1. It is agreed that very little is known about the cause and cure of the scoliosis patient.  Obviously, there is no cure for the disease, or no one would have it.  However, an effective system of treatment for the reduction and stabilization of scoliosis has emerged on the scene.  The fight against early stage scoliosis is being lead by doctors Clayton J. Stitzel and Brian T. Dovorany;  Who specialize in a system of neuro-muscular rehabilitation, spinal adjustments, and vibration therapies that essentially “reverse engineer” the condition. This treatment provides a viable alternative to the “wait & watch” observation, traditional scoliosis brace treatment and scoliosis surgery treatment choices.
3.               Due to the lateral bending and rotation of spinal movement patterns, scoliosis creates a twisting of the spine around its own axis.  Much like twisting a rubber band from the top and bottom, the middle of the rubber band is susceptible to buckling into a curved and rotated position which is the beginning appearance of the spinal curvature.   (include picture of buckled rubber band)

1.               The twisted and bent position of the spine creates a tremendous amount of torque which then further drives the existing spinal curvature into more twisting and bending and results in further buckling (increase in the spinal curvature).  This becomes a self feeding loop which is often referred to as the “coil down effect”.  Often at this point the spinal deformity starts becoming outwardly apparent in the form of a torso translation or a rib hump.

1.               A large scale, medically peer reviewed study clearly shows that curvatures under 30 degrees (measured with the Cobb angle method) in early spinal development (Risser’s sign of 0-1 indicting skeletal immaturity) will see their spinal curvature progress 68% of the time. (1)  Since the majority of spinal curvatures under 30 degrees are diagnosed in pre-adolescents, a progression of the spinal curvature can be expected over 2/3 of the time!

1.               The current medical standard for the treatment of scoliosis does not recommend any treatment for spinal curvatures until they progress to a lofty 25 degrees Cobb’s angle.  At that point, spinal bracing is recommended which has not been showed to effect the progression of the curvature until it reaches a measurement above 30 degrees Cobb’s angle. (2)  While there have been no research attempts to introduce the concept of highly invasive surgery into the early intervention of scoliosis, one study shows a worse outcome for patients whom had the surgery at a younger age than patients whom were older at the time of the surgery. (3)  Spine Cor has attempted to introduce bracing into the realm of early scoliosis intervention with little to no success. (4)  Despite early scoliosis intervention in terms of patient age and size of curvature, both bracing and surgery have shown poor results.It is apparent that a non-surgical, non-bracing early scoliosis intervention for the treatment of spinal curvatures and idiopathic adolescent scoliosis is long over-due. 

1.               The early stage scoliosis intervention program is built on the clinical observation that curvatures under 30 degrees when treated using their protocols respond even better than curves over 30 degrees. In most cases of curvatures under the 30 degree mark, full correction to under 10 degrees is not only obtainable, but fairly common.(insert pre post film). Spinal curvatures reduced to below 10 degrees are no longer considered a scoliosis by most authorities meaning it would be defined as a cure. The bio-mechanical reasoning for this response is most likely due to a lack of “crankshaft phenomenon” being present in curves at this smaller level. Radiographic review of smaller curves, under 30 degrees, demonstrate much less visible spinous process rotation at this level indicating less torque, and therefore more flexibility. The higher the degree of flexibility of the curve the greater amount of correction is possible.
2. There are several ways to identify smaller curvatures including visual posture analysis demonstrating a tipped shoulder, high hip, or even translation of the skull or pelvis, scoliometers can detect even relatively small curvatures.  The most reliable and definitive test would be to take a spinal x-ray. Other factors to consider when suspecting a possible curvature are forward head posture or sway back type postures. For more information regarding early detection of scoliosis curvatures please visit the “early stage scoliosis intervention” section of this website.

