What Is Scoliosis?
Scoliosis is a curvature of the spine that is greater than 10 degrees. The curvature can be to the right or left, and there may be more than one curvature. Scoliosis usually occurs in adolescence. Considering the cosmetic, social, psychological, and health problems that it can cause in this age group, scoliosis is a major problem.
Early diagnosis of scoliosis can be important in changing the course of the disease. For this purpose, scoliosis screenings are performed in schools in many countries. With early diagnosis in scoliosis, it is possible to control the progression of the curvature, the success rate of non-surgical treatment increases, and the rate of surgery decreases.
Scoliosis is usually observed during the rapid growth period before puberty. Some conditions such as cerebral palsy and muscle diseases can also cause scoliosis. Approximately 3% of adolescents have scoliosis. In most cases of scoliosis, the cause cannot be determined.
Scoliosis is usually mild in most people, but sometimes it can progress to a very severe form during the growth period. Severe scoliosis can negatively affect a person’s life, affecting lung capacity and making it difficult for the lungs to function properly.
Children with mild scoliosis should be closely monitored and the progression of the curve should be monitored. In children who are thought to have a worsening curve, bracing can help to prevent this. In cases with severe scoliosis, early surgery may be necessary to stop the progression of scoliosis.
What Are The Symptoms Of Scoliosis?
Normally, when we look at our spine from the side, we see a concave curve in the neck and lumbar regions and a slight outward curve in the thoracic region.
When we look at our spine from the front or back, there should normally be a curvature. If we detect a curvature, this should be investigated.
Signs and symptoms that may lead to the suspicion of scoliosis include: asymmetrical posture of the shoulders and shoulder blades, curvature of the spine to one side, one leg standing longer than the other, asymmetrical posture of the hips, ribs on one side of the torso being higher than the other side when we lean forward, asymmetrical posture of clothes on the body.
In most individuals with scoliosis, pain is usually not observed and neurological examination is normal. However, some patients complain of low back pain.
When Should A Patient With Scoliosis Consult A Doctor?
When you detect scoliosis symptoms or complaints in your child, you should definitely visit a doctor. The doctor you will consult may be an orthopaedic specialist or a physical medicine and rehabilitation specialist.
Mild curvatures may not be noticed because they progress slowly and do not cause pain. Sometimes your child’s teachers, friends or sports coach may first notice scoliosis.
Why Does Scoliosis Occur?
The cause of scoliosis is mostly unknown, but genetic factors, some diseases in the family may increase the predisposition to scoliosis. Neuromuscular system diseases such as cerebral palsy, muscular dystrophy, congenital anomalies affecting the development of the bones of the spine, injuries or infections in the spine are among the conditions that can cause scoliosis.
What Are The Risk Factors That May Cause Scoliosis Development?
One of the risk factors for the development of the most common type of scoliosis is age. Typically, signs and symptoms begin just before puberty during rapid development. Another risk factor is gender. Although there is no difference in the development of mild scoliosis in girls and boys, the risk of progression of the curve is higher in girls and the rate of need for treatment is also higher.
There is a familial predisposition in scoliosis. However, most children with scoliosis have no family history.
What Is the Procedure For Scoliosis Diagnosis?
For the diagnosis of scoliosis, after history taking and examination, X-ray examinations and, if necessary, MRI examinations of the relevant regions are performed to determine the degree of curvature in the spine and other spinal problems that may be associated with it are investigated.
Is There A Period When Scoliosis Progresses Rapidly And Requires More Caution?
The progression of scoliosis decreases after height growth is completed. The period when scoliosis progresses is the period of rapid height growth, especially in the first five years of life and during adolescence. The higher the degree of curvature detected in these periods, the faster the risk of progression.
What Are The Problems That May Occur As A Result Of Scoliosis?
Scoliosis is a mild form of the disease in many people, but sometimes there are complications caused by advanced scoliosis. These include problems with the lungs and heart, back problems and problems with appearance.
In severe scoliosis, difficulty in breathing and difficulty in pumping blood from the heart may occur as a result of compression of the lungs and heart in the chest.
Children with scoliosis experience chronic low back pain in adolescence at a higher rate than the general population. The progression of scoliosis leads to changes that are noticeable from the outside.
These include unevenness of the hips, unevenness of the spine, prominent ribs, and shifting of the waist and trunk to one side. People with scoliosis are often aware of their appearance.
