COVER STORY to general North American bracing practices of jumping to maximum hours right away. Granted, this might also be due to the lack of school screen-ing programs where curves are being diagnosed too late at already large curve angles. In his practice, kids start early with nighttime bracing with 15-degree curves. If curves progress, bracing time increases to out of school bracing, limiting bracing to the home environ-ment. Only for curves that are aggres-sive or that continue to progress will bracing increase to 18+ hours/day. Figure 2 illustrates Dr. Courvoisier’s scoliosis treatment spectrum from initial detection to fusion as a last resort. Chiropractic, naturopathic, physiotherapy scoliosis treatment I’ve briefly discussed bracing but what about the role of chiropractic, naturop-athy and physiotherapy and other healthcare practitioners? The same spectrum of treatment applies. There can be greater treatment impact with smaller more flexible curves. Especially so if there is a known family history of scoliosis. Scoliosis research is continuously identifying genetic precipitators for scoliosis including melatonin defi-ciency to poor collagen and bone quality and opens opportunities for naturopathic intervention. Likewise, chiropractic scoliosis treatment proto-cols and physiotherapy-specific scolio-sis exercises (Schroth, SEAS) can im-pact scoliosis, especially when the curve is mild, moderate and flexible. When a curve is small and flexible, there are numerous treatment options. But these options fall by the wayside and quickly disappear as the curve progresses and often stiffens. But, as I’ve learned the hard way, knowledge on the mechanics of scolio-sis and experience plays a critical role in how a scoliosis patient is managed conservatively. Especially so when a curve keeps progressing into surgical range (50+ degrees) despite best ef-forts. Some scoliosis curves are going to progress no matter what we do. It’s our responsibility to identify when this is happening and then refer out for a surgical consultation. Indeed, after interviewing 30 of the world’s top spine surgeons and talking to many more, it seems the ideal situa-tion is to create a team of Figure 3 illustrates the Rigo Cheneau scoliosis derotation brace. Credit: Dr. Aurélien Courvoisier, MD Pr. Aurélien Courvoisier, Scoliosis Bracing, interviewed by Dr.Derek Lee Photo: Dr. Manuel Rigo, MD Dr. Manuel Rigo, Creator of the Rigo Cheneau Scoliosis Brace, interviewed by Dr. Derek Lee Credit: Dr. Per Trobisch, MD Dr. Per Trobisch, Vertebral Body Tethering/ASC Non-Fusion Scoliosis Surgery, with Dr. Derek Lee Figure 4 illustrates Dr. Per Trobisch’s algorithm (undergoing validation) for choosing what curves are appropriate for fusion or non-fusion scoliosis surgery. multidisciplinary health care practi-tioners including experienced scoliosis chiropractors, physiotherapists, natur-opaths, orthotists and spine surgeons to manage and treat scoliosis patients through their journeys. If conservative treatment and bracing fail, then a surgeon is already involved and a seam-less transition can be made if surgery is necessary. But timing is everything when treat-ing AIS. Even at the point of surgical intervention, there are options whether it be fusion or non-fusion. www.Cndoctor.ca 8 Chiropractic and Naturopathic Doctor November/December 2021
Chiropractic + Naturopathic Doctor November/December 2021: Page 8
