Scoliosis Genetic and Blood Tests Pave the Way for Early Stage Scoliosis Intervention in the Future
The treatment of idiopathic scoliosis has maintained a consistent dogmatic stance of observation for mild curvature less than 25 degrees, bracing for moderate curvatures between 25 and 40 degrees, and highly invasive spinal fusion surgery for curvature over 40 degrees. With the advent of genetic and blood testing this dogmatic stance will be rapidly changing. Controversy amongst scoliosis specialists has been evident especially when dealing with early and moderate treatment zones. With the lack of any genetic profile or understanding of what makes a scoliosis progress to severe surgical levels we simply were unable to tell whether or not the conservative treatments like scoliosis bracing and scoliosis exercise altered the natural course of the disease or if the scoliosis would not have progressed regardless of early attempts to halt progression.
Genetic prognostic testing now available, that will help determine the progressive nature of a patient's scoliosis. An analysis of 53 DNA markers associated with scoliosis has allowed categorization of three specific groups of patients: low risk for progression, moderate risk, and those that will progress to greater than 45 degrees and most likely require fusion surgery. When this testing is used as standard practice it may in fact change the entire paradigm of scoliosis management. Those that will not require treatment considered very low risk will need to be monitored only periodically if at all depending on the patients choice to seek alternative therapies for possible reducing the lower grade curvature. Those that are in the moderate risk zone will still require periodic evaluation and may certainly benefit from conservative methods of treatment, such as scoliosis rehabilitation. Those in the high risk category for curve progression, may be candidates for less invasive non fusion based guided growth type surgeries known as vertebral stapling.
The advent of growth modulation techniques, mainly vertebral body stapling, will most likely become more commonly utilized versus the reactive fusion based surgery that currently dominates the scoliosis surgery market. This guided growth technology may be effective in controlling curve progression until skeletal maturity, at which time the vertebral staples could either be removed or remain based on what the surgeons recommend. This newer technique generally will not negatively impact spinal mobility but at the same time alter curve progression levels and in some cases prevent progression. Further tweaking of the genetic testing may eventually identify those patients who will benefit from physical therapy or spinal bracing, so that these types of scoliosis treatments can be begin at the earliest possible stage in scoliosis development to ultimately maximize their effectiveness. The eagerly awaited scoliosis blood test which measures level of osteopontin (OPN) will hopefully be used in conjunction with the patient's genetic risk analysis and can be used to determine how effective a conservative treatment approach may be for any given patient before they fail a therapeutic trial.
Scoliosis is a condition with both genetic and environmental components (Nature vs. Nurture). Any basic algebra student can tell you that an equation with 2 unknown variables can't be solved and this is why trying to figure out which patients needed which treatments was almost impossible to do with any amount of accuracy. Until now, the Scoliscore test can provide us with the necessary genetic part of the equation and we can now focus on elimination of the environmental aspects of the condition (since altering the genetic component is currently impossible).....this means we can actually start working towards a cure through early stage intervention and elimination of environmental factors.
The prognostic technology of scoliosis is rapidly out pacing the rate of scoliosis treatment advancement. An early stage scoliosis treatment program is being developed in hopes of altering the natural course of the condition and take advantage of the opportunity this prognostic technology can provide.
Genetic prognostic testing now available, that will help determine the progressive nature of a patient's scoliosis. An analysis of 53 DNA markers associated with scoliosis has allowed categorization of three specific groups of patients: low risk for progression, moderate risk, and those that will progress to greater than 45 degrees and most likely require fusion surgery. When this testing is used as standard practice it may in fact change the entire paradigm of scoliosis management. Those that will not require treatment considered very low risk will need to be monitored only periodically if at all depending on the patients choice to seek alternative therapies for possible reducing the lower grade curvature. Those that are in the moderate risk zone will still require periodic evaluation and may certainly benefit from conservative methods of treatment, such as scoliosis rehabilitation. Those in the high risk category for curve progression, may be candidates for less invasive non fusion based guided growth type surgeries known as vertebral stapling.
The advent of growth modulation techniques, mainly vertebral body stapling, will most likely become more commonly utilized versus the reactive fusion based surgery that currently dominates the scoliosis surgery market. This guided growth technology may be effective in controlling curve progression until skeletal maturity, at which time the vertebral staples could either be removed or remain based on what the surgeons recommend. This newer technique generally will not negatively impact spinal mobility but at the same time alter curve progression levels and in some cases prevent progression. Further tweaking of the genetic testing may eventually identify those patients who will benefit from physical therapy or spinal bracing, so that these types of scoliosis treatments can be begin at the earliest possible stage in scoliosis development to ultimately maximize their effectiveness. The eagerly awaited scoliosis blood test which measures level of osteopontin (OPN) will hopefully be used in conjunction with the patient's genetic risk analysis and can be used to determine how effective a conservative treatment approach may be for any given patient before they fail a therapeutic trial.
Scoliosis is a condition with both genetic and environmental components (Nature vs. Nurture). Any basic algebra student can tell you that an equation with 2 unknown variables can't be solved and this is why trying to figure out which patients needed which treatments was almost impossible to do with any amount of accuracy. Until now, the Scoliscore test can provide us with the necessary genetic part of the equation and we can now focus on elimination of the environmental aspects of the condition (since altering the genetic component is currently impossible).....this means we can actually start working towards a cure through early stage intervention and elimination of environmental factors.
The prognostic technology of scoliosis is rapidly out pacing the rate of scoliosis treatment advancement. An early stage scoliosis treatment program is being developed in hopes of altering the natural course of the condition and take advantage of the opportunity this prognostic technology can provide.
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