Scoliosis: Degenerative &

Idiopathic
Dr. James Cox presents treatment of
scoliosis due to various causes,
latest published literature findings,
and in-office patient cases.

Sciatic Scoliosis

Sciatic scoliosis is due to irritation of the spinal neurons

in radiculopathic stimulation and its resultant muscle
activity.

Hirayama et al in Spine 2001;26(6):602-9 reported on

the effects of electrical stimulation of the sciatic nerve
on background electromyography and static stretch
reflex activity of the trunk muscles in rats. They verified
the hypothesis that sciatic scoliosis is induced
reflexively by radiculopathic pain, and that scoliosis
might be maintained by prolonged asymmetric alteration
of the trunk muscle tonus caused by central
sensitization of the spinal neurons that constitute the
postural reflex pathways.

Sciatic Scoliosis
Sciatic scoliosis usually occurs with convexity to the
side of the herniated disc. The neuronal mechanism
of sciatic scoliosis has not been well clarified.
In spinalized rats (transection of the spinal cord), the
sciatic nerve was stimulated electrically as a
conditioning stimulus. Muscle stretch elicited by
bending of the lumbar spine was applied as a test
stimulus.

Sciatic Scoliosis
It was found that the pattern of electromyographic
activity of the trunk muscles evoked by sciatic nerve
stimulation coincided with the typical direction of
sciatic scoliosis in patients with lumbar disc
herniation. It was supposed that the prolonged
asymmetric alteration of the trunk muscle tonus was
caused by central sensitization, and that central
sensitization of spinal neurons may underlie the
neuronal mechanism of sciatic scoliosis.

Sciatic Scoliosis
As opposed to the work of Finneson and Herlin, the
sciatic scoliosis may not be, or not only be, the
mechanical embarrassment of the nerve root or
dorsal root ganglion by disc invasion of territory, but
the embarrassment of the neurological bed of the
nerve root resulting in the resultant muscle spasm
and scoliosis.
This is what we are discussing in this course. Let's
start with a patient case presentation and
treatment...

Left Thoracolumbar Scoliosis

in a Young Male
Cox Technic Flexion-Distraction and Decompression done to all
curves using all motions of the Cox Table lying supine and side-lying.
Side Notes: This patient
moved to Fort Wayne from
another city where he was
treated by a chiropractic
physician with Cox
Technic. He came to our
office seeking the same
care.
At the second visit, the
patient reports a drop in
his VAS score from a 7 to
a 1 with improvement
noted in his shoulder and
low back.

Dr. Cox introduces this discussion of

degenerative scoliosis and its
management.
Fu KMG, Smith J, Sansur CA et
al: Standardized
measures of health
status and disability and
the decision to pursue
operative treatment in
elderly patients with
degenerative scoliosis.
Neurosurgery 2010;
66(1):42-47
Link to Journal Abstract
Glassman SD, Carreon LY,
Shaffrey CI, Polly DW et al:
The costs and benefits of
nonoperative
management for adult
scoliosis. Spine 2010;
35(5):578-582
Link to Journal Abstract

Dr. Cox shows imaging and

discusses scoliosis cases.

Degenerative Scoliosis (cont.)

Bautmans I, Can Arken J, Van mackelenberg M, Mets
T: Rehabilitaiton using manual mobilization for
thoracic kyphosis in elderly postmenopausal
patients with osteoporosis. J of Rehabilitation
Medicine 2010; 42(2):129-135
Link to Journal Abstract
Masharawi Y, Dar G, Peleg S, Steinberg N, Medlej B,
May J, Abbas J, Hershkovitz I: A morphological
adaptation of the thoracic and lumbar
vertebrae to lumbar hyperlordosis in young
adult females. European Spine Journal 2010;
19(5):768-773 Link to Journal Abstract
Upendra B, Meena D, Kandwal P, Ahmed A,
Chowdhury B, Jayaswal A: Pedicle
morphometry in patients with adolescent
idiopathic scoliosis. Indian Journal of
Orthopedics 2010; 44(2):169-176
Link to Journal Abstract
Hee HT, Zhang JT, Wong HK:Effects of cyclic
dynamic tensile strain on previously
compressed inner annulus fibrosus and
nucleus pulposus cells of human intervertebral
disc. An in-vitro Study. J of Orthopaedic
Research 2010; 28(4):503-509
Link to Journal Abstract
Beresford ZM, Kendall RW, Willick SE: Lumbar facet
syndromes. Current Sports Medicine Reports
2010; 9(1):50-56 Link to Abstract
Mayer JM, Haldeman S, Tricco AC, Dagenais S:
Management of chronic low back pain in active
individuals. Current Sports Medicine Reports
2010; 9(1):60-66 Link to Abstract

