SCOLIOSIS

Scoliosis Affects the Entire Body

Scoliosis is generally viewed as a lateral curvature of the spine with an axial twist that causes a distortion of the ribs. Current research shows that ideopathic scoliosis is a multifaceted disease that compromises five of the body's systems: digestive, hormonal, muscular, osseous (bones), and neurological.

Scoliosis affects the entire skeletal system including the spine, ribs, and pelvis. It impacts upon the brain and central nervous system and affects the body's hormonal and digestive systems. It can deplete the body's nutritional resources and damage its major organs including the heart and lungs.

Some factors that can cause scoliosis include: cerebral palsy, birth defects, muscular dystrophy and Marfan syndrome. However, 80% of scoliosis is idiopathic (unknown in origin).

According to the International Scoliosis Society, one in nine females and a smaller percentage of males have some sign of scoliosis. Approximately 4% of the general population is affected. While the average patient is between 10-15 years of age, many adults suffer from this disease as well.

Conditions arising as a result of scoliosis include rib deformity, shortness of breath, digestive problems, chronic fatigue, acute or dull back pain, leg, hip, and knee pain, acute headaches, mood swings, and menstrual disturbances.

Scoliosis is a progressive condition that can continue to progress even after skeletal maturity. Millions of scoliosis sufferers are routinely misinformed about the accelerating nature of their spinal curvature progression

Where Scoliosis Surgery Fails

While surgery may be necessary in some cases, in many cases it is not. Paul Harrington, known for inventing the surgery that implants metal rods in scoliotic spines, stated in 1963, "metal does not cure the disease" of scoliosis, which is a condition involving much more than the spinal column.

Consider these facts:

· Complications of surgery include: hooks becoming dislodged, fracture of the rods, skin protrusion of the upper end of the rods, pseudarthrosis (spine did not fuse), and pain where there once was none (neurological problem).

· Younger patients are susceptible to crankshaft phenomenon (worsening of the rotation and rib deformity).

· Scoliosis affects the entire skeleton (i.e. rib deformities) and impacts on neurological and hormonal systems. Surgical rods do nothing to address the wide range of bodily structures and systems affected by the disease.

· Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and

6.5 after two years with continued loss of 1.0 degrees per year throughout life.

Aggressive Non-Surgical Therapy

The Non Surgical Scoliosis Treatment Program

The impact of scoliosis on the body is more than just spinal curvature. It also impacts muscles, connective tissue, and motor neurons. That is why the process we employ uses corrective bracing to help correct spine and rib cage deformities in conjunction with a total treatment protocol to help re-educate the mind-body system to hold the correction. In order to retrain the mind-body system we may incorporate the following treatment protocols:

Ocular Vestibular Therapy: Neurological connections between the eyes and the spine have long been neglected in non-surgical treatment of scoliosis. New understandings of the Balance system (vestibular) and eye movement (oculomotor) systems allow for new therapies and exercises to improve the central neurological controls of posture. Following a functional neurological evaluation, including the use of state-of-the-art diagnostic equipment (i.e., VENG), neurological retraining therapies and exercises are prescribed on an individual basis.

Electrical Muscle Stimulation: This form of muscle strengthening physiotherapy has been utilized for many years in treating athletes. In the case of scoliosis, this rehabilitation procedure is used to stimulate and strengthen the muscles that support the spine, as well as the torso musculature. In order to achieve lasting correction, the scoliosis patient must develop muscles strong enough to hold a corrected spine.

Flexion Distraction: The flexion distraction table is a special device that, applying chiropractic principles, assists the doctor in stretching the spine through a gentle, non-force procedure. The different spinal curves can be manually realigned by hand more easily with the assistance of this specialized table

Exercise Therapy: The Non-Surgical Scoliosis Treatment program utilizes a proven method of three dimensional respiratory breathing exercises . These exercises are designed to strengthen spinal and pelvic muscles, reshape rib deformity and increase the vital capacity of the lungs.

Nutritional Support: Some scoliosis patients are found to have specific patterns of nutritional and hormonal imbalances. These include depressed levels of essential trace minerals selenium, zinc, and iron as well as absorption problems. When a nutritional imbalance is suspected, the appropriate referral to a nutritionist is made.

Neurological Evaluation

Research has shown the importance of evaluating the neurological system in patients with scoliosis. Cerebello-vestibular dysfunction has been linked to abnormal spinal curvatures.Treatment plans that target these areas have been shown to improve balance, posture and spinal alignment.

Video Electronystagmography is the "gold standard" in the assessment of these systems as well as brain, brainstem and cerebellar control of eye movements. This non invasive diagnostic test can objectively diagnose between Cerebello-vestibular dysfunction and cortical imbalances which may be one of the underlying causes of abnormal curvatures of the spine.

A study of labyrinthine function in patients with adolescent idiopathic scoliosis. I. An electro-nystagmographic study.

