Tag: Scoliosis screening

A Scoliosis Journey: Week 2

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

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.

 

Why scoliosis should be examined by a trained professional

At the UK Scoliosis clinic, we are always campaigning for the widespread adoption of scoliosis screening in schools, clubs and anywhere else where young people gather! It’s not just younger people who need to be concerned about scoliosis either – as we recently wrote on this blog, adult onset or “de-novo” scoliosis now affects 1 in 3 people over the age of 60.

Screening is a vital first step, since spotting scoliosis early makes it easier to treat, no matter the age of the patient. What’s important to remember, however, is that screening is just that – a first step. This week, we take a look at why those who suspect scoliosis after initial screening should seek a consultation with a scoliosis professional as a soon as possible.

 

What is a scoliosis consultation, or a professional evaluation?

Screening and consultations are always available at the UK Scoliosis Clinic

Scoliosis screening is a simple process, designed to identify some of the most common signs and symptoms of scoliosis.  Screening (which takes just a few minutes and  can be done at home) allows you to spot scoliosis developing before it would necessarily become noticeable in everyday life. Once you have confirmed signs of scoliosis, the next step is to seek a professional opinion from a trained scoliosis practitioner.

Where screening can highlight potential signs of scoliosis, and make you aware of any risk factors you may have, only a professional consultation will allow a suitably trained practitioner to offer you a formal diagnosis of your condition. Often, a practitioner will be able to confirm that scoliosis is, in fact, present – however, some screening results can be “false positives”  and turn out to be the sign of a postural problem or other condition instead.

When scoliosis is confirmed, a scoliosis practitioner can offer you a tailored treatment designed to stop the development of scoliosis and reverse the trend as soon as possible.

What you should not do is seek advice from non-scoliosis professional. While there are many reputable professionals who work with the spine and associated conditions (chiropractors, physiotherapists, osteopaths etc.) these individuals must also be either trained scoliosis specialists or have at least received specialist instruction in diagnosing scoliosis in order for their diagnosis to be truly accurate. Scoliosis is a complex, 3D condition which requires a complex response, and that’s something only a trained professional can really deliver.

Accessing a scoliosis professional might mean travelling, and while that can certainly be inconvenient there are many good reasons why you should opt for the right clinic.

 

So why choose a scoliosis professional?

Scoliosis professionals offer a clear advantage

It’s hopefully already obvious that a scoliosis professional offers the best choice when investigating a potential case of scoliosis, but as opposed to non-specialists, those clinics who focus on the treatment of scoliosis offer many other benefits. Professional clinics who specialise in scoliosis can:

Offer a reliable diagnosis – based on years of training and experience, not only can scoliosis practitioners diagnose scoliosis at a fundamental level, they can measure and map the precise nature and magnitude of your scoliosis and recommend an ideal treatment on this basis. While many everyday practitioners may be able to notice scoliosis, only a scoliosis professional can gather the detailed information required to formulate  an effective, evidence based treatment plan which is individually tailored to your case.

Utilise the correct diagnostic tools – It cannot be stressed enough that without the correct diagnostic equipment it is almost impossible to correctly understand a patients scoliosis.  Reputable clinics should be able to provide and evaluate X-Rays to properly understand the nature of your scoliosis. Today, some clinics try to claim that “radiation free” methods of diagnosis (such as ultrasound or laser measurement) are suitable for diagnosing scoliosis. Unfortunately, this is just not the case – currently, only an X-Ray or MRI scan can provide enough detail for a professional to make an initial diagnosis. Other methods can be excellent ways to monitor the progress of treatment, but simply do not provide enough clarity for initial diagnosis.

Rule out congenital factors – Most cases of scoliosis will be either idiopathic (in younger patients) or de-novo (in older individuals). There are other causes of scoliosis, such as congenital or neurological factors which also need to be ruled out, however. In the event that scoliosis may be related to an underlying neurological or congenital condition, a patient should be referred to a specialist in these areas and should not be treated with traditional scoliosis correction methods without further investigation. Reputable, professional clinics can rule out such causes, and also help to refer you to the right person if need be.

