Originally posted by LindaRacine
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I think the issue is that bone simply being out of alignment does not necessarily cause pain. The proof is the people with curves large and small with no pain. It is only when the misalignment causes disc problems or stenosis or something ELSE that triggers pain. Because these same disc problems and stenosis occur in perfectly straight spines, you can't even say the scoliosis definitely caused those issues. So then it comes down to a game of numbers and percentages in prevalences and incidences of these issues in people with and without scoliosis to decide if the curve contributes over and above to painful conditions that the general public experiences with straight spines. See next question.
Somewhere between 80-85% of adults have back pain at least occasionally. The percentage is about the same in adults with scoliosis, regardless of curve magnitude. I actually think people with scoliosis are generally much more stoic about their pain than the general public. Radiographically, adults with scoliosis typically have at least 4 or 5 issues that would be valid reasons to justify surgery. We see patients without scoliosis every day, with a single level that's barely abnormal, who claim that they have 10 out of 10 pain.
Anyway, unless the percentage of people with scoliosis and back pain is measurably greater than ~85%, we cannot know the curve alone is what has caused the disc pain or stenosis given the high amount of these things in the general population.
Now if someone told me ~100% of people with scoliosis will get back pain eventually if they are not fused straighter, I would believe it and agree it was a higher percentage than the general population. If that is the case then we can say the curve over time will trigger disc pain or stenosis OVER AND ABOVE that seen in the general population. Actually, Dr. Hey seems to be saying something like this in arguing for correcting curves... avoiding future damage from simply having a curve over the years. This, by the way, is rarely mentioned to parents and children where the ENTIRE focus is on being below a surgical angular threshold at skeletal maturity. Well if some/most/all of these kids who never make it to frank surgical range (>50*) at the point of skeletal maturity still have pain triggered by the misalignment over time then a miss is as good as a mile and they may not be avoiding surgery after all despite "successful" bracing.
So I think both Burdle and Linda are simultaneously correct within the limits of sematics and the written word.
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