Scoliosis: Life, Support and Friends

AIS & Spinal Deformities - Spine & Trunk

2009-12-01T13:34:00.004+01:00

Spine Journal report about the methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper

Authors: Tomasz Kotwicki, Stefano Negrini, Theodoros B Grivas, Manuel Rigo, Toru Maruyama, Jacek Durmala, Fabio Zaina and the Members of the international Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT)

Published: 26 November 2009

Background
Comprehensive evaluation of the morphology of the spine and of the whole body is essential in order to correctly manage patients suffering from progressive idiopathic scoliosis. Although methodology of clinical and radiological examination is well described in manuals of ortho-paedics, there is deficit of data which clinical and radiological parameters are considered in every-day practise. Recently, an increasing tendency to extend scoliosis examination beyond the measure of the Cobb angle can be observed, reflecting a more patient-oriented approach. Such evaluation often involves surface parameters, aesthetics, function and quality of life. Aim of the study: To investigate current recommendations of experts on methodology of evaluation of the patient with spinal deformity, essentially idiopathic scoliosis.

Methods
Structured Delphi procedure for collecting and processing knowledge from a group of experts with a series of questionnaires and controlled opinion feedback was performed. Experience and opinions of the professionals - physicians and physiotherapists managing scoliosis patients - were studied. According to Delphi method a Meeting Questionnaire (MQ) has been developed, resulting from a preliminary Pre-Meeting Questionnaire (PMQ) which had been previously discussed and approved on line. The MQ was circulated among the SOSORT experts during Consensus Ses-sion on "Measurements" which took place at the Annual Meeting of the Society, totally 23 panellists being engaged. Clinical, radiological and surface topography parameters were checked for agreement.

Results
90% agreement or more was reached in 35 items and superior than 75% agreement was reached in further 25 items. An evaluation form was proposed to be used by clinicians and re-searchers.

Conclusion
The consensus was reached on evaluation of the morphology of the patient with idio-pathic scoliosis, comprising clinical, radiological and, to less extend, surface topography assessment. Considering the variety of parameters indicated by the panellists, the Cobb angle, yet the gold standard, can be seen neither as the unique nor the only decisive parameter in the management of patients with idiopathic scoliosis.

To read the complete article in PDF format to learn more about the Spine Journal report about the methodology of evaluation of morphology of the spine and the trunk in idiopathic scoliosis and other spinal deformities - 6th SOSORT consensus paper.

Scoliosis and Respiratory Muscle Strength

2009-11-30T15:57:00.004+01:00

Spine Health released a new study to examine the Curvature of the Spine, Neuromuscular Disorders and Lung Function

By: Chris Maynard

Online Content Manager, Spine-health

Nov 24, 2009 (Spine-Health) -- Patients with neuromuscular disorders had diminished respiratory muscle strength and pulmonary function compared with a healthy control group, according to a new study also examining how scoliosis affects lung function.

As detailed in a recent edition of The Spine Journal, neuromuscular disorders are known to lead to lung volume loss and respiratory muscle weakness, but the effects of scoliosis on lung function are unknown, a point that served as a basis of this study.

For some context, neuromuscular disorders occur when the neurons, or nerve cells that send messages that control voluntary muscles like the arms and legs, become unhealthy and die. As a result of this breakdown in communication between the nervous system and muscles, the muscles weaken, possibly leading to a wide variety of symptoms (including twitching, cramps, aches, pains, and joint and movement problems) and even affecting heart function and breathing ability.

Scoliosis is an abnormal curvature of the spine that is often marked by one shoulder, side of the rib cage or hip appearing higher than its respective other, the waist appearing uneven, the body tilting to one side, or one leg looking shorter than the other. Back pain is not usually considered a symptom of scoliosis.

For the study, approximately 22 patients with neuromuscular disorders and scoliosis, 17 patients with neuromuscular disorders without scoliosis, and 24 age- and sex-matched healthy controls were subjected to various tests comparing their respiratory muscle strength and pulmonary function, which specifically measures how well the lungs take in and release air and move this oxygen throughout the body.

According to the study’s findings, patients with neuromuscular disorders, regardless of having or not having scoliosis, had diminished respiratory muscle strength when compared to the healthy subjects. Furthermore, patients with neuromuscular disorders and scoliosis had significantly lower pulmonary function scores than not only the control group of healthy patients but the patients who had neuromuscular disorders but were without scoliosis.

The researchers indicated that these findings could mean that the effects of neuromuscular disorders on respiratory function are independent of scoliosis and suggested that clinicians should be aware of the possibility of compromised respiratory function when treating patients with neuromuscular disorders.

Update on my scoli appt- Tuesday

2009-11-28T02:22:00.005+01:00

So I had my half-yearly back check up at the hospital on Tuesday the 24th.

Here's a quick report:

X-RAYS

Bone development: My hand was x-rayed. It revealed that I only had a small amount of growth left. Yay!:D

SPINAL:
My current curves are both 18 - 19 degrees, same as last time. They aren't progressing.

ORTHOPEDIC:

My doctor looked at the wounds on my back and saw the x-rays. He concluded that I only needed to wear my brace 18 hours a day from now on! He told me that 6 hours wouldn't make much of a difference, seeing as I only have a small amount of growth left and the brace wouldn't be able to fix a huge amount.

ORTHOTIC:

My orthotist looked at the scars and told me to wear my brace looser. He put padding in the lower side as well. He advised me to wear my brace to school, as it involves sitting down, which is the worst of the three postures. He said the best time not to wear it is when I'm asleep.

Best news: the orthotist said next time I come in March, I probably will only have to wear my brace 12 HOURS a day! they're slowly "weaning" me out of it. lol :)

But I've been braced for so long that it feels wierd not wearing it for more than an hour. I feel guilty!

Other thing: I don't know if I've mentioned this here but I've been super excited about this dance camp in january. Then I remembered my brace. The orthopedist said it was perfectly okay to go and just wear my brace at night. :D

Last thing. Work experience next year. I have applied for the orthopedics, medical imaging and physiotherapy units at the hospital. I've also applied at an Orthotics and Prosthetics Clinic. I'm so excited! Hope I get one (or 2, seeing as the hospital work experience is during the holidays).

Medtronic introduces 3-D vascular imaging service

2009-11-20T12:59:00.002+01:00

MINNEAPOLIS, Minnesota — Device-maker Medtronic Inc. has partnered with an imaging software firm to introduce a service that provides three-dimensional images of veins, which the company says will help surgeons treat aortic aneurysms.

Author: Brandon Glenn

Medtronic says the service will help surgeons better visualize the inside of a patient’s vein before an operation and better view an implanted stent graft after the operation.

The service, called 3D Recon, converts two-dimensional computed tomography images to three-dimensional images and removes bone and anatomy from the images, according to a statement from Medtronic.

An aortic aneurysm is a weakened and bulging area in the body’s largest blood vessel, a condition that can cause life-threatening bleeding.

The service has been cleared by the U.S. Food and Drug Administration, thanks to a 510(k) granted to Vital Images, a Minnetonka, Minnesota-based visualization software firm that partnered with Medtronic.

A Medtronic spokesman did not immediately return a call.

Earlier this week, Medtronic announced the launch of a spine-fixation system to treat scoliosis.

Shriners Search for Best Treatment

2009-11-20T12:57:00.000+01:00

Three to five of every 1,000 children develop spinal curves serious enough to warrant medical attention. And yet, in general terms, the cause of these curves – known as “scoliosis” – remains unknown, and the effectiveness of the most common treatment is in question.

Researchers at Shriners Hospitals for Children are working hard to discover answers to these questions, and to improve the quality of care and quality of life for children with scoliosis, a curvature of the spine greater than 10 degrees, which makes the spine look more like an “S” or a “C” than a straight line when viewed on an X-ray. Once scoliosis has been diagnosed, the primary concern is whether the curve will progress, and treatment is aimed at stopping that progression.

While scoliosis can occur at any age, the most common type, adolescent idiopathic scoliosis (AIS), affects 2 to 4 percent of children between the ages of 10 and 16, particularly girls. Treatment options include observation for small curves, bracing in hopes of preventing curve progression in patients felt to be at risk, and surgery to fuse the spine in larger and progressive curves.

