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Thread: can curve proggression be predicted?

  1. #1
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    can curve proggression be predicted?

    This is a thought provoking post that is based on a scientific research paper.

    Predicting which cases are likely to progress until surgeons would recommend surgery (usually around 40 degrees) should be very helpful for everybody involved. This should be especially helpful for parents that are dealing with the watch and wait approach utilized by their health care provider.
    The wait and see, is unfortunately the standard approach in curves below 20 degrees as there is no method used today to predict which cases will progress and which will not.

    There may be a way to predict which cases will progress through their time in Boston braces and end up with surgery. I read a research paper written in 1992 called Idiopathic scoliosis: prognostic value of the profile and I posted some insights from it in my blog post will my child need Scoliosis surgery.

    The paper implies that there may be a way of looking at the sagittal profile of the thoracic spine that could help to predict which cases might end up in surgery due to progression of the curve.
    In the research by Castelein and Veraart, adolescent girls with idiopathic scoliosis that eventually required treatment in a Boston brace were reviewed. Their cases were studied from an early stage, before they had their first period (pre-menarche) and when their Cobb angle was still below 20į (degrees). The girls were followed all the way through to the time that they were either weaned (Group 1) of their Boston brace or ended up in surgery (Group 2) due to progression above 40 degree Cobb Angle.

    They found that girls in Group 2 had more backward tilting vertebrae in the upper thoracic area compared to the girls that did not progress until surgery was recommended.

    Is the sagittal profile ever mentioned during your discussion with the surgeon?
    A practitioner seeking answers to enhance the treatment of Idiopathic Scoliosis

    Blog: www.fixscoliosis.com/

  2. #2
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    very interesting. I would love to read the whole article. The figure you post on your website is pretty compelling.
    This paper is too old for me to have access to. I did a search on papers that referenced this paper and found one published a couple of months ago in Spine
    The Pathogenesis of Adolescent Idiopathic Scoliosis: Review of the Literature

  3. #3
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    $64,000 question

    Okay let's assume thoracic vertebrae tilting is a consistent predictor of progression to surgery territory.

    The next question is what controls the tilting and can it be stopped short of surgery?

    If braces "work" by forcing the spine to grow in a certain way (and incidentally weakening muscles through lack of use), how can PT possibly "work" if it is not stopping the growth on certain surfaces of the vertebrae but only building up certain muscles?

    Either bracing is going to be successful or PT is, not both it seems. And that's if one is going to be successful; There is nothing saying either has to be successful. It may just be the case that some surgical technique, fusion or non-fusion, is the only reliable solution.

    Finally, if AIS is controlled by genetics then I don't see how the muscles can possibly build up enough to overcome the abnormal growth pattern of the vertebrae controlled by genes. That is, if it is under genetic control then PT must fail and bracing can only work if it physically prevents the abnormal growth pattern. Big "if" there though.

    What am I missing?
    Last edited by Pooka1; 02-03-2009 at 06:37 AM.
    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
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    Hypokyphosis?

    Fix Scoliosis,

    I checked out your reference and it sounds like they are referring to hypokyphosis, no? Which yes, many people with scoliosis have but for which there is no apparent non-surgical treatment (definitely can't be braced).

    I have read one theory about hypokyphosis as a possible cause of scoliosis: the original problem starts out with the spine growing unevenly and the posterior part of the spine becomes shorter that the anterior. After a while the spine, as it tries to grow but is restricted by the shorter posterior column, so lateral curvature develops (scoliosis). In my mind this is a somewhat similar idea to crankshafting, where the posterior column is fused and thus stops growing, but the anterior side continues to grow, causing crankshaft to occur.

    Thoughts?
    Gayle, age 49
    Oct 2010 fusion T8-sacrum w/ pelvic fixation
    Feb 2012 lumbar revision for broken rods @ L2-3-4
    Sept 2015 major lumbar A/P revision for broken rods @ L5-S1


    mom of Leah, 15 y/o, Diagnosed '08 with 26* T JIS (age 6)
    5/10 VBS Dr Luhmann Shriners St Louis
    5/16 6 yrs post-op, 24*T/ 22* L, mild increase in curves, watching

    also mom of Torrey, 12 y/o son, 16* T, stable

  5. #5
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    Gayle
    You are correct; hypokyphosis canít be corrected with bracing.

    Question is what can?

    In the human spine the sagittal curves seems to behave in relation to each other with reciprocal influence. This is mentioned in few books, but there is no good research paper stating/supporting this.
    Research has shown that there is direct correlation between sacral slope and lumbar lordosis, moderate correlation between lumbar lordosis and thoracic kyphosis.

    What influence does cervical lordosis have on thoracic kyphosis?
    We donít know as nobody has studied this.
    (Improving thoracic kyphosis during scoliosis surgery did not improve cervical lordosis)

    Iíve been collecting material for the past six months to write a paper regarding the reciprocal influence between the sagittal curves in the human spine. I want to create a spark with scientists that has proper facilities to study this, to either validate it or reject it.
    To restore normal thoracic kyphosis one needs to restore normal sagittal balance in the spine and the cervical lordosis is a prime candidate.


    Quote Originally Posted by leahdragonfly View Post
    I have read one theory about hypokyphosis as a possible cause of scoliosis: the original problem starts out with the spine growing unevenly and the posterior part of the spine becomes shorter that the anterior. After a while the spine, as it tries to grow but is restricted by the shorter posterior column, so lateral curvature develops (scoliosis). In my mind this is a somewhat similar idea to crankshafting, where the posterior column is fused and thus stops growing, but the anterior side continues to grow, causing crankshaft to occur.
    Gayle, right again. Dickson RA studied this (paper published in the late 80ís, free access on PubMed)
    Then, why do vertebral bones grow out of sync with the posterior column? Some think it might be genetical. I think we must know what influences bone growth, pressure, compression or distraction alters growth rate and this is something that I will cover over the next 4-5 post in my blog.
    A practitioner seeking answers to enhance the treatment of Idiopathic Scoliosis

    Blog: www.fixscoliosis.com/

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