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.
Tags: idiopathic scoliosis, scoliosis, scoliosis blood test, scoliosis brace, scoliosis of spine, scoliosis spine, scoliosis surgery, scoliosis treatment