Should Orthopedic Surgeons Be Managing Scoliosis Cases? Recent Study Says No

Changing of the Guard in Scoliosis Treatment

Scoliosis Treatment Management Should Not Be Realm of Orthopedic Surgeons Suggest New Study

Editorial by Dr. Marc Lamantia, D.C. B.S. MS, DACNB Science Advisor of Scoliosis Care Foundation– Non-profit educational organization, dedicated to improving awareness and development of non-surgical scoliosis treatment approaches

Changing of the Guard in Scoliosis Treatment

For years we at Scoliosis Systems have been saying the Orthopedic Specialist (Surgeon) is the wrong case-manager  for non-surgical scoliosis patients. The current standards of care call for initial referral by the Primary Care physician to the Orthopedic Surgical specialist, then a course of Observation is employed until surgery is needed. If the patient times her visits when the curvature is between 25 and 40 degrees, the surgeon may suggest a rigid TLSO, or full back brace.  This is of course baffling to me as a rehabilitation specialist.

Contemporary practices crossing many domains of healthcare have been shown to be of benefit to any individual with postural issues, including those with scoliosis. The orthopedic specialist should only be consulted with if and when a curvature is progressive and non-surgical approaches become ill advised as a replacement for surgery.

A recent study in the Journal Pediatrics reported a successful approach to reducing “unnecessary” doctors visits to Orthopedic specialists. The objective of the study was to support a movement in organized medicine to change the “locus” of healthcare from the “Specialist” to the “Primary”, thereby reducing costs, and only mildly reducing efficacy, in my opinion. The authors support changes in referral patterns of Primary Care Physicians who routinely refer to Orthopedic specialists for scoliosis, to “not” refer as much.  

The results showed, through Physician education and decision making matrices  based on longitudinal outcome studies, they were able to change the way the Primary physicians referred, reducing otherwise “unnecessary” visits to the Orthopedist. The authors went on to say, “Adolescent idiopathic scoliosis (AIS) is a relatively common reason for referral to orthopedic surgery, but most referred patients do not require bracing or surgery.”

What they failed to say is what these patients do need. While we agree, the majority of these patients would benefit firstly from education, so they understand their spine is susceptible to worsen if they do not use care in maintaining good posture and are aware of the changes they can make to improve the health of their spine, not only at the time of growth, but throughout their lives.

Patients with scoliosis with recent diagnoses do need education, and support to find evidenced based approaches to improving posture and scoliosis at the same time. Practitioners from every discipline believe they can help scoliosis, from the chiropractor to the yoga teacher, to the physical trainer at your local gym. The problem is very little of it is evidenced based. Even the often, over zealous evidence based practicing Physical Therapists, apply common physical therapy to patients with scoliosis, as if they were injured in a car accident, or have a palsy, dystrophy or myopathy, none of it being shown to be effective for scoliosis.  

Scoliosis is unique, and requires an understanding of the neurological mechanisms responsible for posture, the affect of the gross spinal subluxations on the other systems of the body, and the clinical applications to positively effect them. My training as a rehabilitation neuroscientist, a clinical functional neurologist, an upper cervical chiropractor, a practicing clinician for 15 plus years, an educator, and an trained orthotist, uniquely qualifies me to speak on the subject.  

The greatest thing we can do for patients with non-surgical scoliosis, is provide them with all that is evidence to be helpful, regardless of which domain in science or healthcare it comes from, that is why as a licensed Doctor of Chiropractic, I believe we are the appropriate manager of scoliosis referrals, and hope we can continue to provide quality healthcare to those in need, and hope to publish our findings as to help to continue to educate those in the healthcare fields.  

The greatest obstacle is the lack of knowledge by allied health professions commonly being referred to by the Orthopedist and the lack of referrals to chiropractic doctors who have pioneered combining rehabilitation approaches from stroke, movement and cognitive domains.  The future is bright, and this article is evidence that we have a chance to change scoliosis care for the better. 