Offer personalised treatment – Scoliosis, unlike some conditions, is truly unique in every patient. While there are certainly some common features and trends, each scoliosis treatment is as complex and varied as the patient themselves. What’s more, scoliosis treatment needs to be constantly re-evaluated and adjusted in order to achieve the best results as fast as possible.  All this means that the “standardised” treatment plans offered by some non-specialist clinics are far from ideal when it comes to scoliosis. In some cases, you may just end up with sub-optimal results, but the wrong treatment at the wrong time can actually worsen the condition in some patients.

Chose from multiple treatment methodologies – Clinics and professionals who specialise in scoliosis will certainly have a variety of approaches to treating scoliosis to draw from. Creating a treatment plan for a scoliosis patient will usually involve at least scoliosis specific exercise and some form of bracing but might also include a wide variety of complementary approaches such as chiropractic care or massage for short term management of discomfort. Today, it’s rare that a scoliosis case will be best treated with only a single approach, so a clinic which can offer a variety of treatments, all with scoliosis in mind, presents a clear advantage. Clinics who offer only a single treatment approach may do so with the best of intentions, but this is rarely the best option for the patient.

Offer advice based on the latest research – Scoliosis professionals who are members of a relevant body, such as SOSORT are required to stay up to date with the latest research in the field of scoliosis treatment. This means that a scoliosis professional will always be fluent with the latest thinking, but you’re far more likely to be treated with the most up to date approaches available at a specialist clinic.

Happy New Year from the UK Scoliosis Clinic

A happy new year from everyone here at the UK Scoliosis Clinic!

If you’re a scoliosis sufferer or know someone who is, you might be looking for some impactful new year’s resolutions which can benefit scoliosis sufferers. With that in mind, here are some scoliosis friendly New Years resolutions which we recommend you take on!

 

Number one – Don’t wait and see!!

“Wait and see” is not a treatment!

“Wait and see” or “observation” is the “old school” approach to scoliosis treatment. Observation simply means watching the scoliosis develop with the hope that it will not progress to the surgical threshold. Observation is therefore not a treatment, sadly observation almost always results in a negative outcome, since recent research has shown that scoliosis almost never resolves without treatment.[1] If you’re currently stuck with “wait and see” make this the year you take control!

Don’t just wait – Book a consultation with a scoliosis specialist! Observation once made sense, because it was thought that surgery was the only visible treatment option. Furthermore, it was also assumed that many cases of scoliosis would not process. Today was known that both are untrue – modern research has demonstrated, for example, 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.[2]

On the positive side, the latest work on scoliosis has also shown that modern bracing technology allows for highly effective treatment, such that it has now 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.[3]  As with all treatment, earlier action means better results so don’t wait! (or wait and see!)

 

Number two – Start screening your children

The gift of a scoliosis screening might be a life-changing one for your child. Two to three percent of adolescents between the age of 10 and 15 will develop scoliosis. That might seem like a small percentage, but in fact, it’s about one per class at school. Some studies have suggested a higher level, but two to three percent is an accepted figure.  The risk is highest amongst girls and appears to be greater in individuals who participate in activities such as gymnastics.

If scoliosis is noticed in its very early stages, it is far easier to treat, so screening can make a real difference. What’s more, scoliosis screening is easy to do at home using our ScoliScreen tool. ScoliScreen was developed in Australia by our partner ScoliCare, who spent years researching and designing the easiest home screening tool available. Screening with ScoliScreen at home takes about 10 minutes – you don’t have to take any pictures or upload any information, just follow the steps on screen and note down your results. ScoliScreen isn’t an alternative to a professional consultation, but it’s a highly effective tool to use as a starting point.

 

Number Three- Find balance in your physical activities

Scoliosis SEAS treatment

Specialist exercises can reduce the imbalances created by Scoliosis

Since asymmetrical strength and tension in the involved musculature is a common feature of scoliosis, it makes sense to try to avoid participating in activities which exaggerate this problem. That is to say since scoliosis often leads the muscles one side of the body to be stronger than the other, it makes sense to avoid making that worse with activities which build strength on one side of the body, but not the other. In fact, much of the work done with scoliosis specific exercise is aimed at correcting this imbalance.

Some practitioners suggest that activities which tend to asymmetrically load the body (most things with a bat or racket) should, therefore, be avoided – however, this approach is too broad in most cases and tends to cut off many of the most enjoyable sports!

