patients (age of 10 – 17 years, Cobb angle ≥ 20 – 40 degrees,) were randomly assigned to either a bracing group or exercise group. Twenty-four patients (19 females) were placed in the bracing group and 29 patients (22 females) in the exercise group.

Patients in the bracing group were provided with a rigid thoracolumbosacralorthosis (a Scoliosis brace – TSLO) and asked to wear their brace 23 hours a day, while patients in the exercise group were treated with the Scientific Exercise Approach to Scoliosis (SEAS) protocol. Data regarding angle of trunk inclination, Cobb angle, shoulder balance, body image, quality of life (QoL)[2] were collected every 6 months.

At the first visit, patients assigned to the bracing group were prescribed with a rigid (TLSO) and received an initial pre-treatment evaluation to allow for brace fabrication. To achieve optimum correction, patients were invited to the scoliosis clinic to check the fit and modify (if necessary) the brace after the first month of intervention and then every three months as recommended by SOSORT[3].

The SEAS patients took part in a session of 1.5 hours at which they learned and practiced the core content of their program every two to three months, in which they learnt their personalised exercise protocol. The patients continued treatment at the clinic once a week (40 minutes) plus one daily exercise session at home (10-15 minutes)[4].

 

 

Study Results

At this stage, it’s important to mention that while this study represents an important beginning in this comparative project, the results available at this time reflect only a year of treatment. It is likely that the trends illustrated here will hold good over a longer period, and thankfully we will be able to verify this since the study is still ongoing.

 

Cobb angle 

A 54 Degree Cobb angle (X-ray)

The bracing group achieved a significantly larger reduction in Cobb angle – at 6 months, the mean reduction of cobb angle in the bracing group was 3.13 degrees, and at 12 months the mean reduction was 5.88 degrees.  In the exercise group, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees.[5]

 

Quality of Life

The SRS-22 form used for gauging quality of life factors consists of a number of subsets of data, each of which was individually evaluated during this study. These include a score for pain, function, mental health and self-image. Taken as a whole, the results showed that for the bracing group, the SRS functional score (a measure of the impact of scoliosis on everyday life) as well as the total score (a broader measure of quality of life factors) all showed significant improvement between the initial consultation and 12-month evaluation as well as between the 6-month and 12-month evaluations.  The one exception to this was pain level, which did not differ significantly across the three evaluations.

The researchers also noticed that self-image was significantly improved in the bracing group, especially at the 12 months follow up, this was interesting given the negative self-image association which is sometimes linked to bracing.  Participants did report an increase in their overall satisfaction levels (taking all factors into account), although this was most apparent after passing the 6-month mark.

For the exercise group, all the SRS-22 quality of life subsets showed a slightly larger improvement across the three visits than bracing – especially in terms of the functional score. The exception here again was pain, where no significant change was detected[6].

 

 

Overall comparison

In comparing the two treatment groups, the study investigators noted it was interesting to find that the overall improvement of quality of life was more significant in the exercise group. Although the quality of life scores improved in both groups, at all three visits, the average scores of most subsets in the SRS-22 were higher in the exercise group.  By contrast, the improvement in cobb angle was significantly greater in the bracing group, although the exercise group did also show an improvement at the 12-month mark.

 

 

So which is better?

At this stage, it seems fair to suggest that the results of the study reflect what many scoliosis clinicians are already aware of – Scoliosis Bracing is by far the most effective way to reduce a cobb angle – Indeed, the authors note how “There is no doubt that bracing has proven efficacy in halting the progressive nature of the deformity and reducing the need for surgery”.

At the same time, scoliosis specific exercise has a more positive impact on functional capacity – this comes as no surprise to scoliosis practitioners, since scoliosis specific exercise is intended to reduce muscular imperfections and promote better everyday posture. Exercise approaches also seem to correlate with a greater improvement in quality of life factors than bracing, although this is also to be expected since it is almost universally accepted that any form of exercise serves to boost quality of life in most individuals.

