Scoliosis is a 3-dimension spinal deformity that can have devastating effects on one's life physically, emotionally, socially, and even psychologically. It effects up to 12% of the American female population, but often gets little attention from the general population and even a large portion of the medical community. As a result, research and early stage scoliosis screening programs frequently goes under funded or out of existence entirely.
No one knows when the current treatment protocols were unofficially adopted by the current standards of practice, but many believe it stems from a 4 page article written by William Kane in 1977; which was a study conducted largely on a cost base analysis for the Canadian government. Despite the increased advancements in medical breakthroughs, the scoliosis treatment paradigm hasn't been revisited in over 30 years.
The current system of scoliosis detection, evaluation, early intervention, treatment schedule, and treatment methods need to be completely over-hauled from the ground up. The current system is too patch-worked and broken to be fixed…..It needs to be replaced.
The primary screening tool used by most school nurses and general practioners is called Adam's position (the bending over and looking for rib cage asymmetry test) which isn't sensitive enough to detect scoliosis in its early stages, and is often referred to as "the too late test".
The Cobb's angle was developed in 1948 by Dr. Cobb and is a completely obsolete system of evaluation and charting curve progression. Attempting to describe a condition as complex as scoliosis purely by the means of lateral flexion on a single x-ray is the equivalent to attempting to describe all the features of your new luxury car by only its color. There is so much more to this condition than just a cobb angle, including respiratory volume, pain scales, body image, and quality of life in adulthood.
The Observation only recommendation for early stage scoliosis cases is not treatment, it is simply doing nothing. The advent of genetic testing for scoliosis allows the "at risk" patients to chose an aggressive, non-invasive early stage scoliosis intervention program to prevent the curve from progressing, rather than attempting to treat the spinal curvature after the fact. An adolescent child's best hope of beating scoliosis is reduction and stabilization of the curvature while it is still flexible and before it gets a biomechanical advantage.
Scoliosis bracing should be abolished. It has no clinical value and only serves to psychologically scar our children whom already have enough hurdles to overcome. Scoliosis is a 3 dimensional deformity of the spine and some of the latest CT "in brace" imaging indicates rigid bracing increases the rotation component, especially the rib cage rotation.
Radical, multi-level spinal fusion surgery for scoliosis has been proven and accepted to provide no clinical value to the patient in terms of organic health measures (pulmonary function, cardiac output, elimination of pain, ect). The research on this is clear, the vast majority of orthopedic doctors agree on the subject, and may patients assume it is "medically necessary" and don't even ask. The orthopedic doctor should make this very clear when discussing the procedure, but they don't have an obligation to do so. Every patient must be their own advocate (which goes for every healthcare procedure). Given the high rate of complications, long recovery, and poor long-term outcomes; I feel asking a desperate parent and/or patient to trade deformity for dysfunction should be accompanied with all of the long-term ramifications associated with the decision.
I'm not claiming a conspiracy theory in respect to the orthopedic community, in fact I know many well intentioned and dedicated health care professionals have made scoliosis treatment their life's work, but what real motivation would an orthopedic surgeon have to create a non-surgical solution? Every doctor is bias towards their treatment option, but asking the orthopedic community to re-work the entire problem is likely to receive a disingenuous effort due to financial conflicts of interest alone.
I hope scoliosis patients everywhere can come to the realization that the current system of treatment is broken and it needs to be fixed if we are truly going to offer a solution filled with hope to future scoliosis sufferers. We need a better way.
No one knows when the current treatment protocols were unofficially adopted by the current standards of practice, but many believe it stems from a 4 page article written by William Kane in 1977; which was a study conducted largely on a cost base analysis for the Canadian government. Despite the increased advancements in medical breakthroughs, the scoliosis treatment paradigm hasn't been revisited in over 30 years.
The current system of scoliosis detection, evaluation, early intervention, treatment schedule, and treatment methods need to be completely over-hauled from the ground up. The current system is too patch-worked and broken to be fixed…..It needs to be replaced.
The primary screening tool used by most school nurses and general practioners is called Adam's position (the bending over and looking for rib cage asymmetry test) which isn't sensitive enough to detect scoliosis in its early stages, and is often referred to as "the too late test".
The Cobb's angle was developed in 1948 by Dr. Cobb and is a completely obsolete system of evaluation and charting curve progression. Attempting to describe a condition as complex as scoliosis purely by the means of lateral flexion on a single x-ray is the equivalent to attempting to describe all the features of your new luxury car by only its color. There is so much more to this condition than just a cobb angle, including respiratory volume, pain scales, body image, and quality of life in adulthood.
The Observation only recommendation for early stage scoliosis cases is not treatment, it is simply doing nothing. The advent of genetic testing for scoliosis allows the "at risk" patients to chose an aggressive, non-invasive early stage scoliosis intervention program to prevent the curve from progressing, rather than attempting to treat the spinal curvature after the fact. An adolescent child's best hope of beating scoliosis is reduction and stabilization of the curvature while it is still flexible and before it gets a biomechanical advantage.
Scoliosis bracing should be abolished. It has no clinical value and only serves to psychologically scar our children whom already have enough hurdles to overcome. Scoliosis is a 3 dimensional deformity of the spine and some of the latest CT "in brace" imaging indicates rigid bracing increases the rotation component, especially the rib cage rotation.
Radical, multi-level spinal fusion surgery for scoliosis has been proven and accepted to provide no clinical value to the patient in terms of organic health measures (pulmonary function, cardiac output, elimination of pain, ect). The research on this is clear, the vast majority of orthopedic doctors agree on the subject, and may patients assume it is "medically necessary" and don't even ask. The orthopedic doctor should make this very clear when discussing the procedure, but they don't have an obligation to do so. Every patient must be their own advocate (which goes for every healthcare procedure). Given the high rate of complications, long recovery, and poor long-term outcomes; I feel asking a desperate parent and/or patient to trade deformity for dysfunction should be accompanied with all of the long-term ramifications associated with the decision.
I'm not claiming a conspiracy theory in respect to the orthopedic community, in fact I know many well intentioned and dedicated health care professionals have made scoliosis treatment their life's work, but what real motivation would an orthopedic surgeon have to create a non-surgical solution? Every doctor is bias towards their treatment option, but asking the orthopedic community to re-work the entire problem is likely to receive a disingenuous effort due to financial conflicts of interest alone.
I hope scoliosis patients everywhere can come to the realization that the current system of treatment is broken and it needs to be fixed if we are truly going to offer a solution filled with hope to future scoliosis sufferers. We need a better way.