For years, bracing has been the most frequent treatment method for growing patients with moderate-size curves. Despite the fact that bracing is so commonly used in this clinical situation, there is no good scientific data demonstrating that bracing actually slows or prevents curve progression.

“Bracing a child with scoliosis is not an easy task,” said Matthew Dobbs, M.D., orthopaedic surgeon at Shriners Hospitals for Children — St. Louis and associate professor of pediatric orthopaedic surgery at Washington University School of Medicine. “Adolescents do not want to wear a brace that makes them look and feel different from their friends. Bracing has been the accepted treatment for years for adolescents with a curve of 20 to 40 degrees, but there is no hard data to support that it works. We honestly don’t know what the right treatment is for patients with curves in this range. Some with braces do fine, as do some without. This is definitely a medical question that needs to be answered.”

Shriners Hospitals for Children, together with the National Institutes of Health, is conducting a multi-center research study, Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), to answer this question. Dr. Dobbs is the lead investigator for the Shriners Hospitals for Children portion of this trial. The results could lead to improved care and treatment, improved screening efforts and programs, and improved quality of life for those with AIS, and help determine precisely which patients benefit from bracing and which do not.

A difficult issue surrounding bracing adolescents is compliance – determining whether patients are wearing the brace for the prescribed amount of time, which is often 20 hours a day. In the study, compliance will be determined through data provided by a heat sensor implanted in the brace.

“The braces are uncomfortable and awkward, and generally we are dealing with adolescent girls concerned about appearance and fitting in,” said Dr. Dobbs. “Every day in the scoliosis clinics we deal with tears from the adolescents not wanting to wear the brace and frustration from the parents trying to convince their teens to wear it.

“Bracing is very expensive, as are the school screening programs,” said Dr. Dobbs. “If we find that bracing is not effective, then screening programs to identify scoliosis in early stages could be stopped. On the other hand, if bracing is found to be effective, then more effort and resources could be employed toward improved screening programs to identify children with curves early enough that they can benefit from bracing.

“I believe the findings won’t be that simple. It is likely that we will identify a subset of scoliosis patients that benefit from bracing and others that don’t,” Dr. Dobbs said. “If we can define the patient population based on age and curve type that benefit from bracing, that would be a huge contribution. Whatever the findings, the results of the study will be a major step forward in our understanding of how to treat this relatively common disorder.”

Many children with other conditions, including spinal cord injuries, cerebral palsy and osteogenesis imperfecta, are at a very high risk for developing scoliosis, as well. The same question – whether bracing is the best treatment for scoliosis – needs to be answered for these cases. Studies, in varying stages of development, are also underway at Shriners Hospitals for Children to address these questions.

Medtronic Launch TSRH Spine System

2009-11-19T14:40:00.002+01:00

Medtronic, Inc. (NYSE: MDT), today announced the launch of the TSRH ® 3Dx ™ Spinal System. Designed with procedural efficiency in mind, the TSRH 3Dx Spinal System offers two screws designed to address multiple pathologies. The Multi Planar Adjusting (MPA ® ) Screw option provides surgeons a variable angle posted screw for targeted, controlled correction maneuvers. The OSTEOGRIP ® Screw enhances bone fixation by incorporating a dual-lead thread pattern that reduces toggle at the bone-screw interface.

Building on more than 20 years of clinical success, this next generation pedicle screw system includes competitive differentiating technology for addressing multiple spinal pathologies, from degenerative disc disease to spinal deformity. The system also offers CHROMALOY™ rods and a minimally invasive capability.

“The TSRH 3Dx Spinal System allows me to better match solutions to specific patient needs,” said Dr. Brett Scott. “It gives me confidence by marrying new technologies with a long clinical history of success.”

In 1987, Medtronic’s collaboration with the Texas Scottish Rite Hospital for Children in Dallas, Texas, to develop a system to treat scoliosis, led to the development of the TSRH Spinal System – a hook, rod, and screw system used in complex spinal procedures. Since then, the TSRH System has evolved into one of the most popular spinal systems on the market.

For the approximately 268,000 people who suffer degenerative spinal conditions, deformity, or injury of the thoracic, lumbar, and sacral spine, the TSRH 3Dx Spinal System offers an alternative for spinal stabilization with fusion.

About the Spinal and Biologics Business at Medtronic
The Spinal and Biologics business, based in Memphis, Tenn., is the global leader in today’s spine market and is committed to advancing the treatment of spinal conditions. The Spinal business collaborates with world-renowned surgeons, researchers, and innovative partners to offer state-of-the-art products and technologies for neurological, orthopaedic and spinal conditions. Medtronic is committed to developing affordable, minimally invasive procedures that provide lifestyle friendly surgical therapies.

More information about the company and its spinal treatments can be found at
Medtronic Spinal

And its patient-education Web sites
Back.com
iScoliosis.com
MatureSpine.com
NeckSurgery.com

About Medtronic
Medtronic, Inc., headquartered in Minneapolis, is the global leader in medical technology—alleviating pain, restoring health, and extending life for millions of people around the world.

Any forward-looking statements are subject to risks and uncertainties such as those described in Medtronic’s Annual Report on Form 10-K for the year ended April 24, 2009. Actual results may differ materially from anticipated results.

A Golfing Inspiration: Stacy Lewis

2009-11-19T12:07:00.002+01:00

Author: Matt Cooper

I spotted this article on a golf website and as I knew about Stacy Lewis having Scoliosis I decide to re-print some of the article here to share with our members.

Well, it took longer than expected but we all knew it had to happen sooner or later.

The weight of expectancy was huge but one sensed it was coming.

Welcomed by sponsors, officials and even fellow players.

Much anticipated and greeted with scenes of drama and relief.

Yes - finally an American has won again on the LPGA.

One player excited about the tour's first visit to Houston in 20 years is Stacy Lewis, a Houston resident who has played at the nearby Woodlands all of her career.

Lewis' golfing journey has been an extraordinary one - she started playing the game aged eight, quickly gained a reputation as a great talent, was diagnosed with scoliosis (curvature of the spine), wore a brace for six years, then had surgery, became the number ranked amateur in the US and then finished third in the 2008 US Open (her professional debut).

Oh, she also "won" the 2007 NW Arkansas Championship when still an amateur (although only the first round was completed so it remains an "unofficial" result).

She's packed all of that in and yet 2009 is still her rookie year on tour!

Thrilled to be playing in front of her home town fans, Lewis makes an interesting prospect this week because the host course - The Houstonian G&CC - is designed by Rees Jones.

He also created the Champions course at LPGA International in Daytona Beach which has co-hosted the final stage of Q-school in recent years.

Last year the players completed three rounds on it and Lewis came out on top, winning the event by three shots.

She recently finished seventh in Japan and with her home town connections I like her chances of making the places at 80/1.

I was initially attracted to the claims of South Korea's In-Kyung Kim by her short- and long-term form but, like Lewis, she has an intriguing link with Q-school.

Her form first though: having missed the cut in Alabama she has pulled her socks up to rack up the following form figures: 15-9-8.

Both her last two starts could have been much better but for her inability to break par in the final round.

But she has completed two wins in the last two seasons (at Panther Creek and Blackhawk) so she is not afraid to cross the winning line.

As I hinted above, she also has form on the Champions course - she was joint winner of Q-school in 2006, albeit they only played that layout twice that year.

There is plenty in her favour so I'll take the 40/1.

Final pick is Paula Creamer who is one of the Americans struggling to win in 2009, but who might find herself motivated by Michelle Wie's debut triumph - after all she didn't finish too far away in second place.

A recent fourth place finish at Torrey Pines is of interest (it is one of the US Open courses Rees Jones has re-designed), as is the fact she trounced the Q-school field in 2004 by five shots (but her win involved playing the Champions course even fewer times than Lewis and Kim - just the once in her case).

What also interests me with Creamer is the fact that her coach David Whelan is a short-game expert and the two often talk about the needs and requirements of each venue in a manner reminiscent of Phil Mickelson and Dave Pelz.

