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Rvisitin Consrvativ anant tions or dioathic dolscnt coliosis


by: Christopher Murray, DC, DABCI


Musculoskeletal care in a primary care practice should be o concern to any health care proider. Back and neck pain is a common complaint and their etioloy can be multiactorial and potentially lie-threatenin. n any o these conditions it is imperatie to rule out the most serious causespatholoy, reer to appropriate specialist as needed, and treat any o these conditions in oce as appropriate. As natural health practitioners, e understand that many conditions are multiaceted and thereore are not amenable to one-dimensional approaches. This necessitates that the practitioner utilie science-based hole health treatment plans based o o obectie dianostic 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, oten ithout addressin the oundational causes o such conditions because the etioloical 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 preerably non-inasie, able to be alidated throuh obectieuantiable means, and are not cost prohibitie or the patient.


One idiopathic condition hich has been larely orotten by many in the conseratie health realm is adolescent idiopathic scoliosis (AS). Scoliosis is dened as bein a lateral curature o the spine. enerally speakin, scoliosis is not dened as such until the lateral spinal curature is 10 derees or more. Reports o incidence o scoliosis rane rom 4.5 o the population up to 12. Some scoliotic conditions do hae ell-dened, knon or primary causes, such as conenitalhemiertebra, myopathic as in the case o scoliosis attributed to muscular dystrophy, neuropathic as ound in many spinocerebellar deeneratie disorders, and other conditions. oeer, the maority o adolescent scoliosis (approximately 80) is considered idiopathic and not directly associated to neuropathic, myopthaic, conenital, or other primary causes.


AS occurs beteen 10-18 years o ae. Scoliotic cures in irls are 8 times more likely to proress than in boys. And it should also be noted that the most likely period or scoliosis to proress is rom ae 10 until the early teens. Perhaps another alarmin reality is that those ith AS may see their cures proress een throuhout adulthood. The act that scoliosis is common, is proressie in nature, and can be asymptomatic especially ith smaller


THE ORIGINAL INTERNIST NE 2016


less noticeable cures. This demands that conseratie proiders routinely screen or this serious spinal disorder, consider conseratie treatment approaches, and reer to other proiders as appropriate.


Traditional manaement o AS scoliosis has ocused on to main treatment approaches. For cures up to 25 derees a atch and ait approach is commonly employed. For those cures aboe 25 derees but less than 40 derees, conseratie manaement ith hard bracin is the norm. For those ith cures oer 40 derees, correctie surical care usin medical hardare, such as arrinton rods, is oten considered. O course, all o these eneral protocols are utilied ithin the context o the patient’s clinical picture, ae, cardiopulmonary inolement, etc.


Obiously surery is a less desirable orm o treatment because o the inasieness o the procedure. t should be noted that surical outcomes can be ariable, ith many patients still reportin pain ater surery. Some studies also indicate that post-surery scoliotic cures continue to proress. Bracin, hile less inasie, cosmetically is not appealin to many patients, and may be uncomortable to use or lon periods. And it is airly ell established that the best possible outcome o bracin is that the scoliotic cure doesn’t proress. Because o the obious shortalls o these traditional care approaches, this has led many in the health care eld to seek other conseratie care options. There must be other alternaties to atchin and aitin.


Conseratie care proiders are perect or ealuatin and manain scoliosis patients. Proiders must hae the dianostic trainin and scope to rule out underlyin patholoy, reer to other specialists as needed, and based on obectie ndins (radioraphy, lab testin, MR, etc.) prescribe hole health treatment prorams. Those ith AS do present to our oces, and e need to be prepared to oer conseratie care options, helpin them to obtain optimal hole-health unction.


hile carin or these patients, e most certainly need to monitor them or sins o complication rom the condition itsel. One obious complication ith scoliosis is the potential aects on the cardio-pulmonary system. Pulmonary hypertension and respiratory ailure may certainly occur in seere 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 oces and helps to identiy patients ho may need increased leels o care andor in pursuit o potential improement o their condition.


t is also ery likely that patients ith an unknon scoliotic condition ill present or other reasons besides scoliosis care. Durin the initial exam, a scoliotic condition may be identied or the rst time. Personally,  hae dianosed multiple patients ith scoliosis ho kne they had back andor neck problems but had no clue their condition as symptomatic o scoliosis. nortunately, many proiders don’t realie that conseratie care options, ones represented in the academic literature, are real iable


(Continued on page 65) 63


Assessin lun and


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