Scoliosis Screening: a Case of "Sour Grapes?"
Scoliosis is surrounded by a great deal of controversy, from theories of its etiology, to the effectiveness of bracing, to its effect upon health & society, to the accuracy & need for scoliosis screenings - even whether treatment is necessary at all. Perhaps no other condition has created such polarized debate, which conclusions of opposite extremes. Consider the statements made by the authors of the following studies:
Treating Scoliosis in Young Unneeded (JAMA, Weinstein 2003)
"Many with curvature of the spine go on to lead normal lives. Many adolescents diagnosed with spine curvatures can skip braces, surgery, or other treatment, without developing debilitating physical impairment, a 50-year study suggests."
Routine Scoliosis Screening of Dubious Value (Pediatrics, Bunge 2008)
"We think that abolishing screening for scoliosis seems justified, because of the lack of evidence that screening and/or early treatment by bracing is beneficial."
A Population-based Study of Scoliosis Screening (JAMA, Yawn 1999)
"School scoliosis screening identified some children who went on to receive treatment, but referred many more who did not. This data should be considered in making decisions regarding scoliosis screening."
Now, contrast these conclusions to statements made by authors of other peer-reviewed studies:
Quality of Life in Women with Idiopathic Scoliosis (Spine, Weiss 2002)
"Juvenile patients with IS were unhappier with their lives. They reported more physical complaints, had lower self-esteem, and higher depression.... Adult patients reported more psychological and physical impairment."
Sports Activity of Patients with Idiopathic Scoliosis at Long-term Follow-up (Clin J Sport Med, Parsch 2002)
"Over the long-term, patients with idiopathic scoliosis suffer impairment of their sports activities compared with age-matched controls. The main reasons for this are functional impairment and the frequency of back pain."
The Ste-Justine Adolescent Idiopathic Scoliosis Cohort Study, Part III: Back Pain (Spine, Mayo 1994)
"AIS subjects reported pain that was more intense, continuous, generalized throughout the back, and radiating into the extremities."
Long-term Follow-up of Patients with Untreated Scoliosis: a Study of Mortality, Causes of Death, and Symptoms (Spine, Pehrsson 1992)
"The mortality was significanty increased [in patients with untreated idiopathic scoliosis]."
Adult Scoliosis: a Health Assessment Analysis by SF-36 (Spine, Schwab 2003)
"Taken as a whole, the patients in this study averaged scores much lower than the norms for both the general U.S. population in all 8 categories and the U.S. population for ages 55 to 64 in 7 out of 8 categories of the SF-36 questionnaire. Additionally, patients with scoliosis also showed lower scores compared to that of the norms found of patients with comorbid conditions: back pain/sciatica with hypertension in seven of the eight categories: physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health.... It is our conclusion that adult scoliosis is becoming a medical condition of significant impact, affecting the fastest growing section of our society to a previously unrecognized degree."
It is impossible to deny that scoliosis does indeed impact both the emotional & physical health of those individuals who live with it every day. Similarly, the need for treatment should also be apparent. So how is it that well-credentialed, well-intentioned medical specialists can put forth the point of view that screening & treatment for scoliosis may not be necessary at all?
The answer lies in the definition of treatment. As discussed in last month's newsletter, the established methods of treatment are bracing & surgery, and according to the orthopedic community, these are the ONLY methods of treatment. Thus, if a patient with scoliosis does not require surgery or bracing, according to the surgeons, they do not require treatment at all - yet patients with even minor curvatures can suffer physical impairment & mental distress.
Also, when debating the need for scoliosis screening & treatment, one must consider the effectiveness of "treatment," meaning bracing & surgery. It is commonly accepted that bracing will not improve a scoliosis, and may be effective in halting progression in some patients. Furthermore, it is self-evident that surgery does not correct the scoliotic spine back to a normal spine; it merely "replaces one abnormality (a flexible, curved spine) with another (a rigid, straighter spine)." (Goldberg 2001). Thus, if long-term comparisons between untreated patients and patients who received either brace or surgical treatment show less-than-favorable results, it may seem fair for an orthopedic surgeon to question whether "treatment" (again, meaning bracing & surgery) truly improves the quality of life in people with scoliosis, and thus, to wonder whether it is ethical to diagnose a condition which would then be technically considered to be "incurable."
Let us present the following conclusions:
1) On average, people living with scoliosis have more physical impairments & emotional distress than people living without scoliosis.
2) If a scoliotic spine is returned to a condition of true normal (not simply fused in place to resemble normality), the physical function & mental well-being of the patient is improved. Thus, scoliosis is a condition deserving of research into methods by which this may be accomplished.
3) If current methods of treatment cannot be proven to offer a significant benefit to the patient, by restoring the scoliotic spine to a normal spine, it is indeed valid "to avoid subjecting individuals to traumatic interventions of dubious clinical value like bracing and spinal fusion surgery." (Scoliosis and the Human Spine, by Martha Hawes, PhD, pg. 121).
