**1. Introduction**

In the human being, the spine is curved in the form of two S letters because of upright posture, if seen from the side. It is bent back in the thorax and sacrum and forward in the lumbar and neck regions. If you look from behind, the spine is usually straight when the body is upright. This is true for most healthy people, but asymmetric growth in children can lead to bending of the spine in a sideways manner. This state or condition is called scoliosis [1–4]. The name is of Greek origin, meaning curvature, and was already used by Hippocrates centuries ago [5]. Galen narrowed the meaning to a sideways curvature. Most often and seen from the back, the backbone is curved to the right in the thoracic spine and to the left in the lumbar part. Vertebrae are also twisted, turned in their axis, causing a rib hump to develop in the back [1–4].

Guidelines of the SOSORT Society for the treatment of idiopathic scoliosis from 2011 [1] and 2016 [2] indicate that the goal of conservative treatment is to halt curve progression at puberty (or possibly even reduce it). Bracing is recommended to treat patients with curves above 20 5° Cobb which are still growing. It is recommended that braces should be worn until the end of vertebral bone growth.

Weinstein et al. [6] recently found that wearing a brace prevents curve progression in people with adolescent idiopathic scoliosis, if it is worn for up to at least 13 h a day. Results are better, however, when the brace is worn over a longer time. 90% of children who wore a brace for at least 13 h a day reached the end of the growth period without the need for surgery. Further Aulisa et al. [7] reported that the brace is also very effective in the treatment of juvenile scoliosis. Curve correction was accomplished in 79% of patients, the curve stabilized in 16%, and only in 6% of children did it progress. Juvenile scoliosis starts at the age of 3–9 years and can lead to larger curvatures than adolescent scoliosis which starts between 10 and 17 years of age [1]. Lusini et al. [8] further found that wearing a brace can reduce the curvature even in patients with curve magnitudes over 45° Cobb, who had refused to have surgery.

After maturity, most adult patients are left without any prescribed therapy. But their scoliosis may worsen over time. Usually the curvature progresses slowly also in adulthood. The linear rate of progression is about 1° Cobb per year, and this has been demonstrated to occur in progressive adult scoliosis [9]. Curves larger than 50° are associated with a high risk of continued deterioration or progression throughout adulthood and thus usually indicate the need for surgery [6].

Scoliosis fusion surgery is generally considered the only means to stop the progression of the spinal deformity in patients with adult idiopathic scoliosis. However, when patients with adult scoliosis progress, scoliosis-specific exercises can be effective in order to obtain stability and in some cases to reduce the Cobb angles in degrees. In highly progressive curves, exercises appear to slow down the progression of the curvature [10]. Using traction and massage, Brooks et al. [11] were able to improve chest expansion and decrease thoracic curvature in an adult with idiopathic scoliosis. Negrini et al. [12] hypothesized that the improvement of adult scoliosis that was achieved by one of their patients is a consequence of recovery from a postural collapse without any changes in bone structure. The structural bony component of scoliosis cannot be improved with a cast or other corrective measures and can be seen in a radiograph of a person in the correction with a cast or a brace. The postural collapse component of scoliosis can be seen as the difference between the curvature on a radiograph taken while standing and the one taken while lying down.

For adult patients with late-onset idiopathic scoliosis, cosmetic concerns and pain are the main reasons for seeking treatment. Daily exercise and part-time bracing can also potentially reduce pain in the adult scoliosis population [13].

Rigid braces for the treatment of scoliosis were first used by Ambroise Paré (1510–1590). They were made out of metal. Among other things, he wrote that bracing does not help when the skeleton matures and growth stops [14]. This assertion has rarely been contradicted in the literature and is considered the "truth" up to this day. Brodhurst [15] describes and provides figures of a fairly successful treatment of an 18-year-old girl with his supporting device, which was the precursor of today's rigid braces and acted in the same way. It put pressure on the convex side of the curve and lifted the shoulder in the concave side, just like a modern

### *Living with a Severe Spinal Deformity: An Innovative and Personal Patient Account… DOI: http://dx.doi.org/10.5772/intechopen.90294*

Chêneau brace made of plastic. His instrument (**Figure 1**), as he called it, consisted of a frame made out of a pelvic hoop, upright crutches, and connecting dorsal band placed at the superior extremity of the primary curve. The shoulder sling or loop was placed on the shoulder which corresponded to the concavity of the primary curve and was connected to the lever. The convexity of the primary curve was supported by a large pad. The effectiveness of a combination of Schroth and SEAS exercises together with wearing a brace in adult patients with scoliosis was reported by Papadopoulos [16].

My scoliosis was discovered when I was around 7 years of age when I was treated with a Milwaukee brace in the orthopedic hospital in Valdoltra. But when I was 11 years old, I experienced acute renal failure. The inflammation that followed left lasting effects on my kidneys, and since 1978 when I was 16 years old, I had to attend hemodialysis regularly. As this was a life-threatening condition, my parents decided to stop the therapy of scoliosis which unfortunately was left unmanaged since then. For a few years, I still grew and unfortunately over the years the back curvature increased.

In 2005 I decided to finally do something about my scoliosis. I was 43 years old at that time, and the predominant view was that after growth is completed, the correction of scoliosis without surgery is no longer possible. The risk of complications in surgery in adults is very high, and long-term effects are questionable [17]. So I decided to take action by my own method.

