September 8, 2014

Does my child have Neuro-skeletal Scoliosis?

Neuro-skeletal scoliosis is a relatively new description which describes the pathophysiology of a particular type of progressive Scoliosis. (Neuro) meaning, under the influence of the nervous system, mainly the autonomic nerves which get their start in a part of the brain called the hypothalamus, and (Skeletal) pertaining to the growing bones, nerves and blood vessels all of which are involved in scoliosis.

The Hypothalamus is responsible for regulating our bodies homeostasis,  which includes temperature regulation, feeding, satiety and hormonal balance. The Hypothalamus has direct links to the pituitary gland which is responsible for the onset or puberty and hormonal maturation. Nerve pathways from the hypothalamus follow along the sympathetic nerve chains to synapse on bone cells called Osteoclasts and Osteoblasts. Both of these cell types work to grow and remodel bone based on genetic coding, local sheer forces and neuropeptides directly from nerves.

Other Facts to Consider: Neuropeptides are tiny molecules produced and released by the nerve fibers as a consequence of local and global activation. Both Sensory nerves and motor nerve function influence bone symmetry and growth especially in adolescence. Global motor tone of the nervous system has influence over bone symmetry via the pontomedullary reticular formation (PMRF) pathways, which also influences vestibular function Heart rate and rhythm, sympathetic inhibition (sweating, pupillary dilation, and regional blood flow).

Why is it important to know if my child has Neuro-skeletal Scoliosis? When nerve function is disrupted, imbalanced or left uninhibited, or overactive, it results in asymmetry of bone growth and progressive scoliosis. Many of nerve imbalances can be improved, reduced or balanced by functional neurology approaches, physiotherapeutics and chiropractic methods.

How is Neuro-skeletal Scoliosis Diagnosed? A thorough clinical neurological exam may reveal neuro-skeletal motifs that can be treated clinically. Basic exams should include testing of: a. Reflexes b. Vibratory sense c. Ability to measure movement of the limbs d. Sensory appreciation of space, e. balance etc.

When Neuro-skeletal scoliosis is suspected, a more thorough exam should include:

1. Vestibular and oculomotor testing (VNG)

2. Somatosensory evoked potentials (SSEPs)

3. Brainstem Auditory Evoked Potentials (BAERs)

4. Functional assessment of the Pontomedullary Reticular Formation

5. Neurohormonal assessment (stress hormones, pituitary hormones, adrenal hormones, thyroid hormones (in adults)

6. EEG when cortical syndromes are suspected.

7. Chronic Upper Cervical Subluxation

What Treatments can be done if Neuro-skeletal Scoliosis is confirmed? Treatment objectives should be discussed with your clinician about your child’s specific condition. A multi-disciplinary approach may be necessary. In general, when patients have vestibular imbalances (studies show this is prevalent in 80% of Idiopathic cases), patient specific vestibular rehabilitation should be performed by a trained professional. That same patient may have neuro-hormonal issues, and may require care from an endocrine specialist. It is our opinion, a Functional Neurologist is the best managing clinician for these types of cases, however doctors of chiropractic and non-surgeon orthopedic specialists are often needed and therefore are also valuable in this regard.