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Displaying items by tag: scoliscore
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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.
“How to fix scoliosis” doesn’t seem like it would be that difficult of a question to answer, yet, for 3,500 years of recorded human history no one has been able to answer, “how to fix scoliosis”. Even with today’s genetic testing, computer data bases, and scoliosis blood test the question of “how to fix scoliosis” still remains.
Perhaps the reason the “how to fix scoliosis” questions hasn’t been answered is because no one has thoroughly examined the “why does scoliosis occur” question. While there are many scoliosis theories abound, virtually all of them cite a neurological deficient in the automatic postural control centers of the brain as the root cause. This means, idiopathic scoliosis is really primarily a neurological condition and secondarily a spine condition. In other words, almost 500 year’s worth of scoliosis brace treatment attempts where doomed from the start, because it only attempt to treat idiopathic scoliosis as a spinal condition and not a neurological condition. I guess scoliosis brace treatment only further proves “there’s no right way to do the wrong thing”.
In 1865 the French orthopedic community attempted to answer the “how to fix scoliosis” question with the first scoliosis surgery, which was shortly followed by the first orthopedic medical malpractice lawsuit (no kidding, it’s true). Once again, scoliosis surgery is based on the premise that scoliosis is solely a spine condition with no neurologic root problem in the automatic postural control centers of the brain. The rate of complications during or shortly after scoliosis surgery is an alarming 68% (whist in all fairness includes things like bacterial infections that are present in all surgeries), which as very high number that should make everyone stand up and take notice. Unfortunately, the long-term prognosis for scoliosis surgery treated scoliosis patients is even more bleak with one 2002 long-term study finding 40% of all scoliosis surgery treated patients qualifying as “severely disabled persons.”
So back to the question, “how to fix scoliosis”; Well scoliosis brace treatment appears to be worthless and scoliosis surgery may be worse than doing nothing, so now what.
Armed with the fundamental understanding the idiopathic scoliosis much be treated like it is a neurological condition first and a scoliosis spine condition second, a team of dedicated team of doctors across the United States began work on a scoliosis exercise based scoliosis treatment program that focused on re-training the automatic postural control centers in the brain, so the scoliosis spine would “learn” how to hold the spine in a straighter position automatically.
Over the course of several years this group morphed into what is now the CLEAR Institute non-profit organization.
The Scoliscore genetic test was release and brought into wide spread use in 2010 and for the first time in human history, allowed doctors to identify the most “at risk” idiopathic scoliosis patients before the scoliosis spine began rapid progression towards scoliosis surgery. This “scoliosis warning in alarm bell” in terms of genetic pre-disposition for a severe scoliosis condition has now created a demand for an Early Stage Scoliosis Intervention program that focuses on the environmental factors which trigger the genetics and create the condition known as idiopathic scoliosis.
It appears that a “cure for scoliosis” may not be possible, but a combination of Scoliscore genetic testing and Early Stage Scoliosis Intervention may prove an effective “scoliosis prevention” approach to non-invasive scoliosis treatment.
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Is Scoliscore going to be utilized as a high-tech paperweight?
I must admit, I’m a little taken back by the level of resistance I’m seeing in regards to the use of the Scoliscore AIS prognostic test and how it will (or actually won’t) effect treatment decisions for early stage scoliosis patients. I’m even left scratching my head after watching the patient testimonial video on the www.scoliscore.com website entitled “Isabelle’s story”.
http://www.scoliscore.com/patient-re...0/Default.aspx
The patient (Isabelle) is diagnosed with early stage scoliosis and isn’t immediately tested with the Scoliscore test. Instead she is placed into the age old “watch & wait” mentality. The doctor only recommends the use of the Scoliscore test AFTER she has experienced a “big curve increase” following a growth spurt! They immediately put her in a rigid brace (again, following the same old AIS treatment protocol) before determining her genetic risk for progression with the Scoliscore test. The test results come back and she has a Scoliscore of 16 (very low genetic risk for curve progression to a surgical level), which begs the question…..So then why did she experience the “big curve increase” following the growth spurt? I mean, it’s great that she has a low genetic risk for developing a severe curvature (40+ degrees), but the “big curve increase” during the growth spurt was certainly less than optimal or desirable. She obviously has a very high environmental factors risk that is going completely unaddressed (and will continue to be unaddressed in the rigid brace they prescribed to her in the video). Incredibility enough, at the end of the video they in a large part use the genetic risk factor evaluation in the decision to discontinue ANY forum of treatment in Isabelle’s case, so she can go off to summer camp, without the brace (which probably wouldn’t have helped anyway since it doesn’t reduce or eliminate the environmental risk factors that are obviously driving her curve progression to this point), so she can engage in dance and swimming……Two known high risk activities for AIS patients! Ahhh! This just goes to show that the most incredible technological advancements can be defeated by incompetence or an unwillingness to adapt to change.
