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Updating How Adolescent Idiopathic Scoliosis Is Treated

Updating How Adolescent Idiopathic Scoliosis Is Treated

The editors of "" are proud to conduct and provide candid interviews with some of the most trusted, experienced, and forward-thinking minds in the realm of treating scoliosis. In this, the first interview of many, we probe the mind of Dr. Clayton J. Stitzel, co-founder of ScoliSMART with over 21 years of scoliosis treatment experience. A bit brash, and always outspoken, Dr. Stitzel's straightforward, head-on approach rarely fails to fan the waves of innovation. We thank Dr. Stitzel for his time and insights during this interview.


Q: How did you decided to become a "scoliosis guru"?

Dr. Stitzel: <Chuckling out loud> "I'm not sure anyone starts out or chooses to become a scoliosis "guru". That would be choosing a life of frustration for sure. I, like most in my position, started out with a very sterile and clinical view of idiopathic scoliosis based on lectures from college professors who most likely never even managed a scoliosis case in their entire lives. It is only after developing a personal connection with someone suffering from scoliosis that it moved from the theoretical world to the real world. It became a very personal mission for me and remains so to this day."


Q: Where did ScoliSMART come from?

Dr. Stitzel: "The term "ScoliSMART" is actually an acronym for "Scoli" Sensory-Motor Auto-Reflex Treatment". The concept of "reactive rehab" was adapted from the Pettibon Spinal Biomechanics Institutes work in the 1990's by the CLEAR Institute. I, among others, adapted the concept for the unique needs of treating scoliosis. My colleagues and I at ScoliSMART further advanced the concepts into what we have and use in our Scoliosis BootCamp programs today. While the equipment and applications have improved a great deal over the decades, the fundamental concepts and premises remain very similar to the original work done by the Pettibon group. They got it right the first time."


Q: How has scoliosis treatment changed over the last 20 years?

Dr. Stitzel: "By in large, it hasn't. Just as many kids are being stuffed into back braces, just as many are having scoliosis fusion surgery. In terms of the larger picture, we haven't made any real progress in the treatment of scoliosis over the past 20 years. However, on the fringes, we are seeing the winds of change begin to gather and take shape. Advancements in scoliosis DNA testing, the implementation of fusionless scoliosis surgery's, the rise of social media giving parents a real voice and access to many different ideas and opinions for their child's treatment options. Change is often slow, and advancements in treating scoliosis have traditionally been even slower, but an appetite for a better way to approach the treatment of adolescent idiopathic scoliosis is growing."

Follow up question: What do you think will provide the "tipping point" for change?

Dr. Stitzel: "It won't be data, research, or scholarly lectures, it will be the mom's and dad's who collectively decided they aren't going to take the guided tour of the treatment options when making decisions for their child. Change is always lead by the early adopters of technology and new ideas."


Q: Why do you feel scoliosis exercises are more effective now than previously?

Dr. Stitzel: "Progress is the way of the world. The more time, energy, thought, and talent dedicated to a topic, the better understanding and application of the topic occurs. The original exercises for pediatric scoliosis focused more on repetitive motions in the opposite direction (Schroth method) of the spinal curvature. Later concepts attempted to rehabilitate the "weaker" muscle concept on one side of the curve. Today, we understand postural control is completely automatic and completely regulated by reflex arches, thus requiring a completely new understanding and approach to scoliosis exercises. The "Torso Trainer" and ScoliSMART Activity Suit are 2 examples of how resistance-based scoliosis physical therapy can be applied in a manner that recruits the intrinsic spinal muscles through the reflex arches in the brain stem. This is the only way to imprint a new "posture memory" in the patient's mind, so they eventually learn to hold their spine in a straighter and less twist way automatically.


Q: You have been a harsh critic of scoliosis bracing in the past, why?

Dr. Stitzel: "Scoliosis braces are a classic example of thinking harder, not smarter in my opinion. I view it as an oversimplified approach to a vastly complex problem, but mostly, I criticize the bracing concept, because it makes no actual attempt to treat the scoliosis condition itself. Back bracing is based on the concept of vertebral body or vertebrae guided growth, much like staking down a tree trunk in your yard. By simply forcing the spine straight in hopes it will "grow" more vertical. It's an archaic way to think about the human spine and treatment in general. We need to look beyond the spinal deformities and x-ray."


Q: What are your views on minimally invasive scoliosis tethering surgical treatment vs scoliosis fusion surgery?

Dr. Stitzel: "More advanced scoliosis surgery procedures like VBT (vertebral body tethering), ASC (Anterior Scoliosis Correction), and Apifix, have certainly burst onto the scene in the last decade. I will say the term "minimally invasive" seems to be a bit of a misnomer, as these are still very invasive procedures, but less so than spinal fusion surgery, which is one of the most invasive spine surgery methods ever conceived. With that being said, I do feel fusionless scoliosis surgery is a step forward, with the understanding long-term data is unavailable, but in comparison to the relatively poor long-term back pain outcomes of post spinal surgery cases, I can't imagine the outcomes of tethering could be worse. It's a "can't fall off the floor" type scenario."


Q: What are your thoughts on the advent of scoliosis genetic testing?

Dr. Stitzel: "It has been widely accepted that idiopathic scoliosis is rooted in genetics. While it has been agreed there is no single "scoliosis gene", patterns of genetic mutations (variants) have been identified and show great promise. The implications for proactive screening, risk of curve progression identification, and personalize nutrient therapies interventions are almost endless. Genetic stratification (comparing patients with similar genetic risk factors) could also prove extremely useful for determining the efficacy of various scoliosis treatment methodologies. We could finally compare "apples to apples" to determine which treatments are actually working vs only effective with patients who had a low genetic risk anyway."


Q: Your enthusiasm for the ScoliSMART Activity Suit seems endless, why?

Dr. Stitzel: "Truly new and original ideas are rare. Most things are modifications or re-packaged versions of an existing concept or product. The ScoliSMART Activity Suit (SAS) is a completely new and original concept for treating scoliosis. This is why the United States government awarded the SAS with several patents in 2022 and 2023. The ScoliSMART Activity Suit is unique because it re-trains the patient's brain to untwist or uncoil the scoliosis curvature by recycling the torque from their own cross crawl walking motion. It is one of the only ways to target the spinal rotation that drives spinal curve progression, creates new long-term posture memory, re-coordinates muscle firing patterns (reducing back pain), and is easy and comfortable for the patient to use all while maintaining a very high quality of life. It can even be utilized by patients post vertebral body tethering, fusion implants or with degenerative scoliosis. It's a win-win-win-winner."


Q: What is the future of scoliosis treatment?

Dr. Stitzel: "The future of treating scoliosis is prevention, not treatment itself. Identification of kids genetically at risk for developing a spinal curve with scoliosis-specific nutrient therapies may be able to prevent a curvature from even developing in most cases. Early-stage scoliosis intervention programs using active resistance scoliosis exercises that create a new posture memory should also be employed in mass. Hopefully, the days of "watch & wait" and passive treatment like scoliosis braces will soon become a relic of the past. There is so much more to scoliosis beyond the spinal deformities on x-ray and back pain. A lot will depend on which methodologies parents adopt in the future. People always vote with their wallets and in a market driven health care system, innovation is almost always incentivized to follow the money."