Prolotherapy for Scoliosis

Scoliosis

Introduction: Scoliosis is a lateral curvature of the spine of 11 degrees or more. Scoliosis is usually discovered during adolescence and is called idiopathic scoliosis, a fancy term meaning the doctor has no idea what caused the scoliosis. In common language, scoliosis means that the spine is crooked.

Many young people are diagnosed with what is called idiopathic scoliosis. That means there is no known cause for their spinal curve of greater than 10%. They also are afflicted for a lifetime. Over half a million adults in the United States suffer with symptoms from scoliosis which include low back pain, popping, muscle spasms and referred leg pain. The severity of symptoms and the need for treatment generally correspond with the severity of the curvature.

Scoliosis is a genetic condition. Interestingly, some researchers have also found a correlation between scoliosis and another genetic condition afflicting young people…hypermobility. Hypermobility is a collagen disorder which causes ligaments to be lax and joints to be unstable, even joints of the spine. The spine is held together by ligaments. And if the ligaments are loose, then the spine will be loose.  In scoliosis, the ligaments are stretched at the tip or apex of the curve, and become weak. For this reason, patients often experience pain at the site where the spine curves.

Bracing is the common treatment for scoliosis, and for mild cases it has been shown to be beneficial. When the condition is more severe, surgery may be recommended, but it is a major surgery that involves placing large rods in the back to stabilize the spine. When seeking pain relief from scoliosis, as well as hypermobility, non-surgical Prolotherapy treatments can be an effective option. Because Prolotherapy triggers the body to thicken and strengthen the ligaments, it can help stabilize the spinal segment and alleviate pain.

Ligaments

The spine is held together by the same thing that holds all the bones together, ligaments. The patient often experiences pain at the site where the spine curves. At the apex of this curve, he ligaments are being stretched with the scoliosis, and localized ligament weakness is one of the etiological bases for it. (There are many possible causes for scoliosis. In this article we are going to focus on one possible cause, ligament weakness and the spinal instability it causes.

In 1994, Nancy Hadley Miller, MS, MD and researchers from the Department of Orthopedic Surgery, Baylor College of Medicine, published a study in the Journal of bone and joint surgery (1)  looking for the possible causes of adolescent scoliosis. This study focused on the problems of spinal ligaments, especially the ligamentum flavum, the thick ligament that runs from the C2 to S1 vertebrae.

The ligamentum flavum, as do all ligaments, has an elastic fiber system (stretchy, resilient tissue) that allows the ligament to behave like a strong rubber band. The ligaments stretch to accommodate movement and keep the bones they are attached to in place. The ligament has a strong grip on the bones.

In 23% of the adolescents in this study, the elastic fibers showed a marked decrease in fiber density and a non-uniform distribution of fibers throughout the ligament (structural instability).

A possible cause for scoliosis was at hand.

Solving Scoliosis pain

Scoliosis, is typically treated through observation, bracing and surgery, particularly in adolescents. Although bracing has been shown to decrease the progression of mild scoliosis, it does nothing to strengthen the weakened ligaments in the back and, thus, does not alleviate the chronic pain that people with this condition experience.

Another standard practice of modern medicine is to inject steroids or prescribe anti-inflammatory medications. However, in the long run, these treatments do more damage than good. Cortisone shots and anti-inflammatory drugs have been shown to produce short-term pain benefit, but both result in long-term loss of function and even more chronic pain by actually inhibiting the healing process of soft tissues and accelerating cartilage degeneration. Plus, long-term use of these drugs can lead to other sources of chronic pain , allergies and leaky gut syndrome.

Surgery is generally the option for severe scoliosis when bracing has failed to stop the progression of the condition. Unfortunately, surgery often makes the problem worse. Surgeons will use x-ray technology as a diagnostic tool, which does not always properly diagnose the pain source.

Scoliosis pain produces common patterns depending on where the scoliosis is located. These pain patterns are reproduced by palpating the ligaments over
the scoliotic segments of the spine. A positive “jump sign” will be elicited, ensuring the diagnosis. Prolotherapy treatments over the entire scoliotic segment
are effective at eliminating the pain of scoliosis. It has the added benefit of causing the ligaments to strengthen, which will help stabilize the segment. If the
scoliosis is progressing quickly, then bracing would be necessary in addition to Prolotherapy. For these reasons, Prolotherapy should be a part of comprehensive
scoliosis management.

Proximal Junctional Kyphosis after scoliosis surgery

An October 2022 paper in the Journal of clinical medicine (2) describes the post-surgical complication of  Proximal Junctional Kyphosis.

The researchers of this study write: “Proximal junctional kyphosis (an abnormal bend in the spine, is), one of the most discussed problems after corrective surgery in adolescent idiopathic scoliosis.” They go on to say the problem of Proximal junctional kyphosis  is not fully understood and seems to be caused by multiple factors. One factor that these researchers zeroed in on is the “destruction of posterior ligaments by resection of spinous processes and some parameters concerning rod contouring as risk factors. . . ”

The researchers offered this evidence for their focus on the posterior ligaments of the spinous processes.

  • 192 patients with adolescent idiopathic scoliosis who had corrective surgery via a posterior approach between 2009 and 2017 were included.
  • The participants were divided into two groups (Proximal junctional kyphosis group and non-Proximal junctional kyphosis group).
  • The incidence of Proximal junctional kyphosis was 15.6%.
  • Contrary to the results of previous biomechanical studies, they could not find any significant influence of the spinous process resection causing Proximal junctional kyphosis. However, the Proximal junctional kyphosis group had significantly larger pre-surgery T4-T12 kyphosis. Furthermore, the Proximal junctional kyphosis group showed a significantly larger rod contour angle and mismatch of pre-surgery proximal junctional angle  and rod contour angle compared to the non-Proximal junctional kyphosis group.

The regenerative medicine approach to Scoliosis pain

Since the chronic pain and spinal curvatures associated with scoliosis are due to ligament laxity, a better approach to treating scoliosis is to strengthen the weakened ligaments with Prolotherapy. If the scoliosis is progressing quickly, bracing also may be necessary. Prolotherapy is the safest and most effective natural medicine treatment for repairing tendon, ligament and cartilage damage. Prolotherapy is the regenerative injection treatment that stimulates the body to repair painful areas. It does so by inducing a mild inflammatory reaction in the weakened ligaments. It stimulates the body’s natural healing response at the site of the overstretched/weakened ligament attachments.

1 Hadley-Miller N, Mims B, Milewicz DM. The potential role of the elastic fiber system in adolescent idiopathic scoliosis. JBJS. 1994 Aug 1;76(8):1193-206. [Google Scholar]
2 Boeckenfoerde K, Schulze Boevingloh A, Gosheger G, Bockholt S, Lampe LP, Lange T. Risk Factors of Proximal Junctional Kyphosis in Adolescent Idiopathic Scoliosis—The Spinous Processes and Proximal Rod Contouring. Journal of Clinical Medicine. 2022 Oct 16;11(20):6098. [Google Scholar]


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