Category: Blog

Scoliosis awareness and the BrAIST study

Posted on May 27, 2021 by - Blog

Scoliosis awareness month is almost upon us, and as usual, we’d like to take the opportunity to draw attention not only to the condition but also to the importance of ongoing research. Scoliosis awareness month, for those who don’t know, takes place in June each year – with International Scoliosis Awareness Day on the last Saturday of each June.

While Scoliosis awareness day is a great opportunity for fund and awareness-raising events, National Scoliosis Awareness Month runs throughout June and aims, in particular, to highlight the growing need for education, early detection and awareness to the public about scoliosis and its prevalence within the community.

According to the scoliosis research society, the organisers of National Scoliosis Awareness Month, its official objectives are:

  • Using the results from the BrAIST Study, highlight the importance of early detection and the effectiveness of bracing as early, non-operative care.
  • Increase public awareness of scoliosis and related spinal conditions through educational and advocacy campaigns of local activities, and community events during the month of June.
  • Unite scoliosis patients, families, physicians, and clinicians in a collaborative partnership that educate, and advocate, for patient care, patient screening, patient privacy, and patient protection
  • Build networks of community collaborations and alliances to help sustain and grow the campaign[1]

 

It’s the BrAIST study – an important landmark for scoliosis research and treatment which we’d like to discuss today.

 

The BrAIST study

The BrAIST study, overseen by Dr Stuart Weinstein and published in 2013, was perhaps the most impactful study showing the efficacy of bracing in treating scoliosis cases.  In short, the study proved that bracing of adolescents with moderate scoliosis was an effective treatment in the reduction of the number of patients who advance to the need for surgery. In addition, a dose-response was found between the number of hours of brace wear and the success rate of bracing – which is to say, there’s a strong relationship between how long a brace is worn, and how effective the treatment is. Both are critical points when considering the value of scoliosis bracing as a whole.[2]

Unlike many of the smaller studies which inform our understanding of scoliosis and best practice in treating it, the BrAIST study was coordinated between several medical centres, and allowed the highest level of medical study, a randomized clinical trial, to be undertaken. To answer the question of whether bracing is effective in growing children and adolescents with curves.

During the study,  242 patients with curves between 20 – 40 degrees participated.  Patients in the bracing group were assigned to wear a brace 18 hours per day (a typical bracing prescription).  A special monitor was embedded in the brace to keep track of how long it was used per day.  Patients in the observation-only group received no additional treatment.  The endpoint of the study was “treatment failure” defined as progression of the scoliosis to 50 degrees or “treatment success” when skeletal maturity was reached without progression to 50 degrees.

Across the survey group, 72% of brace wearers avoided surgical recommendations, but only 48% of patients in the observational group did the same. Furthermore, however, it was also shown that patients who complied fully with their bracing instructions, and wore the brace for 13 hours or more was greater than 90%, showing both that the amount of time the brace is worn is very important and that the results we can expect with solid compliance are fantastic indeed. The study, therefore, provided strong evidence to the value of brace treatment for those adolescents at high risk of progression of surgery.

 

Why the BrAIST study matters.

The BrAIST study was notable due to its size – a large sample set, its nature – a fully randomised clinical trial and the credentials of its authors – a range of expert Doctors. The impact of the BrAIST study was therefore to provide solid evidence not only for non-surgical treatment but also against the “wait and see” attitude which has existed towards scoliosis for decades.

In the past, the value of a screening examination for scoliosis has been debated due to inconclusive evidence of the success of non-operative treatment for scoliosis – simply put, without strong evidence to show it’s possible to avoid surgery, why screen, and why bother?

Thanks to the BrAIST study, this is no longer true.  It shows that early screening and non-surgical treatment may reduce the number of patients who progress to surgery and, therefore, could serve as a potential cost saving for the health care system and of great benefit to patients. According to the study, Policy statements from professional organizations and governmental agencies regarding scoliosis screening in school programs and primary care settings will need to be reassessed in order to identify at-risk patients who will benefit from bracing for scoliosis[3].

And it’s this final point that highlights why scoliosis awareness month and the BrAIST study now matter more than ever – it’s 2021, and there’s no sign of the UK government even considering screening in schools for scoliosis, and, despite many organisations best efforts, the majority of people are still unaware of scoliosis, and it’s possible treatments.

That’s why this scoliosis awareness month, we invite you to help us spread the word – and, for your own knowledge, take just a moment to read the conclusions from the BrAIST study – you can find it here and read the abstract in about 3 minutes.

Over the next month, we’ll be posting articles about different kinds of scoliosis, how to spot them and what the treatment options could be – keep an eye out and help us to raise awareness throughout June!

 

[1] https://www.srs.org/patients-and-families/additional-scoliosis-resources/scoliosis-awareness-month

[2]     Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

[3] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

Warning: this is NOT a Scoliosis Brace!