The better solution is not to avoid these activities, but instead to carefully monitor growth and symmetry and perform targeted exercise on the non-playing side of the body (usually the non-dominant side) in order to balance out development. While this point is important to scoliosis patients, it’s actually good advice for anyone!

Once again, the best way to access professional monitoring and treatment is through a scoliosis specialist.

 

Number four – Raise awareness about scoliosis

Although scoliosis is a relatively common condition in young people (and actually a very common one in older people) scoliosis is also a mystery to many of us. This is partly because treatment options were limited for many years, but as we have shown this is not the case today.

In order to treat scoliosis more effectively and reduce the number of people eventually requiring surgery, most scoliosis clinicians now agree that school screening for scoliosis would be a positive step to take – for relatively little cost, significant benefits can be obtained for the majority of patients. Screening for scoliosis in schools and other groups, like classes or clubs is quick, easy and cheap. Using our ScolisScreen app, it’s also possible to pre-screen a friend or a family member at home in less than 10 minutes – but individual screening does little to raise awareness overall.

It’s no surprise that scoliosis screening is considered as a beneficial stage of treatment amongst the treatment community, and has been recommended by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT). Despite this, school screening is still not provided in the UK, although it is now common in many other countries.

Because of the misplaced belief in limited treatment options which is common not only amongst the general population but also amongst GP’s – as well as the lack of screening programs, many cases go undetected and therefore progress.

Despite this, there’s much you can do to raise awareness about scoliosis – if you have friends or family with children – especially those between about 10 and 15 – send them the link to our ScoliScreen tool and let them know about screening.  Be sure to let people know that today treatment is accessible and viable!

If you are active in a local school community, ask them about setting up a scoliosis screening program. The UK scoliosis clinic provides free school screening events for schools within a reasonable distance, and many other clinics will be happy to do the same.

Perhaps you’re involved in a larger community group or club – if you’re within a reasonable distance of our clinic get in touch and we’ll be happy to work with you on a group screening or awareness talk event.

 

 

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

[2] 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] ‘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

Is observation a treatment for scoliosis?

When first seeking treatment, many scoliosis sufferers are advised that they should “watch and wait” or  “wait and see” how their condition progresses, in the hope that their curve will remain small enough to avoid surgery.  Medically, this approach is known as “observation”.

 

Is observation ever the right choice?

The argument for observation was once much stronger than it is today – for much of recent history the consensus view has been that surgery was the only effective way to treat scoliosis and since surgery is obviously best avoided wherever possible, observation is the only other choice. Although surgical treatment was once the only option for scoliosis sufferers, this is no longer the case – today non-surgical approaches are highly effective, meaning that observation is probably never the right choice.

 

Avoiding surgery with non-surgical treatment

Today, non-surgical treatment from scoliosis consists of two major approaches, exercise-based and bracing. Scoliosis braces are the most effective non-surgical method for reducing cobb angle[1]. There are many different kinds of scoliosis brace and the way they work is different, 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).

Exercise methods such as the Schroth method (remove comma) or SEAS focus on teaching the scoliosis sufferer to self-correct their scoliotic position. Schroth and SEAS can both be effective as a standalone treatment for smaller curves and is often paired with bracing for superior results.

In both cases, however, catching scoliosis early with screening, and then taking appropriate action to stabilise and correct the Cobb angle is the key to a successful outcome. Unfortunately, many medical professionals today are still unaware of the non-surgical options for treating scoliosis and how effective they can be – unlike 20 years ago, today the prognosis is a good one.

 

Why observation does not work

Simply put, Observation is not a treatment for scoliosis, it is simply the act of watching and waiting, hoping the condition does not worse – however recent research has shown that scoliosis almost never resolves without treatment.[2] While it was once thought that scoliosis would not always progress, modern research has demonstrated, for example, 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.[i]

Because observation is not a treatment, it most often leads to the patient requiring surgery and does not promise any improvement. By contrast, modern bracing technology allows for highly effective treatment, such that it has now 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.[ii]

 

What should I do if I have been prescribed observation?

If you have been diagnosed with scoliosis but have been advised that observation or “wait and see” is the best approach, the best option is to book a consultation with a scoliosis specialist. Even if your condition is not serious enough to merit bracing, some targeted scoliosis specific exercise can, at the very least, help to prevent the curve from developing further rather than simply allowing it to increase.