I can’t tell you have many conversations I have with colleagues of mine (within the CLEAR Institute even!) and orthopedic scoliosis specialists who have a SERIOUS case of the “that’s the way we do things around here” syndrome in regards to adapting their treatment plans in accordance with the vast advantage the information from the Scoliscore test provides. They look at me and say, “well, it’s certainly nice information to have, but it isn’t going to change my treatment plan in anyway.” WHAT!?! I respond back to them with “so your planning on treating a AIS patient with a Scoliscore of 200 (the highest level) exactly the same as a AIS patient with a Scoliscore of 20 (very low genetic risk)?” A blank stare is the only response I have gotten from anyone to this point.
Think about it in a metaphoric sense. Would you react differently if you saw a child standing 20 feet off the rail road tracks as a train was bearing down on them, than a child standing ON THE TRACKS as the rail rolled towards them? I would certainly hope so. Neither case is ideal, but the two situations certainly warrant different responses.
The Scoliscore AIS prognostic genetic test will serve the patient about as much as a high tech paperweight if it isn’t utilized (in conjunction with evaluation of environmental risk factors…not the end result factors….Aka: Cobb angle) to fundamentally change the patient’s treatment plan and/or treatment options.
I think Helen Keller said it best: “The only thing worse than blindness is a person with no vision.” I have (again) attached a flow chart depicting the traditional cobb angle directed treatment plan that attempts to solve the AIS problem without knowing the genetic risk or environmental risks of the patient, so every patient with similar cobb angles are treated the same reactionary way until it is too late and the curve progresses. And the alternative Scoliscore directed treatment plan in which the treatment plan and follow-up evaluations are personalized according to the patient’s individual genetic and environmental risk factors. The alternative pathway also provides 100% of high risk patients the opportunity to utilize guided bone growth type treatment strategies, if deemed necessary, (as well as environmental factor reduction strategies) to the most beneficial degree possible.
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Here is a recent paper Dr. James Ogilvie (past president of the SRS and chief medical advisor at Axial Bio-Tech) wrote in regards to the genetic testing and idiopathic scoliosis (IS). The article is only 3 pages without references and really is worth the 5 minutes it will take you to read it.
One day many years from now, we are going to look back and realize that genetic testing for IS was the landmark moment when the standard of care for IS started to be lifted out of the dark ages.
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The first scoliosis brace attempts date back to as early as 400 A.D. and have been applied in every conceivable manner (without success) since then. The first metal scoliosis brace we constructed by Ambrose Pare in 1575 and again, didn’t work. Since then scoliosis brace makers have continued to innovate without success. Hard scoliosis brace, soft scoliosis brace, night time scoliosis brace, flexible scoliosis brace, rotational scoliosis brace, traction scoliosis brace; in the end each attempt has prove to be as feeble as the last (not due to lack of effort, application, or funding).
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It should come to no surprise to anyone to a reads more than 2-3 threads on this site that I do not support the use of artificial correction in the form of scoliosis brace treatment in adolescent idiopathic scoliosis (AIS). However, I don’t believe I have ever stated my case against brace related treatment in AIS from start to finish and I’m not sure that is even possible in the confines of the forum limitations or electronic communication…..but that won’t stop me from trying.
Process + Application = Results
Process: The thought process of scoliosis brace application is a fundamentally flawed process in the regard to treating scoliosis primarily as a spinal condition, rather than “primarily as a neurological condition with its primary effects on the spine”. This simple adaptation in the thought process (scoliosis is primarily a neurological condition, rather than a spinal one) creates a change in the treatment paradox that is self-evident and makes the current treatment thought process obsolete almost immediately. I mean, would anyone really elect to treat a neurological condition like a spinal condition on purpose? http://www.fixscoliosis.com/threads/...essive-factors
Application: Application sort of becomes a moot point once it is realized that the scoliosis brace treatment is being mis-focused on the symptom of the condition (the spinal curvature) rather than the primary neurological cause, but there are some note worthy bio-mechanical short falls in the application of scoliosis brace treatment that need to be addressed….namely head and neck position.
