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Archive for May, 2009

When the body is looked at from behind, a normal spine is straight without much deviation from one side to the other.Scoliosis is a disorder that is generally associated with a lateral, or side-to-side, curvature of the spine.The disorder shouldn’t be confused with poor posture, even though it often gives the appearance that the individual is leaning to one side. Scoliosis is a troublesome deformity that is defined by both lateral curvature and rotation of the vertebra often causing a symptomatic “rib hump” in the mid or thoracic spine. This is created by the vertebrae in the area of the major curve rotating toward the concavity and pushing their fastened ribs posterior hence producing the characteristic rib hump seen in thoracic scoliosis. The pulmonary and cardiac functions can be obstructed if the thoracic curve and rib rotation exceeds 70 degrees. Often later in life in untreated severe idiopathic infantile and juvenile scoliosis patients, this amount of curve and resulting cardiac and pulmonary changes can be life threatening.

Anatomy

The spine reveals four normal curves: the cervical, thoracic, lumbar, and sacral, all of which are observable from a side view of the trunk. The thoracic, in the chest vicinity, has a normal round curve, “reversed C,” called a kyphosis, while in the lower spine there is a healthy “C” curve, known as swayback or lordosis. Increased kyphosis in the thoracic area is called hyperkyphosis, while increased swayback is termed, hyperlordosis. Scoliosis changes regularly accompany diversions from normal on a side view. A few round back deformities are simply due to poor posture and can often be resolved with postural exercises. A small percentage of people with kyphosis have more rigid deformities than the postural type, which are coincidental with vertebral deformity. This kind of deformity, called Scheuermann’s kyphosis, is much harder to treat than postural kyphosis, and it’s cause is unknown.

Even a layman can help to identify a child or fully-grown individual with scoliosis just by viewing the person in a standing position, preferably with no shirt and in shorts, and observing the following:

• One shoulder may be raised than the other.

• One scapula (shoulder blade) may be raised or more prominent than the other.

• With the arms hanging loosely at the sides, there may be more area between the arm and the body on one side.

• One hip may look to be raised or more conspicuous than the other.

• The head is not centered over the pelvis.

• When the person is analyzed from the rear and asked to lean forward until the spine is horizontal, one side of the back seems higher than the other.

The child or adult should be sent to a healthcare professional, such as a chiropractor, for further evaluation once scoliosis is suspected. your chiropractor would be happy to help.

The most prevalent type of scoliosis is, by far, Idiopathic, and though there are various origins and many types, Idiopathic Scoliosis accounts for about 85% of all cases. “Idiopathic” means “no known cause” and is observed with equal prevalence in boys and girls in the mild or low curve magnitudes. Depending on the age of onset, this condition can be sub-classified into infantile, juvenile and adolescent cases. Idiopathic Scoliosis may be linked to genetic or hereditary influences as it commonly runs in families. Though it is unknown why, girls are five to eight times more likely than boys to have their curves increase in size and require treatment. The most general time for the development of Idiopathic Scoliosis is during adolescence when children are finishing the last major growth spurt. Unfortunately, at this age young people are reluctant to allow their body to be looked at by parents and other adults, so it is very important to have this age group examined on a regular basis.

If a scoliotic curve is observed in the growing adolescent, it is very important that the curves be monitored for advancement by periodic examination and from time to time standing X-rays. In ninety percent of instances, the scoliosis is mild and does not require active treatment, however increases in spinal deformity necessitate evaluation to ascertain if a brace or other management is required. In a small number of patients, surgical treatment may be required.~Surgery may be necessary for a small number of patients.

Brace treatment (orthosis) is recommended for newly-identified symptoms of moderate scoliosis or abnormal kyphosis, as well as when an increase in scoliosis or kyphosis is discovered in both juvenile and adolescent children. There are a number of types of braces, all created to prevent curves from increasing by acting as a buttress for the spine during active skeletal growth. Bracing is effectual in preventing curve progression in a very large portion of skeletally-immature adolescents. Nevertheless, braces generally won’t make the spine completely straight, and cannot always keep a curve from getting bigger.

Scoliosis has no simple resolution. The majority of cases, even though often monitored, are not actively treated. The standard medical treatment for moderate cases is a brace, whereas severe cases in some cases are treated surgically. You may want to see your local chiropractor first.

Along with bracing, many other therapies have been used successfully like specialized exercise, electric stimulation of spinal muscles, nutritional programs, and chiropractic treatments. It seems like the most effective results have been sustained with a multi-faceted approach to the management of this condition.

