Your child and scoliosis

Scoliosis is a fixed lateral curvature of the spine. Frequently noted in adolescents, it is often picked up in "school screening" where a nurse evalautes a childs aligjnment on a forward bend test, and a note is sent home that the child needs evaluation for scoliosis. There are a number of causes of scoliosis and the natural history and treatment differ depending on the cause. Thus, it is important to understand the cause of your child's scoliosis before embarking on a treatment.

Scoliosis may be caused by severe muscle weakness (such as in muscular dystrophy), neurological abnormalities (such as cerebral palsy), spinal cord abnormalities (such as a syrinx which is an abnormal fluid filled cavity within the spinal cord), or congenital abnormalities in the way the bones of the spine are put together (referred to as "congenital scoliosis"). Finally, the most common cause of scoliosis is termed "idiopathic," meaning that the cause is "peculiar to the individual." Approximately 80% of scoliosis that comes into a physician's office is "idiopathic," and only about 30% of these idiopathic curves progress (get worse).

Because there are different types of scoliosis, the behavior and problems that result differ dependent on the cause. For instance, the curvature that occurs in severe cerebral palsy occurs in the lower spine (thoraco-lumbar or lumbar curves) that cause difficulty sitting and may result in pain. However, they do not generally cause problems with the heart or lungs.

While the causes of idiopathic scoliosis remain elusive, there are a number of things that we do know about it. Idiopathic scoliosis can run in families and thus there is some genetic influence. While the gene (or more likely, genes) involved have yet to be defined, we are likely to have a much better understanding of the inheritance of scoliosis soon. There are some patients that have subtle neurological abnormalities, such as abnormal perception of horizontal or abnormal nystagmus (the little flicker that the eyes make when they move side to side). It is unclear if these are a cause of idiopathic scoliosis or a result of the curve. In the future, we may find that "idiopathic" scoliosis is actually a number of different diseases, each of which has its own natural history.

It is also important to recognize that idiopathic curves behave differently depending on their location, the patient's age, and the size of the curve. Curves in the thoracic (chest) region are the most common. They generally result

in a narrowing of the chest wall (a result of rotation of the vertebral body and resulting deformity of the ribs). If the curve is small (less then 40 degrees) by the time the child reaches skeletal maturity, it is not likely to worsen as an adult. Generally, once the thoracic curve gets over 50 degrees, it is like the Leaning Tower of Pisa, and will continue to worsen with time, potentially resulting in problems with the heart and lungs.Thus, if a thoracic curve reaches 50 degrees or more, most surgeons would recommend that the patient undergo surgery to prevent further worsening

Scoliosis is a fixed lateral curvature of the spine. Frequently noted in adolescents, it is often picked up in "school screening" where a nurse evalautes a childs aligjnment on a forward bend test, and a note is sent home that the child needs evaluation for scoliosis. There are a number of causes of scoliosis and the natural history and treatment differ depending on the cause. Thus, it is important to understand the cause of your child's scoliosis before embarking on a treatment.

Scoliosis may be caused by severe muscle weakness (such as in muscular dystrophy), neurological abnormalities (such as cerebral palsy), spinal cord abnormalities (such as a syrinx which is an abnormal fluid filled cavity within the spinal cord), or congenital abnormalities in the way the bones of the spine are put together (referred to as "congenital scoliosis"). Finally, the most common cause of scoliosis is termed "idiopathic," meaning that the cause is "peculiar to the individual." Approximately 80% of scoliosis that comes into a physician's office is "idiopathic," and only about 30% of these idiopathic curves progress (get worse).

Because there are different types of scoliosis, the behavior and problems that result differ dependent on the cause. For instance, the curvature that occurs in severe cerebral palsy occurs in the lower spine (thoraco-lumbar or lumbar curves) that cause difficulty sitting and may result in pain. However, they do not generally cause problems with the heart or lungs.

