Scoliosis happens in about 2% of ladies and less than 1/2% of men. It usually begins in the early adolescence or pre-teens and may steadily progress as rapid growth takes place (1). Over the years, the figure of scoliosis patients is raising very considerably worldwide. The curves of scoliosis have the possibility to worsen further in which it disturbs the patients' normal life and future. Therefore, the scoliosis sufferers should be exposed with the treatment options available that able to relieve the mild symptoms of scoliosis and reduce the progression of the spine curve.
What is adolescent idiopathic scoliosis?
It is a spinal deformity in which a lateral curvature of the backbone larger than 10 degrees linked with vertebral rotation and on an x-ray the spinal column seems more like the figure of a "C" or an "S". The term idiopathic means that the causes of scoliosis are still unknown and the exact causes are not found in more than 80% of the cases. But latest finding led by Carol Wise at Washington University School of Medicine in St. Louisin in 2007 believes that it is caused by a defect in the gene of CHD7(5). The symptoms related with scoliosis are uneven shoulders height where one shoulder appears higher than the other, asymmetry of the waistline that may cause leg length inconsistency, leaning to one side of the body, and a rib hump which is the most noticeable sign (1, 3, 21). The signs can be observed by the Adam's forward bend test while angle of the curve is measured by the Cobb method. The Cobb method determines the angle of the curve by measuring the angle between the two most slanted vertebrae on the x-ray film (7). The risk of curve progression correlates with the magnitude of the curve, patient's sex, time of menarche and growth potential.
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Adam's forward bend test and Cobb method (21)
In my point of view, the government hospitals should perform routine scoliosis screenings in middle and high schools which are conducted by the doctors or nurses. This simple evaluation can be carried out by an observer stands behind or in front of the student while the child bends forward toward their knees and toes. With early screening and detection, I believe that the majority of the children with scoliosis can be treated to avoid more curvature as they are referred to their specialist for further diagnosis.
Possible Treatments
Dynamic SpineCor Brace
The effectiveness of the SpineCor brace has been shown for milder and moderate curves of Cobb angle of 15o to 40o. It uses muscle activity to enhance cortical activation while promoting the body's natural reflexes to improve muscle staffing pattern and thus rehabilitate the postural support systems (8). Bracing has been shown to be a successful technique to prevent curves from getting worse especially for growing children and adolescents in whom the prediction of a rapid increase in the curve needs to be thwarted. This Dynamic SpineCor brace are highly recommended compare to rigid braces (Boston, Wilmington, Milwaukee, Charleston and TLSO brace) as it has more benefits such as hardly noticeable under clothing, more comfortable, flexible and does not restricts movement (24).
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Dynamic SpineCor Brace (8)
This brace must be worn 20 hours per day for a minimum of 18 months to produce a neuromuscular integration of the Corrective Movement through active biofeedback and normally is discontinued at skeletal maturity.
Comparison of raw data of different studies (25)
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The table shows the studies conducted to investigate the comparison of effectiveness between SpineCor brace and the rigid braces. I can see that the SpineCor brace illustrates approximately 90% rate of success hence this proves that it is a helpful treatment in preventing further progression. In addition, Scoliosis Research Centre also reported that from 1993 to 2006, 493 patients were treated using the SpineCor brace where 249 patients met the standard for inclusion, and 79 patients were still actively being healed. Generally, 170 patients have a perfect outcome (25). However, bracing is no longer useful for curvature greater that 40o.
Surgery
The targets of the surgery are to prevent curve progression and obtain curve alteration. This could be attained by introducing metal implants on the vertebrae and then linked to Harrington rods which regulate the spine curvature and grip it in the corrected position until the spine sections which have been operated on are merged together as one bone (6). Based on my research, I found that surgery is a reasonable option for patients with a significant scoliosis curve plus with increasing discomfort.
Surgical corrections through open anterior (left) and posterior (right) approach (4)
The above diagram shows the two types of surgery for scoliosis which is each kind of surgery only suitable for certain sorts of curves. Besides, latest experts have developed a method that
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assist patients in getting a maximum of correction with a least of disfigurement and morbidity through endoscopic discectomy surgery. Nevertheless, it is only appropriate to correct
Insertion of Harrington rod (26) (p.115)
moderate size curve which is the Cobb angle and fusion rate is less than open surgery (13).The strategy of the operation will rely on the location and magnitude of the curve along with whether backbone pain or nerve root compression are the presenting complaints. Normally, 60% to 80% curve corrections are accomplished through surgery but as the patients get older, the spine becomes less flexible and harder to acquire a large percentage correction (7).
Advantages and Danger of Surgery
From my perspective, I consider that surgery brings benefits in treating severe scoliosis for example the metal instrumentation is place deep under the spine muscle of the patients where in most cases cannot be felt and do not hurt. Thus, it gives an advantage of offering immediate
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and long-term curve corrections and therefore improves the patients' body posture back to normal (4,7). As a result, this will boost their self-confident to socialize with the public hence, increase their life quality and have a normal life just like other people.
However, just like other operations, the patients still facing the risk of failure in scoliosis surgery where the rods require to be removed and the usual reason is unsuccessful fusion or dissociation of the rods from the vertebrae thus I believe that this shows the outcome of surgical treatment are not always the best results. Each year, roughly 8,000 patients who underwent this treatment in their youth are officially described as enduringly disabled for the rest of their lives (12). Besides, the patient will also have to deal with long-term effects of the surgery which is normally obvious about 20 years after the surgery such as severe chronic fatigue, urinary track irritability and chronic pain in lower back (13). In addition, another future problem is the corrected spine may return to its scoliosis condition and get even worse.
