spinal stenosis
Scoliosis of the spine is equally complex and confusing to doctors and patients alike. Over 80% of case have an unknown cause (idiopathic) and generally affects adolescent girls who may experience rapid spinal curvature increases by as much as 20 degrees per month during large growth spurts. Until recently, relatively ineffective spinal bracing and high-invasive spinal fusion surgery have been a patient's only treatment options.
The work we are doing is based on the fact that scoliosis is not just a spinal curvature, but involves abnormal spinal curves in the neck, as well as hip rotation. Active scoliosis patients always present with forward head posture and loss of cervical lordosis (seen on x-ray). There is also abnormal biomechanical mal-position of the head and neck. Therefore before the lateral scoliotic curvature can be corrected the cervical lordosis in the sagittal plane must be re-established. After which the lateral curve (Cobb angle) is reduced. These results are achieved with a combination of specific spinal adjustments done with instruments, specific rehabilitative procedures including proprioceptive neuromuscular re-education, muscle and ligament rehab and vibration therapy. The scoliotic spine compresses and rotates three dimensionally; therefore it must be de-rotated, and de-compressed in order to correct. We use, among other things, vibration platforms and a vibration scoliosis traction chair as well as specific bracing to pull the Cobb angle back into proper alignment.
Scoliosis is the body's natural and innate response to the loss of mechanical function provided by the normal curves of the spine. When these curves disappear, the body re-inserts them in another dimension. If scoliosis has a "cause," then it can only be described as the laws of physics.
Scoliosis is caused by a dysponesis (miscommunication) between the motor-sensory input/output from the upper trunk to the lower. This is in turn caused by a unilateral (one-sided) impairment of the spino-cerebellar loop, which is located in the area between the occiput and the first cervical vertebra. Supporting this theory is the fact that 100% of scoliosis patients have a problem with proprioception (orientation of the
body in time and space), and 100% of scoliosis patients have a loss of the curve in their neck, resulting in forward head posture.
Exercise rehabilitation therapy is mandatory to reverse the scoliosis. Without patient compliance, no amount of care can help. It is necessary to retrain the postural muscles of the body. Vibratory stimulation overrides the body's proprioceptive signals and mechanoreceptors, thus facilitating retraining of the postural muscles.
Cobb angles over 30 degrees cannot be reduced in the same manner as Cobb angles under 30 degrees. The muscles contract more on the convexity of the curve, rather than the concavity, as is the case with angles under 30 degrees. Normal laws of biomechanics do not apply in patients with Cobb angles of more than 30 degrees! One component is universally lacking in nearly all forms of scoliosis treatment today: the effect of the cervical spine in determining spinal pathology, gait, stance, and overall posture. The head controls all components of the spine below it, much like how the engine controls the direction of a train. Without regard for which direction the locomotive is heading in, how is it possible to control the boxcars behind it? The very first aspect that must be addressed in scoliosis correction is the cervical spine; specifically, correcting the forward head posture by restoring the curve and the normal ranges of motion in the neck, especially between the occiput (C0) and the atlas (C1).
This is why lateral cervical views in neutral, flexion, and extension are necessary. Follow-up x-rays should be performed roughly every three months as objective proof of improvement; should the patient's progress plateau or regress, additional rehabilitation or alterations to the protocol may be required. Obviously thoracic views are necessary to measure the Cobb angle, but stay away from full-spine views! The rate of distortion is too high to allow for consistency and accuracy when comparing measurements between pre-and post-x-rays. It is also important to evaluate the curve in the low back, and rotation in the hips with lateral and A-P lumbar x-rays, and correct any deviation from normal that is found.
Dr Brian T Dovorany
Dr Clayton J Stitzel
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