Category: Blog

Paul at SCOSYM, 2022

Posted on September 1, 2022 by - Blog

One of the most enjoyable aspects of working in a field which is growing and innovating as fast as the Scoliosis treatment space is getting to interact with, and learn from, a huge variety of specialists from different backgrounds, all working towards the common goal of developing the most effective Scoliosis treatment approaches possible. With this in mind, our founder, Paul Irvine will be in Greece next week to attend the 3rd SCOSYM Symposium.

Just one of many such events which are fast becoming critical landmarks for Scoliosis professionals everywhere, this meeting represents the 3rd SCOSYM Symposium in a series of successful meetings.

SCOSYM, like several non-surgically oriented events, recognises the tremendous contribution the traditional medical disciplines have made to scoliosis treatment, but also notes that the medical societies that specialize in this ailment have, to quote the organisers “tended to focus their efforts on the study of the epidemiology, aetiology, pathobiomechanic and laboratory, clinical and imaging documentation and treatment, either non-operative or operative.”  Critically for those attending SCOSYM then, it’s vital to recognise that the advent of new technologies is key to the study and advancement of our insight into these diseases, with a goal to improve the quality of life of this group of people.

This year, the conference is focused on these emerging technologies and the opportunities they bring, with a special view to recognising the impressive developments in the implementation of scoliosis school screening programs, physiotherapeutic-specific scoliosis exercises and new surgical approaches for growth modulation for the surgical treatment of early onset scoliosis (read more about all of these on our blog!)

Another key focus, and one which we’re pleased to see being recognised as an essential aspect of treatment for scoliosis, is quality of life – according to the organisers “These developments have led to better patient quality of life compared to what was experienced in the past. However, this topic is still under development and new instrumentation systems are being introduced.

When proper management is not implemented, spinal disorders may lead to significant social problems and to enormous economic losses. Therefore, treatment decisions based on the recent evidence-based literature will result in the optimum outcome. Proper management, including prevention and non-operative or operative treatment, must be tailored and implemented.”

Raising awareness is a core aspect of what we do at the UK Scoliosis clinic and SCOSYM is yet another fantastic event helping to do this, the conference notes that “It is, therefore, very important to increase awareness and advocacy for a social mission regarding the early detection of scoliosis and prevention of progressive spinal deformity. It is imperative to raise awareness about scoliosis and to inform the public, healthcare and policymaking communities about the individual, familial and societal burdens of spinal deformity, as well as the benefits of proper detection, diagnosis and optimal care for all patients.” – we couldn’t agree more!

Paul will be spending his time learning about the best and most promising new research to integrate into our own processes in the clinic, and perhaps enjoying a spot of good weather too!

 

 

Does bracing reduce quality of life?

Posted on September 1, 2022 by - Blog

While modern Scoliosis bracing represents a huge leap forward in the non-surgical treatment of Scoliosis it’s no secret that wearing a brace can be taxing, especially for young people. Modern braces like ScoliBrace have the additional benefit of being low profile, easy to move in and almost invisible under clothing, but no doubt wearing a brace is an additional stressor for a young person to cope with.

 

The Psychology of bracing

Although clinical evidence regarding bracing effectiveness continues to strengthen, there is still uncertainty regarding the impact of brace wear on psychosocial well-being, as well as the impact of psychological well-being on brace wear adherence. We’ve reported on numerous studies which have argued the case both ways on this issue – overall, it’s fair to say that the majority of research suggests that bracing can be a stain for patients, but that interventions designed to support them during the process are also effective in reducing any possible harm.

Some research has found that full-time brace wear can indeed negatively impact a patient’s, emotional, and social well-being, including a significant worsening of body image.[1] In addition, research has found that the adverse effects on a patient’s psychosocial well-being induced by brace treatment can then result in poor brace wear adherence[2]  – on the flip side, some studies have confirmed that interventions aimed at improving poor psychological outcomes can improve brace adherence.[3]

While we might naturally expect these results, other research has found no negative impact on psychological well-being induced by brace treatment[4].

 

Recent study

A recent study has now added to the debate, by going beyond just the obvious question of wheather bracing has negative psychological impacts or not. Rather, the authors noted that some of the discrepancies in the brace wear adherence research could well be due to the type of brace wear data used to assess adherence. It’s an (unfortunate) fact that the majority of research on brace wear adherence is based on subjective reports, such as self-reports through brace wear diaries and logs – even at our clinic, were mostly reliant on patients accurately self-reporting their brace wear (or their parents doing so) in order to continue to tailor and tweak treatment as bracing progresses.