Spontaneous nystagmus (SN) and positional nystagmus (PN) were found in 24 out of the 47 patients with single curvatures and in only one subject in the control group (P less than 0.001).

Significant differences were observed in the caloric response between right and left scoliotic patients (P less than 0.05). The right convex patients had a sensitivity dominance in the right labyrinth and the left convex patients in the left labyrinth (Acta Orthop Scand 1979 Dec;50(6 Pt 2):759-69 Sahlstrand T, Petruson B.)

Vestibular mechanisms involved in idiopathic scoliosis:

It appears, however, that, in children, a slight unbalance in the activity of vestibular complex of both sides escapes the neuronal mechanisms responsible for vestibular compensation and leads to the spinal curvature which characterises Idiopathic Scoliosis.
(Arch Ital Biol 2002 Jan;140(1):67-80 Manzoni D, Miele F.Dipartimento di Fisiologia e Biochimica, Universita di Pisa, Via S. Zeno 31, I-56127 Pisa, Italy)

The results indicated that subjects with adolescent idiopathic scoliosis had a significantly decreased duration of postrotatory nystagmus as well as irregularities in nystagmus form. The recommendation was made that a neurological examination, including assessment of vestibular function, be incorporated into screening methods for scoliosis.
(Jensen GM, Wilson KB. Phys Ther 1979 Oct;59(10):1226-33)

Significant differences were found between patients with right convex curves and those with left convex curves in the distribution of eye predominance and in labyrinthine sensitivity
(Spine 1980 Nov-Dec;5(6):512-8 Sahlstrand T.)

Treating Adult Scoliosis*

Should Adults With Scoliosis Be Braced?

Yes. In many cases, bracing can help reduce scoliosis curvature in adults. A brief review on the reasons bracing is used for scoliosis treatment and an overview about how bone rebuilds itself will help explain why this is so.

Bracing
There are two primary purposes of bracing for treating scoliosis:

1. To stop the curve-forming pressures on the vertebra

2. To reverse and correct any existing vertebra deformity caused by the curvature pressures before bracing treatment began.

The physiologic conditions exist for both adult and child bracing to be effective.

Increased pressures dynamically applied by a brace to the open-wedge side of the vertebra will cause bone to remodel.
Bone Remodeling

Bone is always in the state of remodeling -- reforming itself. In fact, approximately 10% of a person’s total bone mass is always in a state of remodeling. There is no age restriction on bone remodeling. However, remodeling of bone occurs at a quicker rate among children and at a slower rate as one ages.

Bone remodeling has been known about for over a century. Julius Wolff published his seminal 1892 monograph on bone remodeling in which he observed that bone is reshaped in response to the forces acting on it. (ref. 1) Wolff noted that bone is rebuilt more if there are stresses on the bone, less if there are not. His observation of fact became known as Wolff's law.

The physiologic principle behind Wolff’s law is that soft tissue and bone respectively heal according to the manner in which they are stressed. Healing tissue responds to stress by reacting along the lines of the given stress. For optimum healing, tissue must be stressed gradually to accept a given force (ref. 2). This relationship between the mass and form of a bone to the forces applied to it was also appreciated by Galileo (ref. 3), who is credited with being the first to understand the balance of forces in beam bending and with applying this understanding to the mechanical analysis of bone.

For centuries, the scientific equipment did not exist to prove that bone remodeling applied to adults as well as children. As a result, the medical community inappropriately applied the physics of the law to children only, as it was believed that bone modeling stopped when a person reached skeletal maturation. However, since 1990, medical evidence has shown that Wolff’s law extends to adults as well. (ref. 4) So, while the medical community has for years accepted bracing for children, the evidence for bracing to be accepted for adults is now clear -- the physiologic principles are the same.

How Bone Remodeling Occurs

Bone remodeling is a dynamic, continuous process that occurs as a result of the two key components of bone tissue and its remodeling: osteoblasts and osteoclasts. Osteoclasts eat away old bone, while osteoblasts create new bone at the site of the old bone.

Osteoclasts are responsible for what is called bone resorption -- the dissolution of mineral crystals along with a breakdown of the bone’s matrix. This leaves tunnels within the bone when the bone tissue is destroyed. Osteoblasts deposit new bone tissue in these tunnels, thus forming what is called osteons. These osteons contain their own central blood vessel that supplies nutrients to the rebuilding bone. After the osteoblasts have deposited new bone tissue, they then are termed osteocytes, which continue to maintain the bone.