Posted on May 15, 2021 by - Blog

At the UK Scoliosis clinic, we specialise in Scoliosis Bracing – Scoliosis Bracing is a non-surgical treatment for scoliosis, which involves the detailed design and manufacture of a specialised, wearable brace which, over time, gently opposes the scoliotic curve in the spine, and works to guide it back towards a normal alignment.

Once upon a time (not too long ago), it was thought that scoliosis could not be stopped – that is to say, it was accepted that the curve would just continue to develop until, eventually, surgery was required to correct the deformity. Sadly, this approach is still recommended by some practitioners – who do not seem to be aware of the preventative and non-surgical corrective options available today.

The results achievable through modern bracing are however, impressive – to sample just a few studies, recent findings show that specialised scoliosis bracing when prescribed for high-risk patients, has been shown to prevent the need for surgery in most cases[1], that, overall, bracing is an effective treatment method for AIS cases, characterized by positive long-term outcomes[2] and even that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, with most patients reaching a complete curve correction[3]

What’s more, part-time bracing in adults significantly reduces progression of curvatures and improves the quality of life[4], and results suggest that bracing can even be “boosted” through complementary approaches – for example, specialised scoliosis physiotherapy (SEAS), when used in conjunction with bracing, has been shown to improve overall results[5]

There are many reasons to consider bracing as your primary treatment approach if you’re a scoliosis sufferer – however, in order to reap these benefits, it’s vital that you use a specialized, customized scoliosis brace.

 

This is not a scoliosis brace!

It cannot be stated clearly enough that the above studies all relate to medical-grade TSLO over corrective braces – that is to say, specially designed braces that are customized for the patient and their exact spinal condition. What’s more, these are braces that are fitted, designed, monitored and adjusted by Scoliosis professionals at every stage of the process.

As you may guess, this means braces are not cheap – even the most basic in this category cost over £1000 per brace  – this is still far cheaper than surgery and compares favourably with a course of exercise-based treatment – but it’s certainly not an inexpensive item.

It’s probably for this reason that every more products which market themselves as a “scoliosis brace” are appearing on Amazon, eBay and our other favourite shopping sites. It’s critical to realise that these offerings are not even close to the type of brace required for the results discussed above – and in some case, they may cause more harm than good.

These so-called “braces” are (see example right) are very often just posture supports, which may have some marginal benefit for those with a normal spine, but could, in fact, worsen a scoliosis case.

 

THIS is a scoliosis brace

A genuine scoliosis brace (see ScoliBrace right) is of rigid construction, which while still ergonomic, is able to gently apply pressure to the spine, in opposition to the curve. This means that gentle pressure is exerted in the direction the spine needs to correct, and only in this direction. This is the fundamental mechanism of a scoliosis brace- hence it should be obvious that a fabric-based “support” possesses none of the qualities required for scoliosis correction.

It is not the purpose of this article to single out any individual product, nor are we saying that “soft” supports have no use in spinal care – quite the opposite, however, if you are using a “Scoliosis brace” which you have not obtained through a specialist clinic, we would strongly advise you to discontinue use and seek a professional consultation.

 

 

 

[1] Weinstein et al DOI: 10.1056/NEJMoa1307337

[2] Aulissa et al,  https://doi.org/10.1186/s13013-017-0142-y

[3] Aulisa et al, DOI: 10.1186/1748-7161-9-3

[4] Palazzo et al, DOI: 10.1016/j.apmr.2016.05.019

[5] Negrini et al, DOI:10.1186/1471-2474-15-263

 

How is scoliosis treated in 2021? – Part 2

Posted on May 7, 2021 by - Blog

Last week we began looking at how we can best treat Scoliosis in 2021 – this week we’re continuing to look at treatments, this time in terms of exercise and physiotherapy based approaches.

 

Schroth Therapy

Schroth therapy is a well-established and easy to use exercise methodology which some experts consider to be the best exercise-based approach for treating Idiopathic Scoliosis. [i]

As an independent treatment, some studies have shown a reduction of cobb angle of 10-15 degrees over the course of a year[ii] – however Schroth therapy combines particularly well with bracing. When Schroth is combined with bracing superior results can often be achieved more quickly.[iii]

The Schroth method itself is comprised of more than 100 individual exercises, which are chosen and organised individually for each patient. A Schroth program usually consists of 6-8 core exercises which are specifically targeted for the curve in question. This is because the Schroth method recognises that what’s appropriate for the common 3-curve, right thoracic scoliosis, for example, would not work for the 4-curve variety.

At the UK Scoliosis clinic, we adhere to the guidelines of the Schroth Best Practice program, the most up to date development of the methodology based on recent evidence by Dr Hans-Rudolf Weiss, Grandson of Katharina Schroth and son of Christa Lehnert-Schroth. Schroth best practice incorporates the latest evidence-based approaches and includes several new methods for treating specific conditions common to scoliosis sufferers more directly than the original version.