The new paper[5] points out that in many studies bracing adherence rates have ranged from 41% of wearing hours/prescribed to as high 100% of wearing hours prescribed – making it very difficult to make an accurate assessment of the linkage between actual brace wear and any potential negative effects. This study, therefore, addressed this limitation, by using body heat monitor data from the landmark BrAIST study, rather than self-reports to assess relationships between body image, quality of life (QOL), and brace wear adherence. The use of temperature monitors during the BrAIST study was one of the factors which made the research so impactful and the data is considered reliable.

Using this data, the study analyzed relationships among brace wear adherence, body image, and quality of life. Thanks to the BrAIST data, it was possible to compare those patients who wore their brace most consistently, for the longest time – and those who only wore it periodically. If the groups who were more adherent to the brace-wearing time experience more psychological issues than those who wore the brace very little, it would seem reasonable to suggest the two are correlated. When looking at differences between the least-adherent and the most-adherent brace wear groups, however, the findings from the study actually supply no evidence that the amount of brace wear negatively impacts body image or QOL, or that poor body image and poor QOL negatively impact brace wear adherence.

 

Important takeaway

This is perhaps not the result that many parents, in particular, would expect to see – nonetheless, the outcome of the study was to say that those patients who did not wear their braces as prescribed were no better off Psychologically for doing so – they did, however, most likely have a lower curve correction than otherwise would have been the case. Conversely, those who wore their braces as instructed and received the best curve correction possible faced no additional stress or strain for doing so – they simply gave themselves the best chance at an excellent result.

As a Scoliosis clinic, it’s easy for us to repeat the message on the importance of sticking to brace wear time – we’ve pointed out in many articles that doing so directly correlates with better outcomes – as a parent, of course, it’s harder to coerce a child into wearing their brace if you’re also concerned about the stress it might be causing them. This article isn’t to say that bracing isn’t hard (although we try to make it as easy and fun as possible!) but do keep these results in mind!

 

 

[1] Pham VM, Houlliez A, Caprentier A, et al. Determination of the influence of the Cheneau brace on quality-of-life for adolescent with idiopathic scoliosis. Ann Readapt Med Phys. 2007;51:3–8.

[2] Rivett L, Rothberg A, Stewart A, et al. The relationship between quality of life and compliance to a brace protocol in adolescents with idiopathic scoliosis: a comparative study. BMC Musculoskeletal Disorders. 2009;10:5.

Chan SL, Cheung KM, Luk KD, et al. A correlation study between in-brace correction, compliance to spinal orthosis and health-related quality of life of patients with adolescent idiopathic scoliosis. Scoliosis. 2014;9:1.

Donnelly MJ, Dolan LA, Grande L, et al. Patient and parent perspectives on treatment for adolescent idiopathic scoliosis. The Iowa Orthopaedic Journal. 2004;24:76–83.

[3] Donnelly MJ, Dolan LA, Grande L, et al. Patient and parent perspectives on treatment for adolescent idiopathic scoliosis. The Iowa Orthopaedic Journal. 2004;24:76–83.

Matsunaga S, Hayashi K, Naruo T, et al. Psychologic management of brace therapy for patients with idiopathic scoliosis. Spine (Phila Pa 1976). 2005;30:547–550.

[4] Hasler CC, Wietlisbach S, Buchler P. Objective compliance of adolescent girls with idiopathic scoliosis in a dynamic SpineCor brace. J of Children’s Orthop. 2010;4:211–218.

Schwieger T, Campo S, Weinstein SL, et al. Body Image and Quality-of-Life in Untreated Versus Brace-Treated Females with Adolscent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2016;41.

Danielsson AJ, Wiklund I, Pehrsson K, et al. Health-related quality of life in patients with adolescent idiopathic scoliosis: A matched follow-up at least 20 years after treatment with brace or surgery. Eur Spine J. 2001;10:278–288.

Merenda L, Costello K, Santangelo AM, et al. Perceptions of self-image and physical appearance: Conversations with typically developing youth and youth with idiopathic scoliosis. Orthop Nurs. 2011;30:383–390.

Olafsson Y, Saraste H, Ahlgren R. Does bracing affect self-image? A prospective study on 54 patients with adolescent idiopathic scoliosis. Eur Spine J. 1999;8:401–405.

[5] Traci Schwieger, PhD,corresponding author* Shelly Campo, PhD,* Stuart L. Weinstein, MD,* Lori A. Dolan, PhD,* Sato Ashida, PhD,* and Keli R. Steuber, PhD Body Image and Quality of Life and Brace Wear Adherence in Females With Adolescent Idiopathic Scoliosis J Pediatr Orthop. 2017 Dec; 37(8): e519–e523.

Bracing Scoliosis over 45 degrees

Posted on July 25, 2022 by - Blog

For many years it was considered to be the case that surgery was the only option for reversing Scoliosis – while Scoliosis braces did exist, their primary function was simply to stop Scoliosis from progressing. The best outcome available from bracing was therefore to slow Scoliosis down enough that a patient reached adulthood with a tolerable curve.