4) However, it is not valid to state that scoliosis screening is unnecessary without first considering the possibility that scoliosis may be treated effectively without resorting to braces or surgery. Without first making this effort, it is unethical to simply abandon all attempts at detecting scoliosis before it has advanced to the point of a visible spinal deformity. Furthermore, the elimination of scoliosis screening would also deprive us of the opportunity to study this condition in its mild stages, and advance our understanding of how best to predict which individuals are at the greatest risk of progression.
The History of the Scoliosis Traction Chair
CLEAR Institute has invented several innovative & new pieces of equipment that have revolutionized non-surgical scoliosis treatment. Perhaps the most intriguing of these devices is the Scoliosis Traction Chair.
The very first Scoliosis Traction Chairs were modified school chairs, which were customized by hand for each patient. The arm rests were built up and foam blocks affixed via duct tape, according to their individual posture. The entire contraption was then placed on top of a vibrating platform, the purpose being primarily to balance the shoulders. In 2001, research had already demonstrated the effectiveness of vibration in re-modeling posture, and clinical experience had proven the importance of the head & neck in determining the position of the spine below, yet the full potential of this new invention was yet to be realized. Although the initial results achieved through the use of this prototype were encouraging, it was limited in its application in a clinical setting, due to the customized nature.
A cervical traction component was added on the next model, and a motor attached directly to the chair. If the chair was turned on without a person seated in it, it would “float” across the floor. If a person was seated in it, more of the vibration would transmit into the floor than into the patient.
While attending Palmer Chiropractic School in Davenport, Iowa, Dr. Clayton Stitzel had the good fortune to meet and be mentored by Dr. Dennis Woggon. The work that Dr. Woggon was doing with scoliosis patients was innovative and challenging, and Dr. Stitzel was inspired to join him in this endeavor.
Dr. Woggon had already begun developing a treatment protocol that used vibration and traction to successfully treat patients with scoliosis. The two doctors were absolutely on fire with enthusiasm about the potential of making a significant difference in the lives & spines of patients who many claimed could not be helped by chiropractic care. Dr. Woggon and Dr. Stitzel spent countless hours on email & the phone discussing techniques that would achieve the outcome that they so desired for their patients.
It soon became apparent that the two needed the assistance of someone who could turn their ideas into reality. Dr. Stitzel suggested his father, Mr. John Stitzel, a retired school administrator from Manheim, Pennsylvania. John had years of experience in engineering & a great deal of mechanical ability, and, through his son, understood how this information applied to the biomechanics of the human spine. This combination of Mr. Stitzel’s technical know-how and the clinical experience of the two doctors provided the ideal foundation for a piece of equipment which would go on to revolutionize scoliosis treatment for hundreds of doctors & their patients in the years to come.
Mr. Stitzel well recalls when Dr. Woggon first presented the prototype Scoliosis Traction Chair to him. At this time, the chair was sitting on a vibrating platform, and a pulley system was mounted to the ceiling to traction the spine. The arms were not adjustable to accommodate individual patient needs, and the back did not swivel. Foam blocks needed to be taped in place for each individual patient, and the un-padded lateral traction straps were tightened in place manually by the doctor.
One day while vacationing in Ocean City, Mr. Stitzel and his wife, Helen, were taking their granddaughter for a walk and passed by three wooden kitchen chairs had been discarded. Proving the old adage about one man’s treasure, Mr. Stitzel was struck by a flash of inspiration upon viewing the unique design of these particular chairs. He asked permission to bring them home, and a plan began to take shape.
Numerous ideas were explored while designing, and redesigning the chair. Initially, most of the patients who came to Dr. Stitzel and Dr. Woggon were children or young adults, but increasingly adults were inquiring if they could be helped as well. Fortunately for these individuals, both Dr. Woggon and Dr. Stitzel were absent from class on the day that their professors at Palmer stated that scoliosis could not be altered in patients after skeletal maturity, and did it anyway. The demand for Scoliosis Traction Chairs increased and was expanded to include adult-sized patients, who required the chair to maintain & improve upon the corrections achieved through their efforts & the efforts of their doctor.
It was decided that the arms needed to be adjustable so both adolescents and adults could be accommodated, and Dr. Stitzel’s clinic became the design site of the Scoliosis Traction Chair as we know it today. Willing patients, family, and even the occasional friendly UPS delivery man were recruited at Dr. Stitzel’s clinic to sit in the chair and establish the full, necessary range of adjustments and proportions. Dr. Stitzel’s skill with scoliosis treatment had grown quickly to rival his mentor’s, and the doctor continued to provide his time & expertise to evaluate the Scoliosis Traction Chair throughout its development, and suggest additional improvements.
