The purpose of bracing is not to correct scoliosis, but to stop it from getting worse. Unfortunately, even with proper compliance (wearing the brace for 23 hours every day), it frequently fails in doing so. Dolan & Weinstein documented that 23% of patients who wore a brace still ended up undergoing spinal fusion surgery. In comparison, 22% of patients who did nothing underwent surgery for their scoliosis later in life. The evidence in support of bracing is extremely poor, earning an overall rating of "D" in a review of the scientific literature. Bracing can be very emotionally-scarring, at a time in life when "fitting in" means everything, wearing a brace can be a traumatic experience in a young person's life, with some people going so far as to say it left them with a "psychological scar. In addition to the emotional effects, the physical side effects of wearing a brace can include pain, skin & bone problems, and impairment of normal lung function.
Surgery does not cure the disease of scoliosis, but rather replaces one deformity with another. Many people choose surgery because they just want their worries about scoliosis to be over. However, surgery is not the final solution; merely an irreversible one. Scoliosis can continue to get worse even after spinal fusion, and over 20% of patients require more than one operation. Furthermore, 40% of patients are legally disabled 16 years after the procedure. Long-term evidence suggests that living with a fused spine may be worse than living with a curved one. 38% of patients stated that, if they had the chance to go back in time, they would not have undergone the surgery. 76% of patients suffer from back pain after 10 years. After 15 years, patients report increased difficulty sitting, standing, carrying, bending at the waist, participating in sports, lying on their backs or sides, lifting, performing household chores, and driving a car. In every patient who undergoes spinal fusion surgery, there is a permanent loss of spinal flexibility & function. The documented risks of surgery are bone fragments or instrumentation penetrating into the spinal canal; breakage of the implants; and, compression of the spinal nerves. This can lead to neurological deficits such as partial or total paraplegia, quadriplegia, or peripheral nerve damage - which may occur immediately after the operation, or as much as 10 years later. Surgery does not reduce rib deformity; instead, thoracoplasty (shaving down the ribs) or rib removal is often recommended for this purpose. This can result in a serious & permanent impairment of normal lung function, and can in fact cause the scoliotic curvature to progress. Even if the rib hump does improve after spinal fusion, in the majority of patients, the improvement is temporary, and eventually the situation is worse than it was before.
The truth is, spinal surgery is an invasive and dangerous procedure, and one that should only be undertaken after all other options have been exhausted. Unfortunately, it is increasingly being recommended as the first resort for children with progressive scoliosis and adults with painful scoliosis. Once done, it cannot be undone; to operate or not is an important decision, and all factors should be considered carefully before committing to spinal fusion surgery.
Researchers around the world recognize the need for a better way. Provided the use of a complete comprehensive approach, there is very little doubt that it is possible to reduce the need for surgery in the treatment of scoliosis. It cannot be argued against that there is a need for the advancement of research into manners by which a mild case of spinal curvature can be prevented from developing into a serious visible deformity.28 If bracing and surgery were successful, reliable, and effective ways of treating scoliosis, there would not be a need for advancement into new treatment methods. Also, there is increased need for physicians of all specialties to collaborate in the realm of scoliosis treatment.CLEAR Institute is fulfilling these needs by attending conferences of international spinal experts, working with recognized scoliosis specialists in all fields of healthcare, participating in debates about the future of scoliosis treatment, and providing more options to people living with scoliosis.
Our treatment addresses scoliosis 3-dimensionally, in accordance with established laws of biomechanics, to correct the spine in every dimension. It is well-recognized that two of the main factors involved in the progression & etiology of idiopathic scoliosis (IS) are biomechanical and neuromuscular. It is also proposed that the biomechanical and neuromuscular factors involved in the progression of scoliosis contribute to a cyclical pattern that leads to further progression ('vicious cycle').
