Our treatment differs significantly from the standard medical approach due to one single fact -- the standard medical approach does nothing to address the REASONS why the side-ways, Scoliotic-curves are there to begin with.  

The standard medical treatment neglects the other aspects of spinal biomechanics and neurological control, and attempts correction by utilizing traditional bracing and surgical fusions to forcibly straighten the Scoliotic curves.

*When referencing "traditional bracing" it is specifically referring to the Boston Brace, Milwaukee Brace, or similar TLSO brace, which is most commonly used in medical orthopedic Scoliosis bracing.  

Peer-Reviewed Research on Bracing and Scoliosis -- This packet focuses on negative aspects associated with the treatments of bracing and surgical fusion. It is approx 55 pages in length.  "Click Here"

For traditional hard bracing, the goal is simply to ‘stop’ the progression of the curves, not actually correcting or reducing them.  However, research shows that traditional Scoliosis brace treatment DOES NOT prevent or reduce the need for scoliosis surgery.  A study published in 2007, in the medical journal, SPINE, by Drs. Dolan and Weinstein, concluded that observation only (no treatment) or traditional scoliosis back bracing showed no clear advantage of either approach. Furthermore, one can not recommend one approach over another to prevent Scoliosis surgery.

They gave the recommendation for traditional bracing a grade "D" relative to observation only because of "troubling inconsistent or inconclusive studies on any level." [1]  In summary, there is very little quality research showing any advantage to using a traditional medically-prescribed hard brace over doing nothing at all (observation only).   [several examples of bracing can be seen to the right/above]For patients who undergo traditional bracing, many are instructed to wear the brace for up to 23 hours each day, only removing it for bathing and exercising.  It is also common for patients, male or female, to experience a significant amount of emotional distress as a result of having to wear the brace.  This would include the bullying by other students, decreased self-esteem due to negative self-thoughts, etc. 

Additionally, as you can see in the 3D CAT scans to the left, traditional bracing can cause an increase in the 'rib hump' deformity.   While attempting to use pressure against the rib cage to forcibly straighten out the abnormal Scoliotic curves, this can cause further deformity to the rib hump caused by the rotation of the spine.  

Finally, there is new research suggesting that traditional Scoliosis Brace treatment can cause long-term negative effects.  The main problem being addressed is the 'immobilization' of the spine due to the hard brace.  When a brace is worn, it prevents normal motion of the vertebra and discs in the area of the Scoliotic curves.

This restriction of motion causes problems, because these vertebral joints are designed to move.  The research suggests the potential damage to the vertebral discs which play an important part in the development of Scoliosis.  

"Disc deformity is a significant contributor to scoliosis, not specifically measured relative to vertebral deformity by cobb angle. Prevention of progressive disc deformity may require maintenance of mobility as well as reversal of loading asymmetry."  

"The disc wedging structural changes in human scoliosis may result from reduced mobility"

"Both vertebral and disc deformity contribute to the idiopathic scoliosis deformity, but the cobb angle measures both without distinguishing their relative magnitudes, which is approximately equal. Conversely, discs do not grow in height while adolescent deformity is progressing. It appears from a few studies that progression of scoliosis occurs initially in the discs and subsequently in the vertebrae. Nutritional compromise has been implicated premature disc degeneration on the concave (inside) side in scoliosis. Our rat tail model in which a curvature is imposed along with compression develops a 'structural' [Aka: permanent] disc deformity with tissue remodeling after 5 weeks, and we are studying the underlying mechanisms."  [2]

In conclusion, "...If bracing does not reduce the proportion of children with AIS who require surgery for cosmetic improvement of their deformity, it cannot be said to provide a meaningful advantage to the patient or the community." [2a]


An Update:  In the last few years, there have been some advancements in some specialty bracing for Scoliosis.  Some of our very own CLEAR doctors have been utilizing these specialized braces in an attempt to help support a patient with Scoliosis going through the active rehab CLEAR program.  The bracing is not a replacement for the active rehab plan, however, combined, the brace can give an extra level of support to some patients with unique challenges.  The difficult part is that these specialized braces are not available through regular orthopedic or medical doctors.  They are created custom by a few doctors and managed with very specific care.  One example is Dr. Janzen, a CLEAR doctor in California.  

For surgical fusion, metal hardware (such as rods) are connected to the bones of the spine, forcibly straightening the curves.  This type of procedure will fuse or immobilize a large section of vertebra, permanently preventing them from moving.  It is ultimately just trading one deformity for another (a curved, but flexible spine - for a straighter, but fused spine).  It’s not addressing the underlying problems.

