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Thread: My interview with Dr. Douglas Kiester

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    My interview with Dr. Douglas Kiester

    Dr. Douglas Kiester is a professor, spine surgeon and inventor. He holds that patent on several medical devices including the internal scoliosis brace which is currently in development. Dr. Kiester graciously agreed to a short interview that we conducted via E-mail.

    Question) There are many specialties in the field of medicine. What attracted you to Orthopedic Surgery?

    Dr. Kiester) Orthopedics involves doing things. It also treats the entire body. I didn't want to be stuck doing the same old thing to the same old body part day after day after day. I'm also an old farm boy. Physical work and dealing with machinery is fun.

    Question) How long have you been in practice? Do you know how many surgeries you’ve performed or attended?

    Dr. Kiester) I graduated my spine surgery fellowship in 1988. When I looked at a list of surgeries for re-certification recently, I had done 67 surgeries in 3 months.

    Question) You developed a new model to explain the mechanical cause of adolescent Scoliosis. What do you believe is the physical, destructive force that drives curves? Why do curves progress more rapidly during growth spurts? Why do some curves regress or even resolve?

    Dr. Kiester) Scoliosis is not just a lateral bending of the spine. It is a lateral bend linked with rotation. For rotation to occur there must be an axis of rotation in the midline. I proved this with growing rabbits and a dog while I was still in training. What happens is while the spine grows, the back of the spine is tethered by the ligaments, while the front (where the vertebral bodies are which support the weight) grows without restraints. Eventually there is too much length in the front, and very tight structures in the back. The spine then pops off to the side creating a spiral around the tight structures in the back (which stay almost straight). As such it is growth that powers the curve. If the posterior structures can be stretched-out by hormones of pregnancy, exercise, sleep, etc. or the anterior structure shorten by dehydration of the disk, aging, hormones, etc.; then the curve would be expected to improve. After a certain amount of curve, gravity prevents spontaneous correction.

    Follow-up) Your model is intriguing. If I understand it correctly ligament tension leads to rotation which combined with growth ultimately leads to one or more lateral curves. You mention that sleep and exercise may loosen up the ligaments that attach to the spine. Generally speaking how might that work? Since most growth takes place at night is there a thread of logic to having children with Scoliosis stretch out before they go to bed?

    Dr. Kiester) Traction has been tried repetitively for over 100 years without success. I've tried having a few of my patients doing flexion exercises (which might help), but was unimpressed with the results.

    Question) You filed 4 patents in 2008. How will these technologies help treat children with Scoliosis? How long until we see these in use? Do you see a day when adults with Scoliosis will have treatment options available to help straighten their spines?

    Dr. Kiester) None of these had anything to do with adolescent scoliosis. There is other technology from before that is being developed. This technology will straighten scoliosis without fusion. Adult scoliosis is a completely different animal. This occurs because the disk collapses in stead of straight forward as usual, it collapses off to the side. This causes the center of gravity to further rotate the vertebra away from the midline which results in the scoliosis. And yes, there are major efforts underway to better address this. Just in the last 10 years, the current treatments have improved a great deal.

    Follow-up) You own the patent on the internal, fusion-less brace which is a very exciting technology. Does your brace push the spine into the correct position immediately or does it do so slowly over many months or years? How much spinal movement is lost? Is it removed after skeletal maturity? How long until technologies like this become available for children with Scoliosis?

    Dr. Kiester) The device does the correction under supervised external control over time, and then is removed once it has accomplished it's purpose.

    Question) Although bracing isn’t an ideal or foolproof solution it’s the only treatment option available and it has helped many children avoid fusion. However are there certain types of cases where bracing may actually make curves worse?

    Dr. Kiester) It is my belief that bracing does make adolescent scoliosis worse. It is very helpful for neuromuscular scoliosis, but it is rare that I would recommend bracing for adolescent scoliosis.

    Question) Adults with heart disease are encouraged to watch their weight. Some people on Diabetes eat a special diet. Although there is no scientifically proven daily regimen for childhood Scoliosis do you suspect there are things that might help? Are you aware of things that children with Scoliosis might possibly avoid?

    Dr. Kiester) Melatonin levels have been shown to be low at night in some Japanese studies. I suspect that the melatonin may avert the temperature spike just before the children fall to sleep. I recommend Melatonin at night for adolescent scoliosis, but have no solid science behind that recommendation. I don't know of any particular foods to avoid.

    Follow-up) Even small amounts of light from nightlights, LCDs, and streetlights can reduce the body’s natural production of Melatonin. Here is an easy to read article on the subject. Would you suggest that children with Scoliosis eliminate these variables?

