If you have scoliosis, here are some sleeping and living well tips for you...

1.  Don't belly sleep (lying on your stomach while sleeping).  This is probably the worst position to sleep in for anyone with scoliosis. Why is this? All scoliosis conditions are 3-dimensional.  So, if one of the dimensions gets worse it will adversely affect the other dimensions. Belly sleeping causes your thoracic spine to become flatter.  Spine flatness is a huge problem for anyone with scoliosis.  Flatter thoracic spines could cause a thoracic idiopathic scoliosis curvature to progress.  Furthermore, belly sleeping requires you to turn your head to the side. Sleeping with your head to the side would worsen this dimension of your spine. The third dimension would have no choice but to follow suit.

Sleep on a firm mattress.  It is also important to be sleeping on the right kind of mattresses at night.  Firm mattresses are recommended.

2.  Keep moving.  Never sit or stand in one place for too long. It is always a good idea for you to keep your body moving as much as possible. But, if you must sit, be certain to choose a chair with adequate support.

3.  Keep a light load. Do not carry things that are too heavy.  The increased weight from carrying heavy things will only add to the natural pull that gravity has on your spine and will only compress your spine further.

4.  Get help. Always get help when cleaning bathrooms and floors as  the increased bending may exacerbate scoliotic issues. 

5.  Focus on your core strength. Exercises that help to strengthen the core muscles are really good.  Those core muscles help to give support to the spine.

6. Stretching is also important this can help mitigate the pain and or discomfort.

By Dr. Aatiff Siddiqui

Seems like there should be pretty obvious answer to this question doesn’t it? However, this question between scoliosis exercises and scoliosis brace treatment has plagued the scoliosis treatment community for the past 463 years (Ambrose Pare created the first metal scoliosis brace in 1575!). 

Throughout the past several decades scoliosis brace treatment have become the preferred choice among the orthopedic scoliosis specialist community, aided in part to “designed-to-fail” research studies in the 1960’s-1970’s on the effects of scoliosis exercise, in which participants were asked to do exercises for scoliosis in a very general, non-specific manner (think sit-ups and push-ups).  This gave the justification to state that exercise for scoliosis was worthless and all the time, money, and energy should be invested into passive scoliosis treatment methods like scoliosis bracing.

Recent long-term studies published in major scoliosis research journals now call the effectiveness of scoliosis brace treatment into serious question in terms bracing’s ability to halt scoliosis spine progression, prevent the patient from reaching the scoliosis surgery threshold, or even alter the natural course of the condition in any statistically significant manner.  In fact, one of the oral presentations at the 2010 SOSORT meeting in Montreal even presented research on how simulated scoliosis bracing/long-term immobilization in rat tails (which simulate the human spine structurally) rapidly increased the rate of scoliosis disc deformity and thus increased the likelihood of scoliosis spine progression (as opposed to the intended slowing or halting of progression).  It is clear now that the path scoliosis brace treatment has lead the scoliosis community down should have remained “the path less travelled”.

Shifting the focus from the failure of scoliosis bracing efforts back towards exercise of scoliosis efforts, it is very clear that scoliosis exercises applied in a generalized and non-scoliosis specific manner will have little to no effect on idiopathic scoliosis.  The reason is because scoliosis primarily results from a problem in the automatic postural control centers of the brain (and potentially linked to melatonin signaling dysfunction as well) in which the brain doesn’t “recognize” the scoliosis spine is out of alignment and therefore, simply doesn’t trigger the spinal auto-correction mechanisms to kick in and fix the scoliosis curvature.  For whatever reason, the alarm bells just aren’t going off in the brain stem, so the brain just doesn’t know there is even a scoliosis problem to solve.

With this in mind, it becomes self-evident that the scoliosis exercise treatment needs to focus on creating a “stimulus” that triggers the brain to recognize that “something is going wrong down there” and make the necessary auto-correction to the spinal posture.  This means any type of voluntary movement exercises for scoliosis simply are over-ridding the subconscious automatic postural control centers in the brain and not allowing them to truly “learn” how to auto-correct the scoliosis spine (so much for all of the scoliosis exercise and scoliosis brace combinations!) and the only truly effective scoliosis exercises occur when the automatic postural control centers in the brain are stimulate subconsciously. 

Please click on one of the embedded links in this article for more information on how these new and exciting exercises for scoliosis treatment program can work for you.

