Page 1 of 2 12 LastLast
Results 1 to 15 of 16

Thread: Dr. Orr of Cleveland Clinic Session on Adult Scoliosis

  1. #1
    Join Date
    Mar 2009
    Posts
    1,090

    Dr. Orr of Cleveland Clinic Session on Adult Scoliosis

    I am posting an interview (health chat) I stumbled upon a while back that I keep forgetting to post. It is really quite fascinating. The doctor is Dr. Douglas Orr of the Cleveland Clinic. Most interesting is that he mentions that smoking is a risk factor for progression of scoliosis in adults...twice!!

    His most important advice:

    connorb: Is there any way to prevent scoliosis from getting worse and avoiding surgery?

    Speaker_-_Dr__Douglas_Orr: Stay active, keep your weight down, donít smoke and prevent osteoporosis with appropriate diet, weight bearing exercise and sometimes medication.


    A few interesting highlights (click the link below for the whole chat):


    lauramc: Is it true that scoliosis cannot progress in adulthood?

    Speaker_-_Dr__Douglas_Orr: No, this is not true. As the spine ages, the degenerative process can cause the curve to worsen. Typically, lumbar curves are more likely to progress. In general the curves progress about 1 degree per year if they are going to progress.

    lauramc: You mentioned that a curve of 30 degree or greater may progress during adulthood - what's the likelihood of progression of a 40 degree curve? Is there anything that we can do to try to prevent it? Thanks.

    Speaker_-_Dr__Douglas_Orr: It depends on whether a 40 degree curve is in the thoracic (rib cage) spine or the lumbar spine.

    If it is thoracic, the risk of progression after skeletal maturity doesn't really go up significantly unless the curve is over 50 degrees.

    There is little that can be done to prevent progression other than not smoking and maintaining an ideal body weight.

    ladams9200: Hello Dr. Orr! I have had a previous spinal fusion surgery with 2 Harrington rods fused down to L4. I then had a small second surgery. Now, 13 years later, I am curving between the L4-S1 region and it is causing me a lot of pain to the point I'm developing insomnia also. The surgery suggested is not realistic for me this time in my life and was wondering if there was anything you would suggest helping this progressive curve and pain, other than living on pain meds of course. My insurance doesn't cover PT very well so that's not feasible right now either. Anything I could do at home? Why do you think this happens after having previous surgeries? I thought I would be completely fixed but that's not the case.

    Speaker_-_Dr__Douglas_Orr: Fusions for scoliosis immobilize the vertebrae that are fused, but you continue to move through the other discs and these discs may wear out more rapidly as a result. A fusion to L4 with Harrington rods has approximately an 85% chance of leading to problems like you have. If surgery is not realistic for you at this time, there is little other than pain management that can be done.

    lauramc: Is there any correlation between osteoporosis and scoliosis? Should scoliosis patients take extra measures to prevent osteoporosis? If so, do you have any suggestions?

    Speaker_-_Dr__Douglas_Orr: If a patient with scoliosis develops osteoporosis their curve can get much worse and there may come a point where the bone quality is so bad, it becomes impossible to correct. It is vitally important that people with scoliosis be screened for osteoporosis and be treated aggressively if they have osteoporosis.

    Prevention
    connorb: Is there any way to prevent scoliosis from getting worse and avoiding surgery?

    Speaker_-_Dr__Douglas_Orr: Stay active, keep your weight down, donít smoke and prevent osteoporosis with appropriate diet, weight bearing exercise and sometimes medication.


    execute: What types of exercises are beneficial for people with scoliosis?

    Speaker_-_Dr__Douglas_Orr: Exercise is beneficial for any spine problems and there are 2 parts to it. One is a cardiovascular fitness program such as brisk walking, bicycling, swimming, and low impact aerobics. Second is a trunk strengthening exercise program that may be specifically designed for you by a therapist though Pilates and yoga are also quite good.

    michald: I wore a Milwaukee brace for 3 years in the 70's. My scoliosis did not get worse but it is still there. I seem to have a difficult time with exercise. My spine doesn't seem to work like everyone else's. Are there exercises designed particularly for people with scoliosis, or are there some exercises I should just avoid? I think it sometimes causes me not to do the exercise properly and I end up straining another part of my body.

