This interview is for educational purposes and covers information provided by Dr. Rene Castelein regarding his opinions on scoliosis. This video is not an endorsement. Viewers should consult their physicians and treating team accordingly. See highlights via timestamps below.
00:00 Introduction
00:59 Origin of interest in the cause, progression and treatment of scoliosis?
1:35 Always been fascinated why a healthy adolescent quickly develops scoliosis.
5:58 Perspective on what initiates or causes scoliosis.
6:44 Scoliosis is a mechanical disorder of the spine.
6:59 Human spine is the only spine in nature that is rotationally unstable.
7:37 Human spine's sagittal shape and center of gravity above pelvis = rotationally unstable.
7:48 A rotationally unstable spine means it is relatively easy to introduce rotational deformity.
8:12 AIS - lack of balance between rapidly increasing mechanical loads and the person's ability to counteract it during puberty
8:41 AIS likely initiated by rotational instability due to lack of maturity of adolescents stabilizing system.
9:04 Vertebral disc is the most important spine stabilizer. Immature discs during growth spurt cannot effectively counteract rotational instability.
9:28 Lack of synchronicity of dimensions of body and disc maturity.
9:51 Disc matures by ossification of insertion and eventual fusion. Immature discs are less likely to stabilize rotational forces than mature discs.
12:15 Human spine to pelvis anatomy is unique.
14:06 Humans are the only species who's spine has dorsally directed shear loads which reduces rotational stability.
15:50 Magnitude of dorsally directed shear loads to depends on sagittal shape, collagen quality, disc maturation and more.
17:11 Sagittal shape of the spine, collagen quality and maturation is genetically determined.
19:07 Is Relative Anterior Spinal Overgrowth (RASO) always present with scoliosis?
21:25 In the thoracic spine, RASO is almost 100% in the discs, not vertebrae.
22:38 Compensatory scoliosis in a whale.
23:35 A disturbance to the spine can lead to compensatory lengthening in the discs.
24:19 Anterior lengthening in compensatory lumbar curves.
25:04 Surgical treatment of scoliosis: anterior/posterior fusion and VBT.
26:53 Perspective on Vertebral Body Tethering (VBT).
29:07 Perspective on disc release.
31:34 For scoliosis progression, does thoracic hypokyphosis cause rotation or vice versa?
33:12 Scoliosis starts with rotation of the spine.
34:16 Treating scoliosis is a compromise between coronal correction and sagittal alignment.
36:44 Perspective on Dr. Castelein and Dr. Kruyt: Spring Distraction System (SDS).
37:35 Torsion spring in animal models to de-rotate scoliotic spines.
40:37 Perspective on using spring torsion system with AIS.
44:42 Bracing for flat back syndrome.
45:35 Thoughts on thoracic hypokyphosis or flat back.
46:56 Future of scoliosis treatment.
drdereklee.com
/ 1198200727630801