The term “Idiopathic” means “unknown cause” and when applied to scoliosis it can cause sheer terror in the hearts of parents, anxiety in the minds of teenagers, and bewilderment in the thought process of treating doctors.  For literally centuries, the standard of scoliosis treatment has been scoliosis brace treatment and scoliosis surgery, which are only concerned about treating the spinal curvature itself, but not the underlying cause of the idiopathic scoliosis condition.

The most current research and theories on idiopathic scoliosis are focusing the concept of the scoliosis condition being primarily a neurological condition with its primary effects on the spine.  That would mean the crooked spine seen on the x-ray is really a symptom of the underlying neurological condition and not the condition itself.  Metaphorically it could be described as watching the wind through a window.  You can’t actually see the wind, but you can see the effects of the wind (direction, hard it’s blowing, ect) on the trees, grass, flags, ect. and determine a lot of accurate information about what’s going on out there.  The same can be said in regards to the viewing the scoliosis spine on and x-ray and determining a lot of accurate information about the neurological effects of scoliosis.

It’s not surprising that traditional approaches to scoliosis treatment have been skewed to only treat what they can see (since that is human nature) and it is equally not surprising that much of the history of scoliosis treatment (scoliosis brace treatment and scoliosis surgery) is based on this “over-simplified” understanding as well.  Fortunately, the winds are change are once again blowing and new concepts of neurological re-training the automatic postural control centers in the brain as a primary form of scoliosis treatment are starting to emerge. 

While most people take normal spinal posture (automatic neurological orientation to gravity) for granted, this is the core dysfunction the idiopathic scoliosis patient faces.  These automatic postural control centers are located in the hind brain in the same areas many of the other automatic body functions are controlled (heart rate, breathing, digestion, ect) and are not voluntarily controlled.  This means any attempts to stimulate these automatic postural control centers cannot come from voluntary movement patterns that require intentional effort.  The only way to re-train these automatic postural control centers is to create a “re-active” rehabilitation effect that sends correct feed back into the hind brain, which in turn sends out a correct response to the spinal muscles resulting in a 3-D auto-correction of the scoliosis spine.

While this seems rather complicated and difficult to do, it really isn’t all that tough once you understand how the system works.  When the brain automatically orients the spine to gravity it essentially is trying to “line up” the major center masses of the torso (head, torso, pelvic) in 3 dimension space.  This is done through a series of reflexes called “the righting reflexes” which send feedback from the eyes, inner ears, cervical spine, torso, pelvis, and feet.  While it remains unclear exactly which of the feedback mechanisms is not reporting or mis-reporting information to the brain, it clearly is having a dramatic affect on the scoliosis spine position while the patient is vertically relating to gravity (sitting or standing). 

The neuro-muscular re-training system developed specifically for scoliosis by the CLEAR Institute creates the exact stimulus that triggers the auto-correction response from the automatic postural control centers in the brain and will actually “re-train the brain” to “learn” how to hold the scoliosis spine in a new and straighter position if utilized on a daily basis for an extended period of time (4-6 months).  This non-invasive, exercise based approach is the first to target the exact automatic postural control areas through a “re-training” effect and address the underlying root cause of idiopathic scoliosis.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Scoliosis brace treatment and scoliosis surgery could soon be a thing of the past.  Idiopathic scoliosis is a multi-factorial condition in which one’s genetic pre-disposition and environmental factors (bio-mechanical, bio-chemical, and activity related) combine to create an abnormal neurological response to gravity during adolescent growth spurts.  While the exact mechanism remains a mystery, researchers at Axial Bio-tech have developed a new genetic test (Scoliscore) that can identify an individual child’s genetic pre-disposition for developing a severe scoliosis spine.  The test is 99% accurate in identifying the specific sequence of genes and can be utilized by girls and boys from ages 9-14 and scoliosis spine curves of 10-25 degrees.

This scientific break-through now allows clinicians (for the first time in human history) to identify the most genetically “at risk” children and start developing “early stage scoliosis intervention” programs that can prevent the curvature from progressing and potentially even reverse the condition to a large degree.  In addition, having known genetic risk data also allows for direct comparisons of patients whom under-went a specific scoliosis treatment allows for “genetic risk stratification” of the patient populations.  This means we can accurately compare the scoliosis treatment results of low genetic risk patients to low risk genetic patients and high risk with high risk, thus making the data far more relevant. 