 

SEAS

SEAS is the acronym for “Scientific Exercise Approach to Scoliosis”.

SEAS is an approach to scoliosis exercise treatment with a strong grounding in the most modern approaches in physiotherapy. SEAS treatment programs are usually constructed by a practitioner, who will then teach the patient their individual routine. After this, SEAS can be performed at home.

The objective of SEAS exercise is to promote self-correction of the scoliotic posture, using exercises which are often incorporated into a broader exercise program designed to improve overall function and lessen the symptoms of scoliosis.

Unlike other therapies, the SEAS methodology is constantly evolving, so seeking out a practitioner who demonstrates familiarity with the latest research is especially important.

SEAS is also used alongside bracing treatment and is especially useful for avoiding a loss of correction after the conclusion of treatment with a brace. A 2008 study showed that post-brace patients treated with SEAS experienced no loss of correction after 2.7 years.[iv]

 

So….Which treatment is best for me?

In most cases, the best treatment for scoliosis will be bracing – be this part time, full time or night-time based bracing. Whichever treatment you choose, be sure to opt for a clinic which offers customised one to one treatment – If you suspect scoliosis you should seek a professional consultation, but as a rough guide we would suggest:

For small curves, less than 20 degrees a scoliosis exercise program based on SEAS or Schroth might be sufficient, especially if there is a low risk of progression.

For curves over 20 degrees, or curves with a high risk of progression, bracing is the best option. Today, it is fair to say that specialised scoliosis bracing when prescribed for high-risk patients can prevent the need for surgery in most cases.[v] Research indicates that non-surgical treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, whereas part-time bracing in adults significantly reduces progression of curvatures and improves quality of life.[vi]

Often exercise is combined with bracing as part of an overall treatment program – but research shows that in head to head comparison bracing is the most effective treatment in most cases. A recent study showed that over 12 months, bracing led to a mean reduction in cobb angle of 5.88 degrees, whereas exercise reduced curves by just 2.24 degrees.[vii]

 

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

[ii] Kuru T, et al. The  efficacy  of  three-dimensional  Schroth  exercises  in   adolescent idiopathic scoliosis: A randomised controlled clinical trial,

Clinical  Rehabilitation,  30(108); (2015)

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

[iv] 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

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

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

[vii] 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]

 

How is scoliosis treated in 2021?

Posted on May 1, 2021 by - Blog

Scoliosis treatment has come a long way since treatments for conditions first emerged at the start of the last century. Today there are more options for scoliosis sufferers than ever before, so a common question we often get is simply – “how should I treat scoliosis in 2021”? Over the next couple of articles, we’ll try to answer this as simply as possible.

Historically, it was thought that surgery was the only way to treat scoliosis – but today there are a number of non-surgical approaches which, when applied by a specialist scoliosis clinician, can treat scoliosis.

The two main treatment methodologies used are exercise-based approaches and bracing. Bracing is the most effective way to reduce a cobb angle (cobb angle is the measurement of scoliotic curve) and avoid surgery. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[i] Results vary by brace – but some studies have shown success rates with bracing as high as 100%.[ii]

Scoliosis specific exercise can be effective in treating smaller curves (generally below 20 degrees) where there is a lower risk of progression, but is probably best used in support of bracing, as a method to address muscular imbalances and postural problems which can often result from scoliosis.

Although the “wait and see” or “observation” approach to scoliosis management is now outdated, it is often still recommended by GP’s and is sadly still the favoured approach within the NHS. Unfortunately, the vast majority of scoliosis cases will progress, so it is better to seek advice from a scoliosis professional wherever possible.

 

This week, let’s compare the options which are most often known to patients – observation and bracing.

 

Observation (Wait and see)

Observation is not a treatment for scoliosis, it is simply the act of watching and waiting – however, scoliosis almost never resolves without treatment.

Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[iii]

Because observation is not a treatment, it most often leads to the patient requiring surgery. By contrast, today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is 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.[iv]

 

Bracing

Scoliosis braces are the most effective non-surgical method for reducing cobb angle[v] There are many different kinds of scoliosis brace and many work slightly differently, however broadly speaking braces can be classified as active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position).

Results vary by brace – but some studies have shown success rates with bracing as high as 100%.[vi]

Scoliosis bracing in children and adolescents is recommended when Cobb angles over 20° are observed and there is a risk of progression as the child grows. For cobb angles under 20°, bracing might still be a preferred treatment option, since (unlike exercise) no conscious effort is necessary from the wearer.

Night-time braces are also an attractive option for single curves not exceeding 35 degrees in magnitude.[vii]

 

(This article continues next week!)

