Scoliosis Blog

OMG!! As my daughter Gabrielle would say. I really need to schedule time to write more often. I was looking forward to getting on this plane so that I could get time to put something down on 'paper'. I am on the way to the SRS meeting (conference) in Brisbane. SRS stands for Scoliosis Research Society or as some of the more militant groupies on my side of the operating room call Scoliosis Rod Society. The SRS is an American based global group who run meetings in different cities of the world and this year it’s in Brisbane. They are joining with the SSA Spine Society of Australia meeting so it’s back into the territory of the non-believers. I have a lot to say...

But first... Day 5: last session of Intensive week of Schroth sessions. Patient X's mother says 'So what's the use of doing all of this?' 16 year old Patient X was referred by her interstate physiotherapist for an interesting curve that her surgeon was reluctant to operate on. Patient X was experiencing mild pain, was unsure of the aesthetics of her posture and had a very good intense week learning and working on her corrective routine. Her pain had resolved and she was much more comfortable with the aesthetics. I discussed with her mother that she would still need to be monitored as her curve could progress and one day she might still need or elect to undergo surgery.

Our intake forms state our position, we discuss this on day one and through the program but patient x's mom only 'got it' on day 5. Surgery is a big thing, pain is a big thing and body image perception is a big thing. I think a sense of powerlessness makes all these factors a lot worse. Patient X was empowered through knowledge and muscle activity and she left the clinic in a much better place than when she came in.   Her physio interstate sent the following response.

Thank you for your report re xxx. She is doing really well. She has started coming in twice a week now and does her Schroth exercises on 1 day and more of her "pilates" exercises on the other. XXX is still reporting much reduced pain levels. I am doing my best to supervise her exercises even though I dont as yet have any Schroth training. It is on my list to do at some stage.

Back at the airport after a very interesting course. I've now seen the same faces at these meetings for quite a few years. I am glad Rebecca Harding was able to attend. Jeb was there as well. The SRS international delegates included Dr Steven Glassman and Dr Jon Dimar. Dr Glassman is the lead author of a famous paper stating that conservative management has no role in the treatment of adult scoliosis. I really know this paper and I really know the main review paper he quotes in his paper. The spine surgeon from Brisbane who 2.5 years ago at the Medtronic seminar gave one of the first talks. He once again ridiculed conservative management in this talk, maybe with less ridicule, or maybe I am just getting used to the message and the delivery. He did at least mention the Braist study confirming the efficacy of bracing in adolescent scoliosis. It seems that the surgeons are not entirely convinced that the compliance rates are that good. I think they are. But I still think that the brace systems available to the average patient in Australia is well below international standards. IF YOU ARE A PARENT READING THIS THEN YOU HAVE A RIGHT TO DEMAND THAT YOUR HEALTH DOLLARS ARE USED TO EDUCATE THE BRACING SPECIALISTS IN AUSTRALIA TO THE LEVEL OF THE WORLD LEADERS INTERNATIONALLY.   Your surgeon has travelled overseas to learn, let them send their bracing specialist overseas to learn too. Rebecca and I had a chat to a spine surgeon from Melbourne and I was very vocal in saying that it is preposterous to expect braced kids to not be able to take their brace on and off independently. Most public hospital braces are made with the opening at the back which requires the kids to have help to remove and put on the brace!

Anyway, I approached Dr Glassman to enquire about some of the details of his study. He started straight up saying that there were weaknesses in the study with regard to the choice and delivery of some of the conservative management techniques. He then repeated the often repeated statement that there is no credible data on conservative management in the literature. He then asked, which surprised me, if I had heard of SOSORT and said that he will be at SOSORT in Germany in May. I said I will be there too. I didn’t say that I will be presenting a paper on sagittal balance at this conference but it will be quite daunting speaking in front of such an eminent individual. I found out later that Dr Glassman is the current president of the SRS and that is why he will be there. I think he was open to some treatment of scoliosis but is not sure what it should look like. I agree that we need to do more research.

The other news is that I have been accepted into the PhD program at Sydney University. I am still finalizing the protocol with my supervisors but it will involve assessment, measurement and intervention of postural asymmetry.

Next time to write will be on the plane to Germany!!

Oh yes.. another Marathon down. I think it will be a long time before the next one.