Diagnosis and treatment of scoliosis

Description

What is Scoliosis?

Scoliosis is defined as the curvature of the spine over 10
degrees to the right or left, which should normally be placed in a straight
line when viewed from the back. Scoliosis is not just a one-dimensional angular
deformation, but a bone and structural deformation that affects the body in
three dimensions, from the front and from the side.

Scoliosis is a condition that can be seen in every period of
life. Genetic transition can cause scoliosis.

If the scoliosis angle is high, the visual impact of the body is
very disrupted. This shape disorder affects these young children at the
beginning of the adolescence period not only as a health problem, but also
visually, disrupting the confidence in their own bodies and causing
psychological problems. Apart from shape disorder, as the angle of curvature of
scoliosis increases, complaints such as shortness of breath, swelling, fatigue,
especially due to the compression of the lungs and heart in the chest, and can
cause pain. As a result, it can negatively affect the quality of life.

What are the Types of Scoliosis?

Idiopathic scoliosis (Scoliosis ofunknown cause)

The most common type of scoliosis; It is idiopathic scoliosis,
the cause of which cannot be fully clarified. Lateral bending in the spine can
be ‘S’ or ‘C’ shaped. Apart from tilting to the side, rotation of the vertebrae
around themselves is also seen in all idiopathic scoliosis, including the
mildest forms. This rotation in the vertebrae causes asymmetric protrusions on
the back or waist. Genetic and environmental factors are emphasized in its
etiology. It is 8-10 times more common in girls during adolescence.

Neuromuscular Scoliosis

The second most common type of scoliosis is neuromuscular
scoliosis. The main reason of neuromuscular scoliosis is the underlying muscle
and nerve disease. Nerve diseases can originate from the brain and spinal cord;
Muscular diseases can be seen in childhood and later. It can be seen in
cerebral palsy (CP), polio, meningomyelocele, muscular dystrophy, and tethered
cord syndrome.

In neuromuscular scoliosis, unlike idiopathic scoliosis,
respiratory distress and sensory defects are more common.

Congenital Scoliosis

Congenital scoliosis is the third most common. It is a type of
scoliosis due to spinal anomalies that occur during  the development of
the unborn child. Congenital scoliosis progresses rapidly in the early years.
For this reason, the treatment process of congenital scoliosis that occurs in
the early stages may require surgical intervention at a young age. There is no
gender discrimination. It cannot be explained exactly why congenital scoliosis
occurs. Due to a number of events that occur during the development of the
embryo and fetus, some conditions can be seen more frequently with congenital spinal
deformities.

Adult idiopathic scoliosis

Beginning painlessly in childhood; However, it is a condition
that can show its symptoms (pain, posture disorder, etc.) in advanced ages. In
adult idiopathic scoliosis, severe pain may occur due to degeneration in facet
joints. Respiratory functions may be affected due to excessive deformation that
may occur in the chest, and patients may get tired quickly and respiratory
distress may occur.

Adult degenerative scoliosis

Adult degenerative scoliosis is the type of scoliosis that
occurs as a result of wear on the spine with aging. It usually occurs in people
over the age of 50. Also, osteoporosis that occurs at these ages may be one of
the causes of degenerative scoliosis in adults as well as increase in curvature.
Degenerative scoliosis that occurs with wear can be seen in any of the neck,
back and waist regions of the spine; However, the most common area is the waist
region.

What are the Symptoms of Scoliosis?

Scoliosis does not cause any health problems in the early
period, very rarely, back pain can be seen. Therefore, it can be difficult for
families to notice if not careful. Symptoms of scoliosis are visual features
such as one shoulder higher than the other, hip sliding to the right / left, or
hip elevation on one side, and inequality in the posture of the shoulder
blades. The best method that families should do regularly is to ask the chıld
to lean forward with the bare back of the child and visually examine whether
the spine is on a straight line. At the end of such a control, if there is
scoliosis, a protruding height on the right or the path of the back or in the
waist area will be noticeable. The scoliosis may sometimes be accompanied by
color changes on the skin.

Another situation that families should be aware of is that
scoliosis can be seen at the age of 10-16 years and since it is not known when
it will occur, this spine check should be done frequently. Particular attention
should be paid to children with signs of puberty. When scoliosis is suspected,
a physician should be consulted immediately.

What is Done at the Diagnosis Stage in Scoliosis?

After a detailed history is taken and examined by the physician,
imaging methods are used. It is possible to make a definite diagnosis with
standing spine radiographs. Rarely, advanced radiological examinations (MR
films) of the spine are also ordered to distinguish other causes. There are
body topographic analysis systems that do not contain X-rays, which have been
used more frequently in recent years, that allow following curvature.

Early diagnosis is the most important in scoliosis. For this
reason, families should check the spine of their children between the ages of
10-16, and if there is any doubt, they should consult a physician immediately.

What Are The Treatment Steps In Scoliosis?

There are some algorithms determined in scoliosis treatment. If
it is detected early, if it is detected at a low angle, it is a candidate for
conservative (protective) treatments. Treatments for scoliosis include
observation, physiotherapy and rehabilitation applications, corseting and
surgery.

The treatment of scoliosis is determined by the degree of
curvature and the stage of growth. Today, the accepted non-surgical treatment
methods are scoliosis-specific exercises, special scoliosis programs and corset
application. The main purpose of the treatment of scoliosis is to prevent the
progression of the curvature, to protect the mobility of the child’s spine, to
control cosmetic deterioration and to prevent surgery.

Exercise practices are extremely important in scoliosis.
Three-dimensional scoliosis exercises known and becoming widespread as Schroth
exercises are planned individually for each individual according to the
affected body part. The aim is to control the pelvis and the muscles and
ligaments around the affected spine and to control the body cosmetics. For this
purpose, mobilization, spine traction, flexibility and correct posture control
and control of the spine in daily life activities are taken as a basis. Regular
exercises, correct and biomechanical control of the corset for the appropriate
period of time increase the postural balance of the child and control the
progression of the angle in scoliosis. Breathing techniques are also included
in scoliosis exercise programs. Spinal exercises, which have come to the fore
in recent years, offer device-supported programs that allow them to work in a
computer-like environment by integrating them into a game-like environment.
With Valedo, it is possible to exercise in a standing, sitting position and
plank position.

Surgical treatment is applied if the Cobb angle is above 40
degrees in individuals with high risk of progression, as mentioned above, and
conservative methods fail. In scoliosis surgery, the spine is taken in the
midline with plates and screws and the progression of scoliosis is controlled.
In young children, the operation may need to be repeated at regular intervals
to ensure the extension of the spine.