    Speaker_-_Dr__Douglas_Orr: There are no exercises that will cause damage to your spine or worsen your scoliosis. Exercises to strengthen your trunk muscles (commonly called core strengthening) are the most beneficial. Scoliosis does limit the mobility of the spine through the curve and patients with scoliosis may feel stiffer. Stretching exercises may improve but will not eliminate this.

    2cats1dog: What are the risks involved in pregnancy with mild scoliosis?

    Speaker_-_Dr__Douglas_Orr: In the past, it was felt that women with scoliosis would progress their curves during pregnancy. We now know that this is not true. There may be a transient increase in the curve due to hormonal influences but this corrects about 6 months after you stop breast feeding.

    Another myth is that women with scoliosis have a higher incidence of caesarian sections.
    http://my.clevelandclinic.org/multim...ranscript.aspx

  2. #2
    Join Date
    Aug 2009
    Posts
    1,164
    That's really interesting - thanks for posting.

    So, basically, I should encourage my son not to start smoking

    I do wish he hadn't drifted over the 50 degree threshold. We were so sure he was going to be OK when he was 18 and less then 50 degrees, and then he kept drifting up.

    Here's an interesting study on smoking and scoliosis - http://www.ncbi.nlm.nih.gov/pubmed/10361658
    It's showing a link between smoking, scoliosis, and pain. I don't think it was looking at progression.

    That seems awfully important - I'm surprised I've never seen that posted before.
    Last edited by hdugger; 09-01-2010 at 01:25 AM.

  3. #3
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    That's an interesting interview. I wish it was a panel discussion among a few of those guys to se where there is agreement and disagreement on these points.

    From the POSNA talks that were posted, it is obvious there is wide disagreement on any number of topics. The only conclusion possible is that there is much more work to be done and relatively little is known, especially in the out years and how those conditions are affected by decisions made in the early years.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
    Join Date
    Mar 2009
    Posts
    1,090
    Yes hdugger, make sure he doesn't start smoking! All these studies are enough to make me get up and get exercising much more than I do, looks like we're all at risk for degenerative scoliosis!

    That's interesting about smoking and pain. I did a little more searching and came up with this article. Very interesting.

    The Spine and Cigarette Smoking

    Bone is a living tissue dependent on the functions and support provided by the other body systems. When these systems are not able to perform normally, bone is unable to rebuild itself. The formation of bone is particularly influenced by physical exercise and hormonal activity, both of which are adversely affected by cigarette smoking.

    Many smokers have less physical endurance than nonsmokers, mainly due to decreased lung function. Cigarette smoking reduces the amount of oxygen in the blood and increases the level of harmful substances, such as carbon monoxide. This, combined with the effects of smoking on the heart and blood vessels, can limit the benefits from physical activity.

    In men and women, cigarette smoking is known to influence hormone function. Smoking increases estrogen loss in women who are perimenopausal or postmenopausal. This can result in a loss of bone density and lead to osteoporosis. Osteoporosis causes bones to lose strength, becoming more fragile. This silent disease is responsible for many spine and hip fractures in the United States.
    http://www.spineuniverse.com/wellnes...spinal-fusions

  5. #5
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    6,793
    Very bizarre... as far as I know, there's never been anything published showing that cigarette smoking is linked to curve progression. I think it makes sense that it could be linked, but it's surprising to hear a medical professional saying something like that without any apparent backup. And, what kind of medication is he talking about that will keep curves from worsening? (Osteoporosis drugs perhaps?)
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Dilbert
    I'm sarcastic... what's your super power? --Unknown
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    If you've signed up and are having trouble posting, please check your spam folder. An email was sent to the email address which you subscribed. You have to follow the instructions in that email. Done that and still having trouble posting? Contact Joe O'Brien at jpobrien@scoliosis.org.

  6. #6
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    I just hope he sends Schroth/Weiss a telegram reading:

    THERE ARE NO EXERCISES THAT WILL CAUSE DAMAGE TO YOUR SPINE OR WORSEN YOUR SCOLIOSIS SO STOP TELLING PEOPLE TO AVOID ROTATIONS PLEASE FULL STOP
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  7. #7
    Join Date
    Mar 2009
    Posts
    1,090
    Quote Originally Posted by LindaRacine View Post
    Very bizarre... as far as I know, there's never been anything published showing that cigarette smoking is linked to curve progression. I think it makes sense that it could be linked, but it's surprising to hear a medical professional saying something like that without any apparent backup. And, what kind of medication is he talking about that will keep curves from worsening? (Osteoporosis drugs perhaps?)
    I think so. I assumed he was talking about osteoporosis drugs.