The interaction of osteoblasts and osteoclasts maintains an approximate steady state through the first half of adult life. In later adult life, bone resorption may predominate slightly, leading to a gradual diminution in bone mass and strength. In the elderly, while remodeling continues, it is slower and less bone may regrow -- thus osteoporosis.(ref. 5)

Bone remodeling is a very powerful force in the body. Medical studies from 1976 have proven that after complete removal of a particular-shaped bone and its replacement with a graft consisting of a completely different bone, the graft becomes remodeled to resemble the original bone (ref. 6). This is a powerful example of how dynamic the body is, especially when the conditions exist for the changes to occur. Other examples include bone loss in astronauts and in immobilized patients and more bone growth in stressed regions, such as when a nearby bone is lost, or during fracture repair.

Many relevant observations regarding the phenomenology of bone remodeling have been compiled and analyzed. (ref. 7,8) Here are the two most significant findings relevant to the efficacy of bracing as treatment for scoliosis:

1. Remodelling is triggered not by principal stress but by “flexure”

2. Repetitive dynamic loads placed on bone trigger remodelling; static loads do not.

So, it’s easy to see how dynamic bone remodeling applies the vertebra of the spine -- maintain equal pressures on both sides of the vertebra during motion and they will model into their normal shape. This holds true for children. This holds true for adults.

Bracing For Scoliosis

Bracing for treating scoliosis is the application of repetitive dynamic loads placed on bones to trigger remodeling where curvature has occurred. The process of bone remodeling may take longer the older a person is, and the extent of bone regrowth may lessen as one enters old age, but bracing can frequently help reduce scoliosis curvature in adults.

*Information provided by Ed Cleere, D.C.

-References

1. Wolff, J., Das Gesetz der Transformation der Knochen , Hirschwald, Berlin, 1892.

2. Steven R. Tippett, MS,PT,SCS,ATC, and Michael L. Voight, MED,PT,SCS,OCS,ATC., Functional Progressions for Sport Rehabilitation. Published by Human Kinetics, Champlain, IL. Copyright 1995.

3. Galilei, G., Discorsi E. Dimostrazioni Matematiche intorna a due nuove Scienze , pp. 158-172, 1638, Translated by H. Crew and A. deSalvio, Macmillan, NY, pp. 118-134, 1914.

4. Augustus A. White III, MD, and Manohar M. Panjabi, PhD, Clinical Biomechanics of the Spine, Second Edition, 1990, J.B. Lippincott

5. Earl R. Bogoch, MD; Erica Moran, BSc., Can J Surg 1998;41:264-71 From the Orthopaedic Research Laboratory, St. Michael's Hospital -- Wellesley Central Site, University of Toronto, Toronto, Ont. Accepted for publication Dec. 16, 1997

6. Nathan, P.A. and Fowler, A., J. Bone Jnt. Surg ., 58A,719-722, 1976, Remodeling of a metacarpal bone graft in a child..

7. Frost, H. M., Bone remodeling and its relation to metabolic bone diseases, C. Thomas, Springfield, IL, 1973.

8. Frost, H. M., Bone modeling and skeletal modeling errors, C. Thomas, Springfield, IL, 1973.

SpineCor Treatment Overview

SpineCor® is a new breakthrough treatment for idiopathic scoliosis utilising a dynamic corrective brace (DCB), clinical assistant diagnostic software (SAS) and postural measurement equipment (Freepoint). In worldwide clinical use, this new treatment has been shown to be effective in 89% of cases (either by stabilisation or improvement in (Cobb) angle of the curve).

The SpineCor® treatment approach is completely different to that of traditional 3-point pressure rigid braces; it is the first and only true dynamic bracing system for idiopathic scoliosis. SpineCor®’s unique approach to treatment by global postural re-education has been shown to give progressive correction over time which, unlike any previous brace treatment, is extremely stable post brace weaning.

Clinical experience to date also shows better compliance and cosmetic results.

SpineCor®:

Allows patients four hours per day out of brace

Allows total freedom of movement

Offers better cosmesis under clothing, and

Is cooler to wear.

With all of these benefits, it is not difficult to see why compliance might be better than with bulky, rigid braces that severely restrict movement and must be worn 23 hours per day.

Although to date no specific study has been undertaken to quantify cosmetic improvement, subjectively, some striking improvements have been observed clinically. Additionally, some very positive postural changes have been noted in cases where there has been no change in Cobb angle.

Summary

SpineCor® offers:

· A much more acceptable treatment to patients, being cooler to wear, less restrictive, more easily concealed under clothing and 4 hours of out of brace time per day.

· No side effects. Rigid braces cause muscle atrophy and can be harmful to normal development in a growing child.

· Excellent treatment results, particularly when treatment is started early.

· Excellent stability of treatment results post bracing.

· Neuromuscular integration for maintenance of improved posture.

· Potential to reduce incidence of surgical intervention.

Conclusion

SpineCor® is a highly effective for the early treatment of idiopathic scoliosis as demonstrated in the case study and also offers significant benefits to patients who present late. The real challenge is, therefore, to increase awareness of the absolute importance of early diagnosis and, that a viable treatment for early intervention is now available.