Results: Forms of scoliosis brace treatment for scoliosis can be traced back to as early as 5th century AD and the first metal scoliosis brace was constructed almost 500 years ago (1575) by Ambrose Pare. In all that time and experimentation no one has been able to demonstrate consistent results with any scoliosis brace treatment protocols regardless of process or application of the brace. In fact, the most positive research review could only find "There was very low quality evidence from one prospective cohort study with 286 girls that a brace curbed curve progression at the end of growth better than observation (aka: doing nothing) and electrical stimulation.” And that is the good news results?
The bad news results are significantly more damning…..especially the oral presentation done by the Axial Bio-Tech company (developers of the Scoliscore test) at clearly demonstrated that bracing has absolutely no effect on the natural course of the condition (http://www.scoliosisjournal.com/content/4/S2/O59) and a 2007 article in the SPINE journal by Weinstein and Dorlan concluding “that observation only or bracing showed no clear advantage of either approach. Furthermore one can not recommend one approach over another to prevent surgery. They gave the recommendation for bracing a grade "D" relative to observation only because of "troublingly inconsistent or inconclusive studies on any level." I suspect the upcoming BrAIST study will conclude more of the same.
Conclusion: It is time to recognize that we cannot manipulate the application portion of the equation any further and expect a successful result. Only when we summon the courage to re-visit the process of how we actually view and treat this condition will we begin to achieve consistent results and begin to alter the natural course of the condition…..and then and only then will the scoliosis surgery rates begin to drop. Don't let a lifetime be defined by idiopathic scoliosis
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
Scoliosis brace treatment (Generally recommended for curvatures 25 degrees and larger)
Scoliosis surgery (Generally recommended of curvatures 40 degrees and larger)
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.
An Interview with Dr. James Ogilvie, Past President of the Scoliosis Research Society, and Founder & Chief Medical Advisor for Axial BioTech, the Creators of the ScoliScore™ Genetic Prognostic Test for Scoliosis
Dr. James Ogilvie is a board-certified orthopaedic surgeon. In addition to private practice, Dr. Ogilvie is adjunct Professor, Department of Orthopaedic Surgery, at the University of Utah in Salt Lake City and Professor Emeritus, Department of Orthopaedic Surgery, at the University of Minnesota in Minneapolis, MN. He is Staff Surgeon / Attending Staff at Shriners Hospital Intermountain Unit in Salt Lake City.
He is an active member of many prestigious organizations including the Academic Orthopaedic Society, American Academy of Orthopaedic Surgeons, Scoliosis Research Society, and Society of Military Orthopaedic Surgeons. Dr. Ogilvie served as a Commander in the United States Naval Reserve.
CI: Please tell us about the ScoliScore™ prognostic test for scoliosis. What led you to create this test, and how do you feel it will impact the way scoliosis is managed today?
James Ogilvie MD: Our initial goal was to identify the 85% of children with mild adolescent idiopathic scoliosis (AIS) who would not progress to the surgical range untreated. The current standard is to monitor everyone with multiple clinic visits and x-rays which are both expensive and present the danger of radiation exposure to growing children.
CI: Is the ScoliScore™ test expensive? Does it hurt? How accurate is it?
JO: The DNA-based test is less expensive than other comparable genetic tests and costs $2950. Our patient assistance program means that unless someone is wealthy they seldom have an out of pocket expense. It is less expensive than unnecessary years of doctor visits and x-rays. It’s a saliva-based test (no blood drawing required), and has been clinically validated to be 98% accurate. For those with a risk score of less than 50 there is less than 1% probability of progression. We have no cases of progression with scores less than 30. There is a caveat that sometimes a misdiagnosis is present and a patient's curve may progress. An MRI is then indicated and we have instances of syringomyelia or other conditions that cause progressive spine deformity.
CI: One of the reasons we at CLEAR Institute are so excited about the ScoliScore™ test is because of the potential it offers for a more efficient, personalized system of scoliosis treatment. What do you feel are some of the problems with the current system of how scoliosis is managed?
JO: The current clinical guidelines cannot identify progressive from non-progressive AIS. DNA testing allows a personalized risk of progression that is unique to each patient.
CI: You’ve published dozens of important research articles in very well-recognized journals. In one of your recent scientific articles, you utilized the potential of the ScoliScore™ test to determine which patients were at a high risk for progression, and compared two groups of patients - braced & non-braced. Your conclusion was that there is no significant difference in the natural history of scoliosis between the two groups. Could you share with us your thoughts about how this study is different than any other study which has been done on bracing in the past? Did the results of this study surprise you?
