Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace

Posted on November 29, 2019 by - Blog

New research just published by our partner ScoliCare has once again gone to show that the ScoliBrace, coupled with an appropriate exercise regime can be effective not only in reducing scoliosis, but also in treating Scheuermann’s Kyphosis.

Regular readers of the blog will know that a treatable case of Scoliosis is considered to exist when the cobb angle (the bend in the spine) exceeds 10 degrees. Scoliosis causes the spine to bend “from side to side”.  In Scheuermann’s Kyphosis there is a malformation of the spinal vertebrae – specifically, they are slightly shorter in height at the front than at the back, leaving them slightly wedge-shaped – This leads to a “forward hunching” curve in the spine. While both conditions can and do frequently present independently, it is entirely possible for both to be present.

With respect to treatment for Scheuermann’s kyphosis and scoliosis, a course of conservative (that is to say, non-surgical) therapy is recommended wherever possible, with surgical intervention reserved for those patients with severe pain and/or disability at the time of the initial consultation or for individuals who have not responded to conservative management attempts.  The research from 2019 provided a case study of a patient in which both conditions were present, and were managed successfully with ScoliBrace, and appropriate exercise.

Let’s take a look at the recent case study[1] – both because we can learn something about the way that ScoliBrace can be used to treat these cases, but also because many readers may recognise something of their own experience!

 

Scoliosis and Scheuermann’s, a case study

Initial X-ray, taken at the start of treatment

On the 22nd of February 2016, a 26-year-old Caucasian male presented to a chiropractic clinic suffering with from lower back pain and poor posture. He also had a previous diagnosis of Scheuermann’s kyphosis and adolescent idiopathic scoliosis. The patient reported difficulty with prolonged standing and sitting, dissatisfaction with his cosmetic appearance, and difficulty with leisure activities – all of which are common issues for sufferers of both conditions.

Interestingly, the patient in question had not left his spinal conditions untreated – on the contrary, at the age of 15, the patient was referred to the local Children’s Hospital and was prescribed a hospital made thoraco-lumbo-sacral orthosis (TLSO) (a brace) which he wore full-time (23 hours per day) between the ages of 15–17 years.  Unfortunately, the brace provided was not like ScoliBrace, in that it’s action was preventative, rather than corrective – meaning that its objective was simply to hold his curves in place to avoid progression of the scoliosis, rather than to reduce it. The brace also had no effect on the Kyphosis.

At the point of initial examination, the patient reported that he was significantly unhappy with his physical appearance and rated his back pain as 4/10 on average and 7/10 at worst.

Full spine radiographic assessment was performed which revealed a thoracic hyper-kyphosis measuring 79° Cobb (Fig. 1), and a 30° Cobb lumbar scoliosis and sacral obliquity (Fig. 2). A loss of disc height, vertebral wedging and endplate irregularities were noted at several levels in the mid-thoracic spine. A true leg-length discrepancy (short left leg relative to the right) of 6 mm was also noted during the radiographic examination.

Subsequently, he was prescribed a ScoliBrace custom spinal orthosis, a rehabilitation program and a 6 mm heel lift. The ScoliBrace, unlike the Boston brace the patient was previously provide with, is an over-corrective brace, which takes and active approach to correction – this means that rather than simply trying to stop scoliosis progressing, it actually works to reduce the curve. The patients home exercises were simple for him to perform and included a mixture of stretching and strengthening exercises designed to oppose both undesirable curvatures.

 

12 months with ScoliBrace, results!

Follow up X-ray

Since the entire ScoliBrace process is designed to be flexible, reactive and adaptable, patients are typically seen every 6 months or so to assess progress and make any necessary treatment changes. Our patients first follow-up assessment was performed 4.5-months after the initial assessment. After just 18 weeks, the patient reported that, on average, he had been pain-free, with his worst occasional pain being rated as 2/10 pain on occasion.  In terms of the spinal deformity, the hyper-kyphosis had reduced by 16°, from 79° down to 63°, and the lumbar scoliosis curve was reduced by 5°, from 30° down to 25°.

