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Treating Scoliosis in Children

Treating Scoliosis in Children

Hello, everyone! Today we interviewed Dr. Mark Morningstar, a world-renowned scoliosis specialist who has worked extensively on the diagnosis, treatment, and management of all type of scoliosis. We explore the future of spinal curve treatment, and how comprehensive scoliosis management may soon become the norm. So without further ado, let's get started!

 

Q: Why have you dedicated your career to the research and treatment of scoliosis?

Dr. Morningstar: "I have always been a bit of a rehab-oriented clinician. Early in my career, people brought their children to me after being diagnosed with scoliosis, and having an orthopedic surgeon tell them to 'watch and wait.' Many parents didn't want to do that, understandably, so I started down a path of devising and implementing scoliosis treatment strategies that were more proactive and that even young children could perform and master. I think the research side of things is simply a natural extension of my personality. I remember being in school, and one of the first sayings I heard from a well-known MD at the time was, 'in God we trust, all others bring data.' That always stuck with me. I realize that research is not the end-all, be-all, but at least it gives 3rd party observation and confirmation of what we're doing, and whether or not we're on the right track."

 What is Research? - Purpose of Research

Q: Your research has been published extensively, what value does your research provide patients?

Dr. Morningstar: "Research gives people the ability to critically appraise information, and demonstrate that treatments, protocols, or models of care have some type of objective approval. Every doctor has success stories, and those are very meaningful. However, having research published, which peer reviewers have read and determined is worthy of publication, adds a distinct level of credibility to what you're doing. At the end of the day, it gives me the opportunity to tell parents, 'this is my work, it's been reviewed by other physicians and deemed credible.' It gives parents something empirical from which to base their child's scoliosis treatment and management decisions."

 

 

Q: How has your research translated into better scoliosis treatment?

Dr. Morningstar: "Publishing research on a consistent basis allows you to objectively look for patterns in the results of various studies you've published. By focusing on these patterns, we can better hone in on what treatments or management strategies are more successful for various patients and various scoliosis curve patterns. I think there are a lot of physical treatments out there that are good, the main issue is in determining which physical treatment would benefit each patient (even those with congenital scoliosis or neuromuscular scoliosis caused by cerebral palsy) the most. In addition, we're constantly working on finding new ways to provide the most comprehensive care for patients with scoliosis. This includes developing new scoliosis diagnostics and treatments that focus on prevention, such as genomic testing, hormone testing, neurotransmitter testing, and GI testing. All of these avenues are very new in the scoliosis world from a day-to-day clinical perspective."

  

Q: What advancements in treating scoliosis have you seen in the past 20 years?

Dr. Morningstar: "From a non-surgical perspective, the idea that scoliosis is an adaptive response, rather than just a random curve that develops, has led to a lot of treatment advancements. The ScoliSMART Activity Suit is based on the concept that scoliosis is the result of underlying neuromuscular imbalances that must be rehabilitated in order for the brain to accept a different structural resting position. It's not as simple as just using passive force by itself, regardless of the type of passive force used. Conservative treatments have definitely become much more popular in recent years, especially since newer technology allows for better and more thorough physical examination, such as computerized posture and global alignment analysis, and topographical surface measurements of the rib cage. These can all be combined with the traditional radiographic Cobb angle measurement.

As far as bracing for moderate scoliosis goes, there have been incredible advancements in 3D CAD/CAM computer technology that allows a rigid back brace to be fully customized to each patient, and to incorporate more 3D principles of correction into brace construction. This results in better bracing outcomes for those kids who need it. Brace treatment shows better outcomes during adolescence or puberty growth spurts when these kinds of 3D back braces are used to guide significant skeletal growth, versus the more traditional kinds of bracing that are decades old.

From a surgical treatment perspective, spinal surgery has made significant strides, with the advent of vertebral body tethering, to anterior scoliosis correction, to Apifix. These are surgical options that, in my opinion, will soon replace the older surgical techniques such as pedicle screw fusion with metal rods surgery due to quicker recovery times and less invasiveness. These both translate into fewer complications for the patient in both the short and long terms."