Taking these two points, its easy to see how a combination approach is often the best possible option – by pursuing both treatment methodologies it is possible to achieve functional improvement, cobb angle correction and an improvement in quality of life in a flexible way which works for the patient.

More results from this particular study, as well as further research can be expected in this area and we will report it to you as soon as it becomes available!

 

scolibrace results

An example of successfull bracing 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 [Publish Ahead of Print]

[2] The SOSORT SRS-22 Form was used for this data collection.

[3] Negrini S, Aulisa AG, Aulisa L, et al. 2011 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth. Scoliosis 2012;7:3.

[4] Romano M, Negrini A, Parzini S, et al. SEAS (Scientific Exercises Approach to Scoliosis):a

modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis 2015;10:3.

[5] 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 [Publish Ahead of Print]

[6] 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 [Publish Ahead of Print]

Scoliosis bracing is becoming more effective

Posted on July 27, 2018 by - Blog

For some time now, scoliosis clinicians have broadly accepted the view that scoliosis bracing is an effective way to halt the progression of scoliosis, and (with the use of the correct brace) is also an effective way to reduce the curve.

The outlook for bracing was not always a positive as it is today – historically, studies suggested that bracing was only as effective as observation. Over time however, research has tended to show bracing to be more effective than was once thought, so that today the rates of success with bracing are very high.

In 2005, the Scoliosis Research Society (SRS) attempted to standardize the inclusion criteria and outcome measurements for bracing studies, to enable comparison among studies. In the guidelines, it was suggested that a curve progression of less than 5 degrees should be regarded as success. At the time, SRS did not even consider that bracing might actually serve to improve a curve – although it was quickly realised that this was possible. For this reason, the criteria for “improvement” (being a reduction of curve of at least 6 degrees) was established in 2009.

Despite some scepticism in the mid 2000’s however, some bracing studies today have demonstrated rates of surgery prevention as high as 100%[1][2] and the field is one of the major areas of study and advancement – so what caused such an improvement in the prognosis?

 

Braces are getting better

scoliosis braces

Scoliosis braces have come a long way!

One of the major reasons for the improvement in bracing effectiveness has been the improvement in braces themselves.  A recent review study conducted in 2016, attempted to explore this issue by examining 53 studies published between 1990 and 2016[3]. It showed that when comparing the percentage of patients eventually requiring surgery and the improvement rate in the past 26 years, we find that there is a trend towards reduction in surgical rate and an increase in improvement rate. Yet, close inspection showed that the change is strongly related to the type of brace used.

Key factors in bracing outcome are the amount of in-brace correction and comfort for the wearer. In the study, it was shown that large in-brace correction in excess of 50% would be accompanied by improvement at skeletal maturity[4][5] and hours of brace wear are positively associated with the rate of treatment success[6]. Simply put, an active correction brace which is also comfortable to wear is a key factor in significantly reducing surgical requirement[7]. This is why so much effort has been expended in ensuring that our ScoliBrace is the most comfortable brace available!

The study also showed that the effectiveness of a brace depended on the quality of its construction, not just its design[8]. In 2007 Danielsson et al pointed out the importance of the skill and dedication of the orthotist in creating a brace as a critical factor in the eventual success of treatment and similar views have been forwarded by other authors[9]. Today, advancements in technology mean that a higher quality of brace design and manufacture than ever before is available to us. Indeed, at the UK scoliosis clinic we use the latest laser scan and computer aided manufacture processes to create a brace for each client, which fits their needs perfectly.

 

Combination treatment is most effective

Today we also appreciate that in most instances an individualised treatment plan based on a number of complementary methods provides the best chance for a significant reduction of the curve. In fact, today it is generally accepted that bracing should not be employed alone in the management of Adolescent Idiopathic Scoliosis in particular – instead individualised scoliosis specific exercises should also be incorporated. This is because Scoliosis specific exercises improve the muscle strength of the trunk and the postural awareness of the patients. More importantly perhaps, when combined with bracing, evidence suggests the results are an improvement in curve reduction[10]. Properly tailored exercise programs may also help to reduce the loss of correction which frequently accompanies the end of brace treatment if not properly managed.[11]

 

Scoliosis clinicians are working hard to improve bracing technology.

scolibrace

Modern scoliosis braces are highly effective

At the UK scoliosis clinic, we respect and value the work that surgeons can do in correcting very serious cases of scoliosis which are unsuitable for conservative treatment. However, the 2016 review study has suggested that a conflict of interest in bracing development might be a negative factor for patients[12].