At a further follow-up, 12 and a half months after the initial consultation, another series of x-rays showed that the postural improvements had all been maintained. An analysis of follow-up radiographic images (Fig. 6) showed a maintenance of the original postural improvements. [2]

 

 

Treating Scoliosis and Scheuermann’s at the UK Scoliosis clinic

The above case study results are interesting, because fairly few studies have addressed the use of active correction braces in adults, and there is also very little research on the correction of both conditions simultaneously. This case study certainly suggests that ScoliBrace, coupled with targeted home exercise can indeed have a positive impact on these conditions.

Of note is also the fact that this is yet another study to indicate a link between scoliosis and pain. At the UK Scoliosis clinic, we have long observed that pain and discomfort are often associated with these conditions, even if research has yet to confirm this association in an absolute sense. It would be fair to mention on this point that much of the research that would go to establish the validity of bracing as an approach to pain reduction have been affected by low adherence of study participants to their prescriptions – which is a common issue for many studies in bracing.[3]

At the UK Scoliosis clinic, we also offer the Kyphobrace system (from the same developers as scolibrace) which is ideal for treating Kyphosis cases which occur without scoliosis. To learn more, click here.

 

 

[1] Christopher M. Gubbels, DC, Paul A. Oakely, DC, MSc, Jeb McAviney, MChiro, MPainMed, Deed E. Harrison, DC, Benjamin T. Brown, PhD,  Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report, J. Phys. Ther. Sci. 31: 159–165, 2019

 

[2] Christopher M. Gubbels, DC, Paul A. Oakely, DC, MSc, Jeb McAviney, MChiro, MPainMed, Deed E. Harrison, DC, Benjamin T. Brown, PhD,

Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report, J. Phys. Ther. Sci. 31: 159–165, 2019

 

[3] See for example Weiss HR, Moramarco K, Moramarco M: Scoliosis bracing and exercise for pain management in adults—a case report. J Phys Ther Sci, 2016, 28: 2404–2407.

Palazzo C, Montigny JP, Barbot F, et al.: Effects of bracing in adult with scoliosis: a retrospective study. Arch Phys Med Rehabil, 2017, 98: 187–190.

Is scoliosis a risk factor for mental health?

Posted on November 16, 2019 by - Blog

Like all reputable clinics, the UK scoliosis clinic focuses the majority of its time and effort on providing the best possible treatment for scoliosis cases. For the most part, this means keeping up with the latest research, bracing and exercise based techniques which can assist in controlling and reducing scoliosis, however, where we also concentrate a lot of time and attention is to the psychological aspects of living with and being treated for scoliosis.

 

Scoliosis and Psychological factors

Like any condition, Scoliosis can obviously cause distress and concern – but there are some specific factors associated with scoliosis which may make the condition especially difficult for many patients to cope with. The key areas include:

  • The fact that Scoliosis does cause physical deformity, and very often strikes at the most sensitive time in a young person’s life. It’s normal and expected for teens and young adults to experience stress and difficulty associated with physical changes in their body and the formation of their adult identity, even under typical circumstances – scoliosis can certainly complicate this.
  • Misinformation about scoliosis which is frequently repeated. Many still believe that a diagnosis of scoliosis necessitates surgery, which, ironically, can prevent some people from taking advantage of screening. It’s also commonly believed that scoliosis can impact on the ability to have children, take part in physical activity or even live a normal life. While it’s true that if left untreated scoliosis could lead to some of these outcomes, early treatment can often make such outcomes almost completely avoidable.
  • Concerns about bracing, and stigma associated with bracing. It’s certainly the case that “old style” braces such as the Boston brace were visible, clunky and certainly embarrassing for young people – but modern CAD/CAM braces, such as ScoliBrace, are virtually invisible under clothing.
  • Fear of being unable to participate in normal activities. Again, with modern bracing technology this is rarely if ever, an issue – today’s braces are so easy to put on and take off that they can simply be removed for exercise, although designs such as ScoliBrace are actually flexible enough to be left on.