 

 

 

[i] ‘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

[ii] 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, and 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.

[iii] 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.

[iv] ‘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

[vi] 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, and 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.

[vii] Grivas TB, Rodopoulos GI and Bardakos NV, ‘Biomechanical and clinical perspectives on nighttime bracing for adolescent idiopathic scoliosis‘ Stud Health Technol Inform. 2008;135:274-90.

Easter holiday update

Posted on March 30, 2021 by - Blog

The UK Scoliosis Clinic will be closed for Easter from April 2nd – 5th. We’ll be back open as usual on Tuesday 6th.

We do still have appointments available before Easter, but please book soon as they’re going fast – please note that due to satff holiday, we also have limited appointments in the week 15th – 19th.

Can you participate in sport with scoliosis?

Posted on February 28, 2021 by - Blog

Scoliosis or not, physical exercise is fantastic for the body and the mind. At the UK Scoliosis Clinic, we encourage our patients to stay active and enjoy their lives as normal while being treated for scoliosis (after all, that’s the point!). It’s often been suggested, however, that Scoliosis should prevent you from participating in sport – is this true?

 

How to choose sports for Scoliosis

While there’s no evidence that any sporting activity can treat Scoliosis, we do know that the condition can cause muscle weakness and imbalances, which many physical activities can help to address. Scoliosis specific exercise is, of course, the best way to do this, but any core strengthening exercise could be supportive, as long as it is not serving to exaggerate any existing imbalances. Exercise, overall, strengthens the core muscles that support the spine, keeps the body nimble and prevents stiffness and supports overall health and boosts self-esteem. For this reason, we suggest you do seek out exercise to keep fit, and build strength – but seek a professional consultation for advice on your specific case first.

With this in mind, let’s look at some exercises which are great, and some which might be best avoided for Scoliosis.

 

Good sports for Scoliosis

Swimming

It was once thought that swimming might be a treatment for Scoliosis – but research has failed to demonstrate this. Since we now understand that the best way to treat Scoliosis is with targeted exercise designed to oppose scoliotic development, it seems unlikely that this would be true. Nonetheless, swimming is a fantastic low impact, low-risk activity which builds strength and cardiovascular fitness. Strongly recommended, although activities such as high-diving are probably best avoided.

 

Cycling

Cycling is another low-impact sport that gives a great cardiovascular workout without aggravating scoliosis curves. Limit off-road cycling, however, as high-impact jolting can compress the spine.

 

Cross-Country Skiing

Gliding-type activities such as cross-country skiing are often recommended for scoliosis patients because they minimize shock to the vertebrae. Cross-country skiing also works both sides of the body, which is helpful for supporting a strong and balanced spine – don’t live in a country with enough snow? The skiing machine at the gym is also a good choice.

 

Strength Training

Strength training, as a rule, is positive for scoliosis sufferers, as it can help strengthen muscles which support the spine. Caution is needed here, as resistance exercise can exacerbate scoliosis if performed improperly. We recommend strength training, but see your scoliosis professional for recommendations first.

 

Yoga

Yoga may be beneficial for an adult with scoliosis. At the very least it can be calming, and improve overall fitness. There has been some very limited research which has suggested yoga could assist in treating scoliosis, although the evidence is of a low quality. Yoga might, however, be a fantastic complement to targeted Scoliosis specific exercise

 

Stretching

Flexibility training is one of the most important things you can do for scoliosis. Regular stretching relieves tension and helps restore range of motion; if done strategically, it can help counteract the spine’s curvature. Just be aware of which stretches aren’t safe exercises for scoliosis. When practising yoga, for example, use modified poses in place of those that hyper-extend or severely rotate the spine.

 

Bad sports for Scoliosis

If sports which are good for scoliosis are those which load the body evenly, and correct imbalances – sports which are bad do the opposite, they’re typically one-sided activities which stress the body, or the spine, in unusual ways. If you have Scoliosis this does not mean you should never enjoy these activities, but it’s worth consulting with your practitioner about how often you should participate.

 

Gymnastics, ballet, dance – exercises which contort the spine.

There is some evidence that certain types of exercise – specifically those which contort the spine – may promote scoliosis. These include ballet, dance and rhythmic gymnastics. Various studies have suggested that scoliosis incidence is anywhere between 12 and 30% more common amongst gymnasts.

Much more research on these correlations is required in order to make concrete determinations about the risk posed by these kinds of activities – it may, for example, simply be the case that scoliosis is more likely to be noticed among these disciplines since there is more awareness of it. Nonetheless, we do suggest you carefully consider these activities if you or your child has or is at risk of developing scoliosis.

