Everything You Need To Know About Scoliosis
What is Scoliosis?
Scoliosis is the lateral tilt of a group of vertebrae more than 10 degrees with rotation relative to the midline anatomical position. Idiopathic scoliosis is not a posture disorder; It is a structural deformity and constitutes 80% of all scoliosis. The most common “adolescent idiopathic scoliosis” occurs before the onset of puberty. The curvature direction is generally to the right in the thoracic region and to the left in the lumbar region and is more common in girls.
Most scoliosis stops to a certain degree without the need for any treatment. However, some of it progresses by being seriously affected by rapid growth in adolescence and requires treatment. A corset can prevent this progression in the group of patients who are thought to progress to severe problems, and it can be effective in approximately one-third of these patients. In scoliosis, which is believed to exceed the critical level according to age and progression risks, surgery is applied to prevent and correct deformities. Surgery is generally recommended for patients with lumbar curvature exceeding 40 degrees and back curvature exceeding 50 degrees.
Radiography forms the basis of patient evaluation during treatment and follow-up. Routine radiographs should be taken in standing AP and laterally. If there is an indication for conservative or surgical treatment after the first radiographs taken for diagnosis, if there is an increase in traction, bending, and kyphosis, hyperextension radiographs should be taken. The flexibility of the curve should be evaluated. CT or MRI is especially indicated in patients with advanced scoliosis with congenital scoliosis, cord compression, and atypical thoracolumbar and lumbar scoliosis.
While deciding on surgery, the balance and rotation of the curvature, the amount of hump in the ribs, and the sagittal curves should be taken into account, along with the magnitude of the curvature. Generally accepted surgical treatment indications are for curves with an angle of more than 45 degrees, for curves that cannot be controlled with conservative treatment, for curves with balance problems, for severe low back and back pain, or for cases where the deformity has significant pulmonary and psychological effects on the patient.
Most of the patients diagnosed with idiopathic scoliosis do not need treatment. Treatment is required for patients whose scoliotic curves are at risk of progression or who have severe curves at the time of diagnosis. The treatment aims to prevent the progression of the deformity, correct the deformity, and preserve the obtained correction. The growth potential of the adolescent, the size of the curvature at the time of detection, the localization and pattern of scoliosis should be considered in the choice of treatment. The individual’s cosmetic appearance and social factors that may affect the treatment should also be considered in the decision-making phase.
Although many treatment methods have been developed in historical development, the treatment method applied in spine surgery centers today; correction of curvature and providing bone fusion (union) with pedicle screws and rods applied to each level.
Frequently Asked Questions About Scoliosis
Does adolescent idiopathic scoliosis cause back or low back pain?
Scoliosis in adolescents usually does not cause pain. However, pain in patients in this age group should be considered, and possible causes should be investigated and ruled out.
Is scoliosis or kyphosis genetic? If my partner or I have scoliosis, does it mean it will be seen in my children?
It is thought that genetic factors contribute to the development of scoliosis. However, the genetic transmission of scoliosis has not been demonstrated. Even if there is a genetic predisposition, this is not the only factor influential in the development of scoliosis. However, suppose there is a family history of scoliosis. In that case, we recommend that children be carefully observed, especially during rapid growth periods, and that a spinal surgeon should be consulted if possible.
How can I prevent the development of scoliosis in my child?
Unfortunately, there is no method to make this possible.
What is adolescent idiopathic scoliosis?
It is not a posture disorder, and it is a situation that should be taken seriously. First of all, it is very unlikely that the general health of scoliosis patients will be affected by this condition. The vast majority of scoliosis stops to a certain degree without the need for any treatment and does not adversely affect the patient's life in any way. On the other hand, some are affected by the rapid height growth in adolescence and require advanced treatment. In patients seen in the early period and are thought to reach a severe size by progressing, a corset is generally used in the treatments applied to prevent this progression. It can be effective in about one-third of the children. In scoliosis, which is now thought to exceed the critical level, surgery is applied to prevent progression and correct the deformity. Surgery is generally recommended for patients with lumbar curvature exceeding 40 degrees and back curvature exceeding 50 degrees.
Can scoliosis be fatal by causing lung or heart problems?
“It can rarely be true” is more realistic. This is not true for common scoliosis. However, especially in congenital scoliosis, the structural curvature starts at a very young age and adversely affects the development of the developing lungs due to the risk of progression; on the other hand, it can progress much more (over 100 degrees), especially during the developmental period, and cause severe problems for the lungs and heart.
Do heavy school bags cause scoliosis?
No. Scoliosis is not affected by carrying heavy school bags or carrying the load on the same shoulder all the time. However, our recommendation is; Our children should not use bags with more than 10% of their body weight to prevent low back pain.
Why do different people measure scoliosis degrees differently?
Although experienced people measure it, surgeons may have 3-5 degree measurement differences due to the millimetric changes of the reference points taken. A similar difference may also be in the measurements made by the same person at different times, and this is natural. However, if these differences are much higher, it would be appropriate to get a second opinion.
Does brace treatment entirely correct scoliosis and straighten the spine?
There are first-order evidence-based studies on the benefit of corset use in the treatment of scoliosis. However, there should be no expectation that the use of a corset will fully correct the spine.
What is the SpineCore corset? Is this corset superior to others?
The use of the SpineCore corset may have the advantage of being easier to use than other corsets. However, there is no scientific data based on first-degree evidence showing that it has a definitive solution for scoliosis or corrects scoliosis more successfully than other braces.
Is the claim that scoliosis has increased in recent years valid? What is the reason?