Motions of Treatment

In the following videos, Dr. Cox demonstrates

treatment application options for specific conditions.
The caudal section of the flexion-distraction
instrument The Cox7 Table is used here - may
be used or the thoracic restraint or the automated
feature or the cervical spine headpiece or its
restraint. Any condition can be treated in any
number of ways. To clarify how Dr. Cox makes the
table move, please review the following images.

Foot Switch Strip

to Activate Long-Y-Axis while treating
the Thoracic Spine

Tiller Bar Handle Button (top)

to Activate Long-Y-Axis while treating the
Thoracic Spine

Table Handle Locks

Treatment Demonstration:
Charite Disc Replacement/Dextrorotatory
Scoliosis

This is a case of L4
Charite Disc
Replacement with and
L5 Disc herniation
and dextrorotatory
scoliosis.
The Rule of 50% is
discussed in relation to
the treatment plan to
relieve S1 dermatome
pain.

Hyperkyphosis & Scheuermann's

Disease treated in the supine position.

Hyperkyphosis / Scheuermann's Disease

/ Osteoporosis / Any Condition needing
thoracic adjusting

Dr. Cox demonstrates

flexion-distraction long-yaxis decompression spinal
adjusting (low-velocity, lowamplitude adjusting) for
any condition needing
gentle thoracic spinal
adjusting. Patients working
on computers and carry
much stress really
appreciate this care.

Hyperkyphosis / Scheuermann's Disease /

Upper Thoracic Spine Low-Velocity/LowAmplitude (LVLA) Adjusting using the Cervical
Headpiece

Highlights:

Use of the cervical spine

restraint to treat the
thoracic spine curvature.
Long Y axis automated
distraction with cervical
headpiece restraint in
place.

Goals:

drop intradiscal pressures

increase foraminal area
restore physiological
ranges of motion

Hyperkyphosis / Thoracic Spine

Adjusting in the Side-Lying Position

For some patients, this

very gentle application
is preferred.

Compression Fracture Treated

in the Supine Position

Case - Scheuermann's
Disease

Here is a patient case of

Scheurmann's Disease treated
in the office.

use of occipital restraint to

treat hyperkyphosis
use of long y axis automated
to treat thoracic spine (LVLA
low velocity low amplitude)
treatment without
occipital restraint
use of foramen magnum
pump

Initial Visit: 25 year old, postpartum 8 months,

hyperkyphosis, extension
irritates low back pain
Outcome of Case: At the third
visit, the patient reported that
the neck and shoulder pain is
gone and the low back pain is
over 50% gone.

Demonstration of the Mehta

exercises with a male spine

Exercises for scoliosis are for

strengthening the convex side of
the curve and ensuring its mobility,
the same goals for adjusting scoliosis.
We are not looking to necessarily
correct the curve or reverse it, but
rather ensure its mobility. Mehta
Exercises are excellent tools the
patient can do alone or, optimally, with
a helper. Both ways are
demonstrated, first alone in this video
and with a helper in the next.
Source for Mehta Exercise: in
denBoer W, Anderson P, Limbeek J,
Kooljman M: Treatment of Idiopathic
Scoliosis with Side-Shift Therapy: An
initial comparison with a brace
treatment historical cohort. European
Spine Journal 1999; 8:406-410
(Reference #10 - Mehta MH in 1985
which is active correction by side shift
In Warner JO, Mehta MH on scoliosis
prevention from Proceedings of the P.
Zorab Scoliosis Symposium 1983,
Praeger, New York, p 126-40)

Mehta Exercises for Scoliosis

Curve Strengthening

Here is a
demonstration with a
helper assisting.

