Material
24 girls undergoing in-patient rehabilitation, 14 – 16 years of age (at average 15,1 years, SD 0,74) with the diagnosis of an Adolescent Idiopathic Scoliosis (AIS) have agreed to take part in this study. Average Cobb angle was 33 degrees (SD 9,2) ranging from 16 to 49 degrees. 10 of the girls had a thoracic, one a lumbar, 7 a double major and 6 a thoracolumbar curve pattern. 17 girls wore a brace (part time during rehabilitation), 7 Patients had no brace.
The patients were instructed not to wear their braces three days prior to the start of the study.
Methodology
9 Treatment couches have been provided and numbered. Because of practical reasons we decided to treat all patients in a comfortable position lying on the left side. In side lying position the first author was able to place needles front and back as well, in an easy way.
At first every patient had to be scanned with the Formetric® surface topography measurement system. After that all patients had to lie down on the left side for 25 min. without any treatment. Thereafter the patients again have been scanned with the Formetric® system in order to detect the effect of just lying. Then the patients have been divided into two groups. One group underwent real acupuncture on the first day of the study and the patients of this group were distributed to the equal couch numbers, the others received sham acupuncture and the patients of this group were distributed to the unequal couch numbers. After either treatment lasting 25 min. the patients have been scanned another time with the Formetric® system. The patients did not know as to whether they received a real treatment or sham acupuncture.
The next day the groups have been changed to allow every patient to receive one session with real acupuncture and one session with sham acupuncture. Again, before treatment the patients have been scanned as well as after treatment.
For every patient after performance of the study we had one surface scan before just lying on the left side, after lying on the left side (25 min.), before sham acupuncture, after sham acupuncture (25 min.), before real acupuncture and after real acupuncture (25 min.) as well.
SB, AJ and SP have organized the patient distribution to the different couches and took the Formetric® measurements.
Acupucture points used
The first author having a more than 12 year experience in TCM has chosen the acupuncture points used in this pilot study.
In TCM the spine and back are closely related to the "Water Element" and the meridians of Kidney (KI) and Bladder (BL). Left and right of the spine the bladder meridian is located in a double layer (Fig. 1). The central channel (meridian) on the back is the Du Mai channel (DU). This is why these channels have to be addressed in first place in the treatment of scoliosis with acupuncture.
To speak in terms of Qi, Yin and Yang: Yin-Qi is related to material and coldness and Yang-Qi to function and heat.
If the channels around the spine have lost the power to keep it in line, we may assume a Yang-Qi deficiency. As a consequence the concept for acupuncture in the treatment of scoliosis should increase Yang-Qi in the channels named above.
The rational for the acupuncture point selection was:
1 Selection according to channels local distal points: UB 23, Du3, Du 4, Du 20, 67. SI 3 axis point.
According to syndromes: UB 67, KI 3
General energetic points: ST 36, DU20 [5]:
The execution (type of needles, unilateral/bilateral) is described in the list of acupuncture points below:
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1.
BL 23 Shenshu both sides (normal needle, Fig. 2)
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2.
BL 67 Zhiyin right side (ear needle, Fig. 3)
3. KI 3 Taixi left side (normal needle, Fig. 4)
4. ST 36 Zusanli right side (Increase energy in Taixi; normal needle, Fig. 5)
5. DU 20 Baihui (normal needle)
6. DU 3 Yaoyangguan (normal needle)
7. SI 3 Houxi (Opens the Du Mai channel, normal needle, Fig. 6)
Additionally to that two points on the Bladder Meridian have been chosen in the concavity of the main curve, one on the central and one on the lateral part of the Bladder channel (normal needle).
The sham acupuncture consisted of points between two channels in the region of the regular points listed above with the same kind of needles as used in the real acupuncture, inserted the same way as the needles for real acupuncture. The patients did not recognize as to whether they were treated or not because they were not told about the possibility of receiving sham acupuncture before.
A possible "carry over" effect acupuncture/lying is largely ruled out by the fact that the patients were randomly assigned to the subgroups who had been lying on the left side [L] before sham acupuncture [S] or lying on the left side [L] before real acupuncture [R] on the first day of the study.
Surface topography system used for this study
The print-out of the Formetric®-system itself gives a lot of values, the most important are the following: Lateral asymmetry, surface rotation and kyphotic angle.
In the video rasterstereography (Formetric®-system) the whole object is illuminated by a pattern of parallel lines, recorded in a single frame and needing only a short measurement time (40 msec). The automatic image processing consists of the identification of the raster lines and automatic 3-D reconstruction of the back; shape analysis is performed by a computer. The computer helps to evaluate the spine with the assistance of triangulation [23, 24]. The video rasterstereography (Formetric®-system) has a point discrimination of 0.15 mm, and in a typical case of measurement 25000 surface points are calculated (Fig. 7).
Parameters used to compare the short-term effects of the different treatment concepts described were average lateral deformation (root mean square [rms]) with a technical error of 3 mm and average surface rotation (rms) with a technical error of 1,5° as measured and calculated by the Formetric® surface topography system [25–28].
The surface topography values for this study were compared as follows:
The values for lateral deviation and surface rotation (rms) after a session (lying [L], sham [S] and real acupuncture [R]) were compared with the value before the session.
The surface topography values were compared statistically using Winstat® Software.