Dr Stitzel

The growing disconnect in scoliosis treatment

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by , 06-21-2013 at 12:50 PM (4691 Views)
Quote Originally Posted by DrStitzel View Post
I recently attended the SOSORT (Society of Scoliosis Orthopedic Rehabilitation Treatment) in Chicago and I still left there shaking my head (much as I did when I attended the Montreal conference in 2010. Virtually every single viable and accepted theory on the pathogenesis of idiopathic adolescent scoliosis centers around a neuro-hormonal cause, yet virtually none of the scoliosis treatment methodology is being adapted or created to reflect this growing and obvious trend. This disconnect seems to be ever growing as our knowledge of idiopathic scoliosis pathogenesis grows and the current majority of treatment methods remain, painfully, far behind.

Spinal bracing is still largely focused on the “guided growth” concept…..a secondary consequence of abnormal loading of bone as the result of having a spinal curvature, not a primary cause of developing a curvature and the spinal exercise programs are merely voluntary motion (which targets the pre-frontal cortex, not the automatic postural control centers in the hind brain) as if scoliosis is being caused by some sort of repetitive motion syndrome.

While it is agreed that no “smoking gun” has been identified as of yet in terms of the actual mechanism that causes idiopathic scoliosis, it is long past due that we stop acting like we don’t know anything about it either.
Here are a few of my recommendations that could and should be implemented into the current scoliosis treatment system that would more accurately reflect the almost certain role in the neuro-hormonal pathogenesis of the adolescent idiopathic scoliosis condition….In no particular order of importance.

1.Wide spread prognostic testing (genetic, blood testing ….once it is commercially available)
- Early identification of the most “at risk” patients will allow for earlier intervention, risk stratification for research purposes, and a better understanding of the “environmental factors” that cause curve progression.

2.Neurotransmitter testing and supplementation
- Dr. Mark Morningstar has pioneered some potentially breakthrough work on identifying patterns of neurotransmitter imbalances in scoliosis patients that can be very easily, safely, and cheaply treated with supplementation. This is especially important in the role of serotonin which has profound impact on the postural control and Melatonin pathways.

3. Early Stage Scoliosis Intervention™ strategies that focus on Automatic Postural Response Training™.
- This is a specific system of scoliosis exercises the are designed to target the automatic postural control centers in the hind brain by stimulating the brain to react to unbalanced center masses of the head, torso, and pelvis via direct head/pelvic weighting and long lever arm torso weighting (a long lever arm weighting system is preferred for the torso in an effort to reduce compression on the thoracic and lumbar spine). The result is a training effect in which the brain attempts to re-balance the center masses sub-consciously, which reduces the spinal curvature as a result of the center mass re-balancing process.

4. The development of a Scoliosis Activity Suit™.
- This is actually already well under development and very soon ready for wide scale use for scoliosis patients with relatively flexible curvatures and possibly even with adult scoliosis patients as a pain reduction/supportive tool, without the draw backs of conventional scoliosis braces.

5. Increased and improve scoliosis screening procedures
- The bend over test (aka Adam’s test…..aka: The “too late” test) is simply obsolete. Early stage scoliosis will appear as postural distortions far in advance of significant rib cage arching (which is the positive sign for the “too late” test). Proper postural analysis for scoliosis is cheap, easy, and can be taught to parents for home monitoring on a weekly basis if necessary. It’s a no brainer.

6. The development of a tri-dimensional scoliosis system of scoliosis measurement.
- The continued wide spread use and adherence to the current spinal lateral bending on x-ray (aka Cobb Angle……YUCK…..) is mind blowing. Absolutely EVERYONE agrees scoliosis is a 3 dimension distortion of the spine and the rotation is clearly the initiating tension force with drives curve progression, yet it is completely ignored in the evaluation and outcome assessment of an given treatment effort when Cobb angle is used as the sole outcome assessment. This is the most glaringly obvious growing disconnect in scoliosis treatment today….and perhaps the “growing disconnect” most easily implemented due to the public’s growing dissatisfaction with Cobb angle’s high measurement error and unreliability.


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