Today, modern Scoliosis braces have the ability not only to stop the progression of Scoliosis but also to reverse the condition. Such “over corrective” braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic do this by applying gentle pressure to the scoliotic curve in the opposite direction to the curvature – over time, this can gradually help the spine to return to proper alignment. The success of bracing treatment depends on several factors – one of the most important being the flexibility in the spine, however, it’s possible for patients with Scoliosis up to around 60 degrees[1] to see excellent correction when they are young and flexible enough.

Nonetheless, the “wait and see” followed by surgery approach is still common today, which means Scoliosis patients should always do their research and explore their options before committing to a specific course of treatment.

 

When to brace

When to brace a Scoliosis curve is a tricky question, and one of the major benefits of seeing a Scoliosis specialist – very small curves may not need bracing, with an exercise methodology being enough to control the condition. Larger curves, but those under roughly 30 degrees could benefit from either bracing or exercise-based approaches, so the patient’s lifestyle factors and preferences start to play an important role in treatment selection. For curves over 30 degrees Cobb (Cobb angle being the way in which Scoliosis is measured), bracing is usually the best way forward – however many patients with curves over 45 degrees are often recommended a surgical approach, is this the only option?

 

Bracing curves over 45 degrees – study results

A 2011 study[2] looked specifically at treating Scoliosis patients who were recommended surgery but declined it. The purpose of the study was to verify if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment – in most cases, this means a combination of bracing and exercise. Specifically, the methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed.

Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment.

After the course of treatment, two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements were therefore found in 71% of patients, with only a single 5° Cobb progression observed in one patient. As such, the conclusion was that bracing can be successfully used in patients who do not want to undergo operations for Scoliosis, with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance.

 

Is bracing always the right choice for larger curves?

Weather bracing is the right choice for any given curve depends very much on the patient – as studies like this show it’s certainly possible to achieve great results without undergoing surgery – however, the spine needs to be sufficiently flexible and there needs to be time before skeletal maturity is reached still remaining so that treatment has time to work. A consultation with a Scoliosis specialist is always the best way forward when dealing with a suspected or confirmed Scoliosis case, but today it’s certainly true that there are far more tools we can use to prevent and treat Scoliosis than ever before.

 

 

 

[1] Maximum indicated cobb angle for ScoliBrace

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

Do curves continue to grow after bracing?

Posted on July 15, 2022 by - Blog

Scoliosis Bracing is one of the most effective ways to treat Scoliosis – today it’s the preferred method used by Scoliosis specialists, and increasingly it’s seen as a worthwhile methodology even by some spinal surgeons. Bracing works by gently applying pressure to the spine while the brace is being worn – this slowly guides the spine back into the correct position, correcting Scoliosis over time. A natural question which often comes up is, therefore, what happens after bracing? Will the curve return?

 

Scoliosis progression

Scoliosis itself is a progressive condition – this means it tends to get worse over time. In children and young adults it worsens very quickly, especially around growth spurts. Once the body reaches Skeletal maturity (which is usually a bit later than the point at which someone is legally considered an adult) the progression of Scoliosis tends to stop, or at least slow. Research suggests that the size of  a Scoliotic curve a person carries into adulthood is a major factor in determining wheather their cure continues to grow. Larger curves (approximately 30 degrees or more) which are carried into adulthood tend to progress throughout life – about 1 degree per year is a commonly cited figure[1] – conversely, curves which are less than 30 degrees often don’t progress.

Scoliosis also commonly impacts older individuals – the prevalence of scoliosis increases with age, so that roughly 30% of the population over 60 have adult scoliosis, although in older people the cause is slightly different – most cases are age-related due to wear and tear on the spine, although having Scoliosis already can make this kind progress more quickly.

What we can take away from this is that the core objective of Scoliosis bracing should be to get people to skeletal maturity with a curve as small as possible, and below 30 degrees wherever viable. This gives a person the best chance of living the rest of their life with minimal or no impact from Scoliosis.

 

Curves after bracing

While most of the research being carried out in the Scoliosis field relates to treating curves in the first place, some studies have looked at the issue of loss of correction. One recent study aimed to evaluate the

loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.

As part of the study, researchers reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination.

The patients underwent a long-term follow-up at a mean age of 184.1 months (roughly 15 years) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long-term follow-up period. The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.

The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.

The basic conclusion was therefore that Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups.  Interestingly, there was also no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up, which tends not to support the traditional thinking that larger curves progress more through adulthood.

