Results:  Immediate Spinal Improvement

  • Waist - more level
  • Shoulders - more level
  • Scapula wings - less prominent
  • Head - more centered over spine
  • Spinal Curvature - decreased

XRay A

Reference:
     Weiss HR 2007.  Adolescent Idiopathic Scoliosis - case report of a patient with clinical deterioration after surgery.  Patient Safety in Surgery Journal, 1(7) Online at www.pssjournal.com/content/1/1/7

XRay B

Based on this immediate attenuation in the right thoracic curve, the cause of his right thoracic curvature was determined to be Rothbarts Foot. 

Rothbart Proprioceptive Therapy was initiated in order to stabilize the patient's right thoracic curve.

Follow-Up:  

  • The progression of the thoracic curve was  reversed. 
  • There was no longer any need for bracing or surgical intervention.
  • Xray A:   Cobb Angles immediately before surgery: 32/28°
  • Xray B:   Cobb Angles immediately after surgery:    36/22°

This is just one of many case studies that this researcher/clinician has been involved with or observed

Discussion:

  • Prior to the surgery, the 15 year old female had a well compensated (stable) double curve pattern. 
  • One year post surgically, the spinal curves were unbalanced, unstable and getting worse. 
  • The girl’s cosmetic appearance had deteriorated (See Photos above).


What these two case studies Demonstrate:

  • When the cause of the abnormal spinal curve is determined and then correctly treated, as in Case 1, the spine is stabilized.
  • When the cause is not determined and not correctly treated, as in Case 2, the spine becomes unstable and the curves further deteriorate.

Case 2: Right Thoracic Scoliotic Curve (right thoracic/left thoracolumbar) - 15 year old female

 
History:  The parents of a 15 year old girl were concerned over the visual appearance of their daughter’s back and that it might be getting worse and brought her to see an orthopedist.

Initial Xrays were taken at the hospital.  The radiologist's report indicated that the girl's double scoliotic curve was well compensated (stable).
                                   
The orthopedist disagreed with the Radiologist's report.  

  • He diagnosed the girl as having adolescent idiopathic (cause unknown) scoliosis. 
  • He told the parents that the right thoracic curves are most unstable around the time of the beginning of menstruation and that these curves are prone to worsening if not surgically stabilized. 

Based on the orthopedist’s recommendation, the parents consented to the surgery.

Results:​  PreOp vs Immediately Post-Op

Reversing Thoracic Curves

Two Case Studies

  • Case 1 - Proprioceptive Therapy
  • Case 2 - Surgical Intervention

The right thoracic curve had increased 4 degrees from 32º to 36º.

The left thorocolumbar curve had decreased 6 degrees, from 28 degrees to 22 degrees

Follow-Up:  

Six months after the surgery, the parents  brought their daughter to see the orthopedist, anxious over the cosmetic appearance of their daughter’s back, which appeared to be worse than it was before the surgery (See Photos below).  

The orthopedist advised the parents not to be concerned, that the cosmetic appearance would improve in time.

One year after the surgery, the appearance of their daughter’s back was still deteriorating. The parent’s concern continued to escalate. They sought another opinion and were referred to a radiologist for another set of Xrays (See Xray C above):

  • The right thoracic curve was 52 degrees (a 20 degree increase compared to before the surgery was done)
  • The left thoracolumbar curve had lost its surgical correction and was now measuring 28 degrees (the same as prior to the surgery)

XRay C

The most progressive spinal (scoliotic) curve is the right thoracic curve.  Its growth velocity is the fastest at skeletal ages 12-13 (pre puberty), but frequently continues moderately after the age of 16 (Yrjones, 2006).

Reference
     Yrjonen T, Ylikoski M 2006. Effect of growth velocity on the progression of adolescent idiopathic scoliosis in boys. Journal Pediatric Orthopaedics; 15(5):311-315.Reference


Case 1:  Right Thoracic Scoliotic Curve - 13 year old male

History:  The parents of a 13 year old boy brought their son to see their family doctor, concerned over the progressive worsening of the son's scoliosis.  

The doctor suggested a back brace.  The brace proved to be so uncomfortable and difficult for the boy to use in school, that the parents deciced to seek the advice of an orthopedist.

The orthopedist took two sets of Xrays (one year apart) of the boy's spine. 

  • The first set of Xrays show a right thoracic curve of 17 degrees (Cobb's angle). 
  • One year later, the thoracic curve had increased to 31 degrees.

The orthopedist strongly advised surgical intervention (fixation of the thoracic vertebrae) before the thoracic curve deteriorated even further.

The parents decided to seek a third opinion and brought their son to see me.

Findings:

  • Rothbart Foot Structure
  • Right Thoracic Curve


Examination:  

  • Tested using proprioceptive stimulation to determine the impact on the thoracic curvature (See Animation Below)