Dr. Stitzel soon realized the narrow chest and waist belts were very uncomfortable and female patents especially had difficulty tolerating being in the chair for long periods of time. Belt support hooks were added under the arm rests, and Mr. John Stitzel recruited the help of an Amish gentleman who agreed to handcraft leather pads that would distribute the pressure more evenly, making these straps more comfortable for the patient and allowing the patient to tolerate a longer session in the chair. Pads were sent to Dr. Woggon for his evaluation, and their arrival was heralded by a general sigh of relief amongst his patients.
The new pads greatly improved the amount of lateral force that could be applied to straighten the spine. However, scoliosis is much more than simply a sideways deviation of the spine; it also involves a compression and a rotation of the spinal column. To achieve the necessary de-compression that would allow the spine to further correct, Dr. Stitzel and Dr. Woggon requested that a cervical traction component be incorporated directly into the chair. Soon, a post and pulley system was mounted on the chair backrest. In addition, John designed it with the ability to rotate, as well as to raise and to lower. This became important later on, as the realization was made that by turning the patient’s head in one direction, the entire spine below would react, thus further enhancing the chair’s effectiveness in rehabilitating scoliosis.
Initially, the back rest was stationary, which did not lend itself well to addressing the necessary de-rotation of the spine. Mr. John Stitzel invented another modification that allowed the backrest to swivel, raise, and lower. It could now be positioned in exactly the correct position on the spine and rotated into the patient’s back. Through the attachments of the ribs to the spine, the entire spinal column would react, and x-rays taken on patients while they were in the chair now proved that their spine was being repositioned completely back to the ideal by the 3-dimensional activity of the Scoliosis Traction Chair.
The manual traction belts were replaced with a ratchet system that allowed doctors more precise control on the amount of traction they applied to the patient. It also made it possible for patients to effectively use the chairs in their homes. In the fall of 2004, Dr. Stitzel began using one of the original chairs and one was sent to Dr. Woggon.
In the spring of 2005, Mr. Stitzel completed the chair design that is essentially the chair that CLEAR is manufacturing today. Hundreds of hours went into drafting plans, searching for components, building and testing prototypes, and making improvements that would ensure the clinical requirements necessary to achieve results in scoliosis treatment. It was time to begin interviewing craftsmen. Copies of the design were taken to carpenters and welders. Mr. Stitzel met with them personally to eliminate all production problems with the design and oversee the product quality.
There was only one significant issue remaining. At this point, the vibration component was achieved by setting the chair on a vibrating platform. However, Dr. Stitzel felt strongly that a motor should be mounted directly on the chair, which posed a new problem. The vibration needed to be directed into the chair and isolated from the floor, necessitating a re-evaluation of the chair’s foundation. In the winter of 2005, a Scoliosis Traction Chair with a vibrating motor attached was custom-designed and tested in Dr. Stitzel’s clinic. This design was evaluated for more than a year, right next to another chair which was placed on a vibrating platform, allowing Dr. Stitzel to compare the results between patients using only one version exclusively, and encouraging suggestions & comments from other patients who were allowed to use both chairs. While both versions ultimately proved to be very effective, the complete chair has become popular with both doctors and patients for its efficiency, the ease of its use, and its practicality.
The patent was approved, and the Scoliosis Traction Chair went into full production at Lewis Motor Repair in Waite Park, Minnesota, in the winter of 2007. Currently, over three-hundred Scoliosis Traction Chairs have been sold to patients & chiropractors, and roughly two-hundred more are sold each year, helping countless people with scoliosis to change their spines & their lives, without being subjected to the psychological scars of bracing or the physical scars of surgery. However, the chiropractor alone cannot achieve this goal; it requires an honest commitment and active participation on the part of the patient.
We hope that by sharing the story of how the Scoliosis Traction Chair was invented, and the hard work, time, & dedication that allowed it to become a reality, the patient will develop a greater understanding & appreciation of both the opportunity this chair represents, and the possibility it offers - to live a life free from the emotional & physical burdens of scoliosis.
For more information about the Scoliosis Traction Chair, including research & references, please send an e-mail to care@clear-institute.com with the words "STC Flyer" in the subject heading.
Scoliosis Seminar Series at Parker College in Dallas, Texas, begins March 1st!
It's not too late to sign up for the CLEAR Scoliosis Seminar Series held at Parker College of Chiropractic in Dallas, Texas! If you register right away (before this Saturday, February 23rd), you will still receive the pre-registration discount. Part I of the Seminar Series begins March 1st & 2nd. The dates of Part II are April 5th & 6th, and Prt III is held on May 10th. Parts I & II are valid for 12 CE credits each, and Part III is worth 8 credits, for a total of 24 credits.
To sign up for this seminar, please contact the Postgraduate Department of Parker College of Chiropractic at 1-800-GETMYDC.
"In health, there is freedom. Health is the first of all liberties."
- Henri-Frederic Amiel (1828-1881)