Researchers are more and more convinced that idiopathic scoliosis is primarily a neurological condition with its primary effects on the spine in the form of a curvature.  With this in mind, a scoliosis think tank was formed (known today as the CLEAR Institute) with the goal of creating a scoliosis treatment system that could “re-train the brain” to “learn” how to hold the spine in a straighter position automatically.  This meant the entire rehabilitation system needed to be focused on creating a stimulus that generated feedback from the spine and was sent to the brain stem which triggered a “3-D auto-correction” reaction in the spine. 

After years of trial and error, research, and good old fashion hard work, the Early Stage Scoliosis Intervention™ program has been established to provide mild scoliosis patients with an elevated genetic pre-disposition a pro-active approach to treating scoliosis.  We call it “staying ahead of the curve”.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Adolescent idiopathic scoliosis accounts for over 80% of all scoliosis cases and generally occurs between the ages of 9-14 years of age.  For unknown reasons, it targets females to males by an 8 to 1 ratio most of the curve progression occurs during times of rapid growth.  While the condition isn’t life-threatening, it can create massive permanent spinal and body deformity and particularly at a time when teenage girls are often already self conscious about body image.

Clinically speaking, approximately 80% of adolescent idiopathic scoliosis cases will not cause any significant medical issues (although they are at an increased risk of back pain and spine degeneration as adults), but even smaller, non-progressive spinal curvatures can and will have a negative impact on one’s quality of life.  The unfortunately 20% whose spinal curvatures progress though out adolescence are usually presented a very limited number of unattractive, uncomfortable, and ineffective scoliosis treatment options such as scoliosis brace treatment or scoliosis surgery; both of which only focus on treating the spinal curvature and not the neurological root cause of idiopathic scoliosis.

Brand new data supplied by the developers of the Scoliscore genetic test for scoliosis, Axial Bio-Tech, has raised new questions in regards to why certain idiopathic scoliosis cases become progressive curvatures and other don’t.  Only 1% of all idiopathic scoliosis cases are considered “genetically high risk” for scoliosis curve progression, yet approximately 20% of idiopathic scoliosis cases demonstrate progression.  While this would be illogical if idiopathic scoliosis was solely a genetic condition, researchers have long suspected adolescent idiopathic scoliosis to be a multi-factorial condition with both genetic pre-disposition and environmental influences.  Given the fact, that only a tiny percentage of cases are “genetically high risk” for severe progression, and in fact a large percentage of idiopathic scoliosis cases do experience significant scoliosis curve progression it would seem that environmental factors make the most significant role in the progression of idiopathic scoliosis curve progression. 

While teens are notorious for sitting and standing with bad posture (an environmental risk factor for scoliosis curve progression), there are a many other environmental factor/ lifestyle factors to consider as well.……

Sleeping on one’s stomach is not advisable for patients with thoracic scoliosis.  The prolonged position places un-due stress on the mid back and the head turned to one side can increase spinal rotation.

Repeated back bends in ballet or gymnastics can cause scoliosis curve progression.  The repeated hyper-extension of the mid back (back bends) can cause a flattening of the thoracic spine and the de-stabilization may allow a spinal curvature to progress father than it would otherwise.

Spinal trauma that results in ligament damage to the neck is common.  Most people don’t understand the bio-mechanics of ligament damage and think it requires a large amount of force to damage the ligaments in the cervical spine, when it fact it only requires a very “rapidly applied” force.  Minor fender benders are a prime example of trauma that causes ligament damage in the neck.  The resulting instability can change the patient’s head position with profound effects on the scoliosis spine curvature.

Scoliosis in teenagers is a challenging diagnosis to deal with and condition to treat, but new early stage scoliosis intervention therapies that are based on rehabilitating the automatic postural control centers in the brain are having amazing success in halting the progression of scoliosis and reversing the spinal curvature to a large degree.  This new focuses treatment on the reduction/elimination of the environmental factors that combine with the genetic pre-disposition to create the idiopathic scoliosis spine condition rather than only focusing on the spinal curvature.

“Idiopathic scoliosis” is term that has been present in recorded human history for almost 3,500 years, but the mystery of its “unknown cause” is slowly being discovered. As many experts have suspected for decades, breakthroughs in scoliosis genetic testing (Scoliscore) and the scoliosis blood test have uncovered sequences of genetic code that leave an individual “genetically pre-disposed” to the development of severe idiopathic scoliosis. However, since the condition doesn’t appear until adolescence in the vast majority of patients, the search for environmental influences that are connected to un-coordinated growth spurts is on-going.

Virtually all current idiopathic scoliosis research is pointing towards a neurological deficit/under-development in the automatic postural control centers of the brain stem as the root cause of the condition, but the factors that cause severe progression requiring scoliosis brace treatment and /or scoliosis surgery appear to be primarily environmental (bio-mechanical, bio-chemical, and specific activity related) driven.