 

Preventing loss of correction

From the above, we can conclude that a small amount of curve increase is likely when discontinuing bracing treatment – however, It’s important to keep in mind that rather than simply weaning off of a brace, it’s possible to be more proactive about the end phases of treatment. One option, for example, is to continue with a Scoliosis specific exercise regimen – research demonstrates that doing so can help to prevent loss of correction after treatment.[2]

While we are not aware of any specific studies which have looked at this issue, one other factor to consider is a possible weakening of muscles which can take place during bracing. A brace takes much of the load off of the musculature which surrounds the spine, so that after a period of years wearing a brace a person may be less able to support themselves and maintain good posture. Studies have shown, however, that Scoliosis specific exercise can be effective in reducing muscle stiffness and loss of strength during bracing[3] suggesting again that a “proactive” end to bracing may help to reduce the risk of loss of correction even further.

 

 

 

 

[1] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

 

[2] 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

 

[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

 

Scoliosis Bracing in Older Adults, New Research

Posted on June 24, 2022 by - Blog

If you’ve been following the blog this Scoliosis Awareness month, you’ll know that Adult Scoliosis is generally defined as any scoliosis case that exists either in those over 18, or those having reached skeletal maturity – either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis– this is the development of a new scoliosis case, usually as a result of spinal degeneration.

Much recent (and not so recent) research into scoliosis treatment, especially bracing, has focused on younger patients – this is primarily because this group stands to gain the most from bracing – proper treatment of, say a 15 year old with mild to moderate scoliosis stands a good chance of allowing him or her to live the rest of their life free of the condition. Those who have reached adulthood with a scoliotic curve, or develop one through ageing have less of a chance for improvement in the cobb angle (degree of scoliosis) but equally, lower rates of progression in the curve itself. Bracing, however, has been shown to have positive effects for older individuals, primarily around daily function and pain reduction. A recent literature review of relevant studies has confirmed this view.

 

What causes Scoliosis in Adults?

Since there are two kinds of scoliosis in adults, we should take a moment to understand why and how they are different.

ASA is scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life.

Degenerative scoliosis, by contrast, does occur in adult life and is attributable to wear and tear on the spine, but is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age. For many patients, drawing a distinction between the two types may be academic at any rate, since in patients with no known history of scoliosis it may well be impossible to say whether a newly discovered case is a Do-Novo one, or ASA. It is thought that as many as 30% of over 60’s suffer from De-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

Recent study

The newest study[2] taking a broad view of the literature on scoliosis bracing for older adults was a review of relevant papers published between 1967 and 2018 – the study investigators used standardised criteria to select relevant papers for inclusion in their work.

In total, ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Right away, this shows one of the biggest issues with Scoliosis research, especially in older adults – there is a clear gender bias (probably due to the higher incidence of adolescents in females, about 75% of cases) and overall a lack of research, only 8 studies considering rigid bracing of the kind now most frequently employed isn’t a huge number!

In the studies, brace wear prescriptions ranged from 2 to 23 hours per day, and there was mixed brace wear compliance reported, both are consistent with our actual experience of bracing in older adults. Most of the included studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing.

 

Study conclusions

After their review, the study authors reported some key conclusions which are well worth noting. Firstly, they showed that there is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium-term influence on pain and function in adults with either de novo degenerative scoliosis or progressive idiopathic scoliosis. This finding essentially supports the use of bracing in older adults and tallies with our own experience in helping older patients to reduce and manage pain as well as improve function through bracing.

Secondly, and importantly, it was noted that a particular focus on female patients with thoracolumbar and lumbar curves made it difficult to make firm conclusions on the efficacy of bracing for males, and other curve types. It would therefore be highly desirable for further research in this area to focus on a wider variety of case types, in order for us to better understand treatment pathways for older individuals.

 

[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] Jeb McAviney et al. A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data BMC Musculoskeletal Disorders volume 21, Article number: 87 (2020)

Adult Scoliosis – How to Screen

Posted on June 18, 2022 by - Blog

This month, the UK Scoliosis clinic is raising awareness about Scoliosis in adults, as part of our work for Scoliosis awareness month. Over the last few weeks, we’ve looked at the kinds of scoliosis that impact adults, and older adults in particular. This week, we’ll take a look at how you can recognise the signs and symptoms of Scoliosis, as an adult.

 

Recap : Scoliosis in adults

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life. While many Scoliosis cases which are carried into adulthood progress very slowly (and may not progress at all for some time if they are small enough at skeletal maturity)[1] cases can begin to worsen again as we age and the spine (particularly the intervertebral discs) start to degenerate. Accordingly, worsening scoliosis in an ASA case is often referred to as Adult Degenerative Scoliosis.

The second type is Degenerative De-Novo Scoliosis (sometimes noted as DDS) – this is the development of a new scoliosis case, usually as a result of spinal degeneration – the cause is essentially the same as degeneration in ASA, however, we usually refer to De-Novo separately, since there is no prior history of Scoliosis. This being said, it may not always be possible to disambiguate a De-Novo case from an ASA case, since the lack of detection of a scoliosis case does not equate to the absence of scoliosis itself!