With each of these concerns, the critical point to stress is that Scoliosis, if caught early enough can now usually be treated non-surgically and quite quickly, through bracing, exercise or a combination of both. The best possible way to detect scoliosis is through a routine screening, which can often allow the condition to be detected long before it has progressed to a significant degree.

 

Scoliosis and psychological health : scientific research

There has been some limited research which has sought to understand the impact that scoliosis can have on a young person’s psychological health – although it’s still fair to say that only a small part of the literature relating to scoliosis considers this angle, there is still sufficient a body of evidence for us to draw some meaningful conclusions.

One such study looked at adolescents with and without scoliosis in Minnesota who were 12 through 18 years of age. During the study, six hundred eighty-five cases of scoliosis were identified from the 34,706 adolescents. The prevalence was therefore 1.97%  (incidentally, this is slightly below the average figure). The researchers wanted to calculate the odds ratio of scoliosis to some common psychological issues.

Put simply, an odds ratio is a measure of how strongly related two items are – An odds ratio of more than 1 means that there are a higher odds of property B happening with exposure to property A, whereas an odds ratio of exactly 1 means that exposure to property A does not affect the odds of property B. An odds ratio is less than 1 is associated with lower odds of two factors being related. [1]

In the study, of the 685 adolescents with scoliosis, the odds ratio for having suicidal thought among adolescents with scoliosis, compared to adolescents without scoliosis, was 1.40 after adjustment for race, gender, socioeconomic status, and age. The odds ratio for having feelings about poor body development among adolescents with scoliosis was 1.82 compared with adolescents without scoliosis after adjustment for race, gender, socioeconomic status, and age. Scoliosis was therefore deemed to be an independent risk factor for suicidal thought, worry and concern over body development, and peer interactions.

In a 2019 study, which compared scoliosis treatment approaches, the SRS-22 (a standardised scoliosis quality of life screening form) was used to explore the impact which treatment had on psychological health.  Here, researchers noticed that self-image was significantly improved amongst patients treated with a scoliosis brace, especially at a follow up after 12 months of treatment, this was especially interesting given the negative self-image association which is sometimes linked to bracing

Researchers found a similar improvement in patients treated with an exercise methodology –  all the SRS-22 quality of life subsets showed a slightly larger improvement across the three visits than bracing, although the correction of scoliosis was less.[2]

 

Does scoliosis affect psychological health?

From the research which has been conducted, as well as our own experience at the clinic we feel it’s safe to say that scoliosis can be a significant risk factor for psychological health – especially in young people. While this certainly does not mean that everyone with scoliosis will struggle with mental health as a result, it’s clearly important that scoliosis clinicians are aware of the risk, and work to mitigate it.

At the UK Scoliosis clinic, we believe that properly researched information, coupled with effective treatment, applied as quickly as possible is the best possible way to address the psychological risks associated with scoliosis. It’s for this reason that we continue to recommend frequent screening throughout high risk years. It cannot be stressed enough that early detection, coupled with good information can go the majority of the distance in diffusing some of the  main concerns around a scoliosis diagnosis. We would caution parents and sufferers from relying on general advice or information pulled from the internet – the best option is by far a consultation with a scoliosis professional.

[1] Payne, William K. III, MD, et al. Does Scoliosis Have a Psychological Impact and Does Gender Make a Difference? Spine: June 15, 1997 – Volume 22 – Issue 12 – p 1380–1384

[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]

Study suggests bracing is also effective in early-onset scoliosis patients

Posted on October 24, 2019 by - Blog

While the majority of studies on scoliosis bracing focus primarily on adolescent scoliosis sufferers, there are many other groups who do suffer from scoliosis in significant numbers. Over the last few weeks, we have looked at scoliosis treatment in older individuals -this week we’re examining the best options for very young (infantile or juvenile) patients.