Previous attempts in scoliosis treatment have entirely centered on treating the scoliosis spine itself and have almost entirely ignored the obvious neurological component of idiopathic scoliosis. Scoliosis brace treatment is a relatively simple minded approach to “guided growth” in which the spine is essentially forced into a straighter position (in the front view dimension only). The scoliosis spine growth mal-adapts to alter the bio-mechanical loading patterns provided by the scoliosis brace in an attempt to “out-smart” the developing pattern of the scoliosis spine. Unfortunately, this well-studied scoliosis brace treatment approach has been found very ineffective due to the inability for idiopathic scoliosis patients to comply with the 23 hour a day, 7 day a week, 365 day a year scoliosis brace treatment protocol and those whom do comply experience significant muscle atrophy (muscle weakening) and scoliosis brace dependency in which they need to be “weaned” out of the scoliosis brace over the course of weeks or months. In addition to not addressing the primary neurological cause of idiopathic scoliosis, recent research at the University of Vermont conducted on rat tails under simulated scoliosis brace conditions, suggests that scoliosis brace treatment may actually be causing permanent deformity to the scoliosis spine discs that could lead to further curve progression during adolescences or adulthood.

Scoliosis surgery is a “brute force” approach to scoliosis treatment and has under gone many advancements since its inception in 1865, but even to this day the scoliosis treatment goal remains the same…..complete multi-level spinal fusion. While most orthopedic surgeons make substantial efforts to limit the number of vertebral segments fused during scoliosis surgery, it generally includes at least 5-6 segments out of a total 24 moveable spinal vertebrae which completely immobilizes an approximately 25% portion of the patients entire spinal column. The long-terms (15-20 years post scoliosis surgery) are very poor in terms of chronic pain and quality of life measures. Dr. Robert Saulter of the Toronto Hospital for Sick Children summed up the relationship between chronic dysfunction and chronic pain with is famous quote, “Restoration of function is more important than the relief of pain”. Unfortunately for the idiopathic scoliosis patients whom undergo scoliosis surgery the chronic dysfunction (multiple level spinal fusion)will almost certainly lead to severe chronic pain at some point in their lifetime. This may be considered an acceptable trade off if the scoliosis surgery was a “life-saving” procedure, but the research conducted on the effects of scoliosis surgery has concluded the procedures is primarily indicated for cosmetic purposes and is not medically necessary. This is a generally accepted fact with in the scoliosis treatment community, because scoliosis surgery does not improve cardiac function, pulmonary function, eliminate pain, or improve the adolescent idiopathic scoliosis patient’s quality of life in the long-term follow up studies. It should be noted, that a fused scoliosis spine from scoliosis surgery is every bit (or more) dysfunctional that an un-treated scoliosis spine. Perhaps most importantly, scoliosis surgery is not and will not lead to a cure for scoliosis since it still fails to address the underlying neurological deficit/ under-development that is the root cause of idiopathic scoliosis.

The concept of re-training the automatic postural control centers of the brain stem actually dates back several hundred years (if not much further back) to a time when young girls aspiring to become debutants practiced good posture by walking around balancing books on top of their heads (which is not a suggested scoliosis treatment). By making the head (temporarily) artificially heavier with the book, they essentially changed where their body neurologically perceived the center mass of their skull and caused their “body schema” (the neurological “set point” for normal spinal posture) to react to the perceived postural change. Over time the repeated re-training of the young girl’s automatic postural control centers in her brain stem resulted in a permanent change in the “body schema” and the improved posture simply, became “the new normal”. These very same principles (in a much more effective and advanced application) can be applied to scoliosis treatment and permanently alter the natural course of the idiopathic scoliosis condition by treating the root cause of the condition. The future of scoliosis treatment will be found in treating the scoliosis spine, by treating the automatic postural control centers in the brain stem first.

Don't let a lifetime be defined by idiopathic scoliosis

Now that genetic pre-disposition testing for scoliosis progression risk is available; An Early Stage Intervention Program has also been developed to provide scoliosis patients a non-bracing, non-surgical treatment option that allows them to take immediate action in the prevention of the next stage of the standard treatment process (scoliosis bracing or scoliosis fusion surgery).

While it is not the intention of CLEAR Institute to condemn the efforts of sincere and caring medical professionals who have dedicated their lives to helping individuals with scoliosis. We would, however, like to add to the current list of options; to educate those who are personally involved with scoliosis about what the research says; and, to empower these individuals to make their own decision regarding their own spine, and their own life.