 

Adult Scoliosis – General signs

Not all signs of Scoliosis, especially in adults, are of the specific kind which tend to be noticed in children and younger teenagers – in fact, many adult scoliosis cases are discovered as a result of an investigation for back pain rather than concerns about Scoliosis.

Adults with scoliosis very often experience more generalised symptoms than younger people, due to the degeneration of the spinal discs and joints also taking place – this commonly leads to the narrowing of the openings for the spinal sac and nerves, a condition called spinal stenosis which can range from uncomfortable to extremely painful.

Many patients with adult scoliosis may adopt unusual postures in an attempt to avoid and reduce this pain – some patients with adult scoliosis may lean forward to try and open up space for their nerves. Others may lean forward because of loss of their natural curve (lordosis, sway back) in their lumbar spine (low back). The imbalance causes the patients to compensate by bending their hips and knees to try and maintain an upright posture.

Accordingly, back pain, and specifically Low back pain and stiffness are common issues for those with adult scoliosis. Numbness, cramping, and shooting pain in the legs due to pinched nerves, as well as fatigue resulting from strain on the muscles of the lower back and legs are all common issues.

Finally, while not a diagnostic indicator, it is worth noting that many older adults may also experience arthritis, which commonly affects joints of the spine and leads to the formation of bone spurs.

 

Adult Scoliosis – Traditional symptoms

The more traditional, physical symptoms associated with scoliosis of course also apply to adult cases, and it’s these which are easiest to screen for.

Degenerative Scoliosis linked to ASA can often occur in the thoracic (upper) and lumbar (lower) spine, with the same basic appearance as that in teenagers, such as shoulder asymmetry, a rib hump, or a prominence of the lower back on the side of the curvature.

De-Novo cases are typically seen more in the lumbar spine (lower back) and are usually accompanied by straightening of the spine from the side view (loss of lumbar lordosis).

 

Home Screening for Scoliosis

While the more general, painful symptoms are best investigated by a spinal professional (whether scoliosis is the cause or not), a basic home screening for the physical signs of scoliosis is easy to do. Simply follow the steps here!

 

 

 

 

[1] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Scoliosis Screening – For Older Adults!

Posted on June 8, 2022 by - Blog

Scoliosis screening is a topic which we regularly write about on our blog – in our view (and safe to say, in the view of most of the scoliosis treatment community) screening represents a relatively inexpensive way to detect scoliosis as early as possible. In young people, early detection is particularly important – the majority of scoliosis cases progress (at least to come extent) without treatment, whereas early intervention allows for relatively simple, non-surgical approaches to be used in preventing and correcting curve progression. Studies have shown that a large percentage of scoliosis cases are detected between the ages of 11 and 14[1] although the young people outside of this bracket certainly can and do develop scoliosis.

Young people, with their whole life ahead of them, have the highest risk of progression from scoliosis –  however, when the condition is caught early, they also have some of the best prognoses. These two factors together mean that younger patients tend to attract the attention of most medical studies. It’s essential however, that we also recognise the importance of screening in older adults – as many of 1 in 3 of whom will develop the condition in later life.[2]

 

Why screening older people matters

No matter what the age of the individual concerned, spotting scoliosis early is always a benefit, and, put simply, since there are forms of scoliosis – such as “De-Novo” scoliosis –  which begin development later in life, scoliosis is a condition which we need to be vigilant for throughout life.

It’s true that Scoliosis cases (even more significant cases) tend to progress much more slowly throughout adulthood than they do in childhood (something around 1 degree per year is a commonly cited figure[3]) however we also have to keep in mind that one spends much more time as an adult than as a child! Since conditions such as De-Novo Scoliosis are related to the natural ageing process rather than the genetic factors which (as per the latest research available) looks to be the most likely culprit for adolescent scoliosis cases, it’s also possible for someone with no history of scoliosis at all to develop the condition in their 60’s or 70’s.

The good news is that even without public health provision, scoliosis screening is quick, easy and can even be done yourself at home (although it’s easier with someone to help).

It’s for this reason that scoliosis screening is considered a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT).[4]

 

So why have I never heard about scoliosis screening?

At present, scoliosis screening isn’t widely provided in the UK – The latest review from the NHS concluded that screening for the condition isn’t worth doing – as a scoliosis clinic, you can well imagine that we disagree with this!

There are three main reasons which explain the lack of screening in the UK – unfortunately, they’re all pretty poor excuses!

The first is simply the fact that many health professionals have little or no training on Scoliosis, and the general public has even less. We don’t just mean GP’s here – while many professionals, such as Chiropractors, who specialise in spinal health can recognise a scoliosis case, most have not had the benefit of specialist training on how to treat the condition. As the UK Scoliosis clinic we’re thrilled to take referrals from concerned chiropractors from miles around, but not all healthcare professionals have a clear referral route for scoliosis cases. This is an issue for the healthcare community itself to work on as a major step toward improving outcomes for patients.