One of the lest effective forms of brace is the Boston brace – yet these are often favoured by orthopaedic surgeons (especially in the US)[13]. The Boston brace is at least outdated, and in some situations may complicate scoliosis treatment unnecessarily. Boston braces also encourage thoracic flat back, which has been shown to be detrimental to the correction of curves[14].

Why are these braces sometimes favoured then?  –  This maybe because in the event that the brace fails to achieve the objective, the surgeon can go on to treat the patient using surgery, although this might not be the patient’s preference. Conversely, the kinds of modern braces we use at our clinic and which are widely implemented throughout Europe today are predominantly used by physicians who treat patients conservatively. In this instance, failure of the brace requires an external referral for surgical treatment[15] – hence it is in the interest of non-surgical clinics to constantly develop and improve their braces, which results in highly advanced modern braces, like ScoliBrace.

 

 

 

 

[1] De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J.2013;22(6):S815–22.

[2] Aulisa AG, Guzzanti V, Perisano C, Marzetti E, Falciglia F, Aulisa L.Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976). 2012;37(13):E786-E791.

[3] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[4] Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up.

[5] Appelgren G, Willner S. End Vertebra Angle – A roentgenographic method to describe a scoliosis. A follow-up study of idiopathic scoliosis treated with the Boston brace. Spine (Phila Pa 1976) 1990;15(2):71- 74.

[6] A large number of studies are cited in Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[7] Wiley JW, Thomson JD, Mitchell TM, Smith BG, Banta JV. Effectiveness of the Boston brace in treatment of large curves adolescent idiopathic scoliosis. Spine. 2000;25(18):2326–2332.

[8] Rigo MD, Villagrasa M, Gallo. A specific scoliosis classification correlating with brace treatment: description and reliability. Scoliosis. 2010;5(1):1. doi:10.1186/1748-7161-5-1.

[9] For example see Rowe DE, Bernstein SM, Riddick MF, Adler F, Emans JB, Gardner- Bonneau D. Ameta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis. J Bone Joint Surg Am. 1997;79(5):664-674.

[10] Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correctionand task-oriented exercises reduce spinal deformity and improve quality of life insubjects with mild adolescent idiopathic scoliosis. Results of a randomized controlled trial. Eur Spine J. 2014;23(6):1204-14. doi:10.1007/s00586-014-3241-y.

[11] Goldberg CJ, Dowling FE, Hall JE, Emans JB. A statistical comparison between natural history of idiopathic scoliosis and brace treatment in skeletally immature adolescent girls. Spine. 1993;18(7):902-9088.

[12] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[13] Wynne JH. The Boston brace and TriaC system. Disabil Rehabil Assist Technol2008; 3(3):130-135. doi:10.1080/17483100801903988.

[14] Wing-Yan CHAN, Shu-Yan NG, Tsz-Ki HO, Yin-Ling NG (2016) Bracing – Halting Progression or Improving Curves in Adolescent Idiopathic Scoliosis. J Rheumatol Arthritic Dis 1(1): 1-8.

[15] Ibid.

Catch scoliosis early, and don’t “wait and see”!

Posted on July 23, 2018 by - Blog

Catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the cobb angle is the key to a successful outcome. Our message today, to parents in particular, is to have your children screened regularly and act on any concerns you may have. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.

 

Scoliosis school screening is vital

children

3 – 4 % of children will develop Scoliosis

Since Scoliosis usually develops in children and should be treated as soon as possible to maximise the chances of a successful outcome, school scoliosis screening has been a topic of much debate and is something that we strongly advocate here at the clinic.

