Cobb Angle insight from Dr. Morningstar

I thought I would share the contents of a facebook post by Treating Scoliosis, quoting Dr. Morningstar with some wonderful insight on the Cobb Angle.

“Is It Time to Throw Out Cobb Angle Measurements for Scoliosis?
By Dr. Mark MorningStar

Anyone who has scoliosis knows what a Cobb angle is. Physicians and therapists who treat scoliosis know what a Cobb angle is. But, many people don’t realize that the Cobb angle is over 80 years old. In 80 years we haven’t bothered to implement any better, more accurate, and more relevant measurement methods. Yes, there are better methods.

The Cobb angle is a simple measurement that provides only one piece of information: the amount of lateral bending on x-ray. Now here’s the ironic part: scoliosis is not a lateral bending deviation, but a rotational and translational one. Most current scoliosis researchers agree that scoliosis is a 3-dimensional spine deformity, yet the Cobb angle only measures 2 dimensions. Therefore, it is impossible for the Cobb angle to complete information as to the status of the scoliosis.

Aside from the utter lack of validity for the Cobb angle, the Cobb angle value is almost completely arbitrary. Ask 5 different orthopedic surgeons when a scoliosis should be surgically treated, and you just might get 5 different answers. Some say 40 degrees, some say 60 degrees, and some approach it on a case by case basis. Some scoliosis research suggests that the surgical outcome is the same when the scoliosis is measured between 70 to 100 degrees, as compared to operating between 40 and 70 degrees.

Until a better measurement is universally accepted as the gold standard for scoliosis measurement, we will be relegated to using it merely for interprofessional communication. I believe the shift away from Cobb angle will begin to occur when physicians begin placing greater emphasis on the health of the patient and not only the cosmetic impact (although this is important). Many outcome assessments can be used other than Cobb angle to measure the impact of scoliosis on the health of the patient, such as pain level, breathing function, digestive function, psychological health, mobility, and activities of daily living.

With all of the technology available, we should be moving away from using the Cobb angle. It is outdated, has a low level of reproducibility between doctors, and has virtually no validity. Surface topography, 3D posturography, MRI, and spinal ultrasound have all been able to provide more relevant information about the scoliosis deformity.

Since the Cobb angle was first illustrated, women won the right to vote, the Great Depression came and went, we fought in a second world war, and we put a man on the moon. Yet for some reason, we continue to use this basic radiographic assessment of scoliosis. This may well be due to its simplicity, but if it provides no real valid information, why do we use it at all? Instead, why not use rotational measurements (several have already been developed)? Rotational measurements provide much more useful clinical information, such as the impact of rib cage rotation, the position of and torsion on the spinal cord itself, and an evaluation of the active spinal mechanics and whether they are normal or abnormal.

With so many other outcome assessments from which to choose, why in the world do we continue to use a radiographic assessment that is almost as old as x-ray technology itself?”

For more insight from Dr. Morningstar, check out his new book, Scoliosis And ARC3D Therapy.    I am currently in the process of reading this book, and will do a full write up when I am finished.  In the meantime, it is good reading, with some great explanations of the basics of Scoliosis.

This is how a brace is made…

Hi Everyone.  When we were in Virginia getting our braces made at Orthotic Solutions, Mr. Luke let us get some photos and do some participation behind the scenes.  The following is a brief summary of how the brace is made:

1.  Luke scans the patients with a computerized scanning “gun” that makes an exact replica of their body appear on a computer screen.  This takes about 5 minutes.

2.  He then loads the image into a foam cutting machine (not pictured) and it carves a replica of the patient’s body onto a piece of foam.  (My daughter is standing here, next to her foam replica, which is loaded on a spindle for forming)

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3.  Luke pulls a very hot sheet of plastic out of a special industrial oven and applies a color or print to it.  He has many choices, and the prints usually come in thin sheets that are laid on the hot plastic and melted onto the surface.  However, lately he and the other Orthotists were experimenting and came up with a “sponge painting” technique, that my daughter chose – she wanted red and purple. So, here they all are, gathered around and “sponge painting” the brace – they had to be very fast.  Now, if this doesn’t prove that these men care about their patients, I don’t know what would!

