The Future of Scoliosis Screening

Fig 1. An X-ray (posteroanterior) of a patient
with scoliosis typically displays an S- or C- 
shaped, side-to-side curve rather than a 
straight line.

Posted from The Scoliosis Foundation

"The best lightning rod for your protection is your own spine."

- Ralph Waldo Emerson

Scoliosis is an abnormal spine condition that affects millions of Americans. Hallmarked by a lateral curvature of the backbone, it is mostly diagnosed in children ages 10-15 (Fig 1).  Questions remain regarding effective ways to predict curve worsening over time in order to create the appropriate treatment plan.  Research is currently being investigated to address the matter, with DNA testing showing promising results.

There are three types of scoliosis: mild, moderate, and severe.  Each type is classified according to the Cobb method, which measures the acute angle of the side-to-side spinal curve formed in an X-ray (Fig 2).  Mild scoliosis is designated by a Cobb angle of 10-20 degrees, moderate scoliosis by 25-45 degrees, and severe scoliosis by a Cobb angle greater than 50 degrees [1].  Theses types generally begin in childhood.

Fig 2. The three types of scoliosis and associated Cobb angles.
Posted from The Wall Street Journal; Sources: Peter Newton/Randy Children's Hospital San Diego

Scoliosis in children are termed adolescent idiopathic scoliosis (AIS).  5% of children develop AIS by the age of 15. 10% of those have clinical symptoms associated with the ailment, with a female-to-male ratio of 4:1 [2].  As a result, children 10-15 years of age should be routinely screened for the condition [3]. Once a child develops scoliosis, it is uncertain whether the spinal curvature will significantly worsen over time.  This has led to mixed opinions among clinicians on when surgery, fitting a body brace or doing nothing is necessary to prevent potential compromise of respiratory and cardiovascular function caused by further deviation.  Consequently, finding an effective screening strategy for scoliosis is vital.  One such option is a new genetic test called ScoliScore.

The DNA prognostic test, ScoliScore, is used to assess the risk of curve progression in scoliosis patients with a Cobb angle between 10-25 degrees [4].  A 2012 study compared the risk assessment between ScoliScore and traditional screening plans and discovered that the genetic test correctly predicted progression in sixteen times more mild risk patients and five times fewer moderate risk patients [4].  These findings potentially save the patient from additional exposure to x-rays and several appointments to monitor curve progression. Moreover, the need for bracing, which is commonly administered for curves of more than 20-25 degrees as a preventative measure, is drastically reduced [5].  Thus, ScoliScore may save patients from exponential stress and spending thousands of dollars annually.

Scoliscore is an incredible advancement in modern medicine.  With a single test, physicians can reliably predict spinal curve progression, achieving what previously took years of examination, patient burden, and financial strain.  As research in neuroscience continues to advance, a boom in other innovative screening plans may be a few years away.


References:
1. Landro, Laura. "Weighing the Treatment Options for Scoliosis." The Wall Street Journal. Dow Jones & Company, 21 May 2012.
2. Kuchera, W.A., Kuchera, M.L. Osteopathic Principles in Practice. Second Edition (revised), Columbus, Greyden Press, 1994.
3. Savarese, R.G. OMT Review. Third Edition. 2009.
4. Roye, B.D. et. al. Does ScoliScore(TM) Provide More Information Than Traditional Clinical Estimates of Curve Progression. Spine. May 2012: Epub ahead of print.
5. Carlson, B. ScoliScore AIS Pronostic Test Personalizes Treatent for Children With Spinal Curve. Biotechnology Healthcare. Summer 2011: 8(2): 30-1.

Doubt Me

“You may not think you can reach it.  Climb anyway.  You may not think you’ll be heard.  Speak anyway.  You may not think you can change things.  Try anyway.” 

- Maya Angelou

I am in.  It took me a decade of hard work, a bunch of luck, and unconditional support from family and friends to get into medical school.  Yet, like most epic journeys, mine was often tiresome and marred with doubts and temptations to settle for an easier, much more obtainable destination.  If I was able to write a letter to my younger self during those challenging stretches, this is what it would say:

Dear Younger Self,

"The secret of success is to be certain in uncertain times."  These are the words a mentor of mine once told me, words that I look back upon whenever I feel the way you do now.

I am writing to you to let you know that it is ok to doubt.  It does not make you less capable or less passionate than other physicians out there, so please do not allow this feeling to encumber you.  I think doubt is one of the few constants in life, an extra safety measure built-in to encourage us to carefully question our motives in any great pursuit.  I can imagine how incredibly difficult it must be for you to work towards something for so long and only see minimal results, while others have already made it, support back home is beginning to fade, and your age is starting to creep up on you.  

Still, I promise you that this is all going to be worth it.  What you are actually doing in this moment is conditioning yourself to be able to handle something extraordinary later on.  For now, you MUST trust in the process, continue to stay positive and surround yourself with good people whom you can draw inspiration from.  And MOST importantly, you have to put your Faith first.  It will get you through this trying time in your life.  You will see.  

Hold fast to your dreams and follow them with the certainty that they will come true.  I have little doubt that they will when the time is right.

Sincerely,

Humbled Self

Specialize Me

"Two roads diverged in a wood, and I-

I took the one less traveled by, 

And that has made all the difference."

- Robert Frost

When starting medical school, we are encouraged to keep an open mind to all the different specialties available before choosing a path early on.  This makes perfect sense.  We have only been given a limited exposure of what some fields have to offer (through prior clinical experiences and exaggerated medical dramas on TV).  Such passive interactions are usually not enough for us to make an informed decision.  Only a handful of students know exactly which specialty best suits them after matriculation and stick with it through all four years of education.

I have been fortunate to be able to take a year off before becoming a medical student in August, and because of this extra time to reflect on my past, it is becoming apparent to me which field in medicine I may best fit in.  So today, I would like to announce that I will be using this blog to record my entire journey throughout medical school and am excited to see if I will end up specializing in neurology or be destined for another specialty.  Stay tuned.

Wake Me

"Early to bed and early to rise, makes a man healthy, wealthy, and wise." 

- Benjamin Franklin

As the day ends, our body's physiology does as well.  Let's examine why.  From the moment the alarm clock we can't seem to shut off fast enough activates till the anticipated time our heads hit a cool, welcoming pillow at night, our internal machines have been working hard. And like all vehicles that run on energy, our little workaholics produce waste as a byproduct. This filth, in such forms as carbon dioxide, nitrogen and harmful oxygen radicals, accumulate while our daily routine progresses, taxing our thinking and slowing our physiological gears down to a grind.

So to beat this waste traffic jam at the end of my days, I make myself go to bed early and wake up before the sun rises.  This initially difficult but simple change has allowed me to save the bulk of my study time for the mornings and attack the books with a "fresh" mind.  I find that making a habit of this, combined with running daily, to be incredibly empowering.