Today, scoliosis in infants and juveniles is treated either with serial casting or with a bracing approach (bracing usually in children at the older end of the age range.)  Serial casting – where a child is placed in a series of casts, with the goal of correcting scoliosis has often been the preferred approach, since early-onset of scoliosis (EOS) patients are skeletally immature and have the largest potential for fast recovery through non-operative treatments[1]. As bracing technology has improved however, it has also become common practice for bracing to be prescribed after casting to maintain the initial correction. Bracing is now also prescribed to patients who are not able to tolerate casting[2] – but new research is now beginning to explore bracing as a “first choice” option for younger patients.

Such studies are welcome since overall, bracing studies are usually done on AIS patients, which means that while there is a strong case to be made for bracing in other groups, it has been slow to assemble the scientific proof of concept. A recent study from 2019 has now added significantly to our understanding of bracing in younger patients and is (so far as we are aware) the first study to explore the effectiveness of CAD/CAM bracing approaches in very young patients.

 

Bracing in young children – new research

The study[3], conducted at Children’s Hospital of Wisconsin sought to understand how effective a customised over-corrective brace (like ScoliBrace) was in treating scoliosis in young patients with Infantile scoliosis (IS) and Juvenile scoliosis (JS).

Thirty-eight patients (22 males, 16 females; 17 IS, 21 JS) were recruited for this study. 9 children were diagnosed with neuromuscular scoliosis, 1 congenital scoliosis, and 28 with IS or JS. The average age was 6.2 years old (ranging from 4 months to 10-years-old). Criteria for inclusion included:
1) All subjects are diagnosed with IS or JS (idiopathic, neuromuscular, or congenital);
2) Subjects must have not had any type of spinal surgery prior to bracing treatment;
3) Must be under 10 years old during the time of their first scan;
4) Must have had at least one follow up visit after their baseline scan before the 12-month mark.

During the trial, investigators utilised 3D scanning technology (similar to BraceScan) to map the exact requirements for the scoliosis brace for each patient – this was then manufactured using a CAD/CAM approach, facilitating a very high degree of accuracy. At an initial fitting, a scoliosis specialist checked that the brace was functioning as required and made any small adjustments necessary.

Overall, amongst the patients as a group the starting Cobb angle was 38 ± 14° in the thoracic curve (ranging from 19° to 68°), 30 ± 9.6° in the thoracolumbar (ranging from 19° to 42°), and 36 ± 10.3° in the lumbar sections (ranging from 22° to 53°).

 

Results in younger patients

After brace fitting, the investigators followed the patients for 12 months, with a view to assessing change in Cobb angle.  Firstly, no patients required surgery within the 12-month span, whereas without bracing surgery may have been necessary at least in a few cases.

When compared to the baseline measurements, the in-brace correction reduced the Cobb angle in the patients from 38° to 24.2° in the thoracic region (a 36.3% reduction), 30° to 10.3° in the thoracolumbar region (a 65.7% reduction), and from 36° to 18.5° in the lumbar (a 48.3% reduction). The juvenile group had 23% correction, 47% stabilization, and 30% progression of curves. The infantile group had 50% correction, 32% stabilization, and 18% progression of curves. The following table shows the progress over a series of three-month evaluations.

 

Levels of Curve Month Cobb Angle (°) Curve change (°) % Change
Thoracic 0 38.0 ± 14.0 NA NA
3 30.1 ± 19.7 −5.6 −15.6%
6 30.2 ± 21.5 −5.5 − 15.5%
9 31.5 ± 24.2 −4.2 −11.6%
12 29.4 ± 24.3 −6.2 −17.5%
Thoracolumbar 0 30.0 ± 9.6 NA NA
3 25.2 ± 11.2 0.2 0.6%
6 24.8 ± 11.6 −0.2 −0.9%
9 24.3 ± 10.3 −0.7 −2.7%
12 23.9 ± 10.0 −1.1 −4.5%
Lumbar 0 36.0 ± 10.3 NA NA
3 25.4 ± 14.3 −3.5 −12.2%
6 27.9 ± 14.5 −1 −3.5%
9 30.2 ± 14.2 1.3 4.5%
12 29.9 ± 14.2 1 3.6%

 

 

Is Bracing effective in young patients?