Latest Research On Scoliosis

The following slide presentations are

discussions of the latest published articles
related to scoliosis, both idiopathic as well
as degenerative: bracing, exercise,
diagnosis strategies, causes, biomechanics,
potential solutions.
Each slide has a list of the articles
discussed with a link to the abstract of the
article or book chapter for your later study.

Scoliosis Literature
Bracing Sources

Negrini, S; Minozzi, S; Bettany-Saltikov, J; Zaina, F; Chockalingam, N; Grivas, TB;

Kotwicki, T; Maruyama, T; Romano, M; Vasiliadis, ES. Braces for Idiopathic Scoliosis in
Adolescents. Spine 2010; 35 (13): 1285-1293 Link to Abstract
Danielsson, Aina J.; Hasserius, Ralph; Ohlin, Acke; Nachemson, Alf L.
Health-Related Quality of Life in Untreated Versus Brace-Treated Patients With Adole
scent Idiopathic Scoliosis: A Long-term Follow-up
. Spine 2010; 35(2):199-205 Link to Abstract
Lou, E; Hill, D; Raso, J: Brace Treatment for Adolescent Idiopathic Scoliosis.
Conservative Scoliosis Treatment: 1st SOSORT Instructional Course Lectures Book 135.
2009 Link to Book
Scoliosis. Grivas, TB; Rodopoulos, GI; Bardakos, NV: Biomechanical and Clinical
Perspectives on Nighttime Bracing for Adolescent Idiopathic. Conservative Scoliosis
Treatment: 1ST SOSORT Instructional Course Lectures Book 135. Amsterdam: I O S
Press, 2009 Link to Book
Katz, DE; Herring, JA; Browne, RH; Kelly, DM; Birch, JG. Brace Wear Control of Curve
Progression in Adolescent Idiopathic Scoliosis. Journal Of Bone And Joint SurgeryAmerican 2010; 92A (6):1343-1352 Link to Abstract
Fayssoux, RS; Cho, RH; Herman, MJ. A History of Bracing for Idiopathic Scoliosis in
North America. Clinical Orthopaedics And Related Research 2010;468 (3): 654-664
Link to Abstract

Scoliosis Literature
Bracing Discussion

Scoliosis Research II Sources

Schiller, JR; Thakur, NA; Eberson, CP. Brace Management in Adolescent Idiopathic
Scoliosis. Clinical Orthopaedics And Related Research 2010;468 (3):670-678 Link to Abstract
Burwell, RG; Dangerfield, PH; Moulton, A; Anderson, SI: Etiologic theories of idiopathic
scoliosis: autonomic nervous system and the leptin-sympathetic nervous system concept
for the pathogenesis of adolescent idiopathic scoliosis. Research Into Spinal Deformities 6
140. 2008. p.197-207 I O S PRESS, AMSTERDAM Link to Book
Bettany-Saltikov, J; Warren, J; Stamp, M: Carrying a Rucksack on either Shoulder or the
Back, Does it matter? Load Induced Functional Scoliosis in "normal" young subjects.
Research Into Spinal Deformities 6 140. 2008. p.221-224 I O S PRESS, AMSTERDAM
Link to Book
Domenech, J; Tormos, JM; Barrios, C; Pascual-Leone, A. Motor cortical hyperexcitability in
idiopathic scoliosis: could focal dystonia be a subclinical etiological factor?
Kirby, AS; Moulton, A; Dangerfield, PH; Freeman, BJC; Cole, AA; Polak, FJ; Pratt, RK.
Ultrasound femoral anteversion (FAV) and tibial torsion (TT) after school screening for
adolescent idiopathic scoliosis (AIS). Research Into Spinal Deformities 6 140. 2008. p.225230 I O S PRESS, AMSTERDAM Link to Book
Burwell, RG; Aujla, RK; Freeman, BJC; Dangerfield, PH; Cole, AA; Kirby, AS; Polak, FJ; Pratt,
RK; Moulton, A. The posterior skeletal thorax: rib-vertebral angle and axial vertebral
rotation asymmetries in adolescent idiopathic scoliosis. Research Into Spinal Deformities 6
140. 2008. p.263-268 I O S PRESS, AMSTERDAM Link to Book
Stokes, IAF; McBride, CA; Aronsson, DD. Intervertebral disc changes in an animal model
representing altered mechanics in scoliosis. Research Into Spinal Deformities 6 140. 2008.
p.273-277 Link to Book