Rees Jones courses, with their run-off areas and large, undulating greens call for a careful strategy and the Creamer/Whelan partnership might find one.

Add in her habit of making the top five in 33% of her career starts (and in 9 of 22 starts this year) and 16/1 is not a bad price.

Hey all!

2009-11-17T09:32:00.002+01:00

Hi everyone!

It's been a long time since I've signed in, this is because I lost my password and my account stopped working.

Here's an update on my scoli!

Curves

Top: 19 degrees

Bottom: 16 degrees

My half yearly check-up is in exactly a week! For the first time I am going to get an x-ray of my hand to see how much more bone development I have left. It's estimated I'll be done with my brace early 2011.

Recently, I had had the WORST brace scars ever. My hips are red and hurt when I sit too long. the low side of my brace is digging into my ribs and now I have a terrible rash there. It's so embarassing.

any advice? I'm going to the doctors tomorrow.

Tonsillar Ectopia in AIS - Pathogenic - Prognosis

2009-11-16T18:11:00.002+01:00

Scoliosis Journal reported on tonsillar ectopia in adolescent idiopathic scoliosis: does it play a role in the pathogenesis and prognosis or is it only an incidental finding?

Authors: Kasim Abul-Kasim, Angelica Overgaard, Magnus K. Karlsson and Acke Ohlin

Published: 12 November 2009
Abstract (provisional)

Background
There is an ongoing controversy about the significance of tonsillar ectopia among patients with adolescent idiopathic scoliosis (AIS). Aim: To find out if tonsillar ectopia occurs more frequently among patients with AIS and if it plays any etiological or prognostic role in AIS. Study design: Retrospective study.

Methods
Retrospective analysis of 155 consecutive spine MRIs (79 patients with AIS and 76 controls; aged 7-25 years; 55 % were female) with regard to the position of the cerebellar tonsils in relation to foramen magnum and the sagittal diameter of foramen magnum. All images were evaluated independently by two neuroradiologists. Interobserver reliability analysis was performed by calculation of kappa-value, intraclass correlation coefficient, and systematic and random errors. The occurrence of tonsillar ectopia among patients with AIS and controls was estimated and the association of tonsillar ectopia with different predictors has been tested. Statistical significance was set to P [less than or equal to] 0.05.

Results
The interobserver agreement with regard to the occurrence of tonsillar ectopia was almost perfect (kappa 0.84, 95 % CI 0.74-0.93). Tonsillar ectopia was found in 37 % of patients with AIS compared with 13 % among controls (p < 0.001 and odds ratio of 3.8). The occurrence of tonsillar ectopia was not associated with the severity of scoliotic deformity (p=0.85), or rapid progression of scoliosis (p=0.76). Neurological deficit occurs twice as frequently in patients with tonsillar ectopia as in those with no tonsillar ectopia. Two of five patients with tonsillar ectopia showed improvement of their neurological deficit after the surgical correction of scoliosis.

Conclusion
As tonsillar ectopia is significantly more frequent among patients with AIS and may exhibit some prognostic utility in patients with neurological deficit, we conclude that tonsillar ectopia may play a role in the development of the deformity in some patients with AIS. However, occurrence of tonsillar ectopia among 13 % of controls precludes stating a definitive role of ectopia in the pathogenesis of AIS. Some patients with AIS, tonsillar ectopia and neurological deficit showed neurological improvement following the surgical correction of scoliosis.

Download the PDF file and read more about the outcome of tonsillar ectopia in adolescent idiopathic scoliosis: does it play a role in the pathogenesis and prognosis or is it only an incidental finding?

Back Braces - Scoliosis - Study

2009-11-16T17:48:00.003+01:00

Study looks at whether back braces offer benefit for scoliosis

Author: Blythe Bernhard

Kelli Sargent, a seventh-grader from Belleview, Mo., takes off the back brace she wears to treat her scoliosis as she gets ready for basketball practice. (Emily Rasinksi/P-D)

Scoliosis screenings in middle schools find thousands of teenagers with curved spines each year.

What happens next isn't as well planned.

Treatment for scoliosis hasn't changed in five decades — if the spine is curved to a certain degree, the teenager gets a back brace. But research has not conclusively proved the benefits of the braces.

Some young people who don't wear a brace never have any problems and their curves never worsen. Others wear the braces for years and still end up needing back surgery.

A long-term study at Washington University and more than 20 other research centers hopes to figure out why.

"If we can say that bracing doesn't change (the progression of a spinal curve) then it's a treatment regimen that we shouldn't offer," said Dr. Matthew Dobbs, a pediatric orthopedic surgeon and lead investigator at Washington University. "Why do school screenings? Why identify a child with a small curve and put them through years of bracing if it's not going to alter natural curve?"

Half of the participants in the study will receive back braces to wear at least 18 hours a day, and the other half won't wear braces. Both groups will receive regular X-rays to check their spinal curves.

Braces aren't thought to correct the curves but to prevent progression.

"But again we have no data to support that, despite all of us doing this for years and years and years," Dobbs said. "We don't know what the best treatment is; we don't know who's going to progress."

Curves that progress to 50 degrees — about 10 percent of cases — are generally thought to require spinal fusion surgery.

Dobbs predicts the research will show that certain patients benefit from bracing and others don't, depending on the type of spinal curve.

Adolescent idiopathic scoliosis occurs in about one in 1,000 teenagers, and is 10 times more common in girls. It can cause back pain, and in severe cases can affect heart and lung function.

The cause is unknown, although Dobbs and other researchers are studying the disorder's genetic factors.

Most states conduct scoliosis screenings by checking students' backs, typically in sixth and eighth grades. The Missouri health department estimates that 84 percent of schools voluntarily perform the checks. A bill working through the Illinois legislature would require the checks.

Smaller spinal curves are typically monitored by a doctor, but patients whose curves reach between 20 and 40 degrees are usually recommended for back braces.

If it's found that fewer teens need braces, the research could save money on treatments plus spare some teenagers the psychological stress of wearing a brace.

Braces are "mostly put on young teenage girls who are very concerned about appearance in general and don't want anything that makes them look different," Dobbs said.

That's why patients in the study are also monitored psychologically to see how they're handling the brace.

"If we see a child in the study who dips on their mood and mental health during the study, we need to figure out what's going on," Dobbs said.

Kelli Sargent of Belleview, Mo., has worn a brace for 20 hours every day since January, after doctors measured a 27-degree curve in her spine.

The seventh-grader hasn't let scoliosis keep her from activities including volleyball and basketball, which she plays without the brace.

But starting middle school this fall was sometimes tough when new kids asked Kelli about the brace. She also had to start changing for gym class, making it obvious that she wears it.

But "if you just act like it's no big deal," then other kids will too, she said.

Kelli does have a difficult time picking up books from the bottom of her locker and tying her shoes, because the brace can dig into her upper thighs when she bends. And now she has to buy jeans and tops a little bit bigger to fit over the brace.

Otherwise, she's gotten used to it and even nicknamed the brace "Shelly" since it feels like she's wearing a shell.

So, what do you think about bracing for Scoliosis? I believe that if a curve is caught in early years then perhaps bracing/exercise can be worth a shot, however, if a curve is found over 50º (like mine was), then I agree - why put older adolescents through the trauma when surgery could well be a better outcome? Take part in our poll, which you find situated on the left.

Brunei Carrying Out Scoliosis Surgery Independently

2009-11-16T15:40:00.002+01:00

Author: Melvin Jong

Bandar Seri Begawan - Brunei is expected to carry out its own scoliosis (side-bending of the spine) surgeries independently, without the aid of any foreign institutions in the next one to two years, said the chairman of AO Spine Asia-Pacific yesterday.

Brunei receives about 20 reports of new scoliosis patients each year, most of which occur in teenage girls.

Hong Kong-based KV Menon told The Brunei Times that Raja Isteri Pengiran Anak Saleha (Ripas) Hospital's neurosurgeons are now capable and have already performed some 30 scoliosis surgeries under foreign supervision and expertise.

"I think Brunei should be able to perform right now because the Neurosurgery Department in Ripas have actually been performing these surgeries with us for over two years now," he said on the sidelines of the International Workshop on Scoliosis at Ripas from November 9-15.