 

Trampoline, or impact sports

Jumping on a trampoline may be excellent for strengthening your leg muscles, but those with a lumbar type of scoliosis should avoid it. The downward landing force stresses the spine, possibly causing scoliosis to worsen. Similarly, impact sports such as Rugby come with an inherent risk of spinal injury, which is best avoided with Scoliosis.

 

Strength training, long lump, exercises which compress the spine

We’ve listed strength training as bad, as well as a good sport to underscore the need for caution. Heavy lifting can compress the spine over time – and while spinal compression occurs whenever a child takes a step, jumps, or runs, repeatedly engaging in high-impact activities places significant stress on the spine and can aggravate scoliosis over time. Get your scoliosis professional to show you how to exercise safely without unnecessary spinal compression.

 

Tennis, Javelin, Skating etc, exercises which unevenly stress the spine.

These are all sports which stress one side of the body more than the other, possibly leading to increased scoliosis.  It’s the “one-sided” nature of these sports which is problematic, so in many cases, it might be safe to continue by balancing with complementary exercise. Play tennis and serve with the right hand? Some targeted exercise on the left-hand side is probably appropriate.

 

So, can I play?

There’s no reason why people with scoliosis should not participate in sports – but it’s also important to avoid activities which may make the condition worse. It’s well worth investing in a consultation with a specialist to make sure that you’re participating in a way which is safe, and which may even assist in treatment!

Does scoliosis always get worse with time?

Posted on February 10, 2021 by - Blog

One of the first questions which many people ask when they are diagnosed with scoliosis is “will it get worse?” There’s also a lot of misconceptions around this issue to deal with. It’s true that some scoliosis cases do simply stop developing – but despite what you might read on the internet, this is very rare. Today, we understand scoliosis much better than ever before, and so while we can’t fully explain the condition, we can now make some very sensible assumptions about its likely progression.

This week, let’s look at some of our current best information on this question.

 

Scoliosis development

Firstly, it’s important that we outline exactly what we mean by “worse” in this situation.  Scoliosis is a condition which causes a host of unpleasant symptoms, ranging from physical deformation to problems breathing and, perhaps most impactful for most people, a drastic impact on self-confidence. While these are all perfectly valid ways of understanding how” bad” scoliosis is, in a clinical setting we tend to focus on an accepted measurement called cobb angle. Cobb angle measures the deviation of the spine from normal, such that a more pronounced scoliotic curve is said to have a greater cobb angle, or be of a greater magnitude. It is generally true that as cobb angle increases, symptoms will also become more severe. So, what do we understand about the factors which seem to predispose individuals to a greater increase in this regard?

 

Growth potential

Growth potential – that is to say, how much growing a skeleton has already done, and (roughly) how much more it has to do has been strongly correlated with curve progression.  This has been established since the early ’70s , when it was predominately believed that scoliosis progression was fastest during adolescent growth spurts.[1] More recently, however, we have come to understand that in fact, aspects such as the Risser sign (an indication of skeletal maturity) and the onset of menstruation are closely correlated with the potential for curve increase.  Immature children

(Risser sign 0 or 1) with larger curves (20–29°) at initial diagnosis demonstrated a 68% risk for curve progression, whereas mature children (Risser 2–4) with similar curves at initial presentation had a 23% risk for curve progression. Conversely, immature children with smaller curves (5–19°) demonstrated 22% chance for curve progression, while mature children with smaller curves had only a 1.6% risk for curve progression. [2]

 

Size of curve

Perhaps intuitively to most of us, the size of the curve at the point of discovery is also a factor in predicting its growth. Much research has examined the relationship between age and curve magnitude – for example, Nachemson et al, and Weinstein et al, correlated curve progression with age and curve magnitude,[3] however, today we also understand that curve magnitude can be an independent predictor of curve progression – that is to say that generally speaking, larger curves tend to get larger, and can also progress after skeletal maturity. Weinstein et al. and Ascani and colleagues reported that children with curves < 30° at skeletal maturity did not demonstrate curve progression into adulthood, while the majority of curves > 50° progressed at approximately 1° per year[4]

 

Family History

A family history of scoliosis is a major indicator for the development of scoliosis – research indicates that those with a family member who has scoliosis go on to develop scoliosis in between 11.5 and 19% of cases – considerably more than the 2-3% average in the population as a whole. Research also suggests that those who have family members with severe curves are likely to develop more severe curves themselves, although the correlation is not total.[5] Other factors clearly influence scoliosis, which can also impact the severity of a curve, but those with family members with larger curves should be especially aware.

 

Gender

On average, girls are up to 5 times more likely than boys to develop scoliosis and hence you must also consider that many activities which are popular with young women and girls, such as gymnastics, have scoliosis rates up to 12.4 times as high as the general population. [6] While this is a complex area, since boys can, and do, get scoliosis – it’s important to note that 70% of scoliosis cases are girls. If you perform a home screening, or someone mentions that your child may have scoliosis, you should be especially cautious of that child happens to be a girl.