The three medically-sanctioned methods of scoliosis treatment - observation, bracing, and surgery - have been around for decades. A great deal of research has been done on the risks & benefits of each option. However, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many conflicts and inadequacies present in the current model.

Observation Only or the “watch & wait” stage

Once an individual has been diagnosed with scoliosis, no treatment is initially prescribed, and no action is immediately taken, until the Cobb angle has progressed to 25 degrees (which is an arbitrary figure. There is no clinical significance to this number). At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic surgeon, where full-spine x-rays are taken consistently to gauge the progress of the patient's condition.

Scoliosis brace treatment (Generally recommended for curvatures 25 degrees and larger)
If there ever was a time when a patient could benefit most greatly from chiropractic, therapeutic exercise, or non-surgical intervention, it would undoubtedly be during the mild stages of the disease - before the muscles & tissues of the body have been deformed by months or even years of compensating for the abnormal twisting & bending of the spine.

Scoliosis bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces in use, ranging from the venerable and bulky Milwaukee brace, to the traditional TLSO (thoraco-lumbar-sacral orthosis) braces such as the Boston and the Wilmington brace. There are "part-time" braces, designed to be worn at night: the Providence brace, and the Charleston brace. There are also "dynamic corrective braces" which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis. An example of a dynamic corrective brace would be the SpineCor brace, developed at the Sainte-Justine Hospital in 1992, or the Copes brace, developed by Arthur Copes to be used in conjunction with his STARS (Scoliosis Treatment Advanced Recovery System) rehabilitation protocol.

This dizzying variety is further complicated by the fact that not every doctor prescribes the braces to be used in the same manner, and not every patient may follow their doctor's recommendations to the same extent. As a result, research is often conflicting (to say the least) in regard to the true effectiveness of bracing in scoliosis treatment. Some studies have shown very little difference between patients who wore the brace for the prescribed time, and those who wore it barely, if at all. Others have demonstrated patients who have been successfully stabilized for years by wearing a bracing constantly; yet, there are also studies on patients who wore the brace for 23 hours out of every day, seven days a week, and continued to worsen. In every case, all corrective benefit is lost very quickly once the patient stops wearing the brace, and the general consensus is that bracing may prove helpful for some, but not for others.

Scoliosis surgery (Generally recommended of curvatures 40 degrees and larger)
Those patients for whom bracing fails to prevent the progression of their scoliosis are left with only one option: surgery. Those who are confronted with this choice may be told that having a metal rod fused to their spine will not impair their daily activities, and will reduce the rib arch & improve their cosmetic appearance. However, research has consistently shown that surgery - which primarily focuses upon the sideways bending, and does little to address the rotation of the spine (and hence the rib protrusion) - will actually cause the rib arch to worsen (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).

Scoliosis surgery, like most highly-invasive procedures, carries with it the ever-present risk of death. Although mortality rates of less than one percent are claimed, no surgeon can completely eliminate this possibility. There is also the danger of neurological damage, resulting in the loss of sensation or motor function to the arms & legs (paraplegia or quadraplegia). This has become a greater concern in recent years, as surgeons strive for greater corrections in their patients, and place more stress upon the nerves running through the spinal column.

The rate of hardware failure is virtually 100% over the course of a normal lifetime. It may occur immediately after the surgery or several years later, but one or more components of the hardware placed inside the body is highly likely to fail or break. The author of one study stated, "One would expect that if the patient lives long enough, rod breakage will be a virtual certainty". Another study found that amongst seventy-four patients who underwent the surgery, pseudoarthrosis (failed fusion) occurred in 27% of patients within a few years after the procedure.

The truth of the matter is that scoliosis is an abnormality of the spine which involves much more than merely a sideways curve. Yet the "effectiveness" of surgery is measured only by the degree to which it can reduce the lateral deviation through the application of brute force, and a fused spine is every bit as abnormal and dysfunctional as a scoliotic spine.