The incidence of scoliosis is between 1 and 3%. The incidence of scoliosis has not increased in recent years. However, awareness of scoliosis has increased in society, and families have become more conscious about it. This causes the impression that there is a relative increase in the number of patients with scoliosis.
What can be done to prevent scoliosis?
Since the cause of adolescent scoliosis, which is the most common type of scoliosis, is unknown, it is not known how to prevent it. Therefore, there is no sure way to avoid the formation of scoliosis. However, girls of families with a history of scoliosis should be carefully observed, especially before puberty.
Does pregnancy cause an increase in scoliosis?
Since scoliosis is a disease often seen in girls, the coexistence of pregnancy and scoliosis is frequently questioned. However, the results obtained from different studies show that pregnancy does not cause a severe increase in scoliosis angle.
Scoliosis was detected in my child, and surgery was recommended. When can he go back to school?
As the implant systems and techniques we use in scoliosis surgeries have improved, the recovery times of our patients have shortened. Adolescent idiopathic scoliosis patients can return to school approximately three weeks after surgery. However, physical activities should be restricted during this period.
My daughter was diagnosed with scoliosis. Could it happen to my other child too?
Unfortunately, the answer is partly “Yes.” The risk of developing scoliosis, especially in the sisters of a girl with scoliosis, is higher than the average population. Although this is not a definite rule, it is an issue that requires caution and follow-up.
My daughter was diagnosed with scoliosis. Are we too late?
Parents feel most uneasy that they hold themselves responsible for this situation and perhaps think they are doing something missing or wrong. Many studies have been done on the cause of this disease, many theories have been put forward, but none have been fully proven. Since the cause of the disease is unknown, the factors that initiate this disease in the development process have not been demonstrated. Therefore, it is not possible for parents to directly influence this process.
Should all scoliosis be operated on immediately?
In cases other than those described above, the decision and timing of surgery should be made by taking into account the expectation and decisions of the patient and/or family. Essentially, for most cases, scoliosis is cosmetic surgery. If the patient does not have a cosmetic problem related to his current state; There is no obligation to be operated on as soon as it is seen or as soon as possible.
In which situations can scoliosis cause serious problems?
Scoliosis that starts at an early age (because there will be a long growth period in front of it) Rapidly progressive (it will reach the critical threshold at an early age or for different underlying reasons) Curvatures exceeding 50 degrees in the back and 40 degrees in the waist, regardless of age (with the risk of lifelong progression or cosmetic reasons) ) Curves over 80 degrees regardless of age (due to the risk of severe respiratory problems) Scoliosis accompanied by muscle diseases (due to uncontrolled progression and life-threatening situations)
Should every scoliosis exceeding 40-50 degrees be operated?
Depending on your point of view, the answer to this question can be "Yes" or "No.” Scoliosis that exceeds 40 degrees in the waist and 50 degrees in the back shows a lifetime risk of progression. Curvatures above 40-50 degrees generally go to surgery either cosmetically or due to pain. However, the timing of this surgery should be entirely the patient's own decision, and there is no necessity for emergency surgery.
Are scoliosis surgeries risky?
Of course, “0 risk” is not a correct statement. However, this risk has been considerably reduced thanks to surgical experience and neuromonitoring systems. Neuromonitoring detects the possible risk during the operation and gives the surgeon a chance to intervene first. For this reason, thanks to the system, both the operation is safer and more comfortable, and the highest possible level of correction can be achieved during the correction of scoliosis. The reliability of the system reaches 97-98%.
What is the most common cause of hunchback in childhood and adolescence?
In the vast majority of children, the hunchback observed by the parents is a slight hump, often due to poor posture (postural). It can be eliminated by increasing regional muscle strength and physical exercises.
What is a postural hunchback, what are its causes, and how can it be prevented?
Postural kyphosis; is a deformity that can often be detected in school screenings in children. It is more common in adolescence and girls. The curvature is below 60°, and the spine is flexible. There is no structural abnormality in the spine on X-rays. The most critical causes of postural hunchback are sitting in a wrong position and lack of physical condition. Especially in today's children, their mobility has decreased due to computer addiction, and they stay away from sports activities. This lifestyle causes our children to spend most of their time in the wrong sitting position; It also causes them to have impaired physical condition because they cannot do sports.
What is a structural hump?
A structural hump is a hump that is above 55 degrees even in the physiological standing of that person and often occurs due to an underlying bone and/or soft tissue pathology. This hump can be due to congenital spinal anomalies, some bone diseases, spinal infection, damage to the vertebrae due to spinal fractures, or various neuromuscular disorders. It can also occur due to Schuermann's disease for an unknown reason.
What is the most common cause of structural hump in children and teenagers?
The most common cause of structural hump in growing patients is the humpback, defined as "Scheuermann's disease,” when the vertebrae lose their rectangular shape and become wedged due to an unknown cause. Although there are many different interpretations in its etiology, the most widely accepted is avascular necrosis occurring in the growth plates of the vertebrae. If Schuermann's disease is not treated, it can increase the hump and reach dangerous dimensions.
Which sports are beneficial for scoliosis, and which positions are better to prevent?
Scoliosis is a genetically derived structural disorder and is not affected by posture. In other words, your child has not developed scoliosis because he is in the wrong position; on the contrary, he is in the wrong position because he has scoliosis. It is inappropriate to say that a sport such as swimming is beneficial since there is no posture disorder.
Is having scoliosis surgery an obstacle for pregnancy?
Your scoliosis surgery is not an obstacle for your pregnancy or giving birth.