Neuropathological aspects of conservative treatment of scoliosis. A theoretical view point

An upright body posture cannot be maintained passively for reasons including a high location of the centre of gravity (COG) and a small support area. Proper alignment of body parts is maintained automatically, tending towards a pattern encoded in the CNS. A particularly important role in posture regulation is played by the short muscles of the back, which respond to being stretched with a contraction. During the early phase of scoliosis, the CNS automatically corrects abnormalities, but over time habituation occurs and the CNS treats them as something normal. Any attempt to restore proper body alignment is treated as an error and CNS automatically restores this abnormal pattern. With a prolonged deviation in body part alignment, CNS treats it as a defect and runs compensatory mechanisms to restore the balance of the body as a whole. Balance is ensured by postural compensation, but this does not restore proper body part alignment. In the treatment of scoliosis, it is important both to slow down progression and to prevent the development of abnormal postural habits, which are part of a vicious circle even without progression. Secondary prevention is therefore needed in all patients. Passive observation limits the possibilities for prevention and contradicts the principle of early implementation of rehabilitation. Depending on the size of the angle of curvature, recommended treatments of scoliosis comprise observation, corset bracing, and surgery. Physiotherapy is often treated as an unconventional and ineffective treatment. Often, the biggest problem is transferring the resulting correction to automatic maintenance of a correct posture in the vertical position. The aim of this paper was to discuss the conservative treatment of scoliosis with regard to difficulties maintaining the correct alignment of the body parts in the vertical position that accompany scoliosis.     

From patient to discoverer--Niels Ryberg Finsen (1860–1904) --the founder of phototherapy in dermatology

Niels Ryberg Finsen (1860–1904) developed a lamp based on electric carbon arcs (later known as the Finsen light) that was used for skin therapy a century ago. He became director of the Medical Light Institute in Copenhagen, later the Finsen Institute, where he developed this method of treatment. Within a few years, 40 Finsen Institutes were established in Europe and in the United States of America. In 1903, Finsen received the Nobel Prize in Medicine in recognition of his work on the treatment of diseases and, in particular, the treatment of lupus vulgaris by means of concentrated light rays. Finsen's scientific interests were greatly influenced by his health condition. Beginning in 1883, he began to experience symptoms of an illness that would be later diagnosed as Niemann-Pick disease. He spent the last years of his life confined to a wheelchair. Dermatology reaps the benefits of light treatment to this day.     

Tadeusz Reichstein (1897-1996): a cofounder of modern steroid treatment in dermatology

Corticosteroids, which revolutionized dermatologic therapy a half century ago, owe their beginnings to Tadeusz Reichstein (1897-1996), who was born in Poland but emigrated in 1905 with his family to Switzerland. Between 1934 and 1944, he isolated and elucidated the chemical structure of 29 pure substances from the extract of the adrenal cortex. All of them turned out to be steroid derivatives, including corticosterone and hydrocortisone. In 1950, the Karolinska Institute in Stockholm awarded the Nobel Prize in Physiology or Medicine to Tadeusz Reichstein, along with Edward Kendall (1886-1972) and Phillip Hench (1896-1965), for their discoveries relating to the hormones of the adrenal cortex, their structures, and their biologic effects. In 1953, Reichstein isolated the pure crystalline form of a substance with a strong effect on electrolyte and water balance--aldosterone. Reichstein was an author or coauthor of 635 papers, the last ones at the age of 97. He described himself as “a Swiss of Polish-Jewish descent,” but his scientific achievements made him a world citizen.     

Diffuse idiopathic skeletal hyperostosis inducted stridor and dysphagia

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a condition characterized by calcification and ossification of soft tissues, mainly ligaments and enthesis. Dysphagia is the commonest complaint, stridor secondary to osteophyte compression has rarely been documented. The osteophytes may cause symptoms by mechanical compression or by inducting inflammatory reaction. When an upper segment of the C-spine is involved, particular C3 - C4 level, the larynx may be affected. This could be result of hoarseness, stridor, laryngeal stenosis and obstruction. Sometimes vocal fold paralysis may result from injury to the recurrent laryngeal nerve. Treatment of the breathing problems required first on stabilization the airway with tracheostomy. Next step is osteophysectomy which generally relief patients from symptoms.