    I think scoliosis seems to have been so poorly researched that these orthopedists rely a lot on their own and their mentors' experience and probably the scientific conferences they go to.

    I think I remember reading someone who commented that since surgeons said they had "cured" scoliosis through surgery, very little research money had been given to this area of medicine. I don't remember who said it though.
    Last edited by Ballet Mom; 09-01-2010 at 06:59 PM.

  8. #8
    Join Date
    Aug 2009
    Posts
    1,164
    Quote Originally Posted by Ballet Mom View Post
    I think I remember reading someone who commented that since surgeons said they had "cured" scoliosis through surgery, very little research money had been given to this area of medicine. I don't remember who said it though.
    Can't remember the name, but it started with a "P" and the person studies something like bird bones.

    (But, they also claimed that boys had a worse scoliosis prognosis, with no evidence whatsoever to back it up, so I'm not sure I would trust much else they said.)

  9. #9
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    That's The Professor I think. She's a researcher as far as I know but I agree she misspoke on the prognosis in boys.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  10. #10
    Join Date
    Aug 2009
    Posts
    1,164
    I'm seeing a link to degenerative scoliosis and smoking:

    "There is currently no way to prevent idiopathic scoliosis. The risk of congential scoliosis can theoretically be minimized with proper prenatal care, as can the risk of neuromuscular scoliosis. The risk of degenerative scoliosis can be minimized by minimizing the risk of osteoporosis (increasing calcium intake, avoiding (or quitting) smoking, avoiding heavy alcohol use, exercising, taking estrogen, avoiding falls and injuries)."

    from http://www.orthop.washington.edu/uw/...s/Default.aspx

  11. #11
    Join Date
    Mar 2009
    Posts
    1,090
    Quote Originally Posted by hdugger View Post
    I'm seeing a link to degenerative scoliosis and smoking:

    "There is currently no way to prevent idiopathic scoliosis. The risk of congential scoliosis can theoretically be minimized with proper prenatal care, as can the risk of neuromuscular scoliosis. The risk of degenerative scoliosis can be minimized by minimizing the risk of osteoporosis (increasing calcium intake, avoiding (or quitting) smoking, avoiding heavy alcohol use, exercising, taking estrogen, avoiding falls and injuries)."

    from http://www.orthop.washington.edu/uw/...s/Default.aspx
    Yes, I think it all has to do with keeping bones strong and healthy as possible so they don't deteriorate with all the negative things associated with that. It would be pretty sad for surgery to not even be possible if your bones had deteriorated so much due to osteoporosis.

    I hardly remember someone named the professor, so thanks for all who chimed in. I would never have come up with that name.

  12. #12
    Join Date
    Aug 2009
    Posts
    1,164
    It's Prfbones. But, I thought she played a little loose with facts, so I came away not being very certain about the veracity of anything she'd said.

  13. #13
    Join Date
    Jan 2008
    Location
    NC
    Posts
    8,901
    Quote Originally Posted by hdugger View Post
    It's Prfbones. But, I thought she played a little loose with facts, so I came away not being very certain about the veracity of anything she'd said.
    Oh yes that's correct. I think. The Professor is another player in this sandbox. I think. I misplaced my scorecard so I'm lost.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  14. #14
    Join Date
    Mar 2009
    Posts
    1,090
    Quote Originally Posted by hdugger View Post
    It's Prfbones. But, I thought she played a little loose with facts, so I came away not being very certain about the veracity of anything she'd said.
    Prfbones? Well, I definitely don't remember her. I certainly do remember the comment though! I'll take it with a large grain of salt from your warning. I must not have spent much time reading her as I cannot bring her name up from my memory banks at all!

  15. #15
    Join Date
    May 2010
    Location
    Burlington, Ontario
    Posts
    27
    Thank you for the post and the link to the full interview.
    Dr. Orr was actually the first specialist I saw for complete diagnosis, way back when he still practised in Hamilton, Ontario.
    Whether or not I smoked was among the first questions he asked me.
    Given the substance of my own thread from several months ago, I am pleased and reassured by his advice on exercise. He agrees with my own experience that there is nothing that is forbidden, nothing one cannot do. Except that if it hurts, don't do it. One may have to compensate for symetrical inequities, but that can be done. His advice of eating well, regular exercise, and incoproating weight-bearing activities is excellent, with or without scoliosis.
    I appreciate the post. Thank you

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •