The majority of adolescents diagnosed with scoliosis have been presented with two very unattractive treatment options for their spinal deformity: bracing and surgery. After reviewing dozens of research articles regarding the mechanics of this disease there seems to be a consensus among the experts regarding typical 3 dimensional patterns found within the scoliotic patient. One of the most consistent and often overlooked finding is the decrease in thoracic kyphosis. according to most literature this abnormal finding is found in nearly 90% of adolescents with a primary thoracic curvature. Now there is currently no known cause for spinal curvatures and all of the genetic research is inconclusive meaning so far there exists no specific gene that is passed down causing this disease., however there are genetic markers that are related to progression of the deformity but not necessarily cause.There are many theories as to the cause and most biomechanical theories start with the loss of normal kyphosis in the thoracic spine as a major consistent contributing factor in creating scoliosis.
When the spine loses or gains curves in the side view there are significant changes in the normal pressure on discs, spinal joint surfaces and even on the spinal cord itself as documented by Dr. Brieg. Since the spine will innately adjust its position to a lesser stress environment these side view changes almost always result in compensatory changes in other dimensions. If the majority of adolescents with scoliosis have major changes in the side view as a precursor to the compensatory shifting which eventually shows up on the full spine xray as a spinal curvature wouldn’t it make sense to investigate correcting any spinal changes to the side view early on before the spine reorganizes and compensates as it learns and grows?
It’s amazing to me that the only real tangible measurement for scoliosis is the lateral flexion component in the middle of the column when viewing the spine from front to back. A fairly rudimentary system for measuring this deviation known as Cobb’s angle is the only thing standing between a team of surgeons opening up a kids back and permanently fusing this lateral deviation. The entire medical model for scoliosis treatment is hanging its hat on a single component of a very complex disease. The logic behind this system is to stop progression of the curvature in fear that it will spiral out of control and crush the internal organs.
With recent information published by Dr’s Dolan and Weinstein regarding the ineffectiveness of rigid spinal bracing to have any real tangible ability to stop progression with about the same statistical success rate of letting it take its natural course, researchers have obviously approached the disease from a theory of simply pushing against the scoliosis curves in the middle. I believe this has the same effect as stopping a waterfall from the bottom up, ever tried it? Surgery in most cases does stop progression at the expense of tremendous functional loss. Gracovetsky’s book regarding the spinal engine discusses in exhausting detail the biomechanics of human movement. He explains how the spine creates torque through the counter swing of the pelvis and shoulders the torque is manifested in the spinal column and is used to create an extremely efficient system of locomotion. Surgically fusing the entire thoracic spine with titanium will cause this spinal engine to shut down and eventually cause enormous health problems in the future. Imagine fusing your entire foot and walking on it for the rest of your life, ever walk in a ski boot?
My discussion is really not designed to bash bracing and surgery, but rather to ask the question why isn’t there a better way? why don’t we look at the deformity from its onset and establish a sound theory as to why the body is maladapting to gravity? Well the good news is that the current research already points to very sound theories as to why scoliosis begins and gets worse.
There are two main contributing factors that cause scoliosis. Genetic predisposition and environmental factors. The future of scoliosis care will involve knowledge of these two factors shortly after detection of the scoliosis has been made. Then appropriately addressing the environmental factors like the loss of sagital spine curves through brain body based rehabilitation will substantially eliminate environmental influence of gravitational force on poor spine mechanics and postural disorganization. By proactively attacking poor biomechanics and posture in the early stages of the game the outcome (curve progression) will be altered potentially eliminating invasive reaction based treatment like rigid bracing and fusion surgery.
Article : Treating Scoliosis – Rethinking the Scoliosis Treatment Model