Idiopathic Adolescent Scoliosis – or scoliosis for no reason in your kids

What’s this all about?  Well, we’ve seen a few patients with this in the last few days and I’m just not happy about the word ‘idiopathic’ in the diagnosis.  Idiopathic means ‘relating to or denoting any disease or condition which arises spontaneously or for which the cause is unknown.’  Now, in this day and age, surely this is not an acceptable state of affairs.

A team of researchers back in 1976 (Ponseti et al. 1976) showed that connective tissue laxity may predispose to spinal instability and the development of scoliosis.  And I agree, and would suggest in many ‘idiopathic’ cases the cause is connective tissue or ligament laxity and perhaps the juvenile and adolescent scoliosis should be called Connective Tissue Deficit Scoliosis.

What’s the problem:

My hunch is this:

  1. The child is a bit hypermobile – and girls get it more than boys because women’s ligaments tend to have more laxity than men’s (what one doctor characterized as “ligament dominant” rather than “muscle dominant.” In another study they said:  Results were compared between men and women showing that there was a statistically significant difference. Women had a much greater ligamentous laxity of the lateral ankle than men).
  2. The patients get a bit of leg length inequality caused by a twist in the pelvis from playing in the playground or being good at gymnastics (because they are more bendy than their peers) all as a result of their slightly lax ligaments.
  3. This means that their pelvis is not level and that the lumbar spine sits on an oblique foundation and starts to bend.
  4. They then stop doing any form of exercise, particularly at school and are able to opt out by saying their backs hurt, which will be the case. And then they hit puberty and everything starts to change.
  5. Therefore they lose much of the fine control over their low-lumbar and mid-thoracic spine and like a tent pole with the guy ropes undone it all starts to fall apart. This happened at the moment that they are growing at their fastest and things just go from bad to worse.

A great bit of research by a bloke called Malcolm Binns describes this very well and he rounds off his paper by saying:  “Whatever the primary pathology of idiopathic scoliosis it seems that those individuals who manifest hyperlaxity may be more likely to progress to scoliotic deformity, presumably because of reduced spinal integrity.”

What we should be doing is:

At 12 years old a quick ligamentous laxity test is done.  This will take 5 minutes and is the classic “can you touch your wrist with your thumb” test shown in the paper by Binns. Lig laxity tests

  1. If they are borderline or positive for the test they get weekly Pilates classes at school. I know, I know, it’ll cost and take time but it is far, far cheaper for this to happen than the later and inevitable rounds of GP visits, painkillers, followed by consultant visits, x-rays, surgeon visits and then surgery followed up by pain killers (maskers) and more x-rays.    And just imagine the pain and mental anguish we could avoid as well.  If one in say 4 were helped this would be worth the effort.
  2. They are not allowed to slide off the radar for stabilising sports stuff once they hit puberty. In fact they should be, by then Pilates ninjas and be as stable as rocks and feeling pretty good about themselves as well.

I’m going to start a campaign and get this going – it would save a load of pain and money.

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