Free Paper with Discussions on Medical Topics

Discussion group 1: etiology and epigenetics

Post 1: Xuan Zhou

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I agree with your position as this condition has no known cause other than theoretical associations. Studies have revealed that adolescent idiopathic scoliosis is the typical kind of scoliosis that starts in the early teenage stages and disproportionately affecting (Parent, Newton, & Wenger, 2005). However, the problem is denoted by a curve on the spine which has an unknown origin. During the onset of scoliosis the patient may experience some pain, but with time the curve continues to persist without causing any pain which makes it difficult to determine its origin and prognosis. This situation creates a problem for the treatment of the problem, but healthcare providers rely on the natural history or a case to settle on a management or treatment method. Studies have revealed that due to the lack of a precise definition for the etiology of idiopathic scoliosis, the application of conservative treatments such as bracing has always presented with challenges to the orthopedic surgeons (Cheng et al., 2015). Hence, the value of clinical monitoring has been considered as the means to understand the problem and design a reliable treatment for different cases. This process helps to establish the risk of progression, and in combination with physical examination, the providers can make a diagnosis that will improve the condition of the patients. For instance, factors considered during investigation and monitoring include the location of the curve along the spine and skeletal maturity among others.

References

Cheng, J. C., Castelein, R. M., Chu, W. C., Danielsson, A. J., Dobbs, M. B., Grivas, T. B., ... & Stokes, I. A. (2015). Adolescent idiopathic scoliosis. Nature reviews disease primers, 1, 15030.

Parent, S., Newton, P. O., & Wenger, D. R. (2005). Adolescent idiopathic scoliosis: etiology, anatomy, natural history, and bracing. Instructional course lectures, 54, 529-536.

Post 2: Karen Amaya S.

I agree that genetic factors play a tremendous role in the development of this disorder or the spine and the trunk, although is part of the theories that tend to explain the etiology of idiopathic scoliosis. This deformity affects many people across the world but between two to three percent is acceptable for general pollution. More girls are at risk of developing the problem than boys (Cheng et al., 2015). I have also been curious in understanding the disproportionate sex effect exhibited between girls and boys, which led me to a study that described a mechanical model. The theory stated that if lateral curves are assumed to be buckling off a spinal column hence, there is a chance of occurrence of progression proportional to the height of the column and inversely to its thickness (Fadzan & Bettany-Saltikov, 2017). The theory further suggested that short and thick spines are less likely to buckle as compared to the tall and slim. Hence, the conclusion why girls tend to be at risk of the problem is that they have a thin spine accompanied with narrower vertebral boys as compared to boys. Furthermore, the adolescent who participates in particular sports such as ballet and swimming among others have been shown by studies to be at risk. The link to the sport as the cause of scoliosis does not discriminate on gender. These are some of the speculations that are currently considered to inform the effective treatment for this condition.

References

Cheng, J. C., Castelein, R. M., Chu, W. C., Danielsson, A. J., Dobbs, M. B., Grivas, T. B., ... & Stokes, I. A. (2015). Adolescent idiopathic scoliosis. Nature reviews disease primers, 1, 15030.

Fadzan, M., & Bettany-Saltikov, J. (2017). Etiological Theories of Adolescent Idiopathic Scoliosis: Past and Present. The Open Orthopaedics Journal, 11(1).

Discussion group 2: biomechanics and treatment

Post 3: Justin Scott

I share the same thoughts with you on the prognosis of idiopathic scoliosis that other than being linked to genetic and other environmental factors the biomechanic element is vital to consider in facilitating the treatment of this condition. The biomechanics theory suggests that this problem is one of front-back symmetry and not the right-left (Millner & Dickson, 1996). The Reliance on the biological factors, there is a chance for bringing the spinal cord to or beyond its threshold for buckling. This situation means that the spines which are taller and thinner can easily be bend, and when they are misaligned to the sagittal plane, they can easily be moved to other planes to restore the correct alignment. Despite the lack of full understanding of the biomechanics method of bracing being used in the thoraco-lumbo sacral to treat the idiopathic scoliosis patients, it remains the most used option (Clin, Aubin, Parent, Sangole, & Labelle, 2010). Studies have revealed that bracing is applied in the treatment of moderate spinal curves. Also, the immediate adoption of the in-brace methods to correct the scoliotic curves has been shown to have long-term effects on patients. The in-brace improves the spinal stability and promotes the growth of a better aligned spinal cord (Clin, Aubin, Sangole, Labelle, & Parent, 2010). Hence, early diagnosis of the deformed spinal curves and utilizing the biomechanics techniques sooner in life of the patient can lead to the improvement of the outcome in the condition

References

Clin, J., Aubin, C. E., Parent, S., Sangole, A., & Labelle, H. (2010). Comparison of the biomechanical 3D efficiency of different brace designs for the treatment of scoliosis using a finite element model. European Spine Journal, 19(7), 1169-1178.

Clin, J., Aubin, C. E., Sangole, A., Labelle, H., & Parent, S. (2010). Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis. Spine, 35(18), 1706-1713.

Millner, P. A., & Dickson, R. A. (1996). Idiopathic scoliosis: biomechanics and biology. European Spine Journal, 5(6), 362-373.

Discussion group 3: The role of sagittal balance

Post 1

The radiographic assessment of asymptomatic patients have been used in various studies in the quest to understand the parameters and of position and the shape of the spinal cord, to explain the human sagittal balance in the standing position. To understand the spinopelvic balance, three anatomic features are considered by various studies; the center of the femoral head, the inclination of the sacral plate, and plumbline (Laouissat, Sebaaly, Gehrchen, & Roussouly, 2017). The lumbar lordosis and thoracic kyphosis are the spinal curves whose shapes affect the sagittal balance. Hence, the sagittal balance is integral in the treatment of scoliosis. The correction of spinal misalignment in the transverse and coronal plains deformations is assumed to be a solution to the problem in the effort to enhance sagittal balance (Cil, Yazici, Uzumcugil, Kandemir, Alanay, Alanay, & Surat, 2005). Hence, with better alignment, a person has a chance to stand in the right posture or engage in activities that involve bending without straining. Studies on the sagittal balance and their importance on the treatment of idiopathic scoliosis have been published recently in large number, but those focusing on children are still few. This is a challenge for the treatment of this problem when it occurs in the childhood (Mac-Thiong, Labelle, Berthonnaud, Betz, & Roussouly, 2007). Hence, focusing on this areas could help to prevent even scoliosis that occurs in teenage and adulthood.

References

Cil, A., Yazici, M., Uzumcugil, A., Kandemir, U., Alanay, A., Alanay, Y., ... & Surat, A. (2005). The evolution of sagittal segmental alignment of the spine during childhood. Spine, 30(1), 93-100.

Mac-Thiong, J. M., Labelle, H., Berthonnaud, E., Betz, R. R., & Roussouly, P. (2007). Sagittal spinopelvic balance in normal children and adolescents. European Spine Journal, 16(2), 227-234.

Laouissat, F., Sebaaly, A., Gehrchen, M., & Roussouly, P. (2017). Classification of normal sagittal spine alignment: refounding the Roussouly classification. European Spine Journal, 1-10.