Medical research actually shows that there is up to a 40% failure rate (revision rate) that requires additional surgeries for either removal of the failed hardware or treatment of life-threatening infections [3].  
Additionally, research shows that surgical-straightening of Scoliosis does not change or improve a high or low shoulder, which is often experience with a Thoracic or Cervico-Thoracic Scoliosis, in most cases [4]. 

These findings are incredibly important to consider because with a surgical-fusion procedure, it may give the appearance of correction due to the forceful straightening of the spine, but it will do little to alleviate the underlying biomechanical and neurological problems.  Since the biomechanical problems with the normal curves of the spine are left untreated, they will naturally worsen over time, causing additional or aggravating problems, such as pain or disability.  Although there is often a good track record for pain reduction during the first 5 years post-op, surgical fusions have approx. a 20 year lifespan, so considering many of the patients undergoing this are teens, there is a high chance for complications down the road.  To see for yourself, simply join a Scoliosis support group on Facebook, and you will see story after story of adults who are living with chronic pain as a result of a fusion surgery that occurred when they were younger.  
 

The image above is from a surgical fusion procedure for Scoliosis.  

These findings are incredibly important to consider because with a surgical-fusion procedure, it may give the appearance of correction due to the forceful straightening of the spine, but it will do little to alleviate the underlying biomechanical and neurological problems.  Since the biomechanical problems with the normal curves of the spine are left untreated, they will naturally worsen over time, causing additional or aggravating problems, such as pain or disability.  Although there is often a good track record for pain reduction during the first 5 years post-op, surgical fusions have approx. a 20 year lifespan, so considering many of the patients undergoing this are teens, there is a high chance for complications down the road.  To see for yourself, simply join a Scoliosis support group on Facebook, and you will see story after story of adults who are living with chronic pain as a result of a fusion surgery that occurred when they were younger.  

 An additional troubling aspect that we are continually seeing regarding medical treatments for Scoliosis is the false sense of a ‘cure’ for the condition.  I’ve heard from several patients considering the spinal-fusion surgery that have been told by their surgeon, “…the surgery will fix your spine…” or that it will “…CURE your Scoliosis…”  

Regardless of the doctor’s intentions, they are giving false hope.  

After surgery, most patient's curves will increase despite the rods/hardware being implanted.  One research study describes patients with an average Thoracic Cobb angle of 53 degrees before surgery.  At a 2-year post-surgical follow up, the average was decreased to only 38 degrees (a 15 degree average improvement from the surgical fusion).   However, at a 20-year followup, the same curve average had increased to 
45 degrees.  That shows only an 8 degree long term improvement over the course of 20 years.  
This hardly constitutes an impressive treatment outcome for Scoliosis.  [5]

As I stated before, Scoliosis is a neurological disease, not simply a structural, skeletal disease, and does not have a “cure.”  There are different treatment options, with varying degrees of success, but ultimately no cure. Patients will have Scoliosis for their entire life.  

The good news is that by addressing the underlying biomechanical and neurological problems using the CLEAR Scoliosis treatment, Scoliosis can be controlled, and even corrected for many patients.

 

 

 

 

References:

1.   Spine 2007 Sep 1;32(19 Suppl):S91-S100.  http://www.ncbi.nlm.nih.gov/pubmed/17728687

2.   These statements are from a paper presented by Dr. Ian Stokes at the 2010 SOSORT Conference 
      (SOSORT is the Society on Scoliosis Orthopaedic and Rehabilitation Treatments)

2a.  Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine 2001 Jan 1;26(1)42-7 Children's Research 

       Center, Dublin, Ireland

3.   Cotrel-dubousset instrumentation for the correction of adolescent idiopathic scoliosis, Long-term results with an unexpected high revision rate.   

      Franz J Mueller and Herbert Gluch.  Scoliosis 2012, 7:13  http://www.scoliosisjournal.com/content/7/1/13

4.   Eur Spine J. 2013 Jun;22(6):1273-85. doi: 10.1007/s00586-013-2697-5. Epub 2013 Mar 1.  http://www.ncbi.nlm.nih.gov/pubmed/23455950

5.   Helenius et al: Comparison of long-term functional and radiologic outcomes after Harrington instrumentation and spondylodesis in adolescent 

      idiopathic scoliosis: a review of 78 patients. Spine (Phila Pa 1976). 2002 Jan 15;27(2):176-80

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