JO: Rigid bracing has been commonly practiced by spine surgeons for more than 100 years. Unfortunately those studies were unable to risk stratify the enrolled patients. Therefore they observed some that had a high risk of progression and braced some that had less than 1% risk of progression. No definitive answers have come from the current brace studies. Many surgeons have suspected this was the case, but bracing had become the “standard of care” and it was too threatening not to brace young patients.
CI: We’ve heard a great deal about the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) study that is currently being led by Stuart Weinstein, MD, at the University of Iowa, which is the largest NIH-funded clinical trial in the history of orthopaedic pediatrics, and is scheduled for completion this August. What are your thoughts about this study? Do you think patients benefit from bracing?
JO: Without a knowledge of an individual patient’s risk of progression, some patients with little risk are being braced unnecessarily and some who have a very high risk are assigned to the observation arm. In effect, there is one equation with two unknowns, treatment assignment and genetic risk of progression. A single equation with two unknowns cannot be answered.
CI: The roots of bracing as a treatment for scoliosis go back a long ways (as early as 650 AD, Paul of Aegina was bracing scoliosis patients with wooden strips & bandages). What do you see happening in the future for scoliosis braces?
JO: With an understanding of the genetic factors that influence AIS progression and identify an individual’s risk, future spine therapists can challenge the current ineffective treatment routines and innovate on new therapies.
CI: If bracing is found not to be effective, do you think school scoliosis screening programs for scoliosis should be eliminated? How do you think ScoliScore™ will affect the potential benefit of scoliosis screening programs?
JO: Current school screening is not effective. However, early screening in school or a doctor’s visit is necessary to diagnosis AIS in its early stages when non-surgical treatments are more effective.
CI: Many people believe there are barriers to integrated medicine – that is, traditional medicine working hand-in-hand with alternative treatments such as chiropractic. Your presence here today is proof that hope exists for doctors of all specialties to work together for the common good of the patient, and it is greatly appreciated! What do you recognize as the major obstacles that prevent orthopedic surgeons from referring patients with mild scoliosis to a chiropractor?
JO: Health science is not the province of only one discipline. Allopathic medicine is ideally evidence-based. Surgeons will refer appropriate patients to the chiropractic profession, much as we refer patients to orthotists, as scientific evidence is generated that validates non-surgical treatment.
CI: Last March, some of the members of CLEAR Institute, including the founder, Dr. Dennis Woggon, were invited to the headquarters of Axial BioTech in Salt Lake City, Utah, for an opportunity to learn more about the ScoliScore™ test and tour the $19-million dollar facility in person. It made a very positive impression on everyone from CLEAR, and we would like to thank you again for Axial’s warm hospitality at that meeting. It was also an occasion for you to learn more about the methods & protocols developed by CLEAR Institute. What did you think about this new system of scoliosis treatment? Did anything in particular about CLEAR Institute impress you?
JO: I was impressed with two items, first the innovative approach that CLEAR has taken to non-operative AIS treatment is needed. With a realization that bracing is at best not very successful and at worst, not useful at all, innovative physiologic treatment regimes are needed. Secondly, CLEAR has made a commitment to evaluate these new therapies in a manner that will pass scientific scrutiny.
CI: The potential of the ScoliScore™ test to revolutionize research into scoliosis is amazing. For the first time in history, we have a method of identifying which patients are most likely to progress to surgical levels. In your opinion, is it possible that an individual at high risk could undergo a treatment which reduces their chance of progression? In other words, could it be possible to re-test someone after treatment and see a lower ScoliScore™ test result?
JO: It would be unlikely that the human genome will be changed by physical treatments. However, the expression of those genes can be modified.
CI: Dr. Ogilvie, thank you again for donating your time to share your knowledge & wisdom. Do you have any final words for our readers?
JO: DNA prognostic testing is only the beginning of our understanding of AIS genetics. As we learn what those causative genes do we may have even more effective interventions. Thank you for your generosity in letting me introduce genetic science into the treatment of a disorder in which we all have a great interest. Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.
I'm sure many of you have heard about the scoliscore genetic profile test from Axial biotech. My test kits have just arrived and I've finished going through all the literature.....overall, I think it could prove to be very useful in the context of early stage scoliosis intervention/treatment.
The parameters for the test are as follows....