"Maybe we can come once or twice again to generally supervise. The surgical technique is something that they are very confident with at the moment, maybe we can just help with a little of the planning and preparation work," said Menon, adding that there is currently no accreditation system for scoliosis surgery anywhere in the world, apart from spinal surgery accreditation.

According to the chairman, AO Spine visited Brunei for the first time in 2007 when they realised that several of the scoliosis patients had to be sent overseas due to the lack of know-how in Brunei. "This is a major expense for the patients and their families so we thought, why don't we come in and help you do this programme?" he said.

"I came in and performed three or four surgeries, basically to study the environment. We realised we can perform the surgery here very effectively as we have everything that is needed," said Menon, who explained that this led to a programme held twice a year in the

Sultanate to help train Brunei's surgical team.

Ripas Consultant Neurosurgeon Dr Maroon M Pillay said that Brunei diagnoses about 15 to 20 new cases of scoliosis a year on average, a ratio consistent with the rest of the world.

"They are mostly teenage girls and we still have no definite answer why this is so," he said. "There are a lot of theories and studies being done but no one has come up with a clear answer yet."

If left untreated, scoliosis could lead to tilting of the body, leading to not only bad appearances but also breathing difficulties, he said.

A total of 12 individuals from countries such as India, China, Iran and Nepal, participated in the workshop held with the main objective of knowledge transfer. "Scoliosis surgery is not routinely done, so many young surgeons are not exposed to scoliosis surgery," said Dr Pillay.

"Those who want to perform it will have to go through formal training and the goal of this workshop is to transfer this training onto them," he added.

Peng Yan and Rohit Kumar Pokharel, participants of the workshop from China and Nepal respectively, agreed that the workshop has considerably increased their knowledge on scoliosis and that this knowledge will be helpful for both them and their students back in their countries. They also agreed that they found the pre-operation planning training most useful.

"Before you do the operation, you will need to know some rules to guide you to perform the correct surgery. Sometimes if we don't grasp this knowledge, we might choose the wrong approach that might lead to negative results. This workshop has shown us how we can develop a good plan for better results," said Peng.

All these (planning) is essential to allow us to decide ourselves what is the best course of surgery," added Pokharel.

AO Spine is a non-profit foundation which started over 50 years ago to allow an association of surgeons to come together to develop new ideas and techniques for trauma surgery.

"Teaching young surgeons how to do things is our main job. We also develop new techniques, instruments and implants based on the research we do," said Menon.

Based in Switzerland, AO Spine currently boasts a membership of over 4,000, with 1,100 in Asia alone.-- Courtesy of The Brunei Times

Muscle Spasm and Pain

2009-11-10T17:05:00.004+01:00

Which came first, the muscle spasm or the pain?

Every muscle in your body is attached to a bone, but just like the chicken and the egg, a muscle spasm can cause pain and pain can cause a muscle spasm!

Often, when we experience pain a muscle spasm pulls nearby joints out of place, causing a condition known as joint sublaxation. Similarly, if a joint is sublaxated, nearby muscles may spasm in response.

Does it matter which happened first?
Usually, by the time pain has caused you to look for help from the doctor or therapist the cycle of pain and spasm has already begun. Pain causes spasm which pulls joints out of alignment, which more spasm and more pain!

Ultimately, the body accommodates to this cycle and the muscles stay tightened in the contracted state. After two days of spasm, the muscles will adapt to their new unnatural painful state and resist relaxation. The pain may even subside a bit during this adaptation, but now the body is adjusting to the muscles and the joints that are now in improper positions. Individuals can live for years unaware of the problem (as I did!). Many people only seek help when the pain becomes intolerable.

The longer that a muscle is in spasm, the longer it takes to treat the area that is sublaxated. The muscle tissue actually resists the normal relaxed position of the bones. Therefore the longer the condition has been tolerated the more treatments are likely to be required, but not necessarily with all people. Once the pain and spasm cycle has been broken, your muscles can return to their natural pain free state.

Muscle Spasm & Other Conditions
Muscle spasm in specific muscles can have other effects on the body. For example, if the muscles of the neck go into spasm, it can lead to muscle tension headaches. Spasm in the scalene muscles (in the front of the neck) can put pressure on nearby nerves and blood vessels, resulting in numbness, pain or tingling in the arms or hands. Spasms of the small piriformis muscle in the buttocks can cause sciatica pain. If the diaphragm muscle spasms, hiccups may result.

When muscles in the bask spasm, spinal bones can be pulled out of alignment and the result can be interference with nerve function. Imbalances in the muscle groups can also lead to poor posture, which can cause further complications.

There are many conditions that result from these muscle spasms throughout the body. Also, once these conditions become normal for the body, other pressures will be place on internal organs giving rise to a mountain of further imbalances in the body.

Exercises to:
Treat Sciatica
General Mobility Exercises
Neck Exercises

We will continue this thread on Muscle Spasms and Pain and offer the best form of pain relief from experience with our members. If you have a particular treatment that you favour for muscle spasms, please write in and let us know!

The day-to-day issues

2009-11-06T09:58:00.009+01:00

Hey, fellow ScoNuts.

Sorry for my lack of posts, but minus the surgery, there's nothing very interesting about my day-to-day life. At least, nothing none of you aren't already painfully familiar with.

I moved in with my boyfriend, and he's being wonderful to me. He does everything for me, despite my protests; consequently, I have become even more sedentary (I didn't realize that was possible), so my pain has skyrocketed. I know I'm gaining weight, too. I still don't have insurance, but I have the option to buy a policy from the company that used to insure me. Of course, who's going to insure me with a spine like mine? At best, it'll be labeled a preexisting condition and excluded completely. So I have to apply and be approved for disability before I can go back to St. Louis, and God only knows how many years that will take.

Dr. Bones wanted me to wait ten more years, and now it looks like I might have to. :( I've got some tips about good disability lawyers, though, so I'm not without hope. I just know all too well how frustrating and drawn-out the process is.

My biggest problem now is trying to get stronger and healthier. Eating better is where I've decided start, then exercising. I have yet to find my exercise plan among all of the moving boxes. Everyone says walk, but I actually find that to be one of the most painful things to do, which leads to the issue of pain control. I really want to lose the extra weight I've been putting on and strengthen my muscles, which will lessen my pain, but the smallest things are excruciating to me now and make starting that process difficult.

I love my TENS unit, but the stickies are $60 a pack, and the way I use it, they don't last long. Insurance never covered much of the cost anyway, so I don't use the TENS much anymore. Thermacare heat wraps work great, but you can't adjust their position after you stick them on. I'm also starting to build up tolerance to my pills.

I've found having a drink to be an effective muscle relaxer, but it's not very practical as a long-term solution. And on, and on...

I'll try to post occasionally, but I don't feel like I have much to say now. I realized yesterday that I would be in St. Louis right now, had things gone differently. It's such a bummer. Catch me on Twitter, @oddcupcake. I'm a little bit more interesting there.

AIS - Nervous Systems

2009-11-04T23:13:00.002+01:00

Scoliosos Journal discusses the pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy.

Authors: R Geoffrey Burwell, Ranjit K Aujla, Michael P Grevitt, Peter H Dangerfield, Alan Moulton, Tabitha L Randell and Susan I Anderson

Published: 31 October 2009

Anthropometric data from three groups of adolescent girls - preoperative adolescent idiopathic scoliosis (AIS), screened for scoliosis and normals were analysed by comparing skeletal data between higher and lower body mass index subsets. Unexpected findings for each of skeletal maturation, asymmetries and overgrowth are not explained by prevailing theories of AIS pathogenesis.