Scoliosis Research II Discussion

Scoliosis Research III Sources

Fong, Daniel Yee Tak; Lee, Chun Fan; Cheung, Kenneth Man Chee; Cheng, Jack Chun Yiu;
Ng, Bobby Kin Wah; Lam, Tsz Ping; Mak, Kwok Hang; Yip, Paul Siu Fai; Luk, Keith Dip Kei.
A Meta-Analysis of the Clinical Effectiveness of School Scoliosis Screening. Spine 2010;
35(10):1061-1071 Link to Abstract
Ugras, AA; Yilmaz, M; Sungur, I; Kaya, I; Koyuncu, Y; Cetinus, ME. Prevalence of scoliosis
and cost-effectiveness of screening in schools in Turkey. Journal Of Back And
Musculoskeletal Rehabilitation 23 (1). 2010. p.45-48 Link to Abstract
Wang, Chuanfeng; Xu, Weidong; He, Shisheng; Gu, Suxi; Zhao, Yingchuan; Zhang, Jingtao;
Zhu, Xiaodong; Li, Ming. Differences in Postoperative Quality of Life Between Adolescent
Patients With Idiopathic Scoliosis Residing in Urban and Rural Environments. Spine
2010. 35(6):652-656, March 15, 2010. Link
Ogilvie, J. Adolescent idiopathic scoliosis and genetic testing. Current Opinion in
Pediatrics 2010; 22 (1):67-70 Link
Akoume, MY; Azeddine, B; Turgeon, I; Franco, A; Labelle, H; Poitras, B; Rivard, CH; Grimard,
G; Ouellet, J; Parent, S; Moreau, A. Cell-Based Screening Test for Idiopathic Scoliosis
Using Cellular Dielectric Spectroscopy. Spine 2010;35 (13):E601-E608 Link
Grivas, TB; Vasiliadis, ES; Rodopoulos, G. Aetiology of Idiopathic Scoliosis. What have we
learned from School Screening? Research Into Spinal Deformities 6 140. 2008. P.240-244
I O S Press, Amsterdam Link
Yong, F; Wong, HK; Chow, KY. Prevalence of Adolescent Idiopathic Scoliosis among
Female School Children in Singapore. Annals Academy Of Medicine Singapore 38 (12).
DEC 2009. p.1056-1063 Link

Scoliosis Research III Discussion

Scoliosis Research IV Sources

Ciazynski D, Czernicki K, Dumala J: Knowledge about idiopathic scoliosis among students of

physiotherapy. Research into Spinal Deformities 2008; 6(140):281-285 Link to Book Online
Weiss H, Maier-Hennes A: Specific exercises in the treatment of scoliosis. Conservative
Scoliosis Treatment: 1st SOSORT Instructional Course Lectures Book 135; 2009 Link to Book
Romano M, Negrini A, Parzini S et al: Scientific Exercises Approach to Scoliosis (SEAS):
Efficacy, Efficiency and Innovation. Conservative Scoliosis Treatment: 1st SOSORT Instructional
Course Lectures Book 135; 2009 Link to Book
Rigo M, Quera-Salva F, Villagrasa M et al: Scoliosis intensive out-patient rehabilitation based
on Schroth Method. Conservative Scoliosis Treatment: 1st SOSORT Instructional Course Lectures
Book 135; 2009 Link to Book
Dobosiewicz K, Drumala J, Kotwicki T: Dobosiewicz Method physiotherapy for idiopathic
scoliosis. Conservative Scoliosis Treatment: 1st SOSORT Instructional Course Lectures Book 135;
2009 Link to Book
Weiss H, Rigo M: The Cheneau Concept of Bracing - Actual Standards. Conservative Scoliosis
Treatment: 1st SOSORT Instructional Course Lectures Book 135; 2009 Link to Book
Durmala J, Tomalak W, Kotwicki T: Function of the respiratory system in patients with
idiopathic scoliosis reasons for impairment and methods of evaluation. Conservative Scoliosis
Treatment: 1st SOSORT Instructional Course Lectures Book 135; 2009 Link to Book
Rigo M, Weiss H: The Cheneau Concept of Bracing - Biomechanical Aspects. Conservative
Scoliosis Treatment: 1st SOSORT Instructional Course Lectures Book 135; 2009 Link to Book
deMauroy J, Fender P, Tato B, Lusenti P, Ferracane G: Lyon Brace. Conservative Scoliosis
Treatment: 1st SOSORT Instructional Course Lectures Book 135; 2009 Link to Book
Christine C, Alin C, Riward C: Treatment of early adolescent idiopathic scoliosis using teh
SpineCor System. Conservative Scoliosis Treatment: 1st SOSORT Instructional Course Lectures
Book 135; 2009 Link to Book