This raises a question – why are we so ignorant when it comes to scoliosis, especially in older people?  This is the second major problem – the belief held for much of history, that scoliosis is treatable only with surgery, or (often for older adults) that progression was inevitable and simply something one had to “live with” – therefore, it followed that screening to catch it early was of little value.

Until recently, this has been a valid point – but it’s critical to recognise that today there are far more options for scoliosis sufferers, and we’re now able to help many patients overcome scoliosis without ever thinking about surgery. Much of the evidence suggesting scoliosis can only be treated with surgery dates as far back as the 1940’s[5] so it makes sense for us to re-examine the evidence and technology we now have available.

This is all the more important given the results of more recent research which show that exercise[6] and bracing[7][8] based treatments can reduce pain and curve progression as well as improve quality of life in older people, even when used as a part time treatment.

The third reason is cost – and the cost-based argument against screening also flows from the same line of thought – if surgery is the only treatment option, why invest in screening? To be fair it has been true, even in the recent past, that accessing a scoliosis screening in the UK meant attending a specialist clinic, and inevitably that meant incurring a cost. Given that screening should be done yearly at least, and many older adults are working with a fixed income this clearly makes the proposition less attractive.

Today, however, screening need not be expensive – or actually cost anything at all. There are now several guided screening apps available, which, while not a substitute for a professional opinion, are a great initial screening tool. These include our own ScoliCheck app.

 

 

[1] ‘School Scoliosis Screening Programme – A Systematic Review’
Sabirin J, Bakri R, Buang SN, Abdullah AT & Shapie A 2010, Medical Journal of Malaysia, December issue, vol. 65, no. 4, pp. 261-7.

[2] ‘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.

‘The prevalence and radiological findings in 1347 elderly patients with scoliosis‘
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

[3] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

[4] TB Grivas, MH Wade, S Negrini, JP O’Brien, T Maruyama, M Rigo, HR Weiss, T Kotwicki, ES Vasiliadis, LS Neuhaus, T Neuhous, School Screening for Scoliosis. Where are we today? Proposal for a consensus. Scoliosis 2(1)  (2007) 17

[5] AR Shands, JS Barr, PC Colonna, L Noall, End-result study of the treatment of idiopathic scoliosis. Report of the Research Committee of the American Orthopedic Association.  J Bone Joint  Surg 23A  (1941) 963-977.

[6] ‘Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study’
Negrini A, Donzelli S, Negrini M, Negrini S, Romano M, and Zaina F 2015,, Scoliosis Jul 11 10:20

[7] 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.

[8] ‘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

 

Scoliosis Awareness Month – Raising Awareness of Adult Scoliosis

Posted on June 1, 2022 by - Blog

Scoliosis is a condition which affects people of all ages – patients right from birth to old age present at scoliosis clinics around the world, seeking help for many forms of the condition every year. Despite this, there is somewhat of a bias toward thinking of scoliosis as a “young persons” condition – while there are some legitimate reasons for this perception, it’s not an accurate one. As many as one in three over 60’s actually suffer from Scoliosis, struggling with issues such as pain and discomfort which, in many cases, could be treated. This Scoliosis awareness month the UK Scoliosis clinic is focusing on raising awareness about scoliosis in adults – a lesser discussed, but equally important condition.

 

What is adult Scoliosis?

Scoliosis, for those who don’t know – is a condition in which the spine “curves” from side to side. A normal spine can and should have a natural curvature – however, this should be “Front to back”, so that when viewed from the side the spine looks something like an “S”. This natural curvature is not only normal but is actually critical to allowing us to move and remain balanced properly! Scoliotic curves, in which the spine looks like an “S” when viewed from behind are the opposite – they destabilise the spine causing pain, discomfort, aesthetic problems and, in serious cases, can even interfere with breathing. Scoliosis is a condition which tends to progress over time, meaning it usually gets worse without treatment.  Very often, scoliosis is diagnosed in younger teenagers – with girls between the ages of roughly 10 and 15 being the “classic” risk group. This group also attracts the attention of much of the scientific literature, and almost all of the “social” content relating to the condition – but in fact, far more adults, especially older adults, suffer with scoliosis than do younger people.

Adult Scoliosis then, is technically any scoliosis case that exists either in those over 18, or those having reached skeletal maturity, either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis (sometimes noted as DDS) – this is the development of a new scoliosis case, usually as a result of spinal degeneration.

 

What causes Scoliosis in Adults?

