A LATERAL CURVATURE OF THF. SPINE THAT MEASURES 10° OR more is a seoliosis. An idiopathic seoliosis is accompanied by vertebral rotation and rib cage deformity, and usually becomes progressively apparent as the spine grows during childhood. Other causes of seoliosis include congenital (due to cither osseous or non-osseous anomalies), neuromuscular (caused by conditions such as muscular dystrophy or syringomyelia), and functional (secondary to postural habit or leg length inequality). There is currently no known cause for idiopathic seoliosis. Recent scientific research has focused on hormonal and neurological causes, with some promising early results that suggest recommendations for conservative management. Melatonin Imbalance The pineal gland produces melatonin, a hormone that appears to influence the development of a balanced spine. Surgical removal of the pineal gland in young chickens' and in bipedal rats2 has produced spinal curvatures very similar to human idiopathic scoiiosis, including vertebral rotation and rib humps. In the study on rats, the investigators found that providing a source of melatonin prevented the development of scoiiosis in pinealectomized rats. They theorized that "melatonin may facilitate the fine neuromuscular coordination needed to maintain the 24 stacked vertebrae in balance." While some studies have found that human patients with progressive scoiiosis may have lower levels of melatonin, other investigations have not been able to establish a direct correlation.' More recently, a study of 41 patients with adolescent idiopathic scoiiosis found defects in the melatonin signaling pathways in their osteoblasts.4 Coordination and Gait Numerous studies have shown that humans with scoiiosis have various deficiencies in muscle coordination and standing balance, but the source of these difficulties with fine motor control is still unknown. The gait of children with scoiiosis has been found to be somewhat abnormal, but there is controversy about whether this causes a curvature to develop or is simply a result of walking with a curved spine. A study that used sophisticated measuring devices and advanced computer analysis has provided some initial answers.5 The investigators found several significant differences in gait between normal children and those with scoiiosis. and they found that children with scoiiosis had substantially higher intcr-and intra-subject variability. There was also substantial bilateral asymmetry in their lower limbs when walking. This was most noticeable in the medial-lateral component of gait, indicating problems with pronation and supination control. They observed that "These findings indicate a different functional role for the left and right limbs during gait" and that the "...differences between the scoliosis and the control group, together with previously reported abnormalities of torsion in the tibia and femur and the hypothesis of pelvic rotation, suggests these are primary mechanisms of the cause of idiopathic scoliosis." These researchers believe that gait asymmetry could be the underlying cause of the balance and coordination problems that result in a spinal curvature. In fact, they conclude that, "Patients with scoliosis exhibit balance problems during the stance phase of gait and have significant asymmetry in the frequency characteristics. These findings could be a primary effect that contributes to the medial-lateral deformity of the spine and its initiation and progression." Clinical Value These studies are exciting, as they open up the very real possibility of preventing, or at least significantly slowing, the progression of idiopathic scoliosis with conservative methods. While much more study needs to be done, it is quite possible that chiropractic care will be the accepted scoliosis treatment of the future. This will include careful spinal adjustments, custom-fitted orthotics for better foot function and gait symmetry, and nutritional supplementation of melatonin levels, along with exercise recommendations to improve body balance and neuromuscular coordination. Conclusion Each young patient with a scoliosis must be evaluated to determine the classification of the spinal curvature and its potential for progression. When conservative treatment is indicated, nutritional support for the pineal gland should be considered. Perhaps most importantly, the neurological and musculoskclctal systems need to be checked thoroughly. Exercises to develop fine control of balance and posture, as well as gait training, may be helpful. Custom-fitted orthotics should be considered early in the treatment of all patients with scoliosis, to help improve bilateral balance and gait symmetry. See references on page 54 John K. llylaml. D.C.. M.P.H.D.A.C.B.R.. D.A.B.C.O., C.S.C.S., C.H.E.S. is board-certified in two chiropractic specialties, and is also certified as a Strength and Conditioning Specialist and a Health Education Specialist. He has 20 years of clinical practice; for eight years he specialized in chiropractic rehabilitation. He is currently a Research Associate at Parker College of Chiropractic, and an Adjunct Professor of Clinical Sciences at the University of Bridgeport s College of Chiropractic. You can contact him at drjkh\'land(ajinsn.coin.\