 

 

 

 

 

[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] 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

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

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

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

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

Scoliosis : what to look out for

We’re in this week’s OK!

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

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

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

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

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

 

How can I screen for scoliosis?

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

 

Spot scoliosis early and improve your prognosis!

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

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

 

Have questions about scoliosis?

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

 

 

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

[2] Ibid.

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

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

 

Scoliosis school screening is vital

children

3 – 4 % of children will develop Scoliosis

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

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

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

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

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

 

Why does early detection matter?

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

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

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

 

Juvenile scoliosis almost never resolves without treatment

Scolibrace

Scolibrace is a comfortable and effective advanced brace

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

Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability[7].

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

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

 

How we can help

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

 

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

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

2010;65:261–7.

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

2010;35:1607–14.

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

JAMA 1999;282:1427–32.

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

Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

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

Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

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

[8] Ibid.

June is Scoliosis awareness month

Scoliosis is a serious condition which can cause discomfort, disability and eventually require major surgery if left untreated. Catching scoliosis early makes it much easier to treat, so this week please take a moment to read this quick primer on scoliosis and pass it on to those you care about.

 

What is scoliosis?

Scoliosis is a disorder in which there is a sideways curve of the spine. Curves are often S-shaped or C-shaped. In most people, there is no known cause for this curve, although those who have a family history of scoliosis do seem to be at greater risk.

 

What are the signs and symptoms of scoliosis?

In the absence of formal screening programs scoliosis is often first discovered by parents when they see an obvious curve or hump on their child’s back, especially when bending forwards.

Occasionally scoliosis might be detected through a complaint of back pain, but scoliosis is frequently present without pain.

Typical symptoms include:

  • Uneven shoulders
  • Head appears to be off centre
  • Uneven waist
  • One side of the rib cage is higher than the other when bending forward

 

 

How common is scoliosis

Scoliosis is much more common than most people think. The latest research suggests that between 2 and 3% of children aged 10-15 years will develop scoliosis. This might seem like a small number, but 3% would be 3 in every 100 – which would be one in every 30. Therefore, about one child in each school class will develop scoliosis.

Girls are more likely to develop scoliosis than boys (about 75% of scoliosis patients are girls) but boys can and do develop scoliosis too. Research suggests that some sports and activities are associated with a higher risk of scoliosis – the most notable example are ballet dancers and gymnasts, where the condition is us up to 12 times more prevalent[1][2].

 

How is scoliosis treated

If scoliosis is not diagnosed early, or if the scoliotic curve is left to develop unchecked then surgery to fuse the spine may eventually be required. It was once thought that this was the only effective means of treating scoliosis – which is one of the reasons why a screening program was not put into place. [3]

Today there are a wide variety of approaches which can be used to treat scoliosis non-surgically. These methods are far less physically invasive and much less emotionally disturbing, especially for young people. Evidence strongly indicates that non-surgical treatment can be highly successful in reducing the chance that surgery will eventually be required.[4]

Often, more than one approach can be used to develop a treatment program – the two main approaches used at our clinic are scoliosis specific exercise and scoliosis bracing, however we may also complement these approaches with evidence-based Chiropractic treatment or postural correction programs. While these additional tools do not directly reduce scoliosis, they can often assist the sufferer in terms of pain relief, or with regards to improving body symmetry.

 

What can I do?

The biggest single factor in ensuring a good outcome for scoliosis patients is early diagnosis – a very small curve is much easier to stabilise and correct than a larger one. June is Scoliosis Awareness Month. Throughout the month, our aim is to raise awareness about scoliosis screening and the importance of early detection -you can help by raising the issue of scoliosis with your child’s school, local clubs or youth groups.

This month, we are offering free scoliosis screening sessions and informational talks to schools. So if you know anyone who might be interested, please ask them to get in touch!

You can screen for scoliosis yourself, at home, using our scoliscreen tool – available at  (https://scoliosisclinic.co.uk/scoliscreen/) if you’re a parent please feel free to use this tool to screen your own children.  It’s an excellent idea to screen all children, but those between 10 and 15 are at the highest risk. If you do have a child who participates in a high-risk activity, please take a moment to screen them if you possibly can.

If you have concerns about a young person, please don’t worry – simply get in touch to book a free professional screening here at our clinic.