ASA – that was scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life. Degenerative scoliosis is somewhat unusual in the scoliosis world since we understand its cause well – it’s due to wear and tear on the spine, but it is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age – although, in patients with no known history of scoliosis, differentiation from degenerative idiopathic scoliosis may be difficult. It is thought that as many as 40% of over 60’s suffer from de-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

What is the prognosis and treatment for Adult Scoliosis?

ASA can be considered both stable (progression is very slow or non-existent) or unstable, progression is continuing. Whether an ASA case will progress quickly, slowly, or not at all may well depend on the size of the curve itself when adulthood is reached. Research has suggested that simply put, large curves tend to get worse – smaller curves may well be stable. Weinstein et al. and Ascani et al. have reported results showing that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progress at approximately 1° per year.[2] The degree of progression will be the best guide for treating ASA cases – bracing, exercise or even just periodic monitoring could all be the right approach, depending on the case.

De-Novo scoliosis is a condition related to ageing – and since we can’t stop ageing itself, De-Novo Scoliosis always continues – however, the impact upon a person’s life can be greatly minimised with the correct treatment. Patients with de-novo or degenerative scoliosis will often experience constant back and leg pain which makes it difficult for them to walk or stand for any period of time. They may become aware that they cannot stand up straight and lean towards one side, this becomes more noticeable the longer they are upright. Frequently they don’t find relief with medication, or through more standard conservative treatment (such as chiropractic or physiotherapy) and they are not suitable for surgery due to osteoporosis i.e. bone weakening.

The good news is that recent advances in non-surgical treatment have shown significant improvement in terms of reduction of pain and symptoms in those with adult scoliosis.  One approach involves the patient learning how to self-correct their abnormal posture, not just strengthen their lower back or core –  indeed, studies show that simple, exercise based approaches can reduce pain in adult scoliosis cases.[3]

The most effective approach would be the use of a customised brace, such as a ScoliBrace which helps to support the posture in a more comfortable position, pain is reduced (even with part-time bracing)[4] and quality of life is improved. Indeed, De-Novo Scoliosis patients often respond well to a gentle supportive brace, which helps to keep them upright and less tilted thus they can walk or stand more comfortably for longer periods of time.

 

Treatment for adult scoliosis

The main takeaway from this blog, and from our Scoliosis awareness efforts this month, should be that treatment options for adults with scoliosis do exist and, if you’re within travelling distance, they’re available at the UK Scoliosis Clinic!

 

 

 

[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] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.

Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.

Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.

[3] ‘Scoliosis-Specific exercises can reduce the progression of severe curves in adult idiopathic scoliosis: a long-term cohort study’
Negrini A, Donzelli S, Negrini M, Negrini S, Romano M, and Zaina F 2015,, Scoliosis Jul 11 10:20

[4] 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

‘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

 

June is Scoliosis Awareness month

Posted on May 23, 2022 by - Blog

The UK Scoliosis Clinic recognizes June as Scoliosis Awareness Month – as usual, it’s an important opportunity for us to reflect on the importance of ongoing developments in scoliosis treatment as well as to advocate for further research. Critically, scoliosis awareness month is an opportunity to raise awareness of scoliosis, and, the words of the scoliosis research society “Speak Up For Scoliosis”

 

What is Scoliosis?

Scoliosis is a condition that causes the spine to abnormally curve sideways. Although many people have not heard of the condition it is surprisingly common, impacting infants, adolescents and adults of all races, classes, and all genders. Despite this, adolescents (of which a majority are female) and those over 60 are the most commonly diagnosed and should be especially vigilant.

According to the Scoliosis Research Society, Approximately one out of every six children diagnosed with scoliosis will have a curve that requires active treatment, sometimes involving surgery. Early diagnosis is the key to taking important first steps to providing treatment that may prevent more serious problems. Today there are more non-surgical treatment options (such as bracing or exercise based therapy) than ever, but to have the best chance of success early detection is key.

 

What is Scoliosis awareness month?

Every June, National Scoliosis Awareness Month highlights the growing need for education, early detection and awareness about scoliosis and its prevalence.  The campaign also unites scoliosis patients, families, physicians, clinicians, institutions, and related businesses in collaborative grassroots networking throughout the month.

Around the world, Scoliosis screening as a public service is not uniformly provided – in the UK, there’s no provision at all and in the US, on about two-thirds of states mandate or recommend scoliosis screening in schools – this means it is important that friends and family members learn to recognize the signs and symptoms of the condition and know that help is available. It is often parents or primary care providers who first identify the issue. Fortunately, an examination and X-ray can confirm the diagnosis and an expert can recommend treatment, if necessary.

 

About the UK Scoliosis Clinic

The UK Scoliosis Clinic is one of the UK’s most well established specialist scoliosis clinics, we focus on non-surgical treatment of scoliosis in Children and Adults primarily through bracing with the unique ScoliBrace system supported by complementary approaches. To learn more about scoliosis, or how to screen for the condition please see our website at https://scoliosisclinic.co.uk

 

Gamifying scoliosis treatment – could it work?