A speculative pathogenetic theory for girls is formulated after surveying evidence including:
(1) the thoracospinal concept for right thoracic AIS in girls;
(2) the new neuroskeletal biology relating the sympathetic nervous system to bone formation/resorption and bone growth;
(3) white adipose tissue storing triglycerides and the adiposity hormone leptin which functions as satiety hormone and sentinel of energy balance to the hypothalamus for long-term adiposity; and
(4) central leptin resistance in obesity and possibly in healthy females. The new theory states that AIS in girls results from developmental disharmony expressed in spine and trunk between autonomic and somatic nervous systems. The autonomic component of this double neuro-osseous theory for AIS pathogenesis in girls involves selectively increased sensitivity of the hypothalamus to circulating leptin (genetically-determined up-regulation possibly involving inhibitory or sensitizing intracellular molecules, such as SOC3, PTP-1B and SH2B1 respectively), with asymmetry as an adverse response (hormesis); this asymmetry is routed bilaterally via the sympathetic nervous system to the growing axial skeleton where it may initiate the scoliosis deformity (leptin-hypothalamic-sympathetic nervous system concept = LHS concept).

In some younger preoperative AIS girls, the hypothalamic up-regulation to circulating leptin also involves the somatotropic (growth hormone/IGF) axis which exaggerates the sympathetically-induced asymmetric skeletal effects and contributes to curve progression, a concept with therapeutic implications. In the somatic nervous system, dysfunction of a postural mechanism involving the central body schema fails to control, or may induce, the spinal deformity of AIS in girls (escalator concept). Biomechanical factors affecting ribs and/or vertebrae and spinal cord during growth may localize AIS to the thoracic spine and contribute to sagittal spinal shape alterations.

The developmental disharmony in spine and trunk is compounded by any osteopenia, biomechanical spinal growth modulation, disc degeneration and platelet calmodulin dysfunction. Methods for testing the theory are outlined. Implications are discussed for neuroendocrine dysfunctions, osteopontin, sympathoactivation, medical therapy, Rett and Prader-Willi syndromes, infantile idiopathic scoliosis, and human evolution. AIS pathogenesis in girls is predicated on two putative normal mechanisms involved in trunk growth, each acquired in evolution and unique to humans.

Download the complete article as a PDF and read more about the pathogenesis of adolescent idiopathic scoliosis in girls - a double neuro-osseous theory involving disharmony between two nervous systems, somatic and autonomic expressed in the spine and trunk: possible dependency on sympathetic nervous system and hormones with implications for medical therapy

Disability Living Allowance Under Threat

2009-10-23T16:41:00.003+02:00

Senior minister confirms DLA is under threat

Published: 15 October 2009

The truth is finally out. A senior government minister this week confirmed to the House of Lords that axing DLA has definitely not been ruled out, directly contradicting care minister Phil Hope’s earlier claim that DLA is safe

Last month we reported that care minister Phil Hope had told a Disability Now reporter in an off-the-cuff exchange at the Labour Party conference that:

"DLA is not under threat and people can be very happy".

(“DLA is not under threat . . . be very happy” says government minister)

Since then, however, there has been an alarming lack of official confirmation that DLA is not one of the disability benefits that the government intends to axe in order to fund the proposed new national care service.

The reason for that lack of confirmation is now clear: Phil Hope's 'don't worry, be happy' statement does not reflect government policy.

Lord McKenzie of Luton, parliamentary under-secretary of state for the DWP, was responding to a question from veteran disability campaigner Lord Ashley of Stoke, who had asked which disability benefits the government are 'considering integrating into the wider social care budget in England'.

Lord McKenzie replied:

"At this stage, we do not want to rule out any options and so are considering all disability benefits."

Later in the same debate, Lord Low of Dalston specifically referred to the "reported statement by the Minister for Care Services that disability living allowance is not under threat" and asked for confirmation that neither component of disability living allowance "is being considered as a possible source of funding for social care".

Once again, Lord McKenzie’s response was in direct contradiction of Hope's "be very happy" statement:

"My Lords, as I said in answer to the first Question, currently no particular benefit is ruled out of consideration."

The minister did go on to add, somewhat cryptically:

"We are conscious of the fact that DLA is overwhelmingly used by people who are under 65, and obviously care needs are overwhelmingly for people who are older."

Whilst there is still much – deliberate – uncertainty around their precise intentions, Lord McKenzie's statement represents the first clear admission by the government that axing DLA is a real possibility.

Had it not been for the thousands of emails and letters sent by Benefits and Work campaigners to MPs, disability organisations and the Big Care Debate website there is no doubt that the threat to DLA would have remained hidden behind a curtain of political spin until it was too late to do anything about it.

Now the truth is finally and officially out in the open and there's still time to for you to act.

Post your comments on the Big Care Debate website

Sign the No 10 petition DLA & AA Petition

You can read the whole transcript of the short debate on the They Work For You website

Assessment of Angle velocity in girls with AIS

2009-10-23T16:30:00.003+02:00

ScoliosisJournal report about Correction: Assessment of angle velocity in girls with adolescent idiopathic scoliosis

Authors: Ferran Escalada, Ester Marco, Roser Belmonte, Esther Duarte, Josep Ma Muniesa, Roser Boza, Marta Tejero and Enric Cáceres

Publiushed: 10 October 2009

Background
Although it has been demonstrated that the peak height velocity (PHV) is a predictive factor of progression in adolescent idiopathic scoliosis (AIS), little is known about the usefulness of angle progression in clinical practice. The purpose of this study was to establish a relationship between height and angle velocities, as well as to determine if peak angle velocity (PAV) occurs at the same time than PHV.

Methods
A retrospective study of a cohort of girls with idiopathic scoliotic curves greater than 10°. Data of 132 girls who participated in a previous retrospective study about growth in AIS were used to calculate height and angle velocities. Relationship between height and angle velocities was estimated by the use of a Linear Mixed Model.

Results
PHV and PAV take place simultaneously 1 year before menarche in progressive curves managed with a brace in AIS. Changes in angle velocity are influenced by changes in height growth velocity, in such a way that as from 6 months post-menarche, height growth velocity in this group of girls estimates curve progression velocity (β-coefficient -0.88, p = 0.04).

Conclusion
As from 6 months post-menarche, there is an inverse relationship between height velocity and curve progression in the group of AIS girls with progressive curves managed with a brace. Because height velocity is decreasing from 1 year before menarche, this finding corroborates that at the end of puberty, there is still a risk of progression in this group of girls despite bracing. The assessment of both height and angle velocity might be useful in clinical practice at the time of assessing brace effectiveness and how long bracing has to be indicated.

Correction
After publication of this work [1], we noted that we inadvertently failed to include the complete list of all coauthors. The full list of authors has now been added and the Authors' contributions and Competing interests section modified accordingly.

Competing Interests
The authors declare that they have no competing interests.

Authors' Contributions
FE conceived and designed the study, performed analysis and interpretation of data, carried the assessments and gave final approval of the version to be published. EM contributed to acquisition, analysis and interpretation of data and was involved in drafting the manuscript. RBe contributed to design, analysis and interpretation of data and reviewed the article critically for important intellectual content. ED and JMM revised critically for important intellectual contents. RBo and MT contributed to acquisition of data and analysis. EC participated in its design, revised critically for intellectual contents and gave final approval of the version to be published. All authors read and approved the final manuscript.

Read more about the assessment of angle velocity in girls with Adolescent Idiopathic Scoliosis

Medical Marijuana: The Debate Continues

2009-10-12T11:49:00.002+02:00

Medical marijuana debate has multiple dimensions: medical, political, personal

Linda Yelvington rattles off her list of ailments: Severe scoliosis. A prosthetic hip. Cervical degenerative disc disease. DeQuerin’s syndrome in both wrists. Arthritis. Breathing problems from diminished lung capacity because of scoliosis.

The 54-year-old woman then rattles off a list of painkillers she has taken for her health problems.

Author: Derek Spellman

Linda Yelvington rattles off her list of ailments: Severe scoliosis. A prosthetic hip. Cervical degenerative disc disease. DeQuerin’s syndrome in both wrists. Arthritis. Breathing problems from diminished lung capacity because of scoliosis.

The 54-year-old woman then rattles off a list of painkillers she has taken for her health problems.

“None of them are working right,” Yelvington said of the legal drugs, listing some of their side effects.

It has been several months since she has taken her preferred painkiller — marijuana — because it's not legal in Missouri, USA.