While (as we mentioned at the outset) there have been few in-depth studies considering the effectiveness of bracing in younger patients, the research presented here certainly suggests that the positive results which are typically seen in adolescents can be replicated in younger children.

Overall, the bracing approach used was shown to be effective in correcting nearly half of the thoracic curves and one-third of the other curves, over a period of 12 months. When combining all data, 75% of curves were corrected or stabilized.

As well as being effective, a bracing approach also has significant benefits in terms of quality of life, and cost-effectiveness. Since younger children with scoliosis experience such rapid spinal growth and development, traditional casting needs to be repeated every couple of months – This may be less cost-effective and less patient-friendly because visits are more frequent and may require plaster casting to be done with the patient under general anaesthesia. Bracing, by contrast, requires only a single fitting & fewer follow up visits The brace can also be removed for daily washing which is better for the infants skin and hygiene. As the child grows and changes shape, further braces may be required to treat the scoliosis effectively.

If you would like to know more about bracing in younger children, please contact us.

 

 

[1] Mehta MH. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br. 2005;87:1237–47.

[2] Weinstein SL, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369:1512–21.

[3] John Thometz, XueCheng Liu, Robert Rizza, Ian English and Sergery Tarima, Effect of an elongation bending derotation brace on the infantile or juvenile scoliosis, Scoliosis and Spinal Disorders 2018 13:13

Can diet cause, or cure, Scoliosis?

Posted on October 15, 2019 by - Blog

Today there are a wide variety of non-surgical treatment options for scoliosis, and indeed there are a growing range of options within the surgical remit. As society as a whole becomes more aware of scoliosis, many professionals are entering the field and offering their own views about how their specialisms may be able to contribute to treatment programs.

While it is always important to be cautious of new ideas when dealing with scoliosis (after all, a mishandled case often ends in surgery) it’s certainly the case that many “alternative” or “complementary” treatments can have some positive impact for scoliosis sufferers. To take just one example, massage therapy – a discipline not traditionally associated with scoliosis treatment – is now embraced by many scoliosis practitioners, not as a primary treatment, but as an effective (and enjoyable) method to improve some functional issues. Massage is of course also beneficial for improving overall health factors such as sleep patterns.[1]

Clearly, there are many specialisms which can provide a useful piece of the puzzle as far as providing a holistic scoliosis treatment program, this is not especially surprising in terms of a well established and professionally practised disciplines such as massage. Where more scepticism is required, is in cases in which treatments with no prior connection to scoliosis, or to musculoskeletal conditions is concerned

In this vein, recently, several “scoliosis diets” have appeared, along with the suggestion that diet may somehow contribute to scoliosis, or even cure the condition. Let’s unpack this claim and explore its possible consequences.

 

Diets and scoliosis

At the outset, it is important to stress that there is no current evidence which suggests that following a specific diet can do anything to improve an existing scoliosis case. Nor is there any substantial precedent for the idea that nutritional variations can “cure” or “treat” an existing musculoskeletal issue. In short, “scoliosis diets” do not work for those who already have the condition.

Having said this, the question of a link between scoliosis and nutrition is an interesting one – and an area in which further research may prove fruitful. As it stands, studies in this area are currently limited but there is some evidence that many idiopathic scoliosis patients also have lower selenium levels than normal.[2] Other research has suggested a similar pattern in some animal populations, so any relationship between selenium levels and scoliosis would, therefore, be of interest from a preventative point of view – but still not a factor which would be likely to offer any practical form of treatment for those with the condition today.

For the benefit of context, it is also worth keeping in mind that the majority of research into the causes of scoliosis is currently focused on the role of genetics, which is where the bulk of the field currently believe the answer will be found. This does not mean that environmental factors such as diet could not also be contributors, but it seems fair to suggest that they are not likely to be the central factor.