Scoliosis Research IV Discussion

Scoliosis Research V Sources

for Brace Types & Outcomes

Sforzesco Brace - Ananasio, Saina, Negrini: The SPoRT (Symmetci, Patient-Oriented, Rigid, Three-dimensional active)
concept for scoliosis bracing: principles and results. Conservative Scoliosis Treatment: 1st SOSORT Instructional Course
Lectures Book 135. 2009 Link
Boston Brace - Wynne J: The Boston Brace System Philosophy, Biomechanics, Design & Fit. Conservative Scoliosis
Treatment: 1st SOSORT Instructional Course Lectures Book 135. 2009 Link
Cosmetic Effect in IS Kids - Grivas T, Vasiliadis E: Cosmetic Outcome after Conservative Treatment of Idiopathic
Scoliosis with a Dynamic Derotation Brace. Conservative Scoliosis Treatment: 1st SOSORT Instructional Course
Lectures Book 135. 2009 Link
Reduction in Surgical Intervention - Negrini S, Atanasio A, Zaina F, Romano M. et al: Endgrowth resluts of bracing and
exercises for adolescent idiopathic scoliosis. Prospective worst-case analysis. Conservative Scoliosis Treatment: 1st
SOSORT Instructional Course Lectures Book 135. 2009 Link
Quality of Life - Vasiliadis E, Grivas T Quality of life after conservative treatment of adolescent idiopathic scoliosis.
Conservative Scoliosis Treatment: 1st SOSORT Instructional Course Lectures Book 135. 2009 Link
Adult Scoiosis Surgery Effects - Yadla S, Maltenfort M, et al: Adult scoliosis surgery outcomes: a systematic review.
Neurosurgical Focus 2010; 28(3):NIL19-NIL25n Link to Yadla article
Chromium from Scoliosis Rods - Cundy T, Delaney C, Rackham M, et al: Chromium Ion Release from Stainless Steel
Pediatci Scoliosis Instrumentation. Spine 2010; 35(9):967-974 Link to Abstract
Cost of Scoliosis Treatment - Kamerlink J, Quirno M, Auerback J et al: Hospital costs analysis of adolescent idiopathic
scoliosis correction surgery in 125 consecutive cases. J of Bone and Joint Surgery - American. 2010; 92A(5):1097-1104
Link to Abstract
Scoliosis Research Subjects - Bunge E, Habbema J, deKoning H: A randomized controlled trial on the effectiveness of
bracing patients with idiopathic scoliosis. European Spine Journal 2010; 19(5):747-753 Link to Issue to read article
Kyphosis after Scoliosis Fusion - Wang J, Zhao Y, Shen B, Wang C, Li M: Risck facotr analysis of proximal junctional
kyphosis after posterior fusion in patients iwth idiopathic scoliosis. Injury-International Journal of the Care of the Injured
2010; 41(4):415-420 Link to Issue to read abstract

Scoliosis Research V
Discussion of Brace Types & Outcomes

Thank you.

Thank you for studying with me degenerative and

idiopathic scoliosis: the latest in biomechanics,
diagnosis, and treatment. Scoliosis is a challenging
condition demanding confident, gentle care with a
realistic goal of maintaining mobility and flexibility as
well as building strength into a curve that may not
ever be straightened, but deserving of good care.
James M. Cox, DC, DACBR
www.coxtechnic.com
info@coxtechnic.com