While the causes of idiopathic scoliosis remain elusive, there are a number of things that we do know about it. Idiopathic scoliosis can run in families and thus there is some genetic influence. While the gene (or more likely, genes) involved have yet to be defined, we are likely to have a much better understanding of the inheritance of scoliosis soon. There are some patients that have subtle neurological abnormalities, such as abnormal perception of horizontal or abnormal nystagmus (the little flicker that the eyes make when they move side to side). It is unclear if these are a cause of idiopathic scoliosis or a result of the curve. In the future, we may find that "idiopathic" scoliosis is actually a number of different diseases, each of which has its own natural history.

It is also important to recognize that idiopathic curves behave differently depending on their location, the patient's age, and the size of the curve. Curves in the thoracic (chest) region are the most common. They generally result

in a narrowing of the chest wall (a result of rotation of the vertebral body and resulting deformity of the ribs). If the curve is small (less then 40 degrees) by the time the child reaches skeletal maturity, it is not likely to worsen as an adult. Generally, once the thoracic curve gets over 50 degrees, it is like the Leaning Tower of Pisa, and will continue to worsen with time, potentially resulting in problems with the heart and lungs.Thus, if a thoracic curve reaches 50 degrees or more, most surgeons would recommend that the patient undergo surgery to prevent further worsening

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Tritrichomonas foetus Infection in Cats

Gookin JL, Stauffer SH, Dybas D et al: Documentation of In Vivo and In Vitro Aerobic Resistance of Feline Tritrichomonas foetus Isolates to Ronidazole, J Vet Intern Med 24:1003, 2010.


One cause of chronic large bowel diarrhea in cats is a protozoal pathogen called Tritrichomonas foetus. Estimates indicate that up to 30% of purebred show cats and 29% of cats with clinical signs of infection are infected with this organism in the United States. Trichomonads like T. foetus are susceptible to the effects of 5-nitroimidazole drugs because they utilize reductive metabolic pathways. Ronidazole is the only drug demonstrated as effective for treatment of cats infected with T. foetus and resistance to ronidazole has not been reported previously. In this study, two intact male Abyssinian cats with T. foetus were found to have resistance to increasing dosages of ronidazole. Treatment with multiple courses of metronidazole and tinidazole also did not eradicate the infection. The true prevalence of treatment resistance in the infected cat population is not known. A persistent infection in treated cats should be confirmed by the results of follow-up testing rather than assumed on the basis of clinical signs. Cats should be isolated from sources of re-infection. Cross-resistance among 5-nitroimidazole drugs has been described and the current lack of alternative drugs that have clinical efficacy against feline T. foetus suggests the need for an active investigation of other treatment approaches. [VT]

Related articles:
Payne PA, Artzer M: The biology and control of Giardia spp and Tritrichomonas foetus, Vet Clin North Am Small Anim Pract 39:993, 2009.

More on cat health: Winn Feline Foundation Library
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Gookin JL, Stauffer SH, Dybas D et al: Documentation of In Vivo and In Vitro Aerobic Resistance of Feline Tritrichomonas foetus Isolates to Ronidazole, J Vet Intern Med 24:1003, 2010.


One cause of chronic large bowel diarrhea in cats is a protozoal pathogen called Tritrichomonas foetus. Estimates indicate that up to 30% of purebred show cats and 29% of cats with clinical signs of infection are infected with this organism in the United States. Trichomonads like T. foetus are susceptible to the effects of 5-nitroimidazole drugs because they utilize reductive metabolic pathways. Ronidazole is the only drug demonstrated as effective for treatment of cats infected with T. foetus and resistance to ronidazole has not been reported previously. In this study, two intact male Abyssinian cats with T. foetus were found to have resistance to increasing dosages of ronidazole. Treatment with multiple courses of metronidazole and tinidazole also did not eradicate the infection. The true prevalence of treatment resistance in the infected cat population is not known. A persistent infection in treated cats should be confirmed by the results of follow-up testing rather than assumed on the basis of clinical signs. Cats should be isolated from sources of re-infection. Cross-resistance among 5-nitroimidazole drugs has been described and the current lack of alternative drugs that have clinical efficacy against feline T. foetus suggests the need for an active investigation of other treatment approaches. [VT]

Related articles:
Payne PA, Artzer M: The biology and control of Giardia spp and Tritrichomonas foetus, Vet Clin North Am Small Anim Pract 39:993, 2009.

