Autism researchers shifting away from genes - Scoliosis next?

[hdugger]

hmm, the quotes I find now are not exactly what I remembered, but here's what I see:

Effectiveness

The success rate of stable fusion and correction of spinal deformity is very high in experienced hands. The average curve correction is approximately 70 percent and the likelihood of complications has been about 2 to 3 percent overall. The fusion of the bones (enabling the bones to grow together) is permanent.

There are concerns about long-term degenerative arthritis that may appear 30 to 50 years later in segments of the spine that were not fused. Currently, there is not adequate follow-up information on the procedure to know the frequency of this problem.

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

3. Spinal fusion surgery for idiopathic scoliosis addresses problems of deformity and progression of deformity well. However, it does not make the back normal and so the patient may experience degenerative problems in 30 to 50 years which may require additional treatment.

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

Could you please post that when you find it?

Thanks in advance,
sharon

[hdugger]

His PT gave him a set of core and back muscle exercises, along with advice to swim a few times a week and, in a few months, start some non-throwing form of martial arts. We'll check in with a Dr during the winter break to see if there's any improvement.

A mom forwarded me some information about an adult woman with Scoliosis. I'm not sure how bad the woman's curve was but she was in pain and was considering surgery. At some point she decided to give strength training a try. Lifting weights dramatically reduced her pain so she stuck with it. That was many years ago and today she feels great and wouldn't consider surgery. I've read that weak trunk muscles are a significant risk factor for back pain in healthy adults. Maybe the same is true for adults with Scoliosis.

[Dingo]

inflammation

hdugger

It might sound kooky but your son is in this for the long haul so he might want to consider a healthy diet to lower the levels of inflammation in his body. I'd guess that a significant spinal curve would lead to chronic inflammation. Inflammation creates pain and slowly destroys the joints.

Fish oil is a proven anti-inflammatory that helps many different conditions. Doctors even give it to children with Autism to reduce the inflammation in their brains. Over a long period of time this might slow any extra disc deterioration he may experience because of his curve.

There is book called The Gold Coast Cure that teaches people about anti-inflammatory foods. Many people with autoimmune diseases use this system because it's known to reduce inflammation in the body. One of the co-authors has Multiple Sclerosis, the other is a doctor.

Basically a healthy diet, regular exercise, good sleep and low stress all contribute to low levels of inflammation in the body.

[hdugger]

Thanks, Dingo. That's a good idea.

He eats pretty well, but doesn't get much fish in his dorm food. He's also convinced that the sun has some curative power for him.

[Pooka1]

hmm, the quotes I find now are not exactly what I remembered, but here's what I see:

Effectiveness

The success rate of stable fusion and correction of spinal deformity is very high in experienced hands. The average curve correction is approximately 70 percent and the likelihood of complications has been about 2 to 3 percent overall. The fusion of the bones (enabling the bones to grow together) is permanent.

There are concerns about long-term degenerative arthritis that may appear 30 to 50 years later in segments of the spine that were not fused. Currently, there is not adequate follow-up information on the procedure to know the frequency of this problem.

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

3. Spinal fusion surgery for idiopathic scoliosis addresses problems of deformity and progression of deformity well. However, it does not make the back normal and so the patient may experience degenerative problems in 30 to 50 years which may require additional treatment.

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

Hi.

Thanks for posting that.

Development of arthritis above and below fusions can only be interpreted as against the rate of this condition in the general population or in specific age cohorts.

As we have determined, some 85% of the general population will have at least one back problem in their life. So to show that fusion predisposes someone to something like arthritis, you need to determine what the spinal arthritis rate is in the general population, hopefully in various age cohorts.

Now it could be that 100% of folks with fusions get arthritis. Or that fused people tend to get it earlier in life. But you can't show that those situations are unusual and likely related to the fusion until you show the statistics for the general population.

