What Is Scoliosis?
Scoliosis is defined as the curvature of the spine
over 10 degrees to the right or left, which should normally be located in a
straight line when viewed from behind. Scoliosis is not only a one-dimensional
angular deformation, but also a bony and structural deterioration that affects
the body in front and side, that is, in three dimensions.
Scoliosis is a disorder that can be seen in every
period of life. Genetic transmission is responsible for scoliosis. If the scoliosis
angle is high, the visual effect of the body is very disturbed. This cosmetic
disorder affects these young children at the beginning of adolescence visually
as well as being a health problem, and it also disrupts the trust in their own
bodies and leads to psychological problems. Apart from cosmetic disorder, as
the angle of curvature of scoliosis increases, complaints such as shortness of
breath, bloating, fatigue arise due to compression of the lungs and heart in
the rib cage, especially back and back pain. If the dynamics of the spine are
disturbed, it can cause pain. As a result, it can adversely affect the quality
of life.
What are the Types of Scoliosis?
Idiopathic scoliosis (Scoliosis
of unknown cause)
The most common type of scoliosis is; The cause is
'adolescent idiopathic' scoliosis, the cause of which cannot be fully
elucidated. The sideways bending of the spine can be 'S' or 'C' shaped. Apart
from bending to the side, the rotation of the vertebrae around themselves is
also observed in all idiopathic scoliosis, including the mildest forms. This
rotation of the vertebrae causes asymmetrical protrusions on the back or waist.
Its etiology focuses on genetic and environmental factors. It is 8-10 times
more common in girls during puberty.
Neuromuscular Scoliosis
The second most common type of scoliosis is
neuromuscular scoliosis. The main cause of neuromuscular scoliosis is due to
the underlying muscle and nerve disease. Nervous diseases can originate from
the brain and spinal cord; muscle diseases can be seen in childhood and later
periods. It can be seen in cerebral palsy (cp), polio (polio),
meningomyelocele, muscular dystrophy, theoretic cord syndrome.
In contrast to idiopathic scoliosis, respiratory
distress and sensory defects are more common in neuromuscular scoliosis.
Congenital Scoliosis
The third frequency is congenital scoliosis. It is
a type of scoliosis due to spinal anomalies that occur during the development
of the child in the womb. Congenital scoliosis shows a rapid progression in the
first 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 distinction. It is not fully explained why congenital
scoliosis occurs. Due to a number of events that occur at the stage of
development of the embryo and fetus, some conditions may be more common with
congenital spinal deformities.
Scoliosis in Adults
Adult idiopathic scoliosis
Starting painlessly in childhood in the person;
however, it is a disorder that can show its symptoms (pain, posture disorder,
etc.) in later ages. In adult idiopathic scoliosis, there may be severe pain
due to degeneration of the facet joints. Due to excessive deformation of the
rib cage, respiratory functions may be affected and patients may experience
rapid fatigue and respiratory distress.
Adult degenerative scoliosis
Adult degenerative scoliosis is a type of scoliosis
that occurs as a result of wear on the spine with aging. It usually occurs in
people over 50 years of age. Osteoporosis, which also occurs at this age, may
be one of the causes of adult degenerative scoliosis or may cause increased
curvature. Degenerative scoliosis, which occurs with wear, can occur in any of
the neck, back and lumbar areas of the spine; however, the most common area is
the waist region.
In people with severe adult degenerative scoliosis,
the strength and balance of the spine may be impaired. This disorder can cause
the spine in the front and background to tilt the trunk sideways and the trunk
to tilt forward with a decrease in the anatomical angle of the lumbar region.
These imbalances may cause the severity of the curvature to increase, as well
as affect the patient's ability to move, causing pain.
In adult patients with degenerative scoliosis, back
pain, low back pain and pain throughout the distribution area of the nerve due
to nerve compression (radiculopathy) and loss of strength in the muscles fed by
the nerve may be observed. In these deformities that may occur in the spinal
structure, spondylolysis may cause the spinal bone to shift forward. Generally,
non-surgical treatment methods are preferred. Physiotherapy programs,
stabilization, strengthening and stretching exercises can solve muscle spasm
and reduce pain. In adults with a diagnosis of rheumatic disease, scoliosis may
develop in the case of osteoporosis (bone resorption) and after trauma and
infections.
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 they are not careful. Symptoms of scoliosis are
visual features such as one shoulder being higher than the other, hip shifting
to the right/left or hip standing high on one side and unevenness in the
posture of the shoulder blades. The healthiest method that parents should do
regularly is to lean forward with the child's back bare and visually examine
whether his spine is on a straight line. At the end of such a check, if there
is scoliosis, a protruding height is noticeable on the right or path of the
back or in the lumbar region. Scoliosis can sometimes be accompanied by color
changes in the skin.
Another condition that families should know is that
scoliosis can be seen at the age of 10-16 and it is not known when it will
occur because of this spine check at frequent intervals. 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 of scoliosis?
After a detailed history is taken and examined by
the physician, imaging methods are applied. It is possible to make a definitive
diagnosis with standing spinal radiographs. Rarely, further radiological
examinations of the spine (MRI films) are also ordered to distinguish other
causes. There are body topographic analysis systems that do not contain X-rays
and provide the opportunity to monitor the curvature, which have been used more
frequently in recent years.
The most important thing in scoliosis is early
diagnosis. For this reason, families should check the spine of their children
between the ages of 10-16 in the growing age and consult a physician
immediately if there is a doubt.
What are the Treatment Steps in
Scoliosis?
There are some algorithms that have been
established in the treatment of scoliosis. If it is detected early, if it is
detected at a low angle, it is a candidate for conservative (protective)
treatments. Treatments in scoliosis are observation, physiotherapy and
rehabilitation applications, corseting and surgery.
Treatment of scoliosis is determined by the degree
of curvature and at what stage of growth it is. Today, accepted non-surgical
treatment methods are scoliosis-specific exercises, special scoliosis programs
and corset application. The main goal of scoliosis treatment is to prevent the
progression of the curvature, to preserve 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 as Schroth exercises
and becoming widespread, are planned individually according to the affected
body part in each individual. The goal is to control the muscles and ligaments
around the pelvis and the affected spine and to provide control of body
cosmetics. For this purpose, mobilization, spine traction, flexibility and
correct posture control and control of the spine in daily living activities are
taken as basis. Regular exercises, correct and biomechanical control adequate
use of the corset for the proper time increases the postural balance of the
child and controls the progression of the angle in scoliosis. Breathing
techniques are also included in scoliosis exercise programs. Device-supported
programs that allow spinal exercises, which have become more prominent in
recent years, to be integrated into a game-like environment on the computer.
With Valedo there is the possibility to exercise in standing, seated position,
plank position.
The ideal of corsetation is after the age of 10,
when the risser stage is 0-2 (early stages of bone development), the cobb angle
is between 20-40 degrees and it is at most 1 year before or after menarche.
In individuals where conservative methods have
failed and the risk of progression listed above is high, surgical treatment is
applied if the Cobb angle is above 40 degrees. In scoliosis surgery, the spine
is removed to the midline with plaques and screws and the progression of
scoliosis is controlled. In young children, the operation may need to be
repeated at regular intervals to allow the spine to lengthen.