More on cat health: Winn Feline Foundation Library
Join us on Facebook
Follow us on Twitter

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A Review of my Book off the Internet

In my office in Sept 2010

Im happy that someone I have never met before is enjoying the research and effort I put into creating this book. I would like to sincerely thank the site owner or reviewer from Salton Yogurt Maker.. Diet and exercise has and will always be intrinsically associated to all aspects of health from your heart, brain and even the spine. The site and review:

http://www.saltonyogurtmaker.com/health-in-your-hands-your-plan-for-natural-scoliosis-prevention-and-treatment-1451568967.html

This is must have Health In Your Hands: Your Plan for Natural Scoliosis Prevention and Treatment (by CreateSpace) :
 
A brilliant book. This book was recommended to me by my chiropractor. I have had scoliosis since birth and for me I found the contents simply liberating. This is a book that takes a universal approach and looks at matters that most people wouldn't immediately link together. The chapters on diet and nutrition I found to be the most innovative as I have never come across a book that talks about what food people with spinal conditions should eat. The exercises were great too. Would highly recommend it to anyone who either suffers or wants to broaden his or her knowledge on the subject.

I have just finished reading Health In Your Hands. by Dr Kevin Lau and have had to run onto my computer to add my review. What a joyous experience it really was. Everyone must read this book. From start to finish I felt like my knowledge on scoliosis was being perpetually pumped to the point it would burst. Intense, detailed, thought provoking and revolutionary, what more would you possibly want from a book! Go and buy it.

Health in your hands.. Something tells me that I will be coming back to this book for sometime to come, Beautifully articulated with a profound sense of compassion that springs from every chapter. Lau is clearly an author who has devoted himself to understanding and in turn offering precise consultation on the subject of Scoliosis. Some very insightful chapters with tons of information on every aspect of the condition. A pleasure to read and will absolutely be going back to it.

A must read!!!!. I read this book from beginning to end in just 2 weeks. I don't think I have ever read a book that quick. Not only are the subjects relative to anyone who is interested in scoliosis but the books makes for great reading.

I particularly found the `Corrective Exercises for Scoliosis chapter a joy to read. It contained some brilliant pointers that I was previously unaware of. A fully accessible book that I highly recommend to everyone.

GREAT BOOK. I have been after a book like this for such a long time. It contains everything you would ever need to know about Scoliosis, from the condition itself, to appropriate foods, to a range of treatment and exercises that should be incorporated into the lives of scoliosis sufferers. I like the way it has been broken down into three easy to follow sections with clear indications as to the subject of each part. Really awesome book.

In my office in Sept 2010

Im happy that someone I have never met before is enjoying the research and effort I put into creating this book. I would like to sincerely thank the site owner or reviewer from Salton Yogurt Maker.. Diet and exercise has and will always be intrinsically associated to all aspects of health from your heart, brain and even the spine. The site and review:

http://www.saltonyogurtmaker.com/health-in-your-hands-your-plan-for-natural-scoliosis-prevention-and-treatment-1451568967.html

This is must have Health In Your Hands: Your Plan for Natural Scoliosis Prevention and Treatment (by CreateSpace) :
 
A brilliant book. This book was recommended to me by my chiropractor. I have had scoliosis since birth and for me I found the contents simply liberating. This is a book that takes a universal approach and looks at matters that most people wouldn't immediately link together. The chapters on diet and nutrition I found to be the most innovative as I have never come across a book that talks about what food people with spinal conditions should eat. The exercises were great too. Would highly recommend it to anyone who either suffers or wants to broaden his or her knowledge on the subject.

I have just finished reading Health In Your Hands. by Dr Kevin Lau and have had to run onto my computer to add my review. What a joyous experience it really was. Everyone must read this book. From start to finish I felt like my knowledge on scoliosis was being perpetually pumped to the point it would burst. Intense, detailed, thought provoking and revolutionary, what more would you possibly want from a book! Go and buy it.

Health in your hands.. Something tells me that I will be coming back to this book for sometime to come, Beautifully articulated with a profound sense of compassion that springs from every chapter. Lau is clearly an author who has devoted himself to understanding and in turn offering precise consultation on the subject of Scoliosis. Some very insightful chapters with tons of information on every aspect of the condition. A pleasure to read and will absolutely be going back to it.