There are chiropractors, that have expertise treating scoliosis conditions.

Technorati Tags: back pain, chiropractor, scoliosis

As an Orlando Chiropractor, I felt a sinking feeling when I read this NY Times story. One can only hope that patient interests are truly being taken into account.

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A back-pain researcher, Dr. Richard Deyo, recalls the uproar the last time federal officials tried to suggest how doctors should practice their craft.

It was in the mid-1990’s, when Dr. Deyo helped develop federal guidelines urging surgeons not to perform spinal fusions to treat acute pain.

Spine specialists quickly attacked the report, calling it flawed. One medical device maker, Medtronic, sued unsuccessfully to block its release.

Now, 15 years later, the Obama Administration is entering this same medical minefield.

The Administration plans to spend $1.1 billion over the next few years on studies like the one conducted by Dr. Deyo, to compare the effectiveness of competing treatments for common conditions like back pain, heart disease and prostate cancer.

Supporters include many medical researchers, consumer groups, unions and insurers.

The New England Journal of Medicine, published several articles Wednesday supporting the federal effort and rebutting arguments raised by critics.

But potential opponents — which include medical products companies, some doctors and their political allies — warn that the comparative effectiveness movement could lead to inadequate treatment for some patients and even the rationing of health care.

“It is not difficult to see how you can get on a slippery slope very easily,” said Tony Coelho, a former Democratic Congressman who is head of a new industry-backed Washington group called the Partnership to Improve Patient Care, formed to lobby on the comparative effectiveness effort.

Among others, the group is backed by the major trade organizations that represent producers of drugs, medical devices and biological treatments.

Critics like Mr. Coelho also point to a British government agency, the National Institute for Health and Clinical Excellence, or NICE, which considers costs in judging a treatment’s effectiveness.

Whether cost should be a factor in this country was a hot-button issue during the Congressional debate in February, when the comparative-effectiveness funding was approved as part of the economic stimulus package.

Despite that assurance, even supporters of the effort say one goal in identifying effective medical treatments is to stop wasting money on those of little value.

For now, proponents and critics are warily circling one another, as the first administrative steps of the process unfold.

A panel of government health experts is holding a series of public hearings at which people can suggest medical conditions for comparative effectiveness reviews.

“If this research is done in a rigorous way and doesn’t pull strings, then a lot of pressure will come to bear,” on the process, said Dr. Deyo, a professor at Oregon Health and Science University in Portland.

Some conservative and libertarian think tanks, as well as commentators like Rush Limbaugh, have attacked the comparative effectiveness effort as a step towards socialized medicine.

But for now, both Mr. Coelho’s opposition group, as well as drug and device makers, are using more measured rhetoric.

Coelho, a former House Democratic leader who resigned in 1989 over a controversial junk-bond investment, says his organization does not oppose the concept of comparative effectiveness.

His organization includes patient advocacy groups like the National Alliance for Hispanic Health and the National Alliance on Mental Illness, which also receive funding from medical products companies.

Coelho, who was a driving force behind the Americans with Disabilities Act, points to his own experiences with epilepsy, which he has had since he was a teenager, as an example of how patients need to be treated individually.

Under the comparative effectiveness program, the Department of Health and Human Services and two agencies under it –the National Institutes of Health and the Agency for Healthcare Research and Quality — will fund studies that will look at various treatments as well as pay for the development of information -gathering tools like databases of patients being treated for a certain condition.

Right now, “there is no place that helps you sort through a specific option and how that compares to another,” said Dr. Carolyn M. Clancy, the director of the Agency for Healthcare Research and Quality.

The agency, back when it was known as the Agency for Health Care Policy and Research, was the federal body Dr. Deyo worked with in drafting the back pain guidelines in the mid-90’s.

More recently, officials of the Oregon Evidence-Based Practice Center, began producing reports a few years ago comparing the effectiveness of competing drugs, both brand name and generic, in treating specific conditions.

Wherever they went, Dr. Helfand said, he and his colleagues met resistance from drug makers and some patient groups that had rallied to the companies’ side, who raised the same arguments that critics of comparative effectiveness are raising today. The Practice Center’s research, which is continuing, is now used by 14 states.

“Ironically, the motivation for comparative effectiveness is to see what works in practice,” he said, “rather than over generalizing from a few unrepresentative studies.”

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Full article: http://www.nytimes.com/2009/05/07/business/07compare.html?hpw

Technorati Tags: comparing medical treatments, consumer groups, medical treatment