Spine 2001 Mar 1; 26(5):516-25" 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." [So, if a 50 degrees Cobb angle is corrected by surgery to 25 degrees, it will return to its pre-operative condition of 50 degrees after roughly twenty years.]
http://www.scoliosiscorrectioncenter.com/Scoliosis-Surgery-or-Alternative-Treatment.htm
Other than that, scoliosis patients will tend to have more surgeries because the rods might be too long or short, bend or even break completely due to progressing of the scoliosis which needs Harrington re-instrumentation (12). Based on the long-term effects of various cases, many studies propose that the side effects of the surgery is even worst then the side effects of the scoliosis therefore I feel that the doctor should clearly explain to the patients and their family not only about the benefits of the surgery but also short and long-term complications of the operation plus the patients are given enough chance to decide a rational judgment (13).
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Living with scoliosis
Social and Economic Implications.
People with scoliosis may feel embarrass and depress with their abnormal body posture thus cause the patients to have low self- esteem when facing the public. In addition, wearing a body brace or even having metal rods implanted inside their spine might knock off their public image and because of this the patients especially youngsters and children may have a thought of as a freak by people around them. Thus, I believe patients will suffer serious psychological effects which contribute to the sense of social isolation brewed inside them. Besides, other consequences that the scoliosis victims will face in the community are limited job opportunities and low marriage rate and consequently, they become more distress.
Therefore, I would suggest that helps and support by people around the patients especially their friends, family and loved ones able to overcome this problem. These people can do so by encouraging and giving advises to the patients so that they are optimist about all those treatments will have potential to treat scoliosis.
Moreover, patients with scoliosis have to deal with a great financial burden due to the high cost of the treatments which affect the economy especially those from poor monetary background.
In United States, approximately 20,000 Harrington rods implantation surgeries are conducted and the average cost is $120,000 per operation.
http://www.scoliosiscorrectioncenter.com/theuntoldtruth.html
Besides, the Government has to invest a lot of money in funding the research and development done regarding scoliosis and thus this will also affect the country's economy.
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Alternatives.
Due to high risk of irreversible surgical treatment, a few patients tend to take it as the last resort because the operation has the tendency to jeopardize their life. Therefore, they opt several non-surgical options which is I personally consider these methods able to prevent and reverse unusual curves, lessen the pain plus boost vital capacity.
Schroth Method
Schroth Method (9)
It is a three-dimensional therapy developed by Katarina Schroth which is assists to redesign the ribcage and decrease the malformation related to scoliosis.
The Schroth method of scoliosis exercise therapy addresses all three planes -- sagittal, frontal, and transverse.
http://www.schrothmethod.com/about
This method is divided to four sections; conscious posture, rotational breathing, mobilization and home exercise (16). It gives huge stress on conscious alteration of posture throughout the day, not only during tiring exercise time. Besides that, an effective routine of these exercises should
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follow cautious diagnosis where muscle clusters in a patient's body is too feeble and which are overdeveloped and taut. Therefore, the therapist will plan a program to re-establish normal stability. It must be practiced 30 minutes daily hence I would suggest that the patient's fulfillment and discipline is the most important. Based on the evidence that I have found, studies conducted by the Katharina Schroth Clinic in 1989, 80% of 311 patients decreased or eradicated their pain through Schroth program (22). Thus, I would suggest that this method is an effective choice.
Chiropractic treatment
It is normally comprises of spinal treatment, electric stimulation, vigorous exercises, plus shoe lifts. The chiropractor utilizes an excellent combination of Chiropractic Alteration, Therapy, Exercise and Dietary Recommendation to reinstate and keep the patients good health (23). Chiropractic care is totally natural without requirement of drugs or surgery where it endorses the body's own capability to mend itself.
A retrospective case series, entitled "Scoliosis treatment, using a combination of manipulative and rehabilitative therapy", by Mark Morningstar, Dennis Woggon and Gary Lawrence was published in BMC Musculoskeletal Disorders, on September14, 2004. 19 patients were monitored with scoliosis ranging from 15 to 25 degrees Cobb angles. After 4 to six weeks, there was an average reduction of 62% or 17 degrees. 8 of the 19 patients were no longer classified as scoliotic.
http://www.theamericanchiropractor.com/articledetail.asp?articleid=316&category=3
Based on the quote above, I consider that this technique able to halt the progression of the curve and lessen the deformity.
In my personal view, I think that treatment is not consistently successful in all circumstances. Success is depending on factors such as early detection and awareness, diagnostic treatment
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ability, angle of curvature, age of the scoliosis sufferer as well as their compliance to workout. Besides, further studies and development are necessary in the upcoming so that scoliosis can be healed.
Evaluation of references.
I have found the data about the effectiveness of scoliosis surgery from the reference http://www.srs.org/patients/ . It is very helpful in providing useful information related to scoliosis, treatment options and also the overview about Scoliosis Research Society (SRC). Moreover, the SRS has obtained acknowledgment as one of the world's premier spine associations plus the present membership consist of more than 1000 of the world's backbone specialist, researchers, physician helpers who are involved in studies and treatment of spinal malformations. Thus, all the information made by the SRC in this website is trustable.
This website, http://www.scoliosiscorrectioncenter.com/theuntoldtruth.html is very functional in giving information about the risk and long-term effects of surgical treatment towards patients having scoliosis. It contains the testimonials of patients who having various problems and complications years after the surgery and other news and reports related to scoliosis. However, I found that a few content of this website seems out dated as it was published in 2006.
The other source that I found very useful is the Beating Back Pain by Dr. John Tanner. It gives the outline of a comprehensive guide in preventing, treating and overcoming back pain, counting orthodox, alternative and self-help techniques. I consider that the information from this book is reliable as the author is a practitioner in orthopaedics medicine and runs a sports injuries clinic. Nevertheless, this book was published in 1992 thus certain explanations and data in this book are already out dated.
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