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  1. #1
    Professional DrStitzel's Avatar
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    Thumbs up The Low Down on Scoliscore

    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....
    -Caucasian decent (They tell me other ethnic profiles will be available soon)
    -Ages 9-13 (the will test up to 14 or 15 years of age if the patient hasn't reached skeletal maturity)
    -Cobb angle B/W 10-25 degrees

    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.


    Early stage scoliosis detection and intervention = The DEATH OF SPINAL BRACING.
    Given the fact the bracing is only intended to reduce the "need" for surgery (with studies show it has no effect on) and that the 3-D CAT scans are finding the rigid braces probably are actually worsening the rib cage rotation (increasing the body disfigurement)......It would seem the days of back bracing are severely numbered.

    Only 1% (the high risk group) should even consider spinal bracing......and even that is most likely a waste of time.

    <--- This is me being very happy for all of the future scoliosis patients!

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    It is very exciting and encouraging! The consultants at my centre have been following this research for a while now, and indeed it has been a subject for discussion during the various conferences which they travel to. It's great news for everyone who treats kids with scoliosis


  3. #3
    Senior Member mamamax's Avatar
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    Dr. Stitzel ~

    I do question the price tag (and the reliability of) this DNA analysis which is limited to (1) the Caucasian decent only (2) the skeletally immature; and which is based upon a relatively small collection of data.

    And another point - not all AIS is genetic, genetics is only one factor that determines the health (or lack thereof) for anyone. The other factors that effect health (explained to me by a medical doctor) are: environment, life style, and world view.

    Maybe this new testing will one day lead to identifying all the many causes of AIS (which total well over 70 in number at this point), and the best treatments for each. That would be good - and well worth the cost, IF that is what it eventually does. Guess we'll see. For now, my main concern is that the test - is a test, and not something we can rely on 100% - there exist reports of those who were advised that curvature would not progress (based on this test), only to find that it did.

    For now, I see this test as experimental and investigational only. And, I really believe that to use this new test as a primary diagnostic tool is a tad premature (to say the least).

    As for the current and past benefit of bracing - success and failure has been attributed to many things including patient compliance and the skill of the provider. As someone who has personally experienced the benefits of bracing, I would have to say that to consider its death in the near future, based upon this new DNA testing is - an untimely and premature consideration.



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    Professional DrStitzel's Avatar
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    Yes, the scoliscore test only covers a small cross section of the scoliosis community as this moment, but they assure me that other enthnic's profiles will be available soon, and more importantly it shifts the attention of the treatment community to a pro-active stance, rather than a re-active one.

    I have my suspicions about the 99% accuracy as well, but as of now that is what their research indicates.....I guess time will tell.

    I'm not sure how there could be too many reports of spinal curvatures progressed to surgical threshold (which is the only thing the test claims to predict) when the scoliscore said the risk was low, because the clinical trials were only completed this past September. Can you post some links to these reports on the forum?

    I'm glad you have had a positive experience with spinal bracing, but I still think forced correction has little to no long-term effect on the curvature.

    Scoliosis appears to be primarily a neurlogical driven condition......which will require a neurological style rehab, which won't occur as the result of brace treatment.

    J Neurosci. 2009 Oct 7;29(40):12477-83. Links

    Vestibular asymmetry as the cause of idiopathic scoliosis: a
    possible answer from Xenopus.

    Lambert FM, Malinvaud D, Glaunès J, Bergot C, Straka H,
    Vidal PP.

    Centre National de la Recherche Scientifique , Unité Mixte
    de Recherche 7060-Université Paris Descartes, 75006 Paris,
    France.