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4.  The plastic sheet is laid over the foam replica of the patient’s body.  This is also a very fast job that requires multiple people.  Luke is always willing to be the one to get on the floor and take the most uncomfortable position.

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5.  Luke trims the parts off that he doesn’t want, before it hardens too much.

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6.  Luke takes the brace in a back room and performs additional trimming operations and grinds the edges so they are smooth.

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7.  He then takes the brace to his worktable, where he drills holes for the straps

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8.  Next, they insert heavy duty snaps.  My daughter was able to put a couple of her snaps on!

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9.  After the basic brace is made, more trimming is done (after trying it on the patient), pads are put strategically inside, and painstaking efforts are taken to tweak any parts that poke, prod, or discomfort the patient.

The entire staff at Orthotic Solutions are extremely caring, considerate, and thoughtful of their patients and patients’ families.  They have been one of the biggest blessings to us in this entire process.  I cannot say enough wonderful things about them.  Thank-you Orthotic Solutions!

Holiday frenzy!

Hi everyone.  Just a quick “hello” here to say thank-you for all of your messages of support and well-wishes (and prayers!) for our current “bump in the road.”  I appreciate it so very, very much!

As most of you are, I have been extremely busy this holiday season.  Starting off November with a 10 day trip did not help the frenzied feeling upon my return!  I am finally starting to settle into this “new normal”, dealing with the fact that my daughter needs additional physical therapy (Schroth and ARC3D) and that she is not responding as favorably as we’d like her to have responded with her brace.  In fact, we got some x-rays done last week at  Dr. Morningstar’s office to see how her curve is while in-brace (we always x-ray at the Orthopedist out of brace) and she is surprisingly only getting a few degrees of correction.  We are all baffled by this smaller-than-anticipated amount of correction, but we are confident she is in the best brace she can be, regardless.  I guess her curve is very rigid and very stubborn!!  *sigh*.  But, one week into her amped-up therapy routine and she’s been doing a fantastic job self-motivating.  I have to remind her and help her find time to work in the exercises, but she’s been doing better than I expected her to (she’s a bit of a procrastinator).  We worked out a schedule to slowly ramp up the routine over a period of a few weeks, so that it is manageable.  Tonight we go back to Dr. Morningstar to get some new exercises, and then we get to go to the local home improvement store to get new paint and shelves for her room – we plan to do an “Extreme Makeover” of our own in a couple weekends, which she is very excited about.  I am excited, too, for less clutter in her room! 🙂

But, the fact remains that, no matter what hand of cards we are dealt, that the game of life plays on.  Our friends and loved ones pray us through our hardships and support us, but we have to keep moving forward one step at a time.  I have more on my plate this holiday season than I probably ever have, but I am trying desperately to fight for the joy that the season calls for.  It was no coincidence that our Pastor at church is doing a long series on “fighting for joy” that started last weekend.  What a perfectly timed message!  (You can hear these messages at: Colwood Church Sermons.  Our teaching Pastor Jason Garwood is fantastic to listen to.)

I mentioned in my last post that I also got a letter that our Orthopedic Surgeon was moving and that we’d have to find a new one.  I was totally stressing about this.  Then, one day I got a call from the University of Michigan health system and they said that my kids were scheduled with a new Dr.  They assigned this new Doctor to us.  I didn’t have to DO anything!  A brief pop online and I found out that this new Doctor has some wonderful research and specialties that may bring all sorts of new information to the table.  I was stressing about the change, but now I’m excited for it.  New Doctor, new insight, new avenues to explore…we really liked and respected our previous Doctor, but wish her well.  I am working very hard to not only trust our medical team, but to trust the Lord to make all things new, bright, and beautiful every day.

Thank-you for giving me the support I needed in this time.  I hope I can do the same for you.