We can alter the natural course of this disease by identifying which patients are at the highest risk for severe progression via genetic testing (Scoliscore) and by implementing an aggressive, non-invasive Early Stage Scoliosis Intervention program that re-trains the brains involuntary postural controls centers before the spinal curvature reaches the 30 degree "buckling" point

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

Idiopathic scoliosis is a neurological condition primarily creating an early shift in postural presentation. The most common early stage/ mild scoliosis pattern is the head translating left of center gravity creating either a right mid neck or a right upper neck anglelation. The second shift is a pelvic translation to the right creating a left angle between the lumbar and sacrum with or without compensatory tilt often referred to as a forward right pelvis. The combination of a moderate to high genetic score using scoliscore will combine with these initial biomechanical factors creating a cascade of events often leading to the formation and progression of a scoliosis spine. Since the genetic push involves the sensory integration system that being the ability of the body to coordinate afferent and efferent messaging, the biomechanical factors must be stabilized early to avoid a catastrophic event as growth occurs. The sagital presentation in early stage scoliosis often involves anterior head translation, loss of cervical lordosis (the normal forward curve in the neck), and increased sacral inclination leading to thoracic extension. Once asymetrical loading has occurred in this early stage the growth plate undergoes an abnormal histological change which in turn elevates blood levels of osteopontin a cytokine found in AIS blood panels to be elevated.

Since the spinecor scoliosis brace is ONLY recommended for idipathic scoliosis patients with curves less than 30 degrees we feel the need for bracing in combination with our protocols is unsubstantiated. Since the primary goal of the chiropractor is to decrease the biomechanical and neurological factors contributing to the dis-ease of the scoliotic patient we feel the reduction of head and pelvic translation in combination with improving sagital spine profiles is much better achieved using CLEAR methodology than with passive forced correction. Although spinecor statistically has demonstrated that with curvature under 30 degrees it can hold a moderate reduction after 2 years in approximately 50% of patients, we feel that a less invasive chiropractic approach can match this percentage and potentially outperform the spinecor scoliosis brace.

It is CLEAR Institutes sole purpose to find a better way of treating scoliosis without the use of spinal braces and certainly without the use of surgical intervention. Preliminary findings from certified doctors performing CLEAR protocols on early stage cases has been very promising and we are certain that our program can stand alone and make a positive impact on the way in which scoliosis is treated into the future.

Brian T Dovorany DC

Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.

The history of scoliosis treatment is well documented over the past almost 500 years (1^st metal scoliosis brace was created in 1575) and dates back to the early writings of the Hippocrates himself (The Father of Medicine).  For hundreds of years, if not thousands, idiopathic scoliosis patients have been immobilized in various types and applications of scoliosis brace treatment without success, and the current clinical data appears the orthopedic community isn’t any closer to scoliosis brace treatment success even today.  Dr. Stefano Negrini led a comprehensive review of scoliosis brace treatment and concluded “There is a very low quality of evidence in favor of using braces, making generalization very difficult.”  436 years of attempted scoliosis brace treatment experimentation and “very low quality of evidence” is the best they can come up with?  Obviously, we need a better way.

The first scoliosis surgery was conducted (unsuccessfully) in 1865 and subsequently spurred on the first medical malpractice lawsuit in the orthopedic community shortly after.  While scoliosis surgery techniques, hardware, and abilities have vastly improved since that time, the long-term negative complications of fusing multiple levels of freely move-able joints in a patient’s scoliosis spine still haunts the procedure; keeping in mind the wide spread agreement that the primary indication for scoliosis surgery is for improving one’s cosmetic appearance and not medical necessity.

The current state of scoliosis treatment appears to be scoliosis brace treatment is worthless and the scoliosis surgery procedure is worse than the condition itself in many cases.

The need for drastic change and over-haul to the scoliosis treatment system is clearly obvious, yet decade after decade, little to no progress is made other that “improvements” to the existing scoliosis brace protocols and scoliosis surgery procedures.  The obvious question is simply, why?  When the need is so glaringly evident and the technology and thought process is so clearly under-developed; why hasn’t the scoliosis treatment community rushed to meet the needs and demands of a world full of scoliosis patients?  In my opinion it can be summed up in two words:  Cobb angle.

Cobb angle first appeared on the scene in 1948 and has been adopted as the “common” (not necessarily “gold” standard) for scoliosis evaluation every since.  Cobb’s angle is a completely obsolete system of analysis.   Idiopathic scoliosis is a very complex condition and the more we learn about idiopathic scoliosis, the more complex it appears to be.  Attempting to describe a condition as complex as idiopathic scoliosis purely by the means radiographic lateral flexion is the equivalent to attempting to describe all the features of your new luxury car by only its color.  There is so much more to this condition than just a Cobb angle.

The “prognostic” or “predictive” value of Cobb angle in curve progression is only slightly better than the odds of flipping a coin and ALL of the Cobb angle prognostic assumptions are based off a single study by Lonstein and Carlson in 1984, which has never been repeated or re-produced to this very day.

