Scoliosis
IDIOPATIC (OF UNKNOWN ORIGIN) SCOLIOSISScoliosis is the lateral displacement of the spine from the midline axis when viewed from the front. Adolescent idiopathic scoliosis is the scoliosis seen between the ages of 10 and 18 and the cause of which is unknown as of today. It is more common in girls. Adolescent idiopathic scoliosis cause is the most common type of scoliosis. Among the reasons that can cause scoliosis, there are theories such as hormonal disorders, asymmetric growth, and muscle imbalance. Since 30% of patients with scoliosis have a family history, it is thought to have a genetic link.
Adolescent idiopathic scoliosis cause is the most common type of scoliosis. Apart from the idiopathic type, scoliosis may occur due to congenital spinal defect (congenital), due to nerve/muscular diseases (neuromuscular), or calcification in the spine in advancing age (adult).
Although we do not know the exact cause of scoliosis today, we have a significant knowledge about the course and treatment of the disease.
In patients with adolescent idiopathic scoliosis, complaints that cause pain, power, or loss of sensation usually do not occur. Compression in the internal organs due to the curvature, such as shortness of breath, does not occur. Rarely, some patients may have pain in the lower lumbar region. If pain and neurological findings are prominent in a patient with scoliosis, further observation (MRI) and examination should be performed for an underlying spinal cord problem.
Examination Findings:
Since most adolescent idiopathic scoliosis patients do not have pain, the first recognition of the disease is mostly due to some asymmetric body appearances noticed by the patient himself/herself or his/her relatives. The most common of these visible symptoms is shoulder asymmetry, that is, one shoulder is higher than the other.
Sometimes the torso is observed to be displaced laterally on the pelvis. In other words, the body is observed as if the head has been displaced sideways rather than in the midline. Similarly, due to the scoliosis curvature, the pelvis appears higher on one side, giving the impression that one leg is shorter than the other. In scoliosis, a humpback occurs, which becomes more evident when the patient leans forward, as the spine rotates around itself while displacing it to the side.
When the arms are draped to the sides, there may be more space between the arm and the torso on one side. When viewed from the side, an unusual appearance is not observed most of the time.
In adolescent idiopathic scoliosis, there is no problem such as loss of strength or numbness in the legs-arms.
Radiological examination:
Direct x-rays are very important in the diagnosis and follow-up of scoliosis disease. In standard x-ray examination, films are taken of the entire spine from the back and sides, while standing.
The size of the scoliosis curvatures formed on these films are measured in degrees. Meanwhile, curvatures measured below 10 degrees are not considered scoliosis, this is called asymmetrical stance. In addition, the degree of humpback (kyphosis) in the back region and cupping (lordosis) in the lower back region are measured in the lateral radiograph.
If your doctor detects neurological disorders during the examination or findings that suggest a spinal cord problem, he or she will order an MRI of your entire spine.
Treatment:
When choosing the treatment method, planning is made by considering the age of the patient, the size of the scoliosis curvature, and the risk of progression of the curvature. The younger the patient's age and the greater the curvature, the higher the risk of progression. Since girls grow very quickly in the two years after menstruation, the risk of progression of the curvature is higher during this period.
Adolescent idiopathic scoliosis is evaluated by the spinal surgeon in 3 ways.
1. Follow-up of the curvature of scoliosis without treatment
2. Exercise
3. Corset treatment
4. Surgical treatment
In the treatment of idiopathic scoliosis, the angular value of the curvature guides the treatment. After the measurement with the 'Cobb Method', your doctor will call you for control at regular intervals to evaluate the progress of your curvature in curves below 25 degrees. In patients with these degrees, 'Schroth Exercisers', which is thought to be beneficial in some scientific studies in recent years, can be applied.
Curvatures between 25 and 40 degrees in patients with incomplete bone growth are treated with a corset. The purpose of use of the corset is to prevent further progression of the curvature. Corset treatment does not completely treat the curvature, it only prevents its progression or reduces the rate of progression. Corset treatment is continued up to 45 degrees even if the curvature progresses. There are various types of corsets available and they all work on similar principles. The corset is usually successful if used 20-22 hours a day. The corset can be removed during the bath or for sportive purposes. Corset treatment is continued until bone maturation is completed. In girls, this period is usually 2 years after menstruation. In men, bone development can take up to 15-16 years. There is no use in using a corset after this period.
Surgical treatment is preferred in patients with curvature greater than 45 degrees. The aim of surgical treatment is to stop the progression of the curvature and to correct the curvature in a balanced way. In other words, the aim is always to achieve a balanced spine where shoulder asymmetry and trunk axis deviation are corrected, rather than making the curvature '0' degrees. After all, this surgery is a procedure where cosmetic expectations are at the forefront. For this purpose, some metallic screws and rods are applied to the spine to correct the curvature and keep it that way. (photograph)
Scoliosis is a disease often called idiopathic, the cause of which is unknown, that occurs in adolescence. However, there are types of scoliosis that can occur congenitally or in early childhood or in advanced ages. The treatment of scoliosis varies according to its cause. Considering the degree of idiopathic curvature and the age of the patient, only one of the methods of follow-up, brace, or surgical treatment is selected. The decision for this treatment should be made by an experienced spinal surgeon.
NEUROMUSCULAR SCOLIOSIS
The second most common type of scoliosis is neuromuscular scoliosis. Muscle or nerve diseases may be among the main causes of neuromuscular scoliosis. Nervous diseases can originate from the brain and spinal cord, while muscle diseases can be seen in childhood and later. In contrast to idiopathic scoliosis, respiratory distress and sensory defects are more common in neuromuscular scoliosis. Scoliosis coset may not be used during the treatment process due to reasons such as respiratory problems, communication disorders, sensory defects, and epileptic seizures. In this type of scoliosis, younger ages may be preferred for surgical intervention.
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 child in the mother's womb. Congenital scoliosis progresses rapidly 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.
Apart from these, neurofibromatosis, various rheumatic diseases, various connective tissue diseases such as osteogenesis imperfecta, Marfan syndrome, Ehler Dsanlos, spinal fractures, spinal infections, various metabolic diseases such as Morquio, Gaucher disease, and some genetic syndromic diseases may cause scoliosis.
ADULT SCOLIOSIS
Do you have one shoulder higher when you look in the mirror? Is one leg of your pants longer than the other? Is one hip higher than the other when walking? If you answer yes to these questions, you may have scoliosis (curvature of the spine).
Adult Scoliosis often occurs in two ways. It occurs as a result of the awakening of the dormant curvature that has emerged in childhood but has progressed or due to the aging of the spine. It most commonly occurs in the lumbar region, but can also occur in the back and neck region.
More rarely, curvature may occur due to osteoporosis, previous spinal fractures, lumbar slippage, spinal tumor and infection. While the diagnosis is made in the adolescent period as a result of school screenings or the families' awareness, patients consult a doctor with low back pain and pain radiating to the leg at advanced ages. This condition is often diagnosed as lumbar hernia and attention is always focused on the hernia and the underlying progressive scoliosis is overlooked. Similarly, in scoliosis caused by aging, a decrease in walking distance as a result of narrowing of the nerve canal caused by the curvature may manifest itself with lower back and leg pains. As the spine bends to one side, asymmetrical appearances occur in the body.
Increasing life expectancy and more active lifestyle (sports) increase the expectation of treatment. Curvatures of 30 degrees or more in the adolescent period are more prone to progression in adulthood. An average of 0.5-2 degrees progress per year. For this reason, curvatures diagnosed in adolescence should be followed up in adulthood, even if they are not operated. Heart and lung problems occur in curves of 90 degrees and above.