    Dr. Kiester) Great question. I have no idea.

    Question) As early as this year an FDA approved Scoliosis blood test will become available. The first part of the test is taken only once and it detects if the nervous system processes Melatonin properly. If the nervous system isn’t functioning properly it is believed that the child has Scoliosis. The second part of the test is taken several times a year. It is designed to detect a rise in Calmodulin levels. If the levels of this protein rise the risk of curve progression goes up significantly. Calmodulin does many different things. Do scientists understand why increasing levels of Calmodulin correlate with curve progression?

    Dr. Kiester) At this point we don't know what is happening chemically. There is a lot going on with these blood tests. We're all watching.

    Question) Why does the lumbar spine rotate differently when compared to the rest of the spine? Does this tell us anything about Scoliosis? Why would this interfere with the current crop of artificial lumbar disc replacements?

    Dr. Kiester) The Lumbar spine has two axes of rotation where the thoracic and cervical spines have one. How the body causes the lumbar spine to rotate is also a very different mechanism. The posterior axis in the Lumbar is neutralized by the posterior ligament being tight, resulting in very little difference between thoracic and lumbar scoliosis.

    Question) Not long ago fusion surgery tended to leave behind a considerable amount of deformity. Today most fusion surgeries give the patient a significantly straighter spine. What improved outcomes so dramatically?

    Dr. Kiester) The advent of pedicle screws.

    Question) In 2007 Danish researchers released a large twin study on Scoliosis. They found 13% pairwise concordance among identical twins and 0% concordance among fraternal twins. Their study suggested that heredity plays a part in Scoliosis but there is also a considerable amount of environmental input involved. Scoliosis has afflicted children around the world for thousands of years and evidence from Jamaica indicates that it’s prevalence can rise and fall over time. Do you have any thoughts on what this ancient environmental component might be?

    Dr. Kiester) High heels, too good posture, lack of sports, and who knows what else contribute to scoliosis.

    Follow-up) Would you recommend stretching exercises, balance boards, sports or other physical activities for children with Scoliosis?

    Dr. Kiester) The more active the better. The natural incidence of scoliosis is falling. I believe it is a function of increased girl participation in sports, and increased obesity (which reduces scoliosis to a degree in some cases by moving the center of gravity forward away from the spine).
    Last edited by Dingo; 06-08-2009 at 05:20 PM.

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    Thanks Dingo!!!

    Very interesting...thanks for posting.

    The Dr. gave me HOPE, that the future may be brighter ,for kids with scoliosis.

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    Thanks for posting that Dingo. Very interesting. I really wonder how he would explain my daughter's success with bracing. I wonder what's been damaged by her wearing her brace. And I am very interested in his comments about high heels and too good posture being a possible environmental contributor to scoliosis. Interesting because my daughter's pediatrician at every checkup always would comment about what great posture she had and I wonder if pointe shoes qualify as really high heels in terms of possibly affecting the scoliosis. It would be interesting to find out. Thanks for interviewing him for us!

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    Bracing

    Ballet Mom

    I really wonder how he would explain my daughter's success with bracing. I wonder what's been damaged by her wearing her brace.
    I scratched my head on his anti-bracing stance. Generally speaking I think studies suggest that bracing works. Kiester says they don't work. I don't agree with him but he's the genius so I dunno.

    The part I found most interesting was his explanation on the formation of curves. First the spine is rotated, then growth pushes up and creates the lateral curves that we see on an x-ray.

    That fits right in with the latest research that shows that all children with AIS have trunk muscle asymmetry.

    It's another clue that suggests that Mooney is right.
    Last edited by Dingo; 06-09-2009 at 11:22 AM.

  5. #5
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    Very interesting reading....thank you. I typically dont get into the tech. aspects of my disease, not that I dont care, I just think the more I know, the more I dont want to know! Ya know?! lol But this was really informative, and made sense. This forum ROCKS-thanks again!


    Lynn
    Lynn -30.... something
    DxD @ 8 yrs old: 10* curve-no brace-no nothin'!
    At age 26: Thorasic 48*/Lumbar 50*
    At age 34: Thorasic 58*/Lumbar 60*
    Posterior T5-L4 Fusion Jan 14th, 2009 w/Dr Tribus
    UW Madison, WI Hospital
    **AFTER: less than 10* Thorasic/15* Lumbar**

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    Thank you very much. Very interesting especially his theory on the developmental aspects. Like Ballet Mom I was curious about the "too good posture" comment and also the obesity reference in the last answer.