 

And here’s the key takeaway

We now know a lot about the progression of scoliosis – far more than we ever did in the past. This means that we are far better able to predict the outcome of a case and to treat it appropriately. The keyword here is treat – since there’s one common theme which runs through each of these points – most of the time, scoliosis will progress, and often, it will progress quickly. While there is a chance that some curves may stop growing, it’s highly unlikely – research shows that juvenile cases, for example, almost never resolve spontaneously.[7]

Today, scoliosis treatment is highly advanced – if caught early, surgery can be avoided and most cases can be corrected quickly and in a non-invasive way. The longer cases are left to progress, however, the more difficult they are to treat, and the longer this will take.

At the UK scoliosis clinic, we see far too many young people in particular who have developed scoliosis and which has been allowed to progress. Sometimes the curve progression is sadly just too large for us to help – but each of these cases would have started out as a relatively small curve which, while certainly not desirable for a young person, would have been relatively simple to treat.

Please, do not wait to screen for scoliosis – do it today and if you have concerns get in touch!

 

[1] Duval-Beaupere G: Pathogenic relationship between scoliosis

and growth. In Scoliosis and Growth Edited by: Zorab P. Edinburgh,

Scotland: Churchill Livingstone; 1971:58-64.

[2] Bunnell WP: The natural history of idiopathic scoliosis before

skeletal maturity. Spine 1986, 11:773-776.

  1. Lonstein JE, Carlson JM: The prediction of curve progression in

untreated idiopathic scoliosis during growth. J Bone Joint Surg

(Am) 1984, 66:1061-1071.

[3] Nachemson AL, Peterson LE: Effectiveness of treatment with a brace in girls who have adolescent idiopathic scoliosis. A prospective, controlled study based on data from the Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:815-822.

 

Peterson LE, Nachemson AL: Prediction of progression of the curve in girls who have adolescent idiopathic scoliosis of moderate severity. Logistic regression analysis based on data from The Brace Study of the Scoliosis Research Society. J Bone Joint Surg (Am) 1995, 77:823-827.

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.

 

[4]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.

[5] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

[6] ‘ Carol A Wise, Xiaochong Gao, Scott Shoemaker, Derek Gordon, and John A Herring, Understanding Genetic Factors in Idiopathic Scoliosis, a Complex Disease of Childhood’
Curr Genomics. 2008 Mar; 9(1): 51–59. doi:  10.2174/138920208783884874

 

[7] Charles YP, Daures JP, de Rosa V, Diméglio A,  Progression risk of idiopathic juvenile scoliosis during pubertal growth‘ Spine (Phila Pa 1976). 2006 Aug 1;31(17):1933-42. DOI:10.1097/01.brs.0000229230.68870.97

What is the fastest way to treat Scoliosis?

Posted on February 1, 2021 by - Blog

When you or a family member is diagnosed with Scoliosis, it’s only natural to want to know what the fastest way to treat the condition is. At the UK Scoliosis Clinic, we always stress the need to get a quick diagnosis, as Scoliosis can progress quickly – so acting early makes treatment much easier. But once Scoliosis is diagnosed, how long does treatment take and what’s the fastest option?

 

What do we mean by treatment anyway?

Before we explore the fastest possible option for treating Scoliosis, it’s important that we first understand what “treatment” means here. There are two main aspects which Scoliosis treatment is broken down into – firstly, there’s the Cobb angle, this is how much the spine is “curved” away from the position in which it should ideally sit. Secondly, there are the associated factors which arise from scoliosis or are exacerbated by it. These include physical factors such as muscle weakness, as well as psychological factors associated with deformity, anxiety etc.

 

Treating the Curve

Research shows clearly that Scoliosis bracing is the fastest possible way to reduce cobb angle – longer daily bracing periods will reduce curves faster than shorter periods, with patient adherence to wear-time being the main aspect for success. Choice of brace is also of critical importance here – an active brace, like ScoliBrace, must be used, since a passive brace is not designed to correct the Cobb angle, only to hold it in place.

 

The best possible option in terms of speed is, therefore, full time bracing with an active brace, such as ScoliBrace. A recent study which compared the two main treatment pathways, scoliosis bracing and scoliosis exercise showed that bracing yielded an average reduction in Cobb angle at 6 months of 3.13 degrees, and at 12 months of 5.88 degrees.  This compared favourably with another trial group using an exercise-based approach –  here, the 6 months mean reduction was just 0.66 degrees, and at 12 months was 2.24 degrees.[1]

This figure is somewhat misleading, however, since it also factors for subjects who did not wear their brace as instructed or for the time required – nor was the brace use in the study the ground-breaking new ScoliBrace which we offer. While our results depend to a large degree on the individual case, below are some case studies using the ScoliBrace – all of which achieved better than 25-degree curve correction in roughly 2 years.

