News & Updates
October 5, 2020
Adult Scoliosis is a Problem – Three Reasons Why
Is Adult Scoliosis a Problem? I’ll give you 3 good reasons why it is.
I was taught that Scoliosis is only a problem for adolescents. But I know and you know that adolescents grow up to become adults, and there are tons of people with adult scoliosis. But why is surgery often considered the default treatment option when other nonsurgical adult scoliosis treatment alternatives are available?
Reason 1: 4 Times More Adults Have Scoliosis Than Adolescents
Adolescents with Scoliosis account for only about 3% of the population, but when we look at the demographics of adult scoliosis, we find that it affects somewhere between 7%-9% of the population.
Hmm? The numbers don’t add up.
It seems that some adults, in fact, the majority of those adults who have scoliosis, developed in adulthood. Demographic studies confirm you are 3 times more likely to develop scoliosis in adulthood than in adolescence!
In fact, some published studies report 1/3 of people over the age of 65 will develop scoliosis secondary to things like osteoporosis, Parkinson’s disease, and arthritis.
When you add on the adolescent group that grew up to be adults, scoliosis in adulthood is 4 times more prevalent than scoliosis in adolescence.
Reason 2: Scoliosis Patients Suffer More Than People with Other Health Conditions
The mere fact that more adults have scoliosis than adolescents may be eye-opening to you, but it doesn’t matter much if people are living well with it.
In order for a condition to warrant attention, it has to exact a toll. One way to measure the effects of a disease or health condition is to conduct objective measures of a person’s quality of life.
Standardized questionnaires are widely used in medicine and routinely are reported in the literature. Several of these studies were done with adults diagnosed with scoliosis.
The studies show adults with scoliosis report some of the lowest Quality of Life Scores when compared to patients with other known health conditions. They even score lower than patients suffering from Clinical Depression.
Nearly 9 million people in the United States are currently suffering from the effects of adult scoliosis, many of them without a clear understanding that their suffering is related to scoliosis.
Reason 3: Scoliosis Surgery Rates are on the Rise
I’m not a conspiracy theorist, nor do I think medical professionals are somehow plotting to ruin the lives of millions of Americans, But I do believe that money blinds. And I believe adult scoliosis surgery is necessary for hospitals to be profitable. There’s also the old adage: “To a Hammer, everything looks like a nail.” It’s natural for a surgeon, a hospital, and an industry to look at adult scoliosis as a surgical problem when everything they see is viewed through a surgical lens.
With the amount of new braces on the market, and the attention being given to scoliosis by the chiropractic profession, pilates/Yoga instructors, Schroth Therapists, and the like, one would think surgical rates for adult scoliosis would be declining. But unfortunately, adult scoliosis surgery is at its highest rate in over a decade, and it’s increasing every year.
In fact, a study published in the European Spine Journal in October of 2017 reported 14 consecutive years of increases in the incidence of adult scoliosis surgery.
I’m not surprised that surgeons recommend surgery, but I am concerned over the ever-increasing rates of adult scoliosis surgery in spite of the increasing effectiveness of nonsurgical approaches.
Here’s the problem; surgeons should not make non-surgical recommendations. I was taught that if a patient requires a consultation with a surgeon, to refer them to the surgeon. I wouldn’t recommend which type of surgery a patient should get, or even if surgery is a good idea for them, I let the surgeon do the consult and let the patients decide what’s best for them.
But unfortunately, many surgeons don’t have the same hesitation to comment on non-surgical recommendations. This is often in spite of the fact that they typically have absolutely no experience or training in the field.
When a surgeon suggests there is “no evidence”, or something non-surgical doesn’t work, they are in fact speaking from experience. But the problem is that this is misleading since they have No Experience.
Even the recommendation of surgery after a curvature is measured to be 45 degrees should be questioned. I looked into the basis for this recommendation since I need to know if I’m putting my patients at risk by helping them avoid surgery.
After some digging, I found the policy recommendation for surgery for adult scoliosis curvatures of 45 degrees or more was based on a study that followed 50 cases of untreated adolescents with adult scoliosis. Those with curvatures of 50 degrees or more tended to experience progression even after the pubertal growth spurt was completed.
On the surface it seems reasonable, but what if those patients had undergone successful non-surgical care, stabilizing their condition? We know that happens in some cases, no one will dispute that. So if we followed the policy recommendation to require surgery after 45 Degrees, many unnecessary surgeries would take place, and in fact, that is exactly what is happening.
When surgery is recommended for adult scoliosis based on a two-line measurement on an x-ray, NO consideration is given as to the nature of the curvature:
- if it’s flexible,
- if it’s secondary to a short leg,
- if it’s complicated by bone loss,
- whether neurological influence plays a part,
- etc, etc, etc…
This is dangerous because too many people get lumped into the surgical recommendation with this approach. Many, many people have successfully lived with 45-degree curvatures, who have not experienced lifelong progression. Therefore the current criteria for surgical recommendation are overreaching and insufficient.
When I teach courses to other doctors, I put up an x-ray showing a scoliosis of 95 degrees, I ask the learners, “who would recommend surgery for this case?” Most of the doctors strongly voice their opinions on how surgery is the only option, and in fact, the only ethical thing to do; until I reveal the x-ray is of a cadaver. The point is, surgery is not automatically necessary just because you measured a curvature on an x-ray. Even in the living, surgery is a choice and quite often the wrong choice.