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    Quote Originally Posted by Ballet Mom View Post
    Thanks for posting that Dingo. Very interesting. I really wonder how he would explain my daughter's success with bracing. I wonder what's been damaged by her wearing her brace. And I am very interested in his comments about high heels and too good posture being a possible environmental contributor to scoliosis. Interesting because my daughter's pediatrician at every checkup always would comment about what great posture she had and I wonder if pointe shoes qualify as really high heels in terms of possibly affecting the scoliosis. It would be interesting to find out. Thanks for interviewing him for us!
    Not to undermine this doctor's authority, but he is not a member of the Scoliosis Research Society, which means he probably doesn't see nearly as many scoliosis patients as our own specialists do.

  8. #8
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    Great post Dingo! Thanks for taking the time to share the information with us. And much thanks to Dr. Kiester for allowing you to post the interview on this forum. We desperately need good people like Dr Kiester putting their minds into thinking about scoliosis and working toward an effective cure or improving existing treatments.

    The UK scoliosis forum had Dr Lori Dolan sharing her views and now we have Dr Kiester. I hope this sets a precedent. His views on bracing are certainly controversial:

    Dr. Kiester) It is my belief that bracing does make adolescent scoliosis worse. It is very helpful for neuromuscular scoliosis, but it is rare that I would recommend bracing for adolescent scoliosis.
    It would be fascinating to hear that viewpoint elaborated upon. I always thought that "It cant hurt" and may help.

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    Quote Originally Posted by LindaRacine View Post
    Not to undermine this doctor's authority, but he is not a member of the Scoliosis Research Society, which means he probably doesn't see nearly as many scoliosis patients as our own specialists do.
    Well I don’t know. I do know I’d select this doctor based on just what I’ve read here over two active members of the SRS with whom I consulted during my doctor search, especially the one who spent five minutes with me and looked squirmish and puzzled as he studied my x-rays and then just turned to me and said “Why don’t you go get other opinions.”

    Thanks for sharing this interview with us, Dingo.

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    thanks you guys

    Thanks you guys, I'm glad you enjoyed the interview. I wish I had more time to ask more questions but the guy is busy. Like he said in the interview he did 67 surgeries in the past 3 months. That's 5 surgeries per week. I'm lucky he talked to me at all.

    LindaRacine
    Not to undermine this doctor's authority, but he is not a member of the Scoliosis Research Society, which means he probably doesn't see nearly as many scoliosis patients as our own specialists do.
    If that's true it's probably because he's busy developing the devices and procedures that other Scoliosis specialists use.

  11. #11
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    Quote Originally Posted by Dingo View Post
    Thanks you guys, I'm glad you enjoyed the interview. I wish I had more time to ask more questions but the guy is busy. Like he said in the interview he did 67 surgeries in the past 3 months. That's 5 surgeries per week.
    Another clue that he doesn't do a lot of scoliosis surgeries, as I don't think I've ever heard of anyone doing more than one per day. Since most surgeons only operate 2-3 days a week, his surgeries are probably smaller procedures.

    --Linda

  12. #12
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    You didn't ask if AIS is autoimmune.

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    Dingo,

    I don't agree with him but he's the genius so I dunno.
    I agree. No doubt he's a genius, but I'm sure glad I didn't happen to stumble into his office when I first took my daughter in and ended up not getting her braced. Thank God for the little things in life!

  14. #14
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    Dr. Kiester said:

    It is my belief that bracing does make adolescent scoliosis worse.
    I can think of three pieces of evidence in the literature to support his assertion (evidence NOT proof).

    1. Lori Dolans Meteanalysis paper: She noted that if she excluded the Fernandez-Feliberti data
    “the observation surgical rate would be 13%, which is significantly lower than that following bracing.”
    She went on to say that
    An obviously erroneous conclusion would be that bracing causes an excess risk of surgery.
    Maybe it is not “obviously erroneous”.


    2. Lori Dolans Equipoise Paper where she noted that

    A total of 423 surveys were mailed and 92 responses were received. Of these, 10 were from clinicians who declined to participate, and 4 responses were deemed invalid because of bracing failure rates that were uniformly higher than observation failure rates.
    Again, maybe these were accurate responses reflecting surgeons true opinion based on their experience rather than (as she interpreted it) the response indicated they didn’t understand the survey questions.


    3. The Calibration Curve recently present at SOSORT by the Axial BioTech fellow. The braced curve, above the unbraced curve, (weakly) suggests a higher incidence of curve progression following bracing.

    I am guessing that Dr. Kiesters assertion is not based on any of these three pieces of evidence. I would really love to know though just what it IS based on.

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