She contends it works just as well, if not better, with fewer side effects. Yelvington, who started taking marijuana years ago, is well-versed in studies about marijuana's medicinal use.

Asked if the issue of legalizing marijuana for medical use is personal or political for her, she replied, “I think it’s a compassion issue.”

Activists, meanwhile, are gathering support for a statewide initiative that would ask Missouri voters to approve medical marijuana.

The forthcoming debate will likely have two dimensions — one medical and political. Both will be personal.

‘Not harmless’

On the medical debate, both sides cite research and a roster of supporters to back their claims.

A local physician said a lot depends on whether the discussion is about someone who is terminally ill and in agony or whether it is about someone who will have to deal with the long-term effects of using the drug.

“Marijuana is not harmless,” added Matthew Miller, a medical oncologist from Freeman Health System.

The medical debate is also attended by a political debate about whether the marijuana issue is an act of compassion for the dying, or a Trojan horse for outright legalization of recreational use of the drug.

Yelvington, a member of the Joplin chapter of the National Organization to Reform Marijuana Laws (NORML), acknowledged that she would likely advocate for the outright legalization of marijuana even if she didn’t have medical problems. She also acknowledged that the debates over medical marijuana and outright legalization overlap.

Still, she and a number of activists said they believe the two issues can be separated to an extent. They also reject claims that one automatically leads to the other.

I must interject here: the people against Marijuana always claim that it will lead to Cocaine, Heroine, Crack etc. Let me throw a spanner into the works here, does tobacco lead to harder drugs? Smoking tobacco is worse than smoking THC's (found in Marijuana for pain). The people that move to harder drugs is usually due to something else not because they smoked dope - get real people! The people who are drug addicts are not usually people in chronic pain from an illness, all you need do is look around at the drug addicts and see for yourself! On another note the people who say we should not allow people in chronic pain to use Marijuana are usually pain free themselves so I ask -what do they know anyway? Are OTC drugs any better? Are the drugs prescribed by Drs any better for our health? Drs claim "drugs prescribed are herbal anyway because majority of the content is from a plant" well back at ya where Marijuana is concerned, this too is a plant that grows wild so why disallow people to use it?

But there are skeptics.

Notoriety
The Joplin area gained a measure of notoriety in recent years for marijuana activism. Joplin has been host to the Cannabis Revival and already seen one push to put a question to voters about lessening penalties for possession of the drug. That petition did not get the required number of signatures for the ballot.

Missouri Southern State University recently ranked No. 20 on High Times magazine's list of the top 20 colleges for marijuana activism. And earlier this year, the then-mayor of Cliff Village, south of Joplin, claimed that his board of trustees had passed a "symbolic" ordinance that would have legalized the drug inside the village for medical use, although a number of residents later disputed whether that ordinance was ever actually passed.

Yelvington, who moved to Goodman from Kentucky in March, said she first experimented with marijuana decades ago, as many others did.

"I didn’t equate it with pain relief at the time," she said, although in later years she said she discovered it worked better for her as an antiphlegmatic and for curbing depression and muscle spasms.

But now that she is lives in Southwest Missouri, she turns to legal painkillers.

"I have to, because I can’t have medical marijuana in Joplin," she said.

Yelvington said she has family in Missouri and she would like to stay, but she has not ruled out moving to California, Colorado or New Mexico, which have medical marijuana laws in place. Ten other states also allow some form of medical marijuana, according to NORML.

But even in states that have legalized medical marijuana, it is still technically illegal for doctors to prescribe their patients marijuana under federal law, according to Keith Stroup, the legal counsel and founder of NORML. Instead, in those states, patients must have proof that doctors "recommend" marijuana for their patients.

But the patient is still "left to your own imagination" in how they go about obtaining the marijuana, Stroup said.

A few states allow the operation of not-for-profit "dispensaries" that act as cooperatives to supply patients, but otherwise a patient either must grow the plant themselves, have a designated caregiver cultivate the plant or obtain it on the black market, Stroup said.

Even patients in those 13 states who use medical marijuana are still violating federal law, Stroup said. The practical effect, though, is one of sparing the patients from penalties under local and state laws, which spares them from federal investigation. More than 99 percent of marijuana cases are handled on the state and local level, he said.

I hope this lady wins her fight against medical marijuana and I also hope the people who are against can just stop to think for one minute how they would cope if they had chronic pain to fight every day they woke up!

I had Scoliosis surgery 20 years ago and I have suffered as a result ever since, all I have ever been offered is pills, pills and more chuffing pills. I have tried marijuana for pain and have to agree that it works better for muscle spasms (a common complaint of mine).

Well, crap.

2009-10-02T07:50:00.003+02:00

Well, my fame as a blogger seems to be short-lived. Unfortunately I've lost my health insurance, and I won't be having surgery after all. I found out about two weeks ago, but it's been hard to organize my thoughts since then. At first I was extremely relieved, which really surprised me. I hadn't realized I was that scared. Now I'm just crushed. I'm really depressed about it. I had a muscle spasm an hour ago, and it lasted over 15 minutes. I can finally move again, but it's still hurting. Oh, well. Dr. Bones wanted me to wait ten years anyway. Hopefully Dr. STL will still be practicing in ten years.

Brace Treatment: Scheuermann's Disease

2009-09-30T15:29:00.002+02:00

Scoliosis Journal report about brace treatment for patients with Scheuermann`s disease - a review of the literature and first experiences with a new brace design

Authors: Hans-Rudolf Weiss, Deborah Turnbull and Silvia Bohr

Published: 29 September 2009

Background
In contemporary literature few have written in detail on the in-brace correction effects of braces used for the treatment of hyperkyphosis. Bradford et al. found their attempts effective, treating Scheuermann's kyphosis with Milwaukee braces, but their first report did not specifically focus on in-brace corrections. White and Panjabi's research attempted to correct a curvature of > 50 degrees with the help of distraction forces, but consequently led to a reduction in patient comfort in the application of the Milwaukee brace. In Germany they avoid this by utitlising braces to treat hyperkyphosis that use transverse correction forces instead of distraction forces. Further efforts to reduce brace material have resulted in a special bracing design called kyphologicTM brace. The aim of this review is to present appropriate research to collect and evaluate possible in-brace corrections which have been achieved with brace treatment for hyperkyphosis. This paper introduces new methods of bracing and compares the results of these with other successful bracing concepts. Materials and methods 56 adolescents with the diagnosis of thoracic Scheuermann's hyperkyphosis or a thoracic idiopathic hyperkyphosis (22 girls and 34 boys) with an average age of 14 years (12-17 yrs.) were treated with the kyphologicTM brace between May 2007 and December 2008. The average Stagnara angle was 55,6 degrees (43-80). In-brace correction was recorded and compared to the initial angle using the t-test.

Results
The average Stagnara angle in the brace was 39 degrees. The average in-brace correction was 16.5 degrees (1-40 degrees). The average percentage of in-brace correction compared to the initial value was 36%. The differences were significant in the t-test (t = 5.31, p < 0,001). To make these results comparable to other studies, the kyphosis angle of 25 degrees was set to 0 for our sample in order to achieve a norm value adapted (NVA) percentage of in-brace correction. By doing this a correction of 54.1% was achieved. There was no correlation between the percentage of in-brace correction and the age of the patient, but a highly significant correlation between percentage of in-brace correction and the initial Stagnara angle.

Discussion
If we assume that outcome of brace treatment positively correlates with in-brace correction, the treatment should be initiated before the curvature angle exceeds 50 - 55 degrees in a growing adolescent. In scoliosis bracing, if the average in-brace correction equals > 15 degrees, then it is predicted that the result will lead to a final correction. Applying this to hyperkyphosis patients, the average in-brace correction with this brace was also > 15 degrees. We therefore estimated to achieve a favourable outcome using this brace type (once compliance was attained) especially when comparing the correction effects achieved with this new approach to the correction effects reported upon using the Milwaukee brace. The latter brace has been shown to lead to beneficial outcomes in long-term studies with comparable in-brace corrections.