From the archives of the Department of Dialysis of the Ljubljana Medical Centre, I got X-ray images showing my spine. I was able to measure Cobb angles, which are used to measure the curvature and to estimate the severity of deformation. In the images from the years 1997 and 2005, only the thoracic curvature is seen which is equal in both images, so it did not deteriorate over this time period before the

**Figure 1.** *Brodhurst's instrument for the treatment of scoliosis (Brodhurst, 1855).*

treatment. The image from 2010 shows both curves. The upper thoracic curve is larger and measures 104°, while the lower lumbar measures 57°. Curves over 60° are considered a very severe form of scoliosis, and in curves over 80°, it affects lung function which is impaired. The vital capacity of my lungs measured 1380 ml in 2010, a value which is only 40% of the value that is estimated for a man without scoliosis, for my height.

Early-onset scoliosis like mine can result in larger curves than more common adolescent scoliosis because the unbalanced growth of the spine lasts longer. If untreated, juvenile scoliosis can cause serious cardiopulmonary complications and premature death [18]. In comparison untreated late-onset scoliosis causes little physical impairment other than back pain and cosmetic concerns [19]. The prognosis for most patients with more than 100° curvature of the spine is generally death in their 40s or 50s due to respiratory or heart failure, although there are exceptions to this [20].

## **2. The therapy**

I found that my spine is not bent forward in the lumbar area as found in the lordosis of a person without scoliosis. It was only bent sideways. I assumed that the sideways curvature would diminish, if I managed to bend the spine forward, as is correct. I thought that this would also have a beneficial impact on the higher parts of the spine. I decided to buy an elastic bodice from a shop that sold medical equipment. I then stitched longitudinal metal braces to it, which I twisted to the form of my own body. The one that crossed the hump had to be bent almost at right angles to fit. With this corset I then carried out my activities of daily living; I also slept in it and went for walks in the bodice. Three months later, in the spring of 2006, I ordered an underbust corset of the waist cincher type on the Internet, otherwise used by ladies to constrict their waists (Axfords C225, the firm ceased trading since). It forced me into an upright posture and created a lumbar lordosis. I had to take it off before lunch so I could eat, but then I put it on again before I go to sleep. After some months I ordered a longer underbust corset, which grasped the pelvis and ribs better, but since it was not custom made, it did not fit perfectly (Axfords C229). When I received it by post, my mother showed me hers that was very similar, only it was laced by the side, not the rear. She had scoliosis at a young age too, and in that time (the 1950s) scoliosis was treated with corsets made from fabric, like the one I was using. I walked a lot wearing the corset, also in the mountains.

Flat back often accompanies scoliosis [1]. It has the same shortcomings as a flat foot, so it does not allow much flexibility. The spine should ideally be slightly curved, so the creation of a correct lordosis is very important. When the spine is curved in the sagittal plane, curves to the sides may be reduced [21]. In people without a lordotic curve, the head is not positioned above the pelvis, but in front of it. The center of gravity outside the body axis then causes overload of the back muscles causing pain.

When I lost hope that I would achieve anything with the corset that I had used for a couple of years, I then stopped wearing it. After a few days, however, I was surprised to find that there has been an improvement. Thus it was necessary to interrupt my treatment with the corset. I found that I needed a corset that would stretch all the way from the armpits to the pelvis and press the hump in order to reduce it. It needed to be custom made, and I found a website where I could order an overbust corset (reaching above the bust), made to my measures without too much additional charge (Corsetcurves Venus, the website does not exist anymore). *Living with a Severe Spinal Deformity: An Innovative and Personal Patient Account… DOI: http://dx.doi.org/10.5772/intechopen.90294*

**Figure 2.** *Overbust corset used from September 2008 to October 2016. View from the side, front, and rear in July 2011.*

### **Figure 3.**

*Extending to and hanging with the left hand on barely accessible holds has proven to be the most effective exercise for stretching the spine. If a right convex scoliosis is caused by the predominant use of the right hand, it may possibly be improved by the frequent use of the left hand in normal work and exercise.*

It fitted me much better, but behind the hump it lay sideways; this was inevitable due to my rib hump (**Figure 2**). It was made from three layers of fabric with steel reinforcements. I wore it from September 2008 to October 2016.

To successfully derotate my chest, I used additional manipulation and physiotherapy. I pressed on the hump from behind and stretched muscles on the concave side by improvements and overcorrections of my posture. My walks with a backpack in nature were not intended to be part of the therapy; they were part of my job as a biologist, but they proved to be just that: therapy. The straps were forcing my shoulders to be at the same height when wearing a backpack with photo camera equipment. I also found that correcting my posture many times during the day was also very important as this eliminated any unbalanced loading of my skeleton [3]. I added occasional pressure to the hump from behind. This is similar to the treatment recommended also when applying plaster cast as an effective treatment for scoliosis in young children [22]. In order to stretch the spine and reduce side curvature, I also included stretching exercises for the left side of the body into the therapy in 2013. With my left hand, I pushed at the hip while standing or at the thigh while sitting and stretched the left side. I lifted the body with my hands holding the handles of a chair, and the spine stretched due to gravity. With my left hand, I stretched out to reach a shelf above the door. The last exercise in particular has proven to be effective, since the hump reduced during the exercise and the spine straightened significantly (**Figure 3**).