Millner & Dickson described a biomechanical conceptual understanding of scoliosis in 1996 when they pointed out that, "For centuries, engineers have recognised that the mechanical behaviour of a column under load is influenced by geometry, as well as by material properties; it is clear that the spinal column also obeys these well-described laws." They then went on to extrapolate on this concept when they described scoliosis as a viscoelastic, three-dimensional "buckling" of the spine in both the coronal (side-to-side) and sagittal (front-to-back) plane, and noted that successful reproduction of scoliosis in an animal model occurs only when the normal sagittal alignment of the spinal column has been disrupted.This sagittal disruption has been noted and confirmed by several other authors. Researchers have even been able to predict the thoracic kyphosis by evaluating the coronal thoracic curvature, the lumbar lordosis, and the slope of the first lumbar vertebra. New research has discovered that a kyphotic cervical curvature occurs more frequently in patients with severe scoliosis than in a normal population. Axial rotation of vertebrae has been implicated as a risk factor for progression of scoliotic curvature. A positive correlation between the degree of the sagittal & axial disruption and the magnitude of the resultant lateral curvature has been documented. It has also been documented that spinal imbalances have the capability of producing forces which can influence curve progression. It could be taken as an axiom that if certain forces are capable of influencing progression, other biomechanical forces should be capable of influencing the regression of spinal curvature, and it has been suggested that a chiropractic physician who understands the biomechanics of scoliosis may have a rationale for the treatment of scoliotic curvatures. The etiology behind so-called idiopathic scoliosis is extensively biomechanical and driven in a large part by neuromuscular imbalances. Addressing & reversing the neuromuscular & biomechanical imbalances is the goal of CLEAR alternative scoliosis treatment, and this treatment approach is effective in patients of all ages.
This is supported by research which suggests that structural deviation of the nucleus pulposa can greatly affect the progression of scoliosis Physical rehabilitation has been demonstrated to be successful in the management of herniated nucleus pulposa. Physical exercises, postural remodeling, and proprioceptive neuromuscular re-education, combined with manual therapy that is performed with the purpose of achieving specific structural corrections (rather than simple mobilization of a spinal joint), are effective ways of altering the biomechanical forces affecting the spine and thus vertebral column loading. As stated by several preeminent scoliosis researchers, the primary factors influencing progression of the scoliotic spine are biomechanical (shear forces and asymmetrical loading of the vertebrae leading to vertebral wedging as per the Heuter-Volkmann Law, often referred to as the 'vicious cycle' in discussions regarding the pathogenesis of scoliosis), so a spinal biomechanical approach to treatment with the goal of reducing and reversing these forces is logical and has been proposed by other authors. This vicious cycle has been shown to develop in 3 dimensions, not merely in 2, and so biomechanical treatment aimed at reducing axial & sagittal deviation of the spine appears every bit as necessary as reduction of the lateral deviation.The CLEAR approach is the only system that re-trains the brain and spine to work together.
It has been well-documented that patients with scoliosis demonstrate a significant increase in neuroanatomical abnormalities of the corticospinal tract, as well as neurophysiological abnormalities, especially in the areas of vestibular function, proprioception, vibratory sensation, postural reflex mechanisms, abnormal reflex processing, and disordered postural equilibrium. Lateralization of neurophysiology also occurs more frequently in patients with idiopathic scoliosis (IS), and this can be correlated to the convexity of curvature.However, it has been suggested that this laterality is a result, rather than a cause, of scoliosis. While many authors have suggested that brain asymmetry may play a role in the etiology of scoliosis, one recent study did "not support the concept of a generalized brain asymmetry in idiopathic scoliosis," but noted instead that the trend towards asymmetrical neurophysiology was "probably representing subclinical involvement of the corticospinal tracts secondary to mechanical compression.The goal of the chiropractic manipulative therapy provided by CLEAR doctors is to reduce this mechanical compression and thus restore normality.
Neurophysiological compensations may develop as a mal-adaptation to disordered spinal structure; similarly, disordered spinal structure may create muscle imbalances & exacerbate existing neuromuscular imbalances.
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