Studies have shown that school screening can effectively reduce the risk of requiring invasive spinal

fusion surgery[1]. Although there has been debate about the effectiveness of school screening in the past, it is now clear that screening does improve outcomes for children affected by scoliosis. The clinical effectiveness of scoliosis screening has been assessed in numerous studies of different designs, which have been synthesized in a systematic review with clear results.  The review covered 28 studies

published between 1977 and 2004 and concluded that there was sufficient evidence to suggest that school scoliosis screening is safe, may detect cases of Adolescent idiopathic Scoliosis (AIS) at early stages, and may reduce the risk of surgery[2].

Despite this, school screening is still not commonplace in the UK, although this is not the case everywhere. In Hong Kong, for example, scoliosis screening has been conducted as a routine health service since 1995, thereby making it one of the regions with the longest history of routine scoliosis screening in the world. Hong Kong’s screening protocol was demonstrated to be clinically effective for children who studied in the fifth grade during the first two academic years after the program was started; however, no longer term evaluation was attempted[3][4]. In response to this, a longer term study has now been undertaken, in which a total of 306,144 students participated in scoliosis screening. Clearly, screening is considered valuable around the world!

 

Why does early detection matter?

Early detection Is especially important in scoliosis cases since research has shown a direct link between the age of detection and the outcomes achievable. Today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is now highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[5]

The 2015 study included patients aged between 4 to 10 years at the beginning of treatment and with a curve magnitude of 20°-40° Cobb. Curves between 20° and 25° Cobb degrees were included only in the presence of documented curve progression. Patients were prescribed an appropriate scoliosis brace and wear time, based on their individual cases.

The results from the study showed that curve correction was accomplished in 88 patients (77.8%), stabilization was obtained in 18 patients (15.9%). 7 patients (6.19%) have a progression and 4 of these were recommended for surgery. Critically however, the study also demonstrated that treatment appears to be more effective with curves under 30° (incidence of surgery: 1.6%) than curves over 30° (incidence of surgery: 5.5%) – which strongly suggests the need to catch curves early. [6]

 

Juvenile scoliosis almost never resolves without treatment

Scolibrace

Scolibrace is a comfortable and effective advanced brace

Unfortunately, “wait and see” is still a common approach here in the UK – unfortunately this approach is outdated and fails to recognise the outcome of research which has clearly shown that juvenile scoliosis tends to worsen, sometimes aggressively and almost never resolves.

Research has demonstrated that Juvenile scoliosis greater than 30 degrees 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[7].

A 2006 study followed (but did not treat) 205 patients of which 99 (48.3%) were operated on. Of 109 curves less than or equal to 20 degrees at onset of puberty, 15.6% progressed to greater than 45 degrees and were fused. Of 56 curves of 21 degrees to 30 degrees, the surgical rate increased to 75.0%. It was 100% for curves greater than 30 degrees[8].

This research is particularly troubling, in light of the above study, which showed a very high likelihood of total curve correction up to and including 30-degree angles, had these cases been screened, caught early and treated with a corrective brace.

 

How we can help

At the UK Scoliosis clinic, we offer free screening to anyone concerned about Scoliosis. If you have already had a diagnosis and have been advised to wait and see, we especially urge you to book an appointment to see our specialists in order to avoid compromising your chances at a highly effective treatment plan.

 

[1] Richards BS, Vitale MG. Screening for idiopathic scoliosis in adolescents. An information statement. J Bone Joint Surg Am 2008;90: 195–8.

[2] Sabirin J, Bakri R, Buang SN, Abdullah AT, Shapie A. School scoliosis screening programme—a systematic review. Med J Malaysia

2010;65:261–7.

[3] Luk KD, Lee CF, Cheung KM, Cheng JC, Ng BK, Lam TP, et al. Clinical effectiveness of school screening for adolescent idiopathic scoliosis: a large population-based retrospective cohort study. Spine

2010;35:1607–14.

[4] Yawn BP, Yawn RA, Hodge D, Kurland M, Shaughnessy WJ, Ilstrup D, et al. A population-based study of school scoliosis screening.

JAMA 1999;282:1427–32.

[5]  ‘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

[6] ‘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

[7] 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.

[8] Ibid.