 

[1] Tanchev, Panayot I. MD; Dzherov, Assen D. MD; Parushev, Anton D. MD; Dikov, Dobrin M. MD; Todorov, Miroslav B. MD, Scoliosis in Rhythmic Gymnasts, Spine: June 1st, 2000 – Volume 25 – Issue 11 – p 1367-1372

[2] Longworth, Brooke et al. Prevalence and Predictors of Adolescent Idiopathic Scoliosis in Adolescent Ballet Dancers Archives of Physical Medicine and Rehabilitation , Volume 95 , Issue 9 , 1725 – 1730

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

[4] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4)  (2003) 209-14.

Why Scoliosis Screening matters, and what we’re doing about it

Screening for Scoliosis..

Today, most scoliosis clinicians agree that school screening for scoliosis would be a positive step to take – for relatively little cost, significant benefits can be obtained for the majority of patients. Screening for scoliosis in schools and other groups, like classes or clubs is quick, easy and cheap. Using our ScolisScreen app, its also possible to pre-screen a friend of family member at home in less than 5 minutes. Early detection of a developing scoliotic curve means it is easier to treat and has a more successful outcome.

It’s for this reason that scoliosis screening is considered as a beneficial stage of treatment amongst the Orthopaedic community, as it is reported in the Consensus Paper which has been published by the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT)[1].

For years, clinicians have argued that school screening would be the best way to maximise the benefit of what we now know about scoliosis – Despite this, school screening has still not been routinely performed in the UK for many years. At the UK scoliosis clinic, we strongly support school screening – which is why we have an ongoing outreach program designed to provide exactly this service.

 

Arguments against screening

The main arguments against scoliosis screening in schools have been the associated cost, and the possibility of false positives.

Let’s take the cost issue first. It’s fair to say that in the past this argument carried weight – historically It was thought that surgical approaches were the only effective treatment for scoliosis, although some of the studies which informed this opinion were actually highly problematic[2]. Based on this assumption, early detection of scoliosis was not thought to be especially useful, with the argument following that the expenditure was not justified.

The argument that only surgery was an effective treatment for scoliosis also resulted in the argument that a child can simply wait until the curve is severe before it is detected – this means that the child will in the end require spinal fusion. However, this is not in line with the current thoughts of leading world experts from SOSORT and the Scoliosis Research Society (which include the world’s leading scoliosis surgeons).

They both recommend that bracing should be performed as a first line defence against scoliosis progression. When results were published from the BRAiST study in 2013[3], 58% of observed patients had curves greater than 50° at skeletal maturity, while only 25% of braced patients reached curves over 50°. This meant there was a 56% reduction of relative risk to surgery levels in braced patients and treatment costs for braced patients were less than those requiring surgery.

There are some significant issues with this argument however –  firstly, the evidence on which this approach was based was initially conducted all the way back in the 1940s[4] so it makes sense for us to re-examine the evidence and technology we now have available.

Secondly this research did not actually seek to define the cost of scoliosis screening on an individual basis – nor did it do so in the context of the kind of quick and easy screening which is available today, so any judgement about the cost is highly subjective.

In actual fact, we do now know exactly what scoliosis screening in schools would cost on an individualised basis – research carried out between 2000 and 2007 demonstrated that the direct cost for the examination of each child who participated in the program for the above period was just 2.04 €.[5] It is reasonable to suggest that costs today could be even lower!

 

Adams test

The Adams test is a simple test for scoliosis

The second argument against screening has been the chance of false positive results. For many parents, the chance of a false positive is far less of a concern than a missed diagnosis – however there is a great deal which can be done to reduce false positives.

At the UK scoliosis clinic, our scoliosis staff have specialist scoliosis screening training which allows us to screen scoliosis with a high degree of accuracy. Essentially, preventing false positives comes down to properly trained staff using appropriate methods. The best screening services will therefore always be those offered by scoliosis specific clinics, but there is no reason that local medical staff could not be trained to improve their screening ability, taking into account the latest research just as we do at the clinic.

Getting screening right relies on really understanding the way scoliosis and the spine work – For example, by screening children in sitting position with the use of a scoliometer, the number of false referrals can be decreased dramatically because the effect of leg length inequality and pelvic obliquity on the spine is eliminated. The sitting position reveals the true trunk asymmetry which could be associated with Idiopathic Scoliosis (IS)[6] – it is therefore one of our standard diagnostic tools.