Posted on May 17, 2022 by - Blog

One of the most important factors in delivering successful scoliosis treatment is ensuring that patient compliance is high enough to derive a positive outcome. Put simply, treatment only works if you actually do it!

In terms of bracing, it’s easy to measure compliance – a brace is either worn, or it is not. If the brace is being worn, the treatment is being applied, if it is not, the brace does no good. Actually measuring bracing compliance has been a methodological issue in many bracing-based studies, since patients often do not accurately report the length of time for which they really wore the brace. More recent studies have relied on temperature based sensors to objectively measure when a brace is, or is not, being worn, which has been successful from the point of view of study investigators and is generally viewed favourably by patients.[1]

When it comes to scoliosis specific exercises, however, the picture is more complicated – patients must perform their exercises daily in order to have any chance of success, however, they must also perform them correctly. Therefore, simply taking the time to do a scoliosis specific exercise regime does not guarantee results – you must also ensure that you do it right from start to finish.  The need to perform exercise regularly and correctly is a limitation which needs to be considered especially when working with younger children – it’s no slight on any young person to question whether they will have the strength and indeed memory, to be able to perform exercises with precision every single day. What’s more, studies have actually shown that young children perform better when higher volumes of feedback are given  – by contrast, in adults, less feedback leads to higher precision[2] , therefore, home-based exercise approaches may lend themselves more naturally to adults, although it is often children with smaller curves who stand the benefit the most from them.

 

Gamifying Treatment

One novel, but interesting approach to this problem has been to develop video games and interactive apps which can guide young children in performing these kinds of exercises – these have the dual benefit of providing the additional feedback children seem to desire, and also adding some fun to what can be an otherwise boring routine.  One recent study looked at the effectiveness of a so called “Physiogame”, developed by the IT department of the FH JOANNEUM, University of Applied Sciences, Graz, Austria.[3]   The concept is simple, but effective – using the game with an interactive controller the player is instructed so that they remain within a desired splaying space and adopt correctly the 3D positions of the trunk and extremities which are individually adjusted to the corrective posture desired – the game only continues when the posture is correct. This provides both motivation and constant feedback which suits the need of younger participants.

A recently study[4] examing the impact of using such a game showed some real promise for this approach – While the study was small scale (8 patients) and the actual use time of the game in question varied, significant improvements in the accuracy of exercise performed were observed.

In the first month, the participants managed to stay in the predefined 3D space 73% of the gross playing time, and by the last month of the observation period, this increased to 83%. The children improved their performance of the exercise on average by 15%.  The improvement in staying in the corrective posture autonomously and being able to focus more on the game was reflected in the average increase of positive hits per second in-game: they increased from 0.33 in the first month to 0.56 in the last month, for an average increase of 66%.[5]

As part of the program, participants were also asked to evaluate their own performance – interestingly, the study showed that the self-assessment of general performance (“today I did well”) stayed almost the same over the study period, with an average of 2.7 (good) in the first month and 2.3 (very good) in the last month. Similarly, self-assessed stabilization of the vertebral column changed only slightly from 2.6 (good) in the first month to 2.3 (very good) in the last month[6] – hence, the patients improved in their accuracy of exercise without actually being aware of it.

 

Further research

The study authors conclude that further research into the use of these kinds of “gamified” treatments may well pay dividends, especially for younger patients. In the post-covid world, where pandemic resilience and an increased desire to perform more tasks from home are a key features, this kind of interactive “take-home therapist” may well play a key role in treatment in the future.

 

 

 

[1] Sabrina Donzelli et al. Adolescents with idiopathic scoliosis and their parents have a positive attitude towards the Thermobrace monitor: results from a survey Scoliosis and Spinal Disorders volume 12, Article number: 12 (2017)

[2] Sullivan KJ, Kantak SS, Burtner PA. Motor learning in children: feedback effects on skill acquisition. Phys Ther. 2008;88(6):720–32.

[3] Lohse K, Shirzad N, Verster A, Hodges N, Van der Loos HF. Video games and rehabilitation: using design principles to enhance engagement in physical therapy. J Neurol Phys Ther. 2013;37(4):166–75.

[4] Christine Wibmer et al. Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance Scoliosis and Spinal Disorders volume 11, Article number: 44 (2016)

[5] Christine Wibmer et al. Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance Scoliosis and Spinal Disorders volume 11, Article number: 44 (2016)

[6] Christine Wibmer et al. Video-game-assisted physiotherapeutic scoliosis-specific exercises for idiopathic scoliosis: case series and introduction of a new tool to increase motivation and precision of exercise performance Scoliosis and Spinal Disorders volume 11, Article number: 44 (2016)