A must read!!!!. I read this book from beginning to end in just 2 weeks. I don't think I have ever read a book that quick. Not only are the subjects relative to anyone who is interested in scoliosis but the books makes for great reading.

I particularly found the `Corrective Exercises for Scoliosis chapter a joy to read. It contained some brilliant pointers that I was previously unaware of. A fully accessible book that I highly recommend to everyone.

GREAT BOOK. I have been after a book like this for such a long time. It contains everything you would ever need to know about Scoliosis, from the condition itself, to appropriate foods, to a range of treatment and exercises that should be incorporated into the lives of scoliosis sufferers. I like the way it has been broken down into three easy to follow sections with clear indications as to the subject of each part. Really awesome book.

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How Effective is Scoliosis Surgery?

How effective is surgery for treating scoliosis anyway? Admittedly, it is a question with very subjective set of answers, so I thought it would be interesting to compare the benefits of surgical correction for scoliosis against the SOSORT rankings of most important scoliosis treatment outcomes.

Ranking Importance of factors in scoliosis according to SOSORT

1. Aesthetics ( I guess, if you don’t count the big scar going down the entire length of the patient’s back…cosmetic improvement IS the only indication for scoliosis surgery…”Correction of scoliosis is largely an elective cosmetic procedure in the young population, who account for the largest portion of the surgical population. Associated with the correction, however, is a very real possibility of major neurological injury, including paralysis.”)
SCOLIOSIS SURGERY: APPROPRIATE MONITORING. Tod B. Sloan MD, PhD. Anesthesiology Clinics of North America
Volume 15, Issue 3, 1 September 1997, Pages 573-592

2. Quality of life (Nope. Not with 40% of patients being legally defined as severely handicapped with in 17 years post surgery.)
Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrmentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

3. Psychological well-being (Nope. “The psychological health status is significantly impaired.”)
Quality of Life and Back Pain: Outcome 16.7 Years After Harrington Instrumentation
Spine 2002 Jul 1;27 (13) :1456-63 Gotze et al, Dept. of O Surg, Hamm,Germany

4. Disability (Nope. “40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons”
Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

5. Back Pain (Nope. “Standardized gradations of pain and function showed improvement over-all, but significant impairment remained. There was a reduction in the levels of peak and constant pain, but no change in the frequency of peak pain after operation. The number of patients who were pain-free after surgery was not increased…..In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to patients before the procedure is undertaken.”)
Results of surgical treatment of adults with idiopathic scoliosis.
J Bone Joint Surg Am 1987 Jun;69(5):667-75
Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME.

6. Rib hump (Potentially, some cases may require an additional rib resection surgery though….not a small procedure.)

7. Breathing function (Nope. “The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups.”)
Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and posterior instrumentation. Int Orthop 2001;25(2):66-0

8. Progression in adulthood (Nope. “Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life.”)

9. Needs of further treatments in adulthood (Nope. “40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons” )
Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

10 Knowledge and understanding of scoliosis in general and their specific pattern (Nope.)

11 Balance (Unknown, but probably not)

12 Scoliosis Cobb degrees (radiographic lateral flexion) (Yep)

13 Self control of posture (Nope.)

14 Movement of the vertebral column (sagittal plane) (Definitely NOPE)

15 Perdriolle degrees (radiographic rotation) (Yep, but to a lesser extent than cobb angle)

16 Kypho-lordosis Cobb degrees (radiographic lateral alignment) (Yep)

17 Sensory motor integration of the corrective ideal pattern (Nope)

18 Exercise efficiency (Nope.)

19 Equality of weight bearing (Perhaps a little?)

20 Improved body motor awareness and motor learning skills (Nope.)

21 Improved processing of vestibular input (Nope.)

Final total:

5 total positive outcome measures achieved.

14 total Negative outcome measures achieved.

2 unknown outcome measures

Overall: We need a better way!

How effective is surgery for treating scoliosis anyway? Admittedly, it is a question with very subjective set of answers, so I thought it would be interesting to compare the benefits of surgical correction for scoliosis against the SOSORT rankings of most important scoliosis treatment outcomes.