Can You Talk About The Treatment Of Scoliosis?
In the treatment of scoliosis, the classification according to the age of onset and the cause of scoliosis directs the treatment.
The methods we apply in the treatment of scoliosis of unknown cause detected in adolescence include conservative treatment (observation, physiotherapy applications, use of corsets, electrical stimulation, orthoses and other auxiliary techniques) and surgical treatment.
In this type of scoliosis, our main aim is to stop the progression of the curve, to correct the curve and to protect respiratory and cardiac functions.
If the initial curve is large, if the maturation of the skeleton is still continuing and if the child is a girl, more progression in the curve is observed.
In our patients with scoliosis, we keep the patient on follow-up and monitor the progression of the curve with intermittent physical examination and X-rays.
Follow-up intervals are determined according to the degree of the patient’s curvature, the developmental period and the type of curvature.
Can You Talk About Physical Therapy Applications In Scoliosis Treatment?
Today, postural disorders are very common in society as a result of the widespread use of phones and computers. When added to a sedentary lifestyle, many of us are inviting pain into our lives with our muscles becoming weak and developing muscle shortening.
In spinal problems such as scoliosis and kyphosis, it is necessary to ensure proper posture with the awareness of the person, and to make exercise a part of the daily routine with frequent breaks.
During adolescence, children stay at the desk during activities such as reading, writing, and doing homework, and usually stand in the wrong sitting position.
The wrong sitting position causes the scoliosis degree to progress. Similarly, the weight of the backpack and the wrong carrying can have an effect of increasing the curvature. By reducing patients in this regard and including appropriate exercises in daily life, the success of treatment increases.
Special exercise programs for scoliosis are determined according to the direction of the curvature and are done one-on-one with the person. The most commonly used special exercise program for scoliosis is the Schroth method. This method, which has been applied since 1920, aims to provide and maintain normal posture with posture exercises, breathing exercises, and sensorimotor exercises.
It is more effective to do the exercises under observation.
Many of our patients ask the question “Should I use a brace to correct my scoliosis?” Brace or corset use is a method we use to control the progression of scoliosis during the period when skeletal growth is not yet complete.
We stop using the corset after skeletal development is complete. The use of a brace is more effective in curvatures between 25 and 45 degrees. The aim is to control the curvature of the spine and to correct the cosmetic appearance.
As one of the most effective treatment methods other than surgical treatment, the corset is used for 18-23 hours a day to achieve effectiveness.
The strength of the corset and the appropriate use of the corset are important for effectiveness.
Can You Give Information About Surgical Treatment In Scoliosis?
Surgery is recommended in patients with rapidly progressing and severe curvatures despite the use of a brace. The surgical method to be applied is determined according to the patient’s age, skeletal maturation level and the degree of curvature.
Does Scoliosis Cause Low Back Pain?
Scoliosis in adolescence usually does not cause back pain. However, very large curvatures may cause a feeling of discomfort.
If there is severe back pain accompanied by weakness or numbness in the legs, the patient should definitely consult his/her doctor. Further investigations are required to determine whether there is any other accompanying problem.
If Scoliosis Is Not Treated, Will It Heal On Its Own Over Time?
Sometimes small curvatures may improve over time without treatment. Children with very small curves may not need treatment.
However, if large curves are left untreated, they may at best not get worse. Whether the curve does not get worse depends on the stage of development of the child.
If the child has completed its development, the degree of curvature may not progress. However, in a child who is still developing, the curve is expected to get worse and worse.
How is the degree of curvature measured and monitored in scoliosis?
How Is Scoliosis Diagnosed?
In patients who are suspected of scoliosis on physical examination, the diagnosis is confirmed radiologically. Standard radiographs are sufficient to determine the location and degree of scoliosis.
It is recommended that the radiographs taken should include the head and sacrum and that the soft tissue should be visible. Anterior and lateral radiographs are evaluated by ensuring body balance by extending the arms.
The measurement of the angle between the vertebrae where the curvature starts and ends shows the degree of curvature. This angle is called “Cobb angle“.
The Cobb angle measurement is used to track the progression of scoliosis and the response to treatment. In the films taken, the degree of development of the epiphyseal plate in the crista iliaca is graded to assess skeletal maturity.
The skeletal bone age is benefited from the wrist radiograph.