    Human idiopathic scoliosis is characterized by severe
    deformations of the spine and skeleton. The occurrence of
    vestibular-related deficits in these patients is well
    established but it is unclear whether a vestibular pathology is
    the common cause for the scoliotic syndrome and the gaze/posture
    deficits or if the latter behavioral deficits are a consequence
    of the scoliotic deformations. A possible vestibular origin was
    tested in the frog Xenopus laevis by unilateral removal of the
    labyrinthine endorgans at larval stages. After metamorphosis
    into young adult frogs, X-ray images and three-dimensional
    reconstructed micro-computer tomographic scans of the skeleton
    showed deformations similar to those of scoliotic patients. The
    skeletal distortions consisted of a curvature of the spine in
    the frontal and sagittal plane, a transverse rotation along the
    body axis and substantial deformations of all vertebrae. In
    terrestrial vertebrates, the initial postural syndrome after
    unilateral labyrinthectomy recovers over time and requires body
    weight-supporting limb proprioceptive information. In an aquatic
    environment, however, this information is absent. Hence, the
    lesion-induced asymmetric activity in descending spinal pathways
    and the resulting asymmetric muscular tonus persists. As a
    consequence the mostly cartilaginous skeleton of the frog
    tadpoles progressively deforms. Lack of limb proprioceptive
    signals in an aquatic environment is thus the element, which
    links the Xenopus model with human scoliosis because a
    comparable situation occurs during gestation in utero. A
    permanently imbalanced activity in descending locomotor/posture
    control pathways might be the common origin for the observed
    structural and behavioral deficits in humans as in the different
    animal models of scoliosis.

    Translation:

    Vestibular dysfunction PLUS lack of proprioceptive feedback has
    now been proven to create scoliosis.

    Also proven: the root cause of scoliosis can be reversed by
    restoring correct proprioceptive feedback from body to brain.


    I'm searching for the scoliosis treatment of the future!

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    Senior Member mamamax's Avatar
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    I worry about this new DNA test. Well, more precisely, I worry about relying on it too heavily at this point and see it more as a work in progress than trusted diagnostic tool. Of course my opinion is shaded by past tools which claimed to assure folks that their curves would not progress to surgical levels - only to find that they did. In a perfect world, this test would be part of a plan to form a very large data base eventually leading to many unanswered questions we have about scoliosis, and the test would be free. I certainly know how to dream don't I? I know, it takes money (lots of it) to do anything so big.

    Thank you for the extended well wishes regarding my bracing. Which is a form of neuromuscular rehab vs forced correction. We are dealing here with a brace of a different color - or so I see from reading the material available at the Manufacturer's web site.

    Don't you wonder what the answers will be in the end? Sometimes I ponder that the answers will involve a combination of the many things we have talked about and that a combination of genetics and environment will play a significant role in finding a cure.

    Thank you for that report out of France - and your interpretation. The hypothesis offered by the authors is intriguing in the world of frogs. I remember a similar chicken study. Making me question once again - what comes first, the chicken or the egg?



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    Professional DrStitzel's Avatar
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    Spine Cor is definately a horse of a different color and probably a stepping stone to a better way....eventually. I am relatively familar with the spine cor neuromuscular training system and it is definately light years ahead of the rigid brace concept, but I'm concerned about the complete lack of any attempt to control the patient's head position and cervical spine. Scoliosis is way more than just a cobb's angle.

    I hear your concern about the scoliscore test and it may be valid in someways. I'm not recommending scoliscore being the sole source of info.....x-ray eval and early detection programs are still the mainstay. I am primarily interested in the interest it will generage in the early stage treatment concept.


    I'm searching for the scoliosis treatment of the future!

    Toll-Free 1-866-627-3009 to schedule time/date for a free phone consult about your case.

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    Default Genetic testing

    Quote Originally Posted by mamamax View Post
    Dr. Stitzel ~

    I do question the price tag (and the reliability of) this DNA analysis which is limited to (1) the Caucasian decent only (2) the skeletally immature; and which is based upon a relatively small collection of data.

    And another point - not all AIS is genetic, genetics is only one factor that determines the health (or lack thereof) for anyone. The other factors that effect health (explained to me by a medical doctor) are: environment, life style, and world view.

    Maybe this new testing will one day lead to identifying all the many causes of AIS (which total well over 70 in number at this point), and the best treatments for each. That would be good - and well worth the cost, IF that is what it eventually does. Guess we'll see. For now, my main concern is that the test - is a test, and not something we can rely on 100% - there exist reports of those who were advised that curvature would not progress (based on this test), only to find that it did.