 

 

Treating associated factors

While scoliosis bracing is clearly the fastest way to reduce cobb angle, it’s also important to strengthen the muscles around the spine, and improve the posture overall to equip the patient for life after Scoliosis. Indeed, treating the cobb angle alone may even lead to increased muscle weakness in the future, due to the supportive work being taken up by the brace, rather than the appropriate muscles.

Scoliosis specific exercise is a highly effective approach for heading off these issues – having been shown to be effective in improving overall quality of life scores, as defined by the SRS 22 questionnaire, a standard tool used to gauge the impact scoliosis has on a persons life. In the study mentioned above, the group treated with scoliosis specific exercise showed improvements in all the SRS-22 quality of life scores, and a significant improvement in terms of the functional score, a measure of physical impact on daily life from scoliosis. [2]

 

While any form of exercise (and the sense of control and ownership it can bring) will have a positive psychological effect, the same study also noted a significant improvement in self-image amongst the bracing group – especially after the 12 months follow up. Simply put, the reduction in deformity seemed to translate to a tangible improvement in self-image – which, coupled with exercise, can go a long way to beating the psychological issues caused by Scoliosis. [3]

 

The fastest way to treat Scoliosis

Put simply, the fastest way to treat scoliosis is Active bracing – with a brace like ScoliBrace. Scoliosis specific exercise will reduce scoliosis over time, but only at a much slower rate. This makes it applicable for small curves where a large correction is not required, however, if the goal is to correct a small curve quickly, bracing is still a better choice. This being said, it’s only half the story – beating scoliosis means leaving a patient with a reduced, or eliminated Cobb angle and ensuring that they are physically fit, functionally capable and psychologically ready to move on and leave Scoliosis behind.

It’s for this reason that the UK Scoliosis clinic prefers a multifaceted approach to Scoliosis, making use of bracing, exercise and complementary approaches to provide a treatment plan which aims to address all aspects of scoliosis – in the short, and the long term.

 

 

[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] 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]

[3] 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]

Scolibrace Vs. Hospital brace – which is better?

Posted on January 25, 2021 by - Blog

At the UK Scoliosis clinic, our primary focus is to allow as many patients as possible to benefit from the chance to beat scoliosis through non-surgical methods as possible. Research as well as our own experience demonstrates that scoliosis bracing is the best way to achieve this – and for this reason were broadly supportive of any kind of scoliosis bracing technology available. This being said, we’ve said before that all braces are not created equal – some are just more effective than others.

 

Why ScoliBrace?

Our preferred brace and the one we offer at the clinic is the ScoliBrace. ScoliBrace is a totally customised brace, designed to achieve maximum curve correction as quickly as possible – but as well as being a highly effective corrective device, ScoliBrace is (in our opinion) the most patient-friendly brace on the market. It’s a low profile brace, and is practically invisible under clothing – unlike traditional braces, ScoliBrace opens and closes at the front making it easy to wear and remove without assistance. ScoliBrace is even flexible enough to allow the wearer to participate in normal physical activity while wearing the brace. What’s more, you can customise your ScoliBrace! – There are a variety of colours and patterns available for patients to personalise the look of their brace – overall, we think these factors make it the best choice for patients today.

 

How effective is ScoliBrace?

ScoliBrace stacks up favourably vs. the traditional thoracolumbosacral orthosis (TLSO) braces available through hospitals and some other clinics – and one recent study shows just how great the difference can be. The recently published study from Dr Jeb McAviney of ScoliCare (Sydney, Australia) concerned a male patient who was referred to the ScoliCare clinic at the age of seven with a previous diagnosis of juvenile idiopathic scoliosis. The patient had previously been fitted with a traditional 3-point pressure thoraco-lumbo-sacral orthosis (TLSO) that had been designed by a hospital orthotist[1].

The patient reported that he regularly participated in rugby, soccer and swimming. Aside from the spinal deformity, the patient was otherwise healthy. On examination a right thoracic curve and a left lumbar curve were noted.

The patient provided x-rays that had been taken at the time of the initial diagnosis as well as x-rays taken soon after the brace fitting (Figure 1). The initial pre-brace x-rays revealed that the patient’s primary thoracic curve was 32° Cobb and the secondary lumbar curve was 27° Cobb.

An examination of the in-brace x-rays for the hospital made TLSO demonstrated that an adequate in-brace correction had not been achieved with only an 11° reduction in the thoracic curve and no measurable change in the magnitude of the lumbar curve (Figure 1).

Dr McAviney proceeded to design and fit a customised ScoliBrace for the patient – In-brace x-rays taken soon after the fitting of the new ScoliBrace demonstrated a significantly better in-brace correction compared to the previous brace.

