November 11, 2010

Many 50º and greater adolescent cases are inquiring or coming for Schroth treatment lately. As any parent of a child with scoliosis knows, 50º is the dreaded threshold the surgical community identifies as the level where adolescent surgery is necessary because of an increased risk of progression.

Friday afternoon I found myself within earshot of a conversation between Marc and a concerned father of a girl in this range. When Marc’s working from home, we share an office, so I sometimes overhear his conversations. It is always a learning opportunity for me and it invariably provides a chance to pick his brain at conversation’s end. This makes my work on the site easier and often I get blogging inspiration. With each scoliosis story I get increasingly frustrated about the state of scoliosis treatment in America.

The worried father had just returned from the family’s consultation with the spinal surgeon. The visit had succeeded in scaring the family, or should I say scarring – and the doctor didn’t even pick up the scalpel! He warned that if the daughter, who is sixteen and nearly at bone maturity, did not have the recommended spinal fusion surgery, soon, her spine would become rigid and she’d lose mobility.

As I listened to Marc’s end of the conversation, and admittedly I’m biased, I am always impressed with how skillfully he relays his knowledge and clinical experience to comfort concerned parents. It amazes me how he can remain diplomatic and professional in the face of, what I consider to often be, total absurdity and scare tactics on the part of traditional medicine.

To the contrary, I want to jump up and down and scream because it does not have to be this way! First of all, when a child, any child, is diagnosed with scoliosis, probably a year, or two, or three years prior to most such visits to a surgeon -at a time when the Cobb angle is sometimes only in the teens – What can the harm be if physicians inform parents this may be the time to start being proactive about scoliosis? If you are not convinced with my simple logic, consider reading an article by Martha C. Hawes, Ph.D., published in Pediatric Rehabilitation, 2003: The use of exercises in the treatment of scoliosis: an evidence-based critical review of the literature. Martha is the author of Scoliosis and the Human Spine, also highly recommended reading available through the National Scoliosis Foundation.

Instead of having the outward reaction I am unable to contain, Marc provides a voice of reason and offers valuable information. His promise to send articles for the father to read inspired me to get up very early Saturday morning and spend the day re-focusing my efforts on the website. As a result, I will be adding articles pertaining to the conservative treatment of scoliosis so parents and patients who are interested have access.

Information is power. Those with scoliosis will need to harness this power and decline unnecessary surgeries if the state of scoliosis care in America is ever going to change. Questioning the wisdom of ‘watch and wait’ and starting earlier with a more preventive, conservative approach – what Schroth is – makes sense. It certainly can do no harm, and at the very least provides knowledge, body awareness and cognizance of daily activities which may feed into curve progression -and that’s just for starters.

When Marc hung up, I quizzed him on the details of the family’s session with the surgeon. I am always in awe of the dire predictions that tend to come from these visits. He proceeded to inform me of the details of the warning – that rigidity would set in and might possibly and significantly impede the girl’s mobility.

Mind you, these parents are highly intelligent people.The father is a CEO in NYC. It has always been my naive belief that physicians are supposed to have an ethical responsibility not to prey on the emotions of frightened families. But unfortunately, the more I am exposed to people’s scoliosis stories, I know this is not always the case.

This rigidity angle was a new one to me, and my immediate reaction was how IRONIC! What, I submit, is the result of rod implantation accompanied by ten or twelve (the average number of fusions in one scoliosis surgery study) spinal fusions – flexibility? And, what’s happened to common sense?

Not that anyone reading this needs it, but FYI, by definition a spinal fusion is, “a surgical technique in which one or more of the vertebrae of the spine are united together (“fused”) so that motion no longer occurs between them.“ This is from a pamphlet distributed by the North American Spine Society.

I decided to continue to google just for fun -yes, I need to get a life. Without much effort and within seconds I was reading a PubMed study entitled  “The Effect of Scoliosis Fusion on Spinal Motion.” An excerpt from the conclusion states, “Idiopathic scoliosis does not result in a loss of spinal flexibility in patients who have not undergone surgery in the second and third decade of life. However, both anterior and posterior spinal fusion result in significant less thoracic and lumbar flexibility…”

http://www.medscape.com/viewarticle/523414_5 -Spine. 2006;31(3):309-314. © 2006 Lippincott Williams & Wilkins.

Surely, if you are still reading you understand my point, so I’ll wrap up by saying:

  • Goals of Schroth are mobilization and stabilization of scoliosis.
  • Goals of surgery are immobilization and stabilization of the fused levels.

Finally, stop and consider what happens at the levels just above and below the fusion over time.  Ever heard of revision surgery?

What Scoliosis 3DC Patients Are Saying

Toned & Stronger Core

“Wow it is so encouraging for all of us…This is exactly what we see in her – much more toned and stronger core.” Read More

Such a Huge Improvement

“This is such a huge improvement over the past year. Her brace is still fitting very well. We are so very thankful to have had the opportunity to meet and work with you and the entire staff” Read More

Completely Changed My Life

“The fact that I could learn to do breathing exercises that would change my 38 degree curve in my back to a 32 degree curve in such a short time without surgery is astounding! Thank you Dr. Moramarco.” Read More