A Quality Improvement Program to Reduce Unnecessary Referrals for Adolescent Scoliosis

  1. Louis Vernacchio, MD, MSca,b,c,
  2. Emily K. Trudell, MPHa,
  3. M. Timothy Hresko, MDd,e,
  4. Lawrence I. Karlin, MDd,e, and
  5. Wanessa Risko, MD, ScDa,b,c

+Author Affiliations

  1. aPediatric Physicians’ Organization at Children’s, Brookline, Massachusetts;

  2. bDivision of General Pediatrics and

  3. dDepartment of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts; and

  4. Departments of cPediatrics and

  5. eOrthopaedic Surgery, Harvard Medical School, Boston, Massachusetts


OBJECTIVE: Adolescent idiopathic scoliosis (AIS) is a relatively common reason for referral to orthopedic surgery, but most referred patients do not require bracing or surgery. We developed a quality improvement (QI) program within the Pediatric Physicians’ Organization at Children’s, an independent practice association affiliated with Boston Children’s Hospital, to reduce unnecessary specialty referrals for AIS.

METHODS: The QI program consisted of physician education, decision support tools available at the point of care, and longitudinal feedback of data on physician referrals for AIS. Referral patterns in the 2-year postintervention period were tracked and compared with those of the 2-year preintervention period. Clinical characteristics of referred patients were compared through claims analysis and chart review.

RESULTS: Initial visits to orthopedic surgery for AIS declined from 5.1 to 4.1 per 1000 adolescents per year, a reduction of 20.4% (P = .01). Process control chart analysis showed a rapid change in referral patterns after the initiation of the program which was sustained over the 2-year postintervention period and demonstrated that 66 initial and 131 total AIS specialty visits were avoided as a result of the program.

CONCLUSIONS: A QI program consisting of physician education, decision support available at the point of care, and longitudinal data feedback led to a sustained reduction in unnecessary referrals for AIS. This program can serve as a model for other programs that seek to shift the locus of care from specialists to primary care providers.

Considering Alternative Scoliosis Treatment in Tampa Florida?

Scoliosis Treatment in TampaIf you’ve were told that you or your child needs scoliosis surgery, it likely shocked you a bit. You probably wondered “Aren’t there alternative Scoliosis Treatment in Tampa Florida area?”

The answer is quite possibly yes. There are a lot of non-surgical scoliosis options that are now available. Some are better than others. It comes down to knowing what to look for when trying to find the right doctor to help you avoid scoliosis surgery.

Here Are 5 Important Things to Investigate When Looking at Alternative Scoliosis Treatments

1. The Specialist are Certified In Alternative Scoliosis Treatments in St. Petersburg Florida

If you are facing surgery you want to be certain to choose a doctor that specialized and is Certified to treat scoliosis rather than just someone who treats scoliosis patients as a sideline.

Dr. Marc Lamantia, D.C. was among the first doctors to be trained and Certified Providers of SpineCor, a flexible, dynamic tension brace for scoliosis treatment. It has a patented design that helps correct abnormal movement patterns found in scoliosis to help stop the progression and correct curvatures.

Although SpineCor was developed initially for adolescents several years ago our doctors felt that adults would benefit from SpineCor too. So they helped the company pioneer adaptations to make it available for adult scoliosis too.

They are not only certified provide alternative scoliosis treatment in Tampa Florida they also travel to more than a dozen regional centers across the US and work tirelessly to help both adolescent and adult patients with their scoliosis. In the process they have treated thousands of patients becoming the most experienced SpineCor providers in the country.

People seek out our clinics for non-surgical treatment of scoliosis because our doctors advanced training and multiple certifications in alternative scoliosis treatment in Tampa Florida. This has established them as leaders in the field of non-surgical scoliosis treatment and earned them recognition for their work.

A patient, actress Ashley Argota who plays Lulu on Nickelodeon’s “True Jackson VP” discusses her success with her SpineCor brace and our specialized scoliosis exercises. This is what she said:

Many of our other patient’s enjoyed similar successes with their scoliosis and over 70 of them of all different ages have shared their experiences with us on our Youtube Channel.

2. Scoliosis Treatments are Backed By Research

Ask if the doctor if their methods of treatment are “Evidence Based” and back up by research. Unqualified providers using untested methods with equipment that looks like it was made in their basement will tell you that is not important, but you should know if their methods stand up to scientific scrutiny!