1. References:
2. 1.  Lonstein & Carlson, The prediction of curve progression in untreated scoliosis during growth, J Bone Surg Am 1984 Sep;66(7):1061-71

1. 2.  The etiology of Adolescent Idiopathic Scoliosis

  Am J Orthop 2002 Jul;31 (7) :387-95

 Ahn et al, New Hampshire Spine Institute

1.  3.  Brace treatment during pubertal growth spurt in girls with idiopathic scoliosis (IS): A prospective trial
   comparing two different concepts                                                                                                 
2.  Pediatr Rehabil 2005 Jul-Sep;8(3):199-206 (ISSN: 363-8491)
   Weiss HR; Weiss GM

1. 4.  Hawes M., University of Arizona, Tucson, AZ 85721, USA. Pediatr Rehabil. 2006   

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STUDY DESIGN: Retrospective review.

OBJECTIVES: To report the feasibility, safety, and utility of vertebral body stapling without fusion as an alternative treatment for adolescent idiopathic scoliosis.

SUMMARY OF BACKGROUND DATA: The success rate of brace treatment of adolescent idiopathic scoliosis ranges from 50% to 82%. However, poor self-image and brace compliance are issues for the patient. An alternative method of treatment such as a motion-preserving vertebral body stapling to provide curve stability would be desirable.

METHODS: We retrospectively reviewed 21 patients (27 curves) with adolescent idiopathic scoliosis treated with vertebral body stapling. Patients were immature as defined by Risser sign <or=2.

RESULTS: The concept of vertebral body stapling of the convex side of a patient with adolescent idiopathic scoliosis is feasible. The procedure was safe, with no major complications and three minor complications. One patient had an intraoperative segmental vein bleed resulting in an increased estimated blood loss of 1500 cc as compared to the average estimated blood loss of 247 cc for all patients. One patient had a chylothorax and one pancreatitis. No patient has had a staple dislodge or move during the follow-up period (mean 11 months, range 3-36 months), and no adverse effects specifically from the staples have been identified. Utility (defined as curve stability) was evaluated in 10 patients with stapling with greater than 1-year follow-up (mean 22.6 months) and preoperative curve <50 degrees. Progression of >or=6 degrees or beyond 50 degrees was considered a failure of treatment. Of these 10 patients, 6 (60%) remained stable or improved and 4 (40%) progressed. One of 10 (10%) in the stapling group had progressed beyond 50 degrees and went on to fusion. Six patients required stapling of a second curve, three as part of the primary surgery, and three as a second stage, because a second untreated curve progressed. The results need to be considered with caution, as the follow-up is still short.

CONCLUSIONS: The data demonstrate that vertebral body stapling for the treatment of scoliosis in the adolescent was feasible and safe in this group of 21 patients. In the short-term, stapling appears to have utility in stabilizing curves of progressive adolescent idiopathic scoliosis.

Originally published by:Spine (Phila Pa 1976). 2003 Oct 15;28(20):S255-65.

Betz RR, Kim J, D'Andrea LP, Mulcahey MJ, Balsara RK, Clements DH.

Shriners Hospitals for Children, Philadelphia, PA 19140, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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Thirty-nine consecutive patients have had vertebral body stapling of 52 curves (26 patients with one curve stapled and 13 with two). For the group with patients who were 8 years or older with less than 50 degrees preoperative curve and a minimum 1-year followup, coronal curve stability was 87% when defined by progression less than or equal to 10 degrees . Fusion was necessary in two patients. No curves less than 30 degrees at the time of stapling progressed greater than or equal to 10 degrees . Major complications occurred in one patient (2.6%, diaphragmatic hernia) and minor complications occurred in five patients (13%). Further followup of the patient cohort and further research into efficacy and indications are warranted.

Originally published by:

Clin Orthop Relat Res. 2005 May;(434):55-60.

Betz RR, D'Andrea LP, Mulcahey MJ, Chafetz RS.

Shriners Hospitals for Children, Philadelphia, PA, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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STUDY DESIGN: Absolute and relative growth modulation of apical spinal segments were measured during creation and correction of an experimental scoliosis in a goat model.