The current treatment schedule for scoliosis (10 degree diagnosis and then “watch and wait”, 25 degrees scoliosis brace treatment recommendation, 40 degrees scoliosis surgery recommendation) was accepted almost entirely on one article in 1977, by one doctor (Dr. William Kane), who openly admits the numbers are arbitrary and based on a cost based analysis to fit a particular healthcare system. It is not necessarily based off science, and more importantly, not necessarily based off the patient’s best interests.

Cobb angle has a generally accepted +/- 5 degree intra-examiner (same doctor measuring) “measurement error” between 2 separate  x-rays and up to a 9.8 degree inter-examiner (different doctor) “measurement error” between 2 separate x-rays.  This means a scoliosis brace treatment recommendation is essentially being made with an “acceptable” 20% error rate in scoliosis brace treatment recommendations for scoliosis cases of 25 degrees and scoliosis surgery recommendations are being made with a 12.5% error rate for scoliosis cases of 40 degrees.  These measurement error rates are simply unacceptable when making recommendations for highly invasive procedures which have life-long lasting impacts (physically, emotionally, and psychologically) on those scoliosis patients unfortunate enough to be subjected to them.

Cobb angle is measured out of tradition, not an updated scientific understanding of idiopathic scoliosis.

So what is the link between an obsolete, un-reproducible, and un-reliable measurement system (Cobb angle) and the stagnant progress of scoliosis treatment (more useless scoliosis braces and more ways to induce spinal fusion through surgery)?  All “mainstream” scoliosis treatment protocols (scoliosis brace treatment and scoliosis surgery) are entire predicated on Cobb angle.  Remove Cobb angle from the equation and there is no indication for scoliosis brace or scoliosis surgery treatment.  It’s really that simple.  Cut off the head (cobb angle) of the beast and the body (scoliosis brace and scoliosis surgery) dies.

Scoliscore genetic testing and Early Stage Scoliosis Intervention combine to create a new future for scoliosis treatment. 

It has been said that one has to “replace” or “break” a current system, before the old one can be replaced.  For example, email “broke” and “replaced” the fax machine.  Almost overnight the fax machine became completely obsolete and slowly, but surely email is replacing the US Postal Service.  Generally speaking it is easier to “break” the existing system than to “replace” it with something entirely brand new (which is really hard to do and needs to be invented first).  In the case of over-hauling and replacing the current scoliosis treatment system it will need to be “broken” AND “replaced”.

Scoliscore genetic testing for idiopathic scoliosis will “break” the current scoliosis treatment system, because it “breaks” the use of Cobb angle as a predictive tool of curve progression.   Idiopathic scoliosis a multi-factorial condition (aka: a combination of both genetic pre-disposition and environmental influences) and completely unique to every patient’s individual scoliosis case.  No two cases of idiopathic scoliosis will ever have exactly the same genetic pre-disposition and/or environmental influences, so having a “known” variable like the patient’s genetic pre-disposition become invaluable in determining their true curve progression risk.  In other words, a low genetic risk scoliosis case with a 20 degree Cobb angle looks exactly the same as a high genetic risk scoliosis case with a 20 degree Cobb angle on an x-ray; and under the current system to scoliosis treatment they would both receive the same scoliosis treatment recommendation (which in this case would be “observation only”).

The Early Stage Scoliosis Intervention program will “replace” the current scoliosis treatment model when used in combination with the genetic predisposition information provided by the Scoliscore test.  Again, based on the new understanding that idiopathic scoliosis is a multi-factorial condition with both genetic predisposition and environmental influences resulting in the development of a spinal curvature; the current scoliosis brace and scoliosis surgery treatment protocol only attempts to deal with the end result (the spinal curvature) rather than treating and preventing the spinal curvature from developing by reducing/eliminating the environmental factors (the only variable we can currently control at this time).  However, the Early Stage Scoliosis Intervention program is solely targeted towards reduction of the environmental influences and is centered around a neuro-muscular rehabilitation program the specifically  targets the automatic postural control centers in the hind brain, which many researchers feel is genetically predisposed to being “under-developed” in idiopathic scoliosis patients.

This “one, two” punch of accurately determining which patients are most genetically predisposed to developing a severe idiopathic scoliosis curvature with Scoliscore genetic testing and immediately implementing an Early Stage Scoliosis Intervention program which re-trains the under-developed postural control centers in the brain, while simultaneously reducing environmental influences for idiopathic scoliosis is the most scientifically advanced approach to scoliosis spine treatment to date.

