The issue of adolescent idiopathic scoliosis is one many of us are familiar with. This abnormal curvature of the spine usually shows up between the ages of 10 and 16. While each case is different, the risk of undergoing surgery for the condition is only thought to be around 5% [1]. In a new case report carried in the Asia Pacific Chiropractic Journal, a much rarer case is detailed: one in which the scoliosis patient was just 2 and a half years old and already looking at the very real possibility of surgical intervention.
The case in question “discusses the application of Sacro Occipital Technique (SOT)” on the young female patient. Her abnormal curvature showed up in a routine physical when she was just 6-months old. Her paediatrician followed this observation up with ultrasound which confirmed a scoliosis (abnormal curvature of the spine) and thoracic kyphosis (commonly associated with forward head carriage starting in the upper back). Her mother, an existing chiropractic patient, presented her daughter for care when a follow-up study led to an orthopaedic consult in which surgery was recommended. This would include a surgical fusion to stabilise the spine.
Unsurprisingly, given the age of her child, the mother presented for chiropractic care to see if there were “any other less invasive alternatives.” Luckily for this mother, the attending chiropractor was well-informed when it came to previous scoliosis studies showing a record of positive responses to chiropractic management in children.
The youngster underwent a thorough chiropractic evaluation and examination in which standard protocols were used plus SOT protocols and the Moire system which is deployed to assess the severity of a scoliosis.
With a surgery date looming, she commenced a six-week intensive course of chiropractic care “to address her subluxation pattern, stabilize her Category II complex (sacroiliac hypermobility and its effect on the whole body kinematic chain) and to correct the cranial bone and meningeal imbalance [1].”
Full details of the examination can be found at the reference below. However, it should be noted that she had significant clinical findings right through from the cranium and cervical spine through to the lumbar spine and sacral base. The impact of these findings on the child’s function and movement were notable.
Six weeks isn’t long to turn around a situation for which surgery is already scheduled. Additionally, the chiropractor only deploys adjustments that are safe and effective for the age and tensile strength of the paediatric patient. It might seem like a daunting undertaking. However, with 2 visits per week for the first 6 weeks, the orthopaedic surgeon examined her prior to her surgery and it was postponed. She continued under chiropractic care, with Moire Studies every six months to monitor the scoliosis. Her chiropractor continued her care using SOT evaluation and adjusting procedures “as well as reduced force cavitation adjustments … to make corrections.”
Here is what her case notes revealed [1]:
- For the first three weeks, SOT blocking procedures were deployed (which uses pelvic wedges during adjustments so that the chiropractor can “reduce pelvic torsion and joint laxity”). These were deployed to target hypermobility on the right side of the pelvis, left sided psoas contraction (a muscle in the lumbar spine that extends down the leg), thoracic spine subluxations, trapezius muscle issues, and subluxations in the cervical spine (the neck area).
- In weeks 4-6 of her course of care, the category II stabilisation had been achieved and the chiropractor used the SOT indicators to continue to reduce the subluxation pattern.
- “Objective findings and continued orthopedic evaluations using the Moire system of scoliosis tracking continued to show marked improvement.
- One year and eight months after presentations, not only had surgery been deemed unnecessary but the scoliosis had been “drastically reduced” and the patient had normal functional levels.
- Three years and two months after her initial presentations, her Moire study showed “almost complete resolution of her scoliosis, kyphosis and lordosis.”
Once again, full details of her course of care can be accessed via the reference below. While the standard case report limitations apply in that we can’t make generalisations based on one case report alone, this one does offer up some novel and noteworthy contributions to the literature. Firstly, there is a paucity of chiropractic literature on scoliosis surrounding this age group. Secondly, the avoidance of invasive surgery on a toddler/pre-schooler is significant and offers up possibilities in terms of chiropractors and orthopaedic surgeons working together to ensure that the best outcomes are reached for our tiniest patients.
REFERENCES:
Rosen, M., and Blum, C., 2021. Management of a 2 ½ year old female with a 35 degree scoliosis and 2 hemi-vertebrae: case report. Asia Pacific Chiropractic Journal. https://www.apcj.net/site_files/4725/upload_files/Rosenscoliosis.pdf?dl=1
