Rvisitin Consrvativ anant tions or dioathic dolscnt coliosis
by: Christopher Murray, DC, DABCI
Musculoskeletal care in a primary care practice should be o concern to any health care proider. Back and neck pain is a common complaint and their etioloy can be multiactorial and potentially lie-threatenin. n any o these conditions it is imperatie to rule out the most serious causespatholoy, reer to appropriate specialist as needed, and treat any o these conditions in oce as appropriate. As natural health practitioners, e understand that many conditions are multiaceted and thereore are not amenable to one-dimensional approaches. This necessitates that the practitioner utilie science-based hole health treatment plans based o o obectie dianostic data.
diopathic conditions are a conundrum or a ariety o medical and health care specialties. Treatments or many idiopathic conditions become ocused on addressin symptoms o the disease process, oten ithout addressin the oundational causes o such conditions because the etioloical actors are poorly understood or there is a lack o consensus on ho to treat or address oundational causes. Treatment approaches should be ounded in science- based approaches hich are preerably non-inasie, able to be alidated throuh obectieuantiable means, and are not cost prohibitie or the patient.
One idiopathic condition hich has been larely orotten by many in the conseratie health realm is adolescent idiopathic scoliosis (AS). Scoliosis is dened as bein a lateral curature o the spine. enerally speakin, scoliosis is not dened as such until the lateral spinal curature is 10 derees or more. Reports o incidence o scoliosis rane rom 4.5 o the population up to 12. Some scoliotic conditions do hae ell-dened, knon or primary causes, such as conenitalhemiertebra, myopathic as in the case o scoliosis attributed to muscular dystrophy, neuropathic as ound in many spinocerebellar deeneratie disorders, and other conditions. oeer, the maority o adolescent scoliosis (approximately 80) is considered idiopathic and not directly associated to neuropathic, myopthaic, conenital, or other primary causes.
AS occurs beteen 10-18 years o ae. Scoliotic cures in irls are 8 times more likely to proress than in boys. And it should also be noted that the most likely period or scoliosis to proress is rom ae 10 until the early teens. Perhaps another alarmin reality is that those ith AS may see their cures proress een throuhout adulthood. The act that scoliosis is common, is proressie in nature, and can be asymptomatic especially ith smaller
THE ORIGINAL INTERNIST NE 2016
less noticeable cures. This demands that conseratie proiders routinely screen or this serious spinal disorder, consider conseratie treatment approaches, and reer to other proiders as appropriate.
Traditional manaement o AS scoliosis has ocused on to main treatment approaches. For cures up to 25 derees a atch and ait approach is commonly employed. For those cures aboe 25 derees but less than 40 derees, conseratie manaement ith hard bracin is the norm. For those ith cures oer 40 derees, correctie surical care usin medical hardare, such as arrinton rods, is oten considered. O course, all o these eneral protocols are utilied ithin the context o the patient’s clinical picture, ae, cardiopulmonary inolement, etc.
Obiously surery is a less desirable orm o treatment because o the inasieness o the procedure. t should be noted that surical outcomes can be ariable, ith many patients still reportin pain ater surery. Some studies also indicate that post-surery scoliotic cures continue to proress. Bracin, hile less inasie, cosmetically is not appealin to many patients, and may be uncomortable to use or lon periods. And it is airly ell established that the best possible outcome o bracin is that the scoliotic cure doesn’t proress. Because o the obious shortalls o these traditional care approaches, this has led many in the health care eld to seek other conseratie care options. There must be other alternaties to atchin and aitin.
Conseratie care proiders are perect or ealuatin and manain scoliosis patients. Proiders must hae the dianostic trainin and scope to rule out underlyin patholoy, reer to other specialists as needed, and based on obectie ndins (radioraphy, lab testin, MR, etc.) prescribe hole health treatment prorams. Those ith AS do present to our oces, and e need to be prepared to oer conseratie care options, helpin them to obtain optimal hole-health unction.
hile carin or these patients, e most certainly need to monitor them or sins o complication rom the condition itsel. One obious complication ith scoliosis is the potential aects on the cardio-pulmonary system. Pulmonary hypertension and respiratory ailure may certainly occur in seere cases.1
cardiac unction, ia a multi-aceted approach, includin the use o base-line and ollo up spirometry testin and others tests, is standard in many oces and helps to identiy patients ho may need increased leels o care andor in pursuit o potential improement o their condition.
t is also ery likely that patients ith an unknon scoliotic condition ill present or other reasons besides scoliosis care. Durin the initial exam, a scoliotic condition may be identied or the rst time. Personally, hae dianosed multiple patients ith scoliosis ho kne they had back andor neck problems but had no clue their condition as symptomatic o scoliosis. nortunately, many proiders don’t realie that conseratie care options, ones represented in the academic literature, are real iable
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