I looked around the web a bit and couldn't find hard numbers for spinal arthritis in the general population. But I did find the following site which claims that DDD is as certain as death and taxed and that DDD, in combination with other things, causes arthritis of the spine.

http://www.back.com/causes-mechanical-degenerative.html

I also found this twins study (twins studies being always a favorite on this group), claiming to show a large genetic influence on disc degeneration...

http://linkinghub.elsevier.com/retri...2994300801440X

I also found this article which purports to show a genetic basis for lumbar disc degeneration...

http://journals.lww.com/spinejournal...e_Disc.18.aspx

Now I'd like to the see the data indicating possible concern for arthritis above and below fusions that the U of W researchers are referring to in order to compare with what else can be found.

[hdugger]

Ah, here's some info (and sorry Dingo for highjacking your thread - let me know if you want these posts moved to a new thread)

The condition is called Adjacent segment disease. I just did a quick search and grabbed the first few things I found:

"Patients who have been operated upon for scoliosis can also experience pain for reasons that are related to the original scoliosis, or to the surgery that was done to correct it. For instance, the intervertebral discs adjacent to a fused segment of the spine often wear out faster than they would normally, and this condition can become painful. This is called "adjacent segment disease", and it can be a reason why the fusion may need to be extended to include additional levels many years after the original surgery. Also, not all scoliosis surgeries are successful, and certain problems can arise after the operation. A pseudoarthrosis, or false joint, is an area where the fusion has failed to properly develop between two vertebral bodies. The abnormal motion in an area of a pseudoarthrosis can be quite painful and may require further operations in order to get the segment to fuse properly."

http://www.iscoliosis.com/symptoms-pain.html

And then a study

CONCLUSION: Biomechanical alterations likely play a primary role in causing adjacent segment disease. Radiographically apparent, asymptomatic adjacent segment disease is common but does not correlate with functional outcomes. Potentially modifiable risk factors for the development of adjacent segment disease include fusion without instrumentation, protecting the facet joint of the adjacent segment during placement of pedicle screws,fusion length, and sagittal balance. Surgical management, when indicated, consists of decompression of neural elements and extension of fusion. Outcomes after surgery, however, are modest.

http://www.ncbi.nlm.nih.gov/pubmed/15534420

I'll look some more tonight.

[hdugger]

Also apparently called "Transitional syndrome"

"The continuing dilemma in spine care is that multi-level rigid spine fixation typically creates adjacent stress-related pathology of adjacent spinal segments as well as stress-related problems directed to the pelvis; often related to the sacro-iliac joint. These are commonly referred to as "transitional syndromes." These problems are not infrequently create more patient disability than the problem for which the fusion was initially performed to address. Often the treatment of transitional syndromes require additional surgery."

http://www.burtonreport.com/infspine...tionalSynd.htm

Absolutley no idea about the quality of this work, but the premise makes sense.

[Pooka1]

Okay as far as I can tell, these are NOT related to the original post about the incidence of arthritis above and below the fusion. These are OTHER issues.

Ah, here's some info (and sorry Dingo for highjacking your thread - let me know if you want these posts moved to a new thread)

The condition is called Adjacent segment disease. I just did a quick search and grabbed the first few things I found:

"Patients who have been operated upon for scoliosis can also experience pain for reasons that are related to the original scoliosis, or to the surgery that was done to correct it. For instance, the intervertebral discs adjacent to a fused segment of the spine often wear out faster than they would normally, and this condition can become painful. This is called "adjacent segment disease", and it can be a reason why the fusion may need to be extended to include additional levels many years after the original surgery. Also, not all scoliosis surgeries are successful, and certain problems can arise after the operation. A pseudoarthrosis, or false joint, is an area where the fusion has failed to properly develop between two vertebral bodies. The abnormal motion in an area of a pseudoarthrosis can be quite painful and may require further operations in order to get the segment to fuse properly."