The patient’s primary thoracic curve had been reduced to down to 13° Cobb, which represented a 59% correction of the initial curve and a 25% improvement on the correction obtained with the hospital-made TLSO.

The lumbar scoliosis was almost completely reduced (3° Cobb) in the new orthosis. The hospital-made TLSO had not achieved any correction in this region of the spine (Figure 2).

 

This is just one case which demonstrates that all braces are not equal – the right brace at the right time is needed for real improvement.

Is ScoliBrace right for me?

If you’ve been diagnosed with scoliosis you will have numerous treatment options – bracing is one of these, while exercise-based therapy is the other major one. For very small curves exercise-based approaches may be preferable, but in most cases, we recommend you consider bracing.

Since Scoliosis presents in a unique way in every patient, ScoliBraces are custom designed to fit your exact needs – Fundamentally, Scoliosis is a 3 Dimensional condition, so we believe effective treatments need to be 3 dimensional too. Your brace will be designed using 3D full-body laser scanning technology, x-rays and posture photographs.

Each brace is then produced for the individual with Computer Aided design (CAD) and then created with Computer Aided Manufacture (CAM).

ScoliBrace is typically recommended for the treatment of Cobb angles from 25-50 degrees. It is suitable for wearers of all ages and comes custom-designed for your specific requirements. For curves less than 25 degrees, bracing may still be the preferred choice, as it’s a faster treatment than exercise – it’s also much easier for smaller children to manage (just put the brace on, rather than performing complex exercises). For curves greater than 50 degrees, bracing may still be possible – book an appointment with a scoliosis professional today!

Don’t forget that the UK Scoliosis clinic now offers online consultations too – so if you have questions, book an appointment today!

 

Images in this article are courtesy and copyright ScoliCare Australia.

 

 

[1] Dr Jeb McAviney, Superior In-brace Correction Achieved with a ScoliBrace Compared with a Standard TLSO in a Juvenile Scoliosis Patient (ScoliCare, 2020)

 

 

How to treat degenerative scoliosis?

Posted on January 14, 2021 by - Blog

Degenerative (sometimes called De-Novo) scoliosis is one of two main types of adult scoliosis. De-Novo roughly means “new” so degenerative scoliosis is a type of scoliosis which develops over time as a result of degeneration in the spine. The other kind of adult scoliosis is known as Adolescent Scoliosis in Adult (ASA) – and refers to scoliosis which started at a younger age, but was not treated (or was not treated successfully).

 

What is De-Novo scoliosis?

Degenerative scoliosis is fundamentally 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]

 

How is De-Novo scoliosis diagnosed?

While most forms of scoliosis are not usually associated with severe pain, De-novo scoliosis is often discovered as the result of a back-pain investigation. Patients with degenerative De-Novo scoliosis typically present with complaints ranging from debilitating back or lower extremity pain to spinal imbalances, as well as as a response to incidental findings on lumbar radiographs. As usual scoliosis will be diagnosed by a combination of physical examination and X-ray or imaging techniques. In the case of De-Novo scoliosis, a thorough examination of the patient’s medical history will help to determine any underlying condition which is implicated in the development of scoliosis.

Counter-intuitively, the pain caused as a result of adult scoliosis is not related to the size of the curve. Several good studies show there is little to no relationship between the size of the curve and the intensity of pain – therefore a 20 degree and a 55-degree curve have the same chance of causing pain in an adult. This means that visual observation is not always sufficient to rule out scoliosis in adults, and professional consultation is the best approach.

Adult scoliosis patients will typically experience significant back pain and stiffness. As spinal degeneration increases, the intervertebral discs become narrowed and nerve compression develops resulting in constant sciatica, pin’s and needle’s, numbness or weakness in the legs.  The spinal canal can also become narrowed and result in spinal stenosis where the spinal cord is squeezed so the patient experiences heaviness in the legs, leg pain and difficulty walking

 

How is De-Novo scoliosis treated?

To achieve effective treatment for adult scoliosis, it is important to be able to differentiate between the symptoms that are caused by the degeneration of the spine as compared to those that are caused by the deformity and its progression.

This means that unless treatment addresses the postural alteration or deformity, the pain and symptoms won’t be improved. This applies to any back-rehabilitation regime, medication course or surgical procedure. Without treatment, we can estimate the increase in curvature to be approximately 0.82° per year, leading to a significant deformity over a period of, say, 10 years.[2]

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. The most effective approach would be the use of 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)[3] and quality of life is improved.

When non-surgical treatment is ineffective, surgery is often the only option, especially when leg pain becomes incapacitating and walking is almost impossible. Unfortunately, surgery at this stage is always complex and with significant risk. This is why it is important to find not only a good spinal surgeon but also one who specialises in scoliosis for the best possible outcome.

 

 

[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.

‘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

[2] 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.

[3] 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