sagittal plane flattening in scoliosis
Sagittal Plane X-Ray

Here at Scoliosis 3DC (3DC stands for three-dimensional correction), successful conservative management of scoliosis includes exercises for the sagittal plane. From the onset, our program has integrated sagittal plane exercises on the basis that sagittal plane instability may be a cause of scoliosis. Our sagittal plane exercises are used so that patients can learn to modify postures to work toward halted curve progression, or optimally, to achieve some degree of scoliosis correction. To this end, some recent research out of Children’s Hospital of Philadelphia caught our attention. 

A study by Saba Pasha, entitled 3D Deformation Patterns of S Shaped Elastic Rods as a Pathogenesis Model for Spinal Deformity in Adolescent Idiopathic Scoliosis (1), now supports and expands upon previous publications in regard to the sagittal plane, scoliosis and perhaps one explanation regarding the cause of scoliosis.

In an attempt to determine a cause of scoliosis, the author used the sagittal plane x-rays of 126 adolescent females with right thoracic scoliosis (the most common type) and compared them to the sagittal plane x-rays of 3 non-scoliotics. “Computer simulations were then used to investigate how elastic rods, modeling children’s spines, change shape in response to mechanical loading.” Her study concludes that “the shape of a person’s sagittal profile can be a leading cause of scoliosis” (1).

The author explains, “The findings of this study reduced the question of why scoliosis happens to why variation in the sagittal spinal profile occurs in the pediatric population.” The study also states that “the current analysis can be used as a risk assessment tool to predict the risk of spinal deformity development in the pediatric population. This can open a new line of research that aims to prevent the spinal deformity development by determining the spinal loading patterns (the sagittal alignment and flexibility of the immature spine) at a higher risk of 3D deformation in pre-scoliotic pediatric population” (1).

She also asserts, “Conservative methods to protect the spine during this phase can be explored,” and contends that continued research is needed to develop “strategies to prevent a condition for which no preventive measures now exist” (1). 

As previously mentioned, we help patients integrate proactive strategies that can help to positively influence the sagittal plane. The overall goal is to create spinal stability where instability exists in a scoliotic or pre-scoliotic spine (under 10º). The purpose of our approach is to help growing children avoid spinal curve progression or ideally, to improve children’s spines as they grow and develop. 

One way this is accomplished is via our Schroth Best Practice Program. Physiologic ® exercises focus specifically on the sagittal plane. These exercises were studied by Weiss and Klein, 2006. Their findings provided the evidence for one of the upgrades to the Schroth method that resulted in the name change to Schroth Best Practice over a decade ago. Weiss and Klein concluded that Physiologic ® sagittal plane exercises are, “a useful ‘add-on’ to scoliosis rehabilitation with regard to the lateral deviation of the scoliotic trunk in the short-term.” They also state there is evidence that “correction forces applied in the sagittal plane are also able to correct the scoliotic deformity in the coronal plane” (2). In addition, Schroth Best Practice protocols teach active self-correction techniques (3). When applied, these techniques enable the patient to modify their regular postural stances to reduce asymmetric spinal loading – a major contributor to curve progression (4).

Pasha goes on to suggest that for those at risk that perhaps “wearing a brace at a younger age may prevent scoliosis from developing” (1). This again is what we do when parents indicate they prefer proactive treatment for scoliosis, rather than abiding by the watch and wait philosophy. This is especially true when young patients have a high risk of progression. Clinically, the Cheneau Gensingen brace® has proven to be an ideal vehicle in this regard, for curves of varying degrees. This is because Gensingen braces are created for spinal correction in all three planes of scoliosis – a central premise of Cheneau bracing from early on. 

In 2008, van Loon et al. provided evidence of influencing the sagittal plane in regard to bracing. He concluded that “scoliosis deformities are significantly reduced in supine position by a lordotic fulcrum force on the thoracolumbar junction and that these findings may have an impact on bracing techniques” (5). In a follow-up study, it was concluded that “significant reduction of scoliosis and kyphotic curves is possible during growth. By stepwise restoration of thoracolumbar lordosis and preventing overload in compression during sitting creates improved condition” (6).

The 3D protocols we use for scoliosis management are for patients of all curve severities including pre-scoliosis (curves under 10º), mild, moderate and severe. Sagittal plane flattening is something we often see and view as a possible cause of scoliosis as well as a potential indicator of possible progression (regardless of curve severity). Dr. Marc discusses this in his What is Scoliosis? YouTube video. When the right treatments are implemented, sooner rather than later, they have the potential to be more impactful. It’s the reason our tagline is Scoliosis3DC, not wait and see!

1) Pasha, S. 3D Deformation Patterns of S Shaped Elastic Rods as a Pathogenesis Model for Spinal Deformity in Adolescent Idiopathic Scoliosis. Sci Rep 9, 16485 (2019). 

2) Weiss HR, Klein R. Improving excellence in scoliosis rehabilitation: a controlled study of matched pairs. Pediatr Rehabil 9:  3.  190-200 Jul/Sep 2006.

3) Monticone M, Ambrosini E, Cazzaniga D, Rocca B, Ferrante S. Active self-correction and task-oriented exercises reduce spinal deformity and improve quality of life in subjects with mild adolescent idiopathic scoliosis. Results of a randomised controlled trial. Eur Spine J 2014 Feb 28.

4) Stokes IA, Burwell RG, Dangerfield PH; IBSE. Biomechanical spinal growth modulation and progressive adolescent scoliosis–a test of the ‘vicious cycle’ pathogenetic hypothesis: summary of an electronic focus group debate of the IBSE. Scoliosis. 2006;1:16. Published 2006 Oct 18.

5) van Loon P.J., Kühbauch B.A., Thunnissen F.B. Forced lordosis on the thoracolumbar junction can correct coronal plane deformity in adolescents with double major curve pattern idiopathic scoliosis. Spine. 2008;33(7):797–801.

6) van Loon, P.J., Roukens, M. & Wever, D. Brace treatment with progressive lordotic forces at the thoracolumbar junction in adolescent scoliosis and hyperkyphosis. Scoliosis 4, O47 (2009).

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