 

 

Q: How was the ScoliSMART Activity Suit conceived and developed?

Dr. Morningstar: "The ScoliSMART Activity Suit (SAS) was conceived and developed after observing a number of PT clinics in Europe using kinesiology tape for scoliosis. They are using the tape in a wrapping fashion up one leg and around the torso in a cyclone-type pattern. However, repetitive taping becomes burdensome on the family. It can also cause the skin to rash up with repeat applications, thus preventing further taping. I simply found a way to replicate that same force direction and rotation that could be repetitively used. Since 2006, thousands of suits have been used worldwide, and I am very happy to see so many people benefit from this technology. Adults with scoliosis-related back pain have seen tremendous results with the 'SAS', and can still achieve spinal curve improvement as measured on x-ray. These results are still possible even after reaching skeletal maturity. Even when adults have arthritis in their lower back due to the spinal curvature, (also known as degenerative scoliosis), the SAS still affords them significant relief."

 

 

Q: What should be the role of scoliosis exercises in the current treatment model?

Dr. Morningstar: "I believe that treatments that offer little to no downside should be used as primary treatment options regardless of diagnosis. I am always puzzled when I hear how families are told by other physicians that 'exercises for scoliosis won't work, so don't do them.' This is terrible advice in my opinion. This is ample evidence and research out there that exercises can and do help many scoliosis patients. I have even published this kind of evidence on ScoliSMART treatment. There is no drawback to exercise therapy even for larger curves, except for the financial cost of trying it. It's always easier to stabilize or improve mild curves instead of waiting for them to worsen and they try to initiate treatment. More importantly, if it saves a child from experiencing curve progression, and thus needing risky and invasive spinal fusion surgery for severe scoliosis, then it's definitely worth it."

 

 

Q: What are 3 things should every parent of a child with scoliosis do right now?

Dr. Morningstar:

  1. If you've been told to 'watch and wait' because they have mild scoliosis......don't. Be proactive and seek out therapies like ScoliSMART that can stabilize or even reduce idiopathic scoliosis (the most common type).
  2. Consider taking their child to a physician who evaluates all of the parameters associated with scoliosis, such as genetic variants, hormone issues, neurotransmitter imbalances, posture, and bone density problems. All of these can impact the success of treatment.
  3. You only get to be a child once. Let your child do the physical activities they enjoy. Quality of life is important, especially in children. Work with a physician who promotes that concept, and can help use their activities to their advantage without discomfort.

 

 

Q: Are there any new scoliosis treatment ideas you see on the horizon?

Dr. Morningstar: "Most of the more recent advances in surgical treatment, such as the advent of VBT/ASC, Apifix, and other less invasive scoliosis surgery. Orthopaedic surgeons often prefer these options, because they use much less hardware, going from single or double metals rods, to flexible tether cords or very small ratcheting systems. From a non-surgical perspective, much of the newer ideas are focused on scoliosis prevention. For example, in a family where a parent or sibling has a history of scoliosis, we are figuring out that we can genetically test the other siblings to see if they have any genetic variants that might increase the chance of developing a scoliosis. In doing so, we can use functional medicine strategies and lifestyle treatment options to minimize the day-to-day impact of those genetic variants, in the hopes that we can prevent curvature of the spine from developing in that child. This is very exciting for me, because I feel that ultimately it will be proven that scoliosis is easier to prevent than fix. We also see patterns of neurotransmitter imbalances that may predict the likelihood of idiopathic scoliosis progression in children already diagnosed with adolescent idiopathic scoliosis."

 

 

About Dr. Morningstar

Dr. Morningstar is a founding member of the Society on Scoliosis Orthopedic and Rehabilitation Treatment (SOSORT). It is through this and other scientific organizations that Dr. Morningstar continues to promote non-surgical, exercise-based scoliosis like the ScoliSMART treatment.

Dr. Morningstar has been published over 60 times in the biomedical peer-reviewed literature, making him one of the world's most prolific chiropractic researchers. Tune in to Dr. Morningstar's podcast, Scoliosis World on YouTube or SimpleCast.