Thinking more broadly, it is the case that osteoporosis may be a factor in worsening scoliotic curves  (especially in older individuals) – and there are dietary modifications which can be made to help avoid osteoporosis. Vitamin D, in particular, is an important nutrient that helps prevent osteoporosis and inaccuracy for the absorption of calcium.  Sources of vitamin D include cereal, saltwater fish and eggs. Similarly, Calcium is  critical for building bone mass. In the long term, regular calcium consumption during childhood helps prevent osteoporosis during late adulthood, which may then slow the development of scoliosis. Examples of calcium sources include yoghurt, cheeses and milk –  Broccoli and orange juice also contain calcium. Including these foods in your diet and indeed, in the diet of younger children may have some long term benefits – however, it would be disingenuous to suggest that what is, in truth, simply good nutritional advice, constitutes a specific “scoliosis diet”.

 

Summary : can diet cause or treat scoliosis?

At this time there is no specific evidence to support the use of any specialised diet as a treatment methodology for scoliosis, and SOSORT does not recommend the use of diet as a treatment approach.[3] It is true that osteoporosis can, later in life, contribute to the worsening of scoliosis so taking steps to avoid this may be beneficial – although this is certainly the case regardless of scoliosis risk!

While some research does suggest a link between scoliosis and some deficiencies (and this is an area of interest in terms of causality) it is unlikely that any change in diet will act as an effective treatment for scoliosis.

[1] M Hamm, Impact of massage therapy in the treatment of linked pathologies: scoliosis, costovertebral dysfunction, and thoracic outlet syndrome. Journal of Bodywork & Movement Therapies (J BODYWORK MOVEMENT THER), Jan2006; 10(1): 12-20.

[2] Yalaki, Zahide et al. Investigation of Serum Levels of Selenium, Zinc, and Copper in Adolescents with Idiopathic Scoliosis Dicle Medical Journal / Dicle Tip Dergisi. 2017, Vol. 44 Issue 1, p35-41. 7p.

[3] Stefano Negrini et al. 2011 SOSORT guidelines: Orthopaedic and Rehabilitation treatment of idiopathic scoliosis during growth Scoliosis 2012 7:3

Spinal surgery for scoliosis and degenerative disc disease

Posted on September 21, 2019 by - Blog

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

 

Treatment options for scoliosis

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

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

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

 

Post-operative complications – new research

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

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

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

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

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

 

Treating scoliosis without surgery

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

 

 

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

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

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

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

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

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

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

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

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

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

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

Does Degenerative Scoliosis cause pain?

Posted on August 7, 2019 by - Blog

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

 

Adult, or De-novo scoliosis?

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

 

Is de-novo scoliosis painful?

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

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

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

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

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

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

Degenerative or “De-Novo” scoliosis

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

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

 

 

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

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

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

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

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

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

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

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

 

Think Scoliosis Just effects children? Think again!

Posted on July 17, 2019 by - Blog

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

 

The overs 60’s get scoliosis?

De-Novo Scoliosis

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

 

Does scoliosis in adults matter?

De-Novo scoliosis

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

 

Can scoliosis in adults be treated?

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

 

How can I get treatment for scoliosis?

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

A scoliosis Journey – Week 3

Posted on July 8, 2019 by - Blog

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

 

5. Treating scoliosis with scolibrace – the results

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

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

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

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

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

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

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

 

6. After scoliosis

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

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

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

 

scoliosis braces

Scoliosis braces have come a long way!

Could ScoliBrace be right for you?

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

 

 

 

 

 

 

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

 

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

 

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

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

 

A Scoliosis Journey: Week 2

Posted on June 22, 2019 by - Blog

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

 

3. The best treatment?

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

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

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

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

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

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

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

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

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

 

4. Treatment with ScoliBrace

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

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

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

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

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

 

 

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

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

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

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

A Scoliosis Journey: Week 1

Posted on June 12, 2019 by - Blog

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

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

 

1 . Is that scoliosis?

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

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

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

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

 

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

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

 

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

 

2. So, its Scoliosis.

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

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

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

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

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