Conclusions
Conservative treatment of Scheuermann's hyperkyphosis in international literature is generally regarded as an effective treatment approach. Physiotherapy and bracing are the first-line treatments for this condition. An average in-brace correction of > 15 degrees as was achieved using the kyphologicTM brace predicts a favourable outcome. The kyphologicTM brace leads to in-brace corrections comparable to those of the Milwaukee brace, which has previously been shown to provide beneficial outcome in the long-term. A prospective follow-up study seems desirable before final conclusions can be drawn. Future studies should focus more on thoracolumbar and lumbar curve patterns, because these patterns may predict chronic low back pain in adulthood with reduced quality of life of the patients and high costs with respect to medical care and occupational sickness leave. Surgery according to international literature is rarely necessary in this condition.

Download the completed full version about brace treatment for patients with Scheuermann`s disease - a review of the literature and first experiences with a new brace design

ScoliScore (TM) - Axial Biotech

2009-09-28T17:38:00.005+02:00

Axial Biotech declared some news today via PRNewswire, I would like to share that with you. I don´t have much to say about this as I am no Dr!, however, Wow - I have been reading about DNA tests being linked to treatment for Scoliosis and disease progression but now it looks like we are really rocking!

I look forward to following Axial in their developments of DNA.

Axial Biotech Announces Commercial Availability of SCOLISCORE(TM) AIS Prognostic Test

The first marketed product of Axial's pipeline of personalized diagnostics for spine disorders

SALT LAKE CITY, Sept. 24 /PRNewswire/ -- Axial Biotech, Inc., a company personalizing spine care through the development of molecular diagnostics, announced today that its SCOLISCORE(TM) AIS Prognostic Test is now being made available to spine specialists in the United States. SCOLISCORE is a saliva-based genetic test designed to predict the risk of progression of scoliosis, an abnormal lateral curvature of the spine. Spine surgeons from 40 medical centers throughout the U.S. were introduced to the test and have been defining its clinical use since December 2008. DePuy Spine, Inc. will market the test for Axial and will feature SCOLISCORE at the Scoliosis Research Society (SRS) Annual Meeting taking place this week.

One hundred thousand children are diagnosed with scoliosis every year in the U.S. and must be followed on a consistent, often quarterly basis, to determine and assess disease progression. The SCOLISCORE Test is designed for male and female patients diagnosed with Mild (10-25 degree Cobb Angle) Adolescent Idiopathic Scoliosis (AIS) who are from 9 through 13 years of age, and who are self-reported as Caucasian (North American, South American, European, Eastern European, Middle Eastern, Southwest Asian Descent).

"The SCOLISCORE Test, along with other diagnostic testing and clinical examination, enables the physician to confidently recommend a personalized treatment regimen for each patient at the first sign of the disease," said John Climaco, president and chief executive officer of Axial Biotech. "SCOLISCORE and other tests in our product pipeline have the potential to completely transform treatment paradigms and ultimately to lead to improved and more efficient patient care."

The development of the SCOLISCORE Test required more than six years of development by Axial researchers and involved DNA samples collected from more than 9,500 individuals at more than 100 clinical sites throughout the world. SCOLISCORE utilizes 53 DNA markers found to be linked to the progressive form of scoliosis. To identify these DNA markers from nearly one million potential targets, Axial researchers leveraged its proprietary, world class genealogic database called GenDB, which contains information on more than 30 million ancestors and descendants of the original Utah pioneers. The test has been validated in three studies with approximately 800 patients with AIS.

"Axial is the first mover into molecular testing for spine disorders, representing a near-term opportunity that rivals the market size of diagnostics for breast cancer," added Climaco. "We have broken the code to scoliosis, and we are uncovering the important role genetics play in other spinal disorders. We are applying our research capability to identify genetic links that could potentially expand applications in scoliosis and also serve as a basis for a predictive test for the treatment of those suffering from degenerative disc disease."

About Axial Biotech
Axial Biotech, Inc. is advancing first-of-a-kind molecular diagnostics that answer key clinical questions in spine care, allowing for more accurate and personal treatment decisions for spine disorders. Axial markets the SCOLISCORE(TM) AIS Prognostic Test, the first and only test that utilizes the genetic blueprint of progressive scoliosis to enable physicians to identify which patients are likely to progress to a severe curvature. Using the same approach that led to the successful development of the SCOLISCORE AIS Prognostic Test, Axial is currently developing a predictive test for surgical outcomes for patients with degenerative disc disease. Axial is a privately held, venture-backed molecular diagnostics company founded in 2003 by a group of internationally recognized spine surgeons and geneticists.

SOURCE: Axial Biotech, Inc.

Superfoods?

2009-09-24T13:04:00.003+02:00

It’s really hard to tell what to eat these days, one minute something’s good for you, next it might just as well be poison.

Sales of blueberries, walnuts and spinach and other more esoteric things like goji berries, spirulina and chlorella have taken off in the past few years as, everywhere you look, something seems to be telling you about their particular 'health' benefits. Eat them, we're told, to help reduce the risk of cancer and heart disease. But where’s the science?

Actually, there is no definition of superfood. It gets applied to foods from oats to walnuts, spinach to yoghurt, turkey to watercress and beetroot. Meat and fish contain protein and other nutrients. Fruit and vegetables also contain essential vitamins, minerals and other phytochemicals (bioactive non-nutrient components) that are good for health. Labelling some as superfoods could give the impression that they are more health-enhancing than others.

The fruits and vegetables given the superfood tag tend to be high in antioxidants such as vitamin C. The flavonoids, responsible for the colour of dark fruits such as blueberries, and other plant chemicals such as beta-carotene, are also known for their antioxidant properties. This is why brightly coloured fruit and vegetables are considered especially beneficial.

Opinion, based on scientific research, is that because antioxidants are especially effective at combating free radicals - harmful molecules that damage cells and DNA and can contribute to ageing, heart disease and cancer - they make fruit and vegetables particularly good for health.
But phytochemicals, also present in less brightly coloured fruit and vegetables not classed as superfoods, could also act in other ways to protect against disease. Scientists investigating the different ways phytochemicals can act believe too much importance may have been attached to antioxidant activity, and not enough to the other beneficial effects of phytochemicals.

Can all these claims be legal? Following EU legislation introduced in 2007 to prevent unsubstantiated health claims being made for foods, terms such as 'superfood' have to be backed by evidence explaining why the food is healthy and no foods will be allowed to claim they are 'good for your heart', 'help lower cholesterol' or are one of the growing list of 'superfoods', without scientific backing.

During the period before the legislation comes into force, food producers must prove that any claims can be backed up by evidence. Products that are high in calcium, for instance, can legitimately claim that calcium is good for bones. Oats have been shown to help reduce cholesterol as part of a low-fat diet and this claim could be made on a product. So by this time next year, there may be a centralised list of approved claims available for all to use across the European Union.

Eating exotic foods may offer health benefits we don't yet understand. But just because they're eaten in other parts of the world where there is a lower incidence of certain diseases, however, doesn't mean that they'll give the same protection to those following a very different diet and lifestyle in the UK. It may also be that what's important is how a particular food works in combination with other foods.

Eating one so-called superfood to the exclusion of other fruit or vegetables may limit the benefits. Even if certain foods were proved to be much higher in nutrients than others, it's important to eat a range of foods because no food can be super on its own.

Most people fail to meet the target of five portions of fruit and vegetables a day. As long as we don't reject some fruit and vegetables in favour of more fashionable ones, publicity that encourages consumers to eat more fruit and vegetables is to be welcomed.

Scoliosis in Ireland - Hospital Wait Times

2009-09-22T13:52:00.002+02:00

The Irish Medical Times have reported about the backlog at the Crumlin Hospital. There are currently a backlog of 70 operations to correct spinal deformity and by February 2010 this backlog is expected to be cleared, with children due to be operated upon from later this month.

His report below gives a greater description of the situation, written by Gary Culliton

A new initiative to address the waiting list has been agreed between the HSE and Our Lady’s Children’s Hospital in Crumlin; Temple Street; Tallaght; and Cappagh National Orthopaedic Hospitals, in collaboration with consultant orthopaedic surgeons.
Click here

The surgery for the 70 patients, who have had all of their pre-operative assessments completed, will be undertaken at either of the four above hospitals ‘as appropriate, based on the particular clinical needs of each patient’, IMT has been informed.