Ranking Importance of factors in scoliosis according to SOSORT

1. Aesthetics ( I guess, if you don’t count the big scar going down the entire length of the patient’s back…cosmetic improvement IS the only indication for scoliosis surgery…”Correction of scoliosis is largely an elective cosmetic procedure in the young population, who account for the largest portion of the surgical population. Associated with the correction, however, is a very real possibility of major neurological injury, including paralysis.”)
SCOLIOSIS SURGERY: APPROPRIATE MONITORING. Tod B. Sloan MD, PhD. Anesthesiology Clinics of North America
Volume 15, Issue 3, 1 September 1997, Pages 573-592

2. Quality of life (Nope. Not with 40% of patients being legally defined as severely handicapped with in 17 years post surgery.)
Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrmentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

3. Psychological well-being (Nope. “The psychological health status is significantly impaired.”)
Quality of Life and Back Pain: Outcome 16.7 Years After Harrington Instrumentation
Spine 2002 Jul 1;27 (13) :1456-63 Gotze et al, Dept. of O Surg, Hamm,Germany

4. Disability (Nope. “40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons”
Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

5. Back Pain (Nope. “Standardized gradations of pain and function showed improvement over-all, but significant impairment remained. There was a reduction in the levels of peak and constant pain, but no change in the frequency of peak pain after operation. The number of patients who were pain-free after surgery was not increased…..In view of the high rate of complications, the limited gains to be derived from spinal fusion should be assessed and clearly explained to patients before the procedure is undertaken.”)
Results of surgical treatment of adults with idiopathic scoliosis.
J Bone Joint Surg Am 1987 Jun;69(5):667-75
Sponseller PD, Cohen MS, Nachemson AL, Hall JE, Wohl ME.

6. Rib hump (Potentially, some cases may require an additional rib resection surgery though….not a small procedure.)

7. Breathing function (Nope. “The correlation between the change in Cobb angle and the thoracic volume change was poor for both groups.”)
Scoliosis curve correction, thoracic volume changes, and thoracic diameters in scoliotic patients after anterior and posterior instrumentation. Int Orthop 2001;25(2):66-0

8. Progression in adulthood (Nope. “Initial average loss of spinal correction post-surgery is 3.2 degrees in the first year and 6.5 after two years with continued loss of 1.0 degrees per year throughout life.”)

9. Needs of further treatments in adulthood (Nope. “40% of operated treated patients with idiopathic scoliosis were legally defined as severely handicapped persons” )
Gotze C, Slomka A, Gotze HG, Potzl W, Liljenqvist U, Steinbeck J. Long-term results of quality of life in patients with idiopathic scoliosis after Harrington instrumentation and their relevance for expert evidence. Z Orthop Ihre Grenzgeb 2002 Sep-Oct;140(5):492-8

10 Knowledge and understanding of scoliosis in general and their specific pattern (Nope.)

11 Balance (Unknown, but probably not)

12 Scoliosis Cobb degrees (radiographic lateral flexion) (Yep)

13 Self control of posture (Nope.)

14 Movement of the vertebral column (sagittal plane) (Definitely NOPE)

15 Perdriolle degrees (radiographic rotation) (Yep, but to a lesser extent than cobb angle)

16 Kypho-lordosis Cobb degrees (radiographic lateral alignment) (Yep)

17 Sensory motor integration of the corrective ideal pattern (Nope)

18 Exercise efficiency (Nope.)

19 Equality of weight bearing (Perhaps a little?)

20 Improved body motor awareness and motor learning skills (Nope.)

21 Improved processing of vestibular input (Nope.)

Final total:

5 total positive outcome measures achieved.

14 total Negative outcome measures achieved.

2 unknown outcome measures

Overall: We need a better way!

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Scoliosis Sufferers in India Now Have a Natural Solution

Residents in India can now purchase the scoliosis book at a site: http://www.flipkart.com/health-your-hands-kevin-lau-book-1451568967

Residents in India can now purchase the scoliosis book at a site: http://www.flipkart.com/health-your-hands-kevin-lau-book-1451568967

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