In a study published in May 2011, researchers reported a 34.4% major complication rate following adult revision scoliosis surgery (cho 2011). This was a retrospective cohort comparative study, which means the researchers reviewed actual adult scoliosis surgery outcomes at two major University hospitals; Mount Sinai School of Medicine and Washington University Center for Orthopedic Surgery.
Revision surgery is done usually following a failed back surgery or as a result of the effects of aging on a spinal deformity.
Of the 166 patients reviewed, 107 were diagnosed with “de novo Scoliosis”, meaning they developed scoliosis in adulthood, matching the statistics I quoted initially.
At Scoliosis Systems LLP we pride ourselves on offering EVIDENCED BASED care for adults with scoliosis. We are certain the majority of the 9 million adults with scoliosis can and ARE living their best life without surgery. Even those who have had surgery are in need of ongoing scoliosis-specific healthcare.
I consider myself a guide for those who are seeking truth in the Scoliosis healthcare space. If you are on a journey and our paths cross, you can count on me to shine light whenever I can.
If you have questions about your specific situation, please take advantage of our Free Phone Consultation offer. You can book your free phone consultation on our home page.
February 8, 2020
Spinecor Brace vs. ScoliSmart Activity Suit
Getting a Scoliosis Diagnosis is life-changing. If you’re like most people, you are educating yourself about Scoliosis treatment options, and most likely you’re using the internet for your information. The problem with this is the information we are consuming may not be the whole truth, and some of it is flat-out deceptive marketing.
Let me start by saying, scoliosis in the adolescent is best treated with a full-time brace. The published studies do not indicate which type of brace is best, just that bracing is necessary for optimal outcomes.
In the Adult with Scoliosis treatment is a little more complicated. Adult scoliosis is often complicated by arthritis, disc degeneration, and osteoporosis. For these reasons, adults with scoliosis should have a thorough evaluation and any treatment should be provided under the supervision of a trained professional.
So let’s Compare and Contrast the Spinecor Brace and the Scoliosmart Activity Suit.
Spinecor- Full-time Orthopedic Brace for Scoliosis
ScoliSmart Suit- Designed to be worn for 2 hours and is not a brace
Spinecor- 43 Published Studies in the Peer-reviewed Medical Literature.
ScoliSmart Suit- 0
Spinecor- Custom Fitted by a Doctor with over 26 fitting options
Scolismart Suit – mail order, not custom fitted
Spinecor- Has an Insurance Code, reimbursed as Durable Medical Equipment
ScoliSmart Suit-not recognized by major medical insurance carriers.
Please use this information to make informed decisions. Scoliosis is a medical condition and should not be treated with unproven methods.
March 1, 2016
Neuroskeletal Management of Scoliosis-Certificate Program for D.C.s
2 Hour Live Webinar – 2CE
Introduction to Neuro-skeletal Scoliosis ($50)
Learn the 5 Mistakes Chiropractors Make when treating Scoliosis
- Ask live questions about cases you currently are seeing
Co-Sponsor; New York Chiropractic College
Give us your Contact Information if you would like to receive alerts about Seminar Dates and Times
February 9, 2014
Scoliosis Treatment Success
Presentation: A 62 year old female presented herself without referral for the examination. Her medical history included multiple recent falls, adult progressive scoliosis and a possible diagnosis of Multiple Sclerosis from her medical neurologist.
Observations posture reveal chronic towing of the spine to the right, shuffling gate with wide stance and the need to constantly hold on for stability.
Exams: a comprehensive neurological exam was performed including a sensory motor exam, a cerebellar and brainstem cranial nerve exam with appropriate testing of vestibular and oculomotor function. Clinical findings were nomometric in regards the motor examination. Ranges of motion were restricted in an age appropriate manor and sensory exam was further unremarkable. Vidoe Electronystagmography allowed for the evaluation of the vestiublar Cranial nerve portion, and as well as oculomotor testing. Upon vision denial testing in the upright seated posiition the patient presented with a non fatiguing right beating nystagmus with not tornsional or vertical component. The nystagmus was not visible without vison denial goggles. Oculomotor testing revealed findings of an adduction lag in the left eye during optokinetic stimulus. Xrays of the spine revealed an atypical towering scoliosis with severe lumbar disc degeneration and hyperostosis of the weight bearing joints.
Chiropractic evaluation included stereo views of the full spine posture and radiological views of along the X,Z, and the Yz axes and were reviewed in clincial context to recent MRIs provided by the patient. An occipito-atlanto-axial misalignment was measured. Reflexive retraction of the lower limb in non weight bearing supine posture was observed, and nerve root swelling with associated allodynia was localized by palpation at the c1 nerve root region. furhtermore, nucheal rigidity on the ipsilateral posterior neck musculature ws observed.
Differential Diagnosis: Cerviical Subluxation complex, Adult progressive scoliosis and associated osteoarthritis, left unilateral vestibulopathy, demeyelenating of the medial longitudinal fasicular tract from the right adbucens nucleus to the left oculomotor nucleus. CSF flow disruption.
Plan: Follow up clincial testing is necessary. Xrays, caloric testing as well as repeat oculomotor testing is necessary to reproduce earlier findings. Chiropractic intervetion can begin immediately to reduce upper cervical spine dysfunction and C1 nerve root irritation. The patient is recommended to wear a spinal orthosis designed to improve dynamic control of the trunk and spine. Conservative treatment for vestibular and oculomotor findings.