OBJECTIVE: To differentiate relative and absolute changes in growth on the concavity and convexity of an experimental scoliosis treated with anterior vertebral stapling.

SUMMARY OF BACKGROUND DATA: The creation and correction of vertebral wedge deformities have been previously described in a rat tail model using external fixation as well as in a goat model using anterior vertebral body stapling.

METHODS: Progressive, structural, scoliotic curves convex to the right in the thoracic spine were created in 14 Spanish Cross-X female goats using a posterior asymmetric tether. After 7-13 weeks, all tethers were removed, and goats were randomized into stapled (n = 8) and untreated (n = 6) groups. Stapled goats underwent anterior vertebral stapling with 4 shape memory alloy staples (Medtronic Sofamor Danek, Memphis, TN) along the convexity of the maximal curvature. All goats were observed for an additional 7-13 weeks. There were 12 additional goats matched for age, sex, and weight used as growth controls throughout the study. Serial radiographs were used to document progression or correction of the maximal scoliotic deformity, and changes in relative and absolute growth at the apical spinal segment T9-10 (2 adjacent vertebrae and the intervening disc).

RESULTS: All tethered goats had progressive, structural, scoliotic curves of significant magnitude during the tethering period (average 61.4 degrees, range 49 degrees to 73 degrees) (P = 0.001). There was 1 goat from each group eliminated from the study because its apical spinal segment did not match the T9-10 level used to establish normal growth in controls. During the treatment period, stapled goats had a correction of -6.9 degrees (P = 0.03), whereas untreated goats had little change (-1.4 degrees). Apical spinal segment wedging progressed in all tethered goats, from 11.1 degrees to 22.4 degrees, during the tethering period (P = 0.001). During the treatment period, wedging corrected -2.2 degrees (range 22.5 degrees to 20.3 degrees) in the stapled goats but progressed +3.5 degrees (range 22.3 degrees to 25.8 degrees) in the untreated goats (P < 0.05). Apical spinal segment growth in all tethered goats was decreased on the concavity by 78% and increased on the convexity by 33% when compared to growth controls (P < 0.001). During the treatment period, growth on the concavity of the apical spinal segment of the stapled goats was decreased by 10% but increased in the untreated goats by 37% when compared to growth controls. On the convexity, apical spinal segment growth at T9-10 was decreased in the stapled goats by 18% and increased in the untreated goats by 29% when compared to growth controls (P < 0.04). CONCLUSIONS: Data in this study show the ability to modulate relative and absolute growth, according to the Hueter-Volkmann law, at the apical spinal segment of a progressive experimental scoliosis. However, anterior vertebral stapling, although able to control progressive wedging and scoliosis at the apical spinal segment, was not able to reverse fully the Hueter-Volkmann effect.

Originally published by:Spine (Phila Pa 1976). 2006 Jul 15;31(16):1776-82.

Braun JT, Hines JL, Akyuz E, Vallera C, Ogilvie JW.

Department of Orthopaedics, University of Utah, School of Medicine, Salt Lake City, UT, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it

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The recent investigations of convex anterior vertebral body stapling have offered promising early results with use of improved implants and techniques. The use of a shape memory alloy staple tailored to the size of the vertebral body, the application of several staples per level, the instrumentation of the Cobb levels of all curves, and the employment of minimally invasive thoracoscopic approaches all offer substantial improvements over previous fusionless techniques. Patient selection may also play a role in the current success of these fusionless treatments, with perhaps the ideal candidates for this intervention possessing smaller and more flexible curves. Long-term results of the effects on the instrumented motion segments and adjacent spine are not yet available.

Originally published by:

Orthop Clin North Am. 2007 Oct;38(4):541-5, vii.

Guille JT, D'Andrea LP, Betz RR.

Division of Spinal Disorders, Brandywine Institute of Orthopaedics, 600 Creekside Drive, Suite 611, Pottstown, PA 19464, USA. This e-mail address is being protected from spambots. You need JavaScript enabled to view it