 

Why we should screen

Aside from the fact that the arguments against screening no longer seem to stand up it’s also clear that screening for scoliosis in schools provides the best (sometimes only) opportunity for early diagnosis and therefore allows for non-surgical treatment, which is often not the case in the absence of screening[7].

In their most recently published joint information statement on scoliosis screening, the American Academy of Orthopaedic Surgeons, Scoliosis Research Society, Paediatric Orthopaedic Society of North America and American Academy of Pediatrics all agreed that there does not appear to be any significant medical reason not to screen for scoliosis[8].

Scoliometer

A scoliometer is used to measure scoliosis

Today there is significant evidence which shows that the number of scoliosis sufferers eventually requiring surgery can significantly be reduced where non-surgical treatment (such as scoliosis specific exercise, or bracing) is available on a high standard.[9][10][11] If we work from a modern viewpoint, rather than an outdated one, we can therefore see the real value of school screening. Indeed, school screening is often the only tool we have to detect mild and moderate spinal curves which can be easily treated with non-surgical methods.

The most recent research also confirms that this is more than just informed speculation – research does confirm that in areas where screening programs exist, fewer patients ultimately require surgery for IS.[12]

In 2006, research from the University College Hospital and The London Clinic[13] assessed the severity of scoliosis presentation over 30 years. What the authors found was, that since mass school screenings were abandoned in the 1990’s, in the year 2000 only 8% of patients had been identified at school compared to 32% in 1985 and that the number of patients presenting with curves greater than 40° had increased to 70%. This meant that for many of these patients non-surgical care would be less effective and the likelihood of requiring surgery was much greater. The author’s recommended that greater community awareness was required to enable earlier detection.

 

What we’re doing

At the UK Scoliosis clinic, our guiding principle is to follow the latest research in order to treat scoliosis with the most up to date methods available. We’re therefore strongly in favour of screening in schools, and amongst higher risk populations such as gymnasts and dancers.

On our website you can find our free to use scoliscreen tool – which will help you to screen a friend or family member for scoliosis. This is a great starting point if you have concerns.

Professional and highly detailed (but totally painless!) screening is always available at our clinic – book in for a consultation and we’ll be able to determine if you have scoliosis, or if you might be at the risk of development. If scoliosis is detected, were ideally positioned to help.

The UK Scoliosis clinic also offers scoliosis screening events to schools, sports groups and organisations.

 

 

 

 

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

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

[3] BRAiST https://www.nejm.org/doi/full/10.1056/NEJMoa1307337

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

[5] TB Grivas, ES Vasiliadis, C Maziotou, OD Savvidou, The direct cost of Thriasio school screening program.  Scoliosis 2(1) (2007) 7.

[6] TB Grivas, E Vasiliadis,  G Koufopoulos,  D. Segos, G Triantafilopoulos, V Mouzakis, Study of trunk asymmetry in normal children and adolescents.  Scoliosis 1(1)  (2006) 19.

[7] WP Bunnel, Selective screening for scoliosis. Clin Orthop Relat Res 434  (2005) 40-5.

[8] Information Statement: Screening for idiopathic scoliosis in adolescents. American Academy of Orthopaedic Surgeons (AAOS), Scoliosis Research Society (SRS), Pediatric Orthopaedic Society of North America (POSNA) and American Academy of Pediatrics (AAP), October 1, 2007.

[9] M Rigo, C Reiter, HR, Effect of conservative management on the prevalence of surgery in patients with adolescent idiopathic scoliosis. Pediatr Rehabil 6(3-4)  (2003) 209-14.

[10] T Maruyama, T Kitagawa, K Takeshita, K Mochizuki, K Nakamura, Conservative treatment for adolescent idiopathic scoliosis: can it reduce the incidence of surgical treatment?  Pediatr Rehabil 6(3-4)  (2003) 215-9.

[11] B Lee, The Correct Principles of Treatment of Angular Curvature of the Spine. 1872, Philadelphia, USA.

[12] T.B. Grivas et al.  “How to Improve the Effectiveness of School Screening for IS” The Conservative Scoliosis Treatment (2008) p 120

[13] Detection of adolescent idiopathic scoliosis, Muhammad Ali Fazal, Michael Edgar, Acta Orthopaedica Belgica, 2006, 72, 184-186