The hospitals have communicated with the patients and their families regarding the arrangements.

According to the Dublin critical care paediatric ICU report published last year, which looked at the facilities in Temple Street, Tallaght and Crumlin hospitals, major structural deficiencies in the service remain, and campaigners point out these will not be resolved simply by clearing the waiting list.

While the HSE is aware of a chronic shortage of paediatric consultant anaesthetists at Crumlin, extra anaesthetic cover should allow surgical teams to increase productivity in the orthopaedic area by between 25-30 per cent.

According to sources at Crumlin, if the Executive was to sanction the appointment of key anaesthetic staff, throughput of scoliosis cases could reach two to three cases per week — the level needed to cope with current demand. However, specialist beds would also need to reopen, they add.

The hospital has raised funds through donations and work that its surgeons carry out in Cork. In addition, a company has offered to provide implants free of charge to 30 children — a benefit worth between € 300,000 and € 600,000.S

Angle Velocity in Girls with Adolescent Idiopathic Scoliosis

2009-09-22T13:28:00.004+02:00

Scoliosis Journal reported an assessment of angle velocity in girls with adolescent idiopathic scoliosis

Authors: Ferran Escalada, Ester Marco, Roser Belmonte, Esther Duarte, Josep M Muniesa, Marta Tejero, Roser Boza and Enric Caceres

Published: 16 September 2009

Background
Although it has been demonstrated that the peak height velocity (PHV) is a predictive factor of progression in adolescent idiopathic scoliosis (AIS), little is known about the usefulness of angle progression in clinical practice. The purpose of this study was to establish a relationship between height and angle velocities, as well as to determine if peak angle velocity (PAV) occurs at the same time than PHV.

Methods
A retrospective study of a cohort of girls with idiopathic scoliotic curves greater than 10o. Data of 132 girls who participated in a previous retrospective study about growth in AIS were used to calculate height and angle velocities. Relationship between height and angle velocities was estimated by the use of a Linear Mixed Model.

Results
PHV and PAV take place simultaneously 1 year before menarche in progressive curves managed with a brace in AIS. Changes in angle velocity are influenced by changes in height growth velocity, in such a way that as from 6 months post-menarche, height growth velocity in this group of girls estimates curve progression velocity (beta-coefficient -0.88, p= 0.04).

Conclusions
As from 6 months post-menarche, there is an inverse relationship between height velocity and curve progression in the group of AIS girls with progressive curves managed with a brace. Because height velocity is decreasing from 1 year before menarche, this finding corroborates that at the end of puberty, there is still a risk of progression in this group of girls despite bracing. The assessment of both height and angle velocity might be useful in clinical practice at the time of assessing brace effectiveness and how long bracing has to be indicated.

Download a full complete version in PDF about the Angle Velocity in Girls with Adolescent Idiopathic Scoliosis

Scoliosis Treatment of Thoraco Lumbar Curves

2009-09-21T21:48:00.004+02:00

Scoliosis Journal have reported about the treatment of thoraco-lumbar curves in adolescent females affected by idiopathic Scoliosis with a progressive action short brace (PASB): assessment of results according to the SRS committee on bracing and nonoperative management standardization criteria.

Authors: Angelo G. Aulisa, Vincenzo Guzzanti, Marco Galli, Carlo Perisano, Francesco Falciglia and Lorenzo Aulisa

Published: 18 September 2009

Background
The effectiveness of conservative treatment of scoliosis is controversial. Some studies suggest that brace is effective in stopping curve progression, whilst others did not report such an effect. The purpose of the present study was to effectiveness of Progressive Action Short Brace (PASB) in the correction of thoraco-lumbar curves, in agreement with the Scoliosis Research Society (SRS) Committee on Bracing and Nonoperative Management Standardisation Criteria.

Methods
Fifty adolescent females (mean age 11.8 +/- 0.5 years) with thoraco-lumbar curve and a pre-treatment Risser score ranging from 0 to 2 have been enrolled. The minimum duration of follow-up was 24 months (mean: 55.4 +/- 44.5 months). Antero-posterior radiographs were used to estimate the curve magnitude (CM) and the torsion of the apical vertebra (TA) at 5 time points :beginning of treatment (t1), one year after the beginning of treatment (t2), intermediate time between t1 and t4 (t3), end of weaning (t4), 2-year minimum follow-up from t4 (t5). Three situations were distinguished: curve correction, curve stabilisation and curve progression. The Kruskal Wallis and Spearman Rank Correlation tests have been used as statistical tests.

Results
CM mean value was 29,30 +/- 5,16 SD at t1 and 14,67 +/- 7,65 SD at t5. TA was 12.70 +/- 6,14 SD at t1 and 8,95 +/- 5,82 at t5. The variation between measures of Cobb and Perdriolle degrees at t1,2,3,4,5 and between CM t5-t1 and TA t5-t1 were significantly different. Curve correction was accomplished in 94% of patients, whereas a curve stabilisation was obtained in 6% of patients.

Conclusion
The PASB, due to its peculiar biomechanical action on vertebral modelling, is highly effective in correcting thoraco-lumbar curves.

Download a complete version of this as a PDF which talks about the treatment of thoraco-lumbar curves in adolescent females affected by idiopathic Scoliosis with a progressive action short brace (PASB): assessment of mentresults according to the SRS committee on bracing and nonoperative management standardization criteria.

Scoliosis: AIS Bracing and Exercises SOSORT

2009-09-10T20:02:00.003+02:00

ScoliosisJournal have reported on the effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: results according to the SRS criteria for bracing studies - 2009 SOSORT Award Winner

Authors: Stefano Negrini, Salvatore Atanasio, Claudia Fusco email and Fabio Zaina

Published: 4 September 2009

Background
The SRS criteria give the methodological reference framework for the presentation of bracing results, while the SOSORT criteria give the clinical reference framework for an appropriate bracing treatment. The two have not been combined in a study until now. Our aim was to verify the efficacy of a complete, conservative treatment of Adolescent Idiopathic Scoliosis (AIS) according to the best methodological and management criteria defined in the literature.

Methods
Study Design. Retrospective study. Population. We included all AIS patients respecting the SRS inclusion criteria (age 10 years or older; Risser test 0-2; Cobb degrees 25-40 degrees; no prior treatment; less than one year post-menarchal) who had reached the end of treatment since our institute database start in 2003. Thus we had 44 females and four males, with an age of 12.8+/-1.6 years at the commencement of the study. Methods. According to individual needs, two patients have been treated with Risser casts followed by Lyon brace, 40 with Lyon or SPoRT braces (14 for 23 hours per day, 23 for 21 h/d, and seven for 18 h/d at start), and two with exercises only (1 male, 1 female): these were excluded from further analysis. Outcome criteria. SRS (unchanged; worsened 6 degrees or more; over 45 degrees at the end of treatment; surgically treated; two years' follow-up); clinical (ATR, Aesthetic Index, plumbline distances); radiographic (Cobb degrees); and ISICO (optimal; minimal). Statistics. Paired ANOVA and t-test, Tukey-Kramer and chi-square test.

Results
Median reported compliance during the 4.2+/-1.4 treatment years was 90% (range 5-106%). No patient progressed beyond 45 degrees, nor was any patient fused, and this remained true at the two-year follow-up for the 85% that reached it. Only two patients (4%) worsened, both with single thoracic curve, 25-30 degrees Cobb and Risser 0 at the start. We found statistically significant reductions of the scoliosis curvatures (-7.1 degrees): thoracic (-7.3 degrees), thoracolumbar (-8.4 degrees) and lumbar (-7.8 degrees), but not double major. Statistically significant improvements have also been found for aesthetics and ATR.

Conclusions
Respecting also SOSORT management criteria and thus increasing compliance, the results of conservative treatment were much better than what had previously been reported in the literature using SRS criteria only.

Download the PDF for the full version of this study regarding the effectiveness of complete conservative treatment for adolescent idiopathic scoliosis (bracing and exercises) based on SOSORT management criteria: results according to the SRS criteria for bracing studies.