Basically, the test compares the patients genetic markers against 53 other markers that have been identified as high risk from the profile of 1000's of patients whose curves progressed beyond 40 degrees before skeletal maturity. The more marker matches to the profile the higher the risk. The list price of the test is a little steep ($2,900), but it is readily covered by insurance and they have financial assistance programs for those who qualify. They claim the test is 99% accurate (seems a little too good to be true) at determining whether or not the curvature will reach surgical threshold (40-45 degrees) while the patient is skeletally immature. That is all it measures. A 15 degree curve could still progress to a 39 degree curve with a low risk on the scoliscore test. Here is the real pay off in my mind. Patients who have a low or intermediate risk according to scoliscore don't even need to see an orthopedist for their condition. Plus, just think of the anxiety it will reduce for patients and parents alike....AND the x-ray monitoring schedule can be completely re-thought for low/intermediate risk cases vs. high risk cases. A non-high risk scoliscore patient can be managed entirely with an active rehab program during the condition's early stages to minimize and reduce the risk and effect of the condition on body image/disfigurement.
Only 1% (the high risk group) should even consider spinal bracing......and even that is most likely a waste of time. Please click here to receive a FREE SCOLIOSIS TREATMENT INFORMATION KIT.
Unfortunately, the lowest common denominator that all non-surgical scoliosis treatments have in common is the hope of preventing the "need" for scoliosis surgery......standing at approximately 38,000 per year in the US right now. I say that it is "unfortunate", because this seems like it should be a rather low bar to hurdle, but to date no one has been able to effectively demonstrate the ability to do this on a large scale. The advent of genetic testing (Scoliscore) will provide the necessary genetic predisposition data to determine if a given non-surgical treatment has actually altered the natural course of the condition, so hope is on the horizon, but to simply boil down all treatment effort to avoiding surgery is abandoning a much loftier and noble goal of finding a cure. I would rather fail attempting to achieve high expectations, than succeed achieving low standards. The current review of scoliosis brace data clearly demostrates that brace treatment does NOT reduce the rate of scoliosis surgery (Weinstein, 2007 and Oglivie, 2009); and rehab based programs like Schroth, CLEAR Institute, FITS, SEAS, Yoga, Pilates, ect haven't produced any large scale data to determine effectiveness in reducing surgical rates at this time, so we're in a bit of a tough spot here. It has always been stated that one of the greatest challenges the scoliosis practioner has had was determining which cases would progress and how far, but in reality bracing's known and proven inability to alter the natural course of the condition made that a moot point anyway, and essentially there is nothing standing between the adolescent idiopathic scoliosis (AIS) patient and surgical intervention except genetic predisposition and luck. This is simply unacceptable. The gap between prognostic testing for AIS and the ability to alter the natural course that prognostic testing can help predict is wide and widening further by the day. We have entered a realm in which we can tell a patient they are essentially a ticking time bomb for severe scoliosis, but there is no way to de-fuse it, so sit back, watch it get worse and we'll perform a highly invasive surgical procedure that very often results in long-term chronic pain and disability once the curve gets bad enough. Again, this is simply unacceptable. So what can be done to lower the rate of spinal fusion rates for scoliosis in the future? 1. Earlier detection of small curves. This allows for genetic testing to determine genetic predisposition and the opportunity for early stage scoliosis intervention for the patients whom are at elevated risk for severe curve progression. 2. Early Stage Scoliosis Intervention. A neuro-muscular re-education based rehab program that targets the involuntary postural control centers of the brain stem that will "re-train" the brain to hold the spine in a straighter position automatically....when the spinal curvature is still relatively small and flexible for maximum benefit to the patient. 3. Vertebral Body Stapling (VBS). This is a relatively new, minimally invasive non-fusion surgical procedure which provides a "guided bone growth" type mechanism. It is mostly indicated for juvenile scoliosis cases, but could be used in certain "high genetic risk predisposition" AIS cases if the curve is discovered at an early enough age and the patient fails to respond to the early stage scoliosis intervention program. 4. Improved spinal rehab techniques for patients with larger spinal curvatures. As effective any any screening program could be and as well as any early stage scoliosis intervention program is, there will always be some patients whom "fall through the cracks" and need an effective rehab based program that is specifically designed and targets the unique biomechanical needs of patients with large spinal curves. To date, it appears that only CLEAR and Schroth are making in roads into this area. 5. Increased patient education in the risk/benefit and long-term consequences to chosing surgical intervention for scoliosis. Scoliosis surgery is not medically necessary...even in very severe cases....and is almost entirely based on improving the cosmetic deformity of the condition. However, trading deformity for dysfunction comes with a very steep price......chronic pain, hardware failure, rapid degeneration around the non-fused areas, ect. In short, many scoliosis patients would be far better off doing nothing than choosing spinal fusion surgery. They should be more aware and better educated on the fact that they indeed do have a "choice". This is certainly not an exhaustive list, nor is it beyond debate, so please feel free to dispute, comment, or add to this discussion as you see fit. |