    For now, I see this test as experimental and investigational only. And, I really believe that to use this new test as a primary diagnostic tool is a tad premature (to say the least).

    As for the current and past benefit of bracing - success and failure has been attributed to many things including patient compliance and the skill of the provider. As someone who has personally experienced the benefits of bracing, I would have to say that to consider its death in the near future, based upon this new DNA testing is - an untimely and premature consideration.
    The cost of genetic testing for progressive idiopathic scoliosis is less than most other genetic testing (breast cancer, Marfan, etc) and answers the question of who will progress for immature patients with AIS, about 85% of all AIS. The cost savings for fewer doctor visits, fewer x-rays, long term risk of cancer from x-rays to the breasts, bone marrow and thyroid of children, unnecessary bracing and indirect cost to parents more than off-sets the cost of genetic testing.

    There is no evidence that "not all AIS is genetic." There are more than 75 conditions/syndromes associated with scoliosis, but they are not "idiopathic."

    The test has been validated in two clinical trials and is not experimental or investigational. What remains to be seen is how this scientifically valid information will be incorporated into clinical practice. It is bracing that is experimental and investigational because it has not been scientifically validated in more than 300 years of checkered use.


  8. #8
    Senior Member mamamax's Avatar
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    Greetings Attitude -

    $2,900 is a lot of money for a test that has not yet proven 100% effective and only (at this point) is designed to predict risk of progression among children between 9 and 13 years of age (with mild scoliosis) among the Caucasian race only. Over the last 50 years or so kids in that age group with mild curves have been told the risk of progression was low - only to find out later that it was higher than expected. I'm not convinced this test is necessarily going to tell us any more than we now know - especially in light of the fact that genetics does not tell the whole story regarding the health of any one individual person. Life style and environmental factors also effect health outcomes. Be all that as it may, we will know more in the future - after this test has been utilized for a number of years. I figure the 9 year old of today will know fifty years from now just how accurate the test is. My personal opinion is rather controversal. I think the test should be free until we know wheather or not it is 99.9% accurate. You tell me the test has been through 2 successful clinical trials. How long did they last? If the trials were only a few years in length, I can't see how that is indicative of definitive life long results. As for less exposure to radiation - we have the technology to do that now, it just is not being used widely.

    Please show me the literature that indicates that IS is always genetic in origin. I agree that it is only idiopathic because no one can point to a single cause in each and every case.

    Bracing - this works for enough people that I am truly glad that everyone is not of the same attitude you report. Hopefully the BrAIST study will reveal more answers to all that than we have now. Meanwhile I am with Hanti - Don't condemn bracing! There is a very informative German forum and an English section for those interested: http://www.skoliose-info-forum.de/viewforum.php?f=19

    Scoliosis truly is multi-factorial and we are finding that many methods may improve it - I'm of the opinion that any which show promise, should not be dismissed.


    Last edited by mamamax; 01-07-2010 at 12:14 AM.

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    Professional DrStitzel's Avatar
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    Quote Originally Posted by mamamax View Post


    Over the last 50 years or so kids in that age group with mild curves have been told the risk of progression was low - only to find out later that it was higher than expected. I'm not convinced this test is necessarily going to tell us any more than we now know - especially in light of the fact that genetics does not tell the whole story regarding the health of any one individual person. Life style and environmental factors also effect health outcomes. Be all that as it may, we will know more in the future - after this test has been utilized for a number of years. I figure the 9 year old of today will know fifty years from now just how accurate the test is.
    In all fairness to the scoliscore test.......they only claim the test can accurately predict the likelyhood of the spinal curvature reaching "surgical threshold" (which I believe they are defining as 40 degrees) before the patient reaches skeletal maturity.


    I'm searching for the scoliosis treatment of the future!

    Toll-Free 1-866-627-3009 to schedule time/date for a free phone consult about your case.

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    Administrator Dr Kalla's Avatar
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    Just wanted to add, that if anyone want to find additional and more recent conversations on this forum about this topic please click on this: Scoliscore

    Singapore chiropractor promoting awareness and sharing ideas to enhance scoliosis treatment.

    Blog: Singapore Chiropractor


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