Evidence based treatment means that it has been researched and found to be effective in the scientific literature. We encourage the people that contact us to do their homework and interview doctors before they make a decision. Those that do tend to choose us because they learn that our equipment and methods are backed up in the literature. Click her to Learn More About the Research Behind Our Scoliosis Treatment.

Scoliosis Care Foundation, our non-profit organization, was founded as a way to support scientific research on non-surgical treatments of scoliosis. We created our Parent’s Guide to Scoliosis to help better educate parents about non-surgical, evidence based scoliosis treatments as a FREE download on our Facebook page.

3. Scoliosis Exercises Should Be Highly Specific and Unidirectional

What do I mean by “unidirectional”?

Scoliosis may appear on x-ray like a side to side abnormality, but it is far more than that. It is a unilateral rotation dysfunction of the spine where the spine coils, kind of like the helix of a spring.

Straightening out a crooked spine requires specific rehabilitative exercises that are only done in one direction in each area of the spine to correct counter rotation dysfunctions of the shoulder girdle, the torso and the hips. This means that unlike most other exercises scoliosis exercises MUST only be done in on area of the spine that is counter rotated to the area found above or below.

Since almost all other exercise programs are taught to be performed in both directions this can create a problem by doing the exercise the wrong direction can worsen the scoliosis curvature!

We recommend the Schroth Method of “scoliosis specific exercise” originally developed over the past 80 years ago in Germany. Because it is highly effective and well regarded in the scoliosis literature it has become the Gold Standard in scoliosis treatment in much of Northern Europe. Our doctors are among a handful of Schroth Certified Instructors in the US qualified to teach these highly specialized, unidirectional exercises for scoliosis.

4. Minimize the Exposure to Harmful Radiation

Although we cannot fully eliminate the need for x-rays in most cases of scoliosis we can significantly reduce it with an non-radiation alternative to x-rays called Formetric Rastersterography that we use to monitor a patient’s scoliosis improvement over their follow up visits.

Developed over 20 years ago, since that time this highly accurate technology has been used by research universities and orthopedic offices in Europe for scoliosis monitoring. With this we can reduce our patients x-ray exposure over the course of care by as much 75%!

5. Scoliosis Treatment for Related Conditions with Latest Technology

Scoliosis causes are many so treatment varies as well. Your specialist should be up to speed with all the latest breakthroughs. One of the most intriguing neurological causes comes from the field of pediatric neurology and involves misalignment of the upper cervical spine affecting the portion of the brain that controls posture, movement and balance.

When the top vertebra, called the Atlas, moves out of alignment it causes pressure to these underlying structures that can cause a back up of cerebral spinal fluid surrounding the brain that adversely affects control of balance and postural. These can significantly aggravate a scoliosis so relieving the source of this pressure can help reduce the neurological contribution of the scoliosis curvatures.

We incorporate treatment to reduce this type of misalignment in our office. It is called Advanced Atlas Orthogonal (AO) and is aa sophisticated system of treatment and analysis that can determine the exact nature of the misalignment with precise x-rays of the upper neck.

If a misalignment is found that is contributing to your scoliosis then this highly effective treatment will gently re-aligns the vertebra using a gentle pulsed Orthogonal instrument to relieve pressure to the brain and nervous system. During your initial evaluation in our office if it is determined that misalignment of the Atlas is present then further Atlas Orthogonal work up will be recommended to determine is this is contributing to your scoliosis.

So if you are looking for alternative scoliosis treatment in Tampa Florida then give us a call to find out if one of our research backed treatments could help you. Our doctors at (727) 491-5339 for a FREE Phone Consultation to discuss the particulars of your case with you. Call today and find out if alternative scoliosis treatment is right for you.

Don’t Delay, Call Now!  (727) 491-5339

One of our doctors will get a hold of you to discuss your case with you within the next 24 hours.


Email us your scoliosis question.

Dr. Marc Lamantia




Dr. Marc Lamantia, D.C.
Scoliosis Systems of Tampa
11454 N. 53rd St
Tampa, FL 33617
(727) 491-5339