These are well-known and it is equally well-known when they occur (i.e., mainly a function of where the fusion ends as I understand it.) If it ends about L1 or L2, this is not expected to occur per my understanding. My daughter's fusion ends at L1 and I was told she is not expected to need an extension in her life due to this or any reason. "One-stop shopping" for surgery in her case is what the surgeon told me.

http://www.iscoliosis.com/symptoms-pain.html

And then a study

CONCLUSION: Biomechanical alterations likely play a primary role in causing adjacent segment disease. Radiographically apparent, asymptomatic adjacent segment disease is common but does not correlate with functional outcomes. Potentially modifiable risk factors for the development of adjacent segment disease include fusion without instrumentation, protecting the facet joint of the adjacent segment during placement of pedicle screws,fusion length, and sagittal balance. Surgical management, when indicated, consists of decompression of neural elements and extension of fusion. Outcomes after surgery, however, are modest.

http://www.ncbi.nlm.nih.gov/pubmed/15534420

I'll look some more tonight.

That study concerns LUMBAR fusions and is not known to be relevant to thoracic fusions as far as I know.

If you can find the data about arthritis incidence above and below the fused segments that the U of W researchers are apparently referring to, that would be edifying.

[Pooka1]

Also apparently called "Transitional syndrome"

"The continuing dilemma in spine care is that multi-level rigid spine fixation typically creates adjacent stress-related pathology of adjacent spinal segments as well as stress-related problems directed to the pelvis; often related to the sacro-iliac joint. These are commonly referred to as "transitional syndromes." These problems are not infrequently create more patient disability than the problem for which the fusion was initially performed to address. Often the treatment of transitional syndromes require additional surgery."

http://www.burtonreport.com/infspine...tionalSynd.htm

Absolutley no idea about the quality of this work, but the premise makes sense.

Again, this is only relevant to lumbar fusions.

If you find anything on thoracic fusins long-term, I would be keenly interested in that. Our surgeon told me my (thoracically-)fused daughter is back in the general population on risk of all future back issues. Now obviously that reflects the state of evidence now and is a projection since there are no long-term studies with this instrumentation.

ETA: It also likely reflects the 85% incidence of back issues in the general population.

[Dingo]

Spine Surgery

Years ago I had one vertebrae fused in my neck due to what I believe was a sports injury that eventually gave out. I was in tremendous pain and I'm glad that I had surgery.

However...

The surgeon accidentally snagged my vocal chords during the procedure and I lost most of my voice for a couple of months. Immediately after surgery my sneezes became twice as loud and that is true to this day. I can't explain that one. A few years after surgery I began to feel a scratch in my throat that has never gone away.

If my child needed fusion I'd do it, but it would be my last resort. All you have to do is read a few threads about surgery horror stories on this and other boards to see why.

[LindaRacine]

Spine (Phila Pa 1976). 2009 Aug 15;34(18):E659-63.Click here to read Links
Comparison of the melatonin and calmodulin in paravertebral muscle and platelets of patients with or without adolescent idiopathic scoliosis.
Acaroglu E, Akel I, Alanay A, Yazici M, Marcucio R.

Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey. eacarogl@hacettepe.edu.tr