The current state of scoliosis treatment is deplorable.  The Cobb angle system of scoliosis evaluation is antiquated (and thanks to Scoliscore genetic testing, now obsolete as well), and the scoliosis treatment system (scoliosis brace and scoliosis surgery treatment) employed under its (Cobb angle) direction is equally antiquated.  In order to “turn the page” to a new day in scoliosis treatment, the scoliosis treatment community will need to embrace Scoliscore genetic testing as a way to “break” the hold Cobb angle has on scoliosis treatment protocols and adopt an Early Stage Scoliosis Intervention program to “replace” the current observation, scoliosis brace treatment, and scoliosis surgery treatment methodology in favor or a more pro-active strategy which prevents the spinal curvature (hence eliminating the need for scoliosis brace and scoliosis surgery treatment) and re-trains the neuro-muscular under-developmental cause of idiopathic scoliosis.

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A legacy of failure: The history of scoliosis treatment.

The history of scoliosis treatment is as old as the condition of idiopathic scoliosis itself.  The first known historical records of scoliosis come from the Greeks (Hippocrates, the father of medicine, none-the-less) in 400 BC and Galen who first coined the term “scoliosis” sometime between 131-201 AD.  Through the ages scoliosis treatment has seen its fair share of creativity and brutality.  During mid-evil times the typical treatment consisted of using gravity and extension of the scoliosis spine to treat a curvature.  Other attempts consisted of forcing the rotation out of the scoliosis spine, and yes, the historical record even shows attempts to straighten the scoliosis spine through the use of the rack (one of the less creative attempts).  Scoliosis brace treatment dates back to approximately 650 AD, when Paul of Aegina suggested bandaging idiopathic scoliosis patients with wooden strips.

In 1575, Frenchman Ambrose Pare become the first to create a metal scoliosis brace the patient could wear full time as a mechanism of artificial correction for scoliosis treatment.  The odds are that light weight materials weren’t readily available at that time, so comfort was probably not at a premium.

The discovery of x-ray technology in 1876 allowed for a scoliosis spine to be viewed and measured prior to any scoliosis treatment attempts.  The high x-ray radiation doses at that time may have been more dangerous than the idiopathic scoliosis condition itself.

Today, there are "part-time" scoliosis braces, designed to be worn at night: the Providence scoliosis brace, and the Charleston scoliosis brace. There are also "dynamic corrective braces" which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis. An example of a dynamic corrective scoliosis brace would be the SpineCor brace, developed at the Sainte-Justine Hospital in 1992.  There is an amazing variety of scoliosis braces in use, ranging from the venerable and bulky Milwaukee scoliosis brace, to the traditional TLSO (thoraco-lumbar-sacral orthosis) braces such as the Boston and the Wilmington scoliosis brace.

In 1865, a French surgeon named Jules Rene Guerin (1801-1886) first began applying surgical methods to scoliosis correction. He severed the muscles and tendons of almost 1400 patients in an attempt to reduce the visible effects of the deformity & re-align the spinal column.  As one may expect, the post scoliosis surgery results were not positive, but the procedure continued to be implemented anyway.

Paul Harrington developed the Harrington Rod procedure in the 1950’s. A single inflexible steel rod secured the straightened spine.  Due to poor outcomes, eventually bone from the patient's own hip was harvested and driven into the vertebral spaces to stimulate a fusion. This scoliosis surgery was performed only from the back and caused the patient to lose all flexibility the full length of the fusion.  It was successful at halting progression if the fusion was complete, but didn't allow much correction of the scoliosis spine itself.

The pedicle screw system (still most commonly used today) developed by Cotrel & Dubousset was the first system that allowed for de-rotation of the vertebral bodies which allowed for far greater correction in multiple planes.

Although correction rates achieved by posterior pedicle-screw are good overall, the rate of per-operative complications is very high. One study found that 68% of patients experienced minor or major severe complications, including two deaths (out of 50 patients).

The development of new prognostic technologies like the Scoliscore genetic testing and soon-to-be-released Scoliosis blood test are going to be quantum leaps forward, but only if we scurry to close the ever growing divide between the rapid pace of prognostic scoliosis technology and treatment methods that are able to take full advantage of the opportunity this technology provides.

The continued creation, implementation, and world wide spread of a neuro-muscular scoliosis treatment rehabilitation program that actually prevents and reverses idiopathic scoliosis in its earliest stage is the next critical leap forward in the field of scoliosis spine treatment.