STUDY DESIGN: Controlled clinical study. OBJECTIVE.: To compare muscle and platelet calmodulin and melatonin concentrations of scoliotic and nonscoliotic populations. SUMMARY OF BACKGROUND DATA: Melatonin and calmodulin are potential key molecules in scoliosis etiology. Calmodulin is not only a second messenger of melatonin but also has been shown to have effects on muscle contractility. There is a possibility that it may be of importance in the regulation of spinal alignment. Platelets have been defined as mini muscles calmodulin and melatonin levels of which may be the projections of muscle values. METHODS: Twenty patients undergoing posterior surgery for adolescent idiopathic scoliosis (AIS) and 9 thoracic-lumbar trauma patients undergoing posterior surgery constituted the population. Autologous bloods were collected and processed to obtain platelets. Paravertebral muscle tissue samples from both sides were obtained at T12-L1 level intraoperatively. Muscle and platelet samples were analyzed for the levels of melatonin by radio immuno assay and for calmodulin by enzyme-linked immunosorbent analysis. Groups, concave (left side for the control group) and convex side (right side for the control group), muscles and platelet median protein concentrations, and optic densitometry (OD) ratio values were compared. RESULTS: AIS group consisted of 2 male and 18 female patients. Mean age was 16.1 +/- 3.78 (11-29). Control group consisted of 5 male and 4 female patients. Mean age was 35 +/- 13.47 (16-55). Platelet Calmodulin OD/Supernatant's OD ratios and both convex and concave sides' muscle Calmodulin OD/Supernatants' OD ratios were not different between groups. On the other hand, convex side muscle calmodulin to total muscle calmodulin ratios were higher in AIS group compared with concave (P = 0.048); likewise, concave side calmodulin to total calmodulin ratios were lower in AIS group compared with control (P = 0.035). Convex side calmodulin to concave side calmodulin ratios were significantly different among groups (P = 0.048). Neither platelet melatonin to total protein ratios, nor convex or concave side muscle melatonin to total protein ratios, nor convex to concave side melatonin ratios were significantly different between groups. Convex or concave side calmodulin or melatonin values were not correlated with platelet values. CONCLUSION: AIS group had an asymmetric distribution of calmodulin in paraspinal muscle, higher at the convex side and lower at the concave. Neither platelet melatonin nor platelet calmodulin was found to be representative of the muscle protein values.

[Dingo]

Melatonin thread

LindaRacine

This study probably belongs in the Melatonin thread. I talked to one of the scientists involved in this study and another noted researcher who reviewed this study for me.

This particular study dug up some gold but that relates to Torso Rotation Strength Training, not Melatonin.

[Ballet Mom]

Prostate Cancer’s Worst Form Linked to Gene-Influencing Virus

By Rob Waters

Sept. 7 (Bloomberg) -- A virus has been linked to the most aggressive form of prostate cancer, potentially leading the way to identifying men with the deadliest tumors and pinpointing their treatment.

The discovery, reported today in the Proceedings of the National Academy of Sciences, involves the XMRV virus, discovered just three years ago, said Ila Singh, an associate professor of pathology at the University of Utah in Salt Lake City. Forty-four percent of men with tumors graded 9 out of 10 for severity on a standard scale had evidence of XMRV, Singh’s study found.

More than 190,000 U.S. men will be diagnosed with prostate cancer this year and 27,000 will die, according to the National Cancer Institute. A more accurate way to identify the riskiest cases might improve therapy, since some tumors are slow growing and don’t require aggressive treatment with surgery, chemotherapy or radiation, all of which carry side effects.

“There is a need for a better test to help determine who would benefit from treatment versus who could be left alone,” said Singh, in a Sept. 4 telephone interview. “If this virus turns out to be a cause for a subset of aggressive tumors, then it would be a good test to use and might be better than PSA"..........

http://www.bloomberg.com/apps/news?p...d=a4mbqkGaCrqs

[Pooka1]

Breakthrough Discoveries of Alzheimer's Genes

http://richarddawkins.net/article,42...via-Yahoo-News

Fifteen years since the last discovery of its kind, scientists have finally identified a new set of genes that may contribute to Alzheimer's disease.

The three new genes, known as clusterin, complement receptor 1 (CR1) and PICALM, were uncovered by two separate research groups, one in Wales and one in France, who linked the genes to the most common form of the memory disorder, late-onset Alzheimer's - the type that affects patients in their 60s or later and accounts for about 90% of all Alzheimer's cases. The only other gene connected with the condition, apolipoprotein E (ApoE), was identified in 1993; since, researchers have tirelessly hunted for other key genes, knowing that 60% to 80% of the progressive, incurable disease is genetically based.

[Dingo]

Good find!

Ballet Mom

Good find, I don't think I've ever heard of a prostate cancer virus!