Scoliosis, also known as spinal curvature, is a condition that occurs when the spine bends to one side and can affect people of all ages, from infants to adults. The incidence of scoliosis in the community is around 2%-3%. It occurs equally in men and women. However, it is known that the condition can be more progressive in women. Although conditions such as polio and muscular dystrophy (muscular diseases) are risk factors for scoliosis, the cause of scoliosis in children is often unknown. A visible curvature of the spine, inequality in shoulder levels, and one shoulder and hip tilting to one side are among the symptoms of scoliosis. Although mild cases of scoliosis usually do not indicate a serious danger, follow-up is important to see if the curvature of the spine worsens. Scoliosis can usually improve with treatment and scoliosis pain can be relieved. Depending on the severity of the spine curvature, scoliosis treatment includes surgery or non-surgical treatments such as corset, exercise, and physical therapy.
What is Scoliosis (Spine Curvature)?
Curvature of the spine, scoliosis as it is called in medicine; It occurs as a result of a disorder in the alignment of the bones that make up the spine. A normal and healthy spine, which should appear straight when viewed from the front, takes the “S” shape due to this misalignment, and each vertebral bone makes a certain degree of rotation around itself. Most scoliosis is mild, but some spinal curvatures can become more severe with growth and development. A severe spinal curvature can reduce the amount of space inside the chest, making it difficult for the lungs to function properly.
In scoliosis, the spine takes an “S” shape due to the misalignment of the bones forming the spine.
Although scoliosis is caused by conditions such as polio and muscle diseases, the cause of scoliosis is often unknown. Types of scoliosis are named as cervical (neck), thoracic (back), lumbar (waist), cervicothoracic (neck-back) and thoracolumbar (back-waist) according to the place of formation of the curvature in the spine. However, the most common type is idiopathic scoliosis, which means curvature of the spine of unknown origin.
Scoliosis type; Cervical (neck), thoracic (back), lumbar (waist), cervicothoracic (neck-back) and thoracolumbar (back-waist) spinal curvature may differ according to the place of formation.
Idiopathic scoliosis is a type of scoliosis, the cause of which is not fully understood, but the increased growth rate during adolescence is thought to play a role. Although idiopathic scoliosis can occur at any age, 80% of it occurs during adolescence. Early diagnosis is very important in the treatment of scoliosis, as the risk of progression of the curvature is high during periods of high growth rate. In most cases, early scoliosis treatment and follow-up can prevent the condition from becoming severe enough to require surgery.
In idiopathic scoliosis, the control period may vary depending on the degree of spinal curvature and the rate of progression of the scoliosis. In general, a control examination should be done every 6 months. In these controls, body asymmetries are re-evaluated, joint range of motion and flexibility are evaluated. Scoliosis x-rays are repeated in which the entire spine is taken anteroposteriorly and laterally. By calculating the angle of curvature on this x-ray, the progress of the curvature is evaluated according to previous examinations.
Although a curvature of at least 10 degrees seen on an X-ray of the spine is considered scoliosis, this mild curvature may not show any symptoms. As the spine curvature progresses to 20 degrees or more, abnormalities such as body tilting to one side begin to be noticed.
What Causes Scoliosis (Spine Curvature)?
Although it is thought that carrying heavy backpacks or lying on your side can cause scoliosis, this is not usually the case. The cause of about 8 out of 10 cases of scoliosis is unknown (idiopathic scoliosis). Some neuromuscular diseases such as polio or muscular dystrophy, congenital defects that affect spinal development, spinal injuries or infections, spinal cord abnormalities are some of the factors that can cause scoliosis. However, there is also evidence to suggest that scoliosis may be genetic. A family history of spinal curvature was found in approximately one-third of patients with scoliosis that appeared during adolescence.
What are the Symptoms of Scoliosis (Spine Curvature)?
Scoliosis Symptoms; especially in the early stage of scoliosis or mild scoliosis with low degrees, there are no noticeable symptoms, no palpable asymmetry or complaints. During growth and puberty, the scoliosis symptoms of can often become more pronounced. Depending on the location of the scoliosis and the angle of curvature, the symptoms of scoliosis are generally as follows:
- Uneven shoulder levels
- Asymmetry in the shoulder blades,
- Abnormal hunchback,
- Side curvature,
- Level difference at the points on the pelvis,
- The difference in distance between the arm and the waist when the arms are hung to the side,
- Asymmetrical protrusion on the back when bending forward from the waist,
- Leg length inequality.
These signs of scoliosis may catch your eye especially when you are dressing or in front of a mirror. In advanced scoliosis, there may be more serious symptoms such as limitation of joint movements, difficulty in walking, respiratory problems, and difficulty in activities of daily living.
Scoliosis symptoms of in children and infants show similar features, moreover, children may appear to always lean to one side, the waist may be sloping, and the ribs may be more prominent on one side.
Conditions such as uneven shoulder levels, asymmetry in the shoulder blades, and lateral curvature are among the scoliosis symptoms.
How Is Scoliosis (Curved Spine) Diagnosed?
For the scoliosis diagnosis, your doctor first listens to your health history and complaints, and examines the signs of scoliosis by performing a physical examination. For the scoliosis diagnosis in children, the growth and development process is evaluated. X-rays are requested to scoliosis diagnose and to see the severity of the spinal curvature. Also, magnetic resonance imaging (MRI) may be recommended if another underlying condition, such as a spinal cord abnormality, is suspected to be causing the scoliosis.
Scoliosis diagnosis; physical examination, evaluation of the growth and development process of children, and x-rays.
Scoliosis (Spine Curvature) Treatment
Back pain is one of the main problems caused by scoliosis, so scoliosis treatment should be mainly aimed at pain relief. There are treatment options such as scoliosis exercises, corset, physical therapy and surgical methods. If scoliosis is not severe and does not cause any back pain, treatment may not be needed yet. In moderately severe scoliosis, scoliosis treatment options such as bracing or surgery can be applied. If you suspect scoliosis, be sure to consult your doctor for an appropriate scoliosis treatment plan.
In the period when the skeletal maturation does not end, that is, growth continues, starting the brace treatment by deciding according to the degree of spinal curvature may slow down the progression of the spinal curvature. A personalized corset is prepared according to the angle, direction and location of the curvature. The use of a scoliosis brace is generally recommended full time (20-24 hours).
Follow-up evaluation should be done every 4 months in the period when the growth is the fastest and every 6 months in the following period. In the treatment with the scoliosis brace, it is decided to change the duration of use or stop it according to how the curvature responds to this treatment.
Depending on the curvature of the spine in scoliosis, changes in the length of many muscles, deterioration in joint structure, shift in the body’s center of gravity, deterioration in the normal posture of the body and decrease in respiratory functions are in question. With scoliosis exercises, it is aimed to prevent all these situations, to stop the progression of the curvature and to reduce the angle of curvature.
It is wrong to focus only on the muscles around the spine in the scoliosis exercises program. Depending on the curvature of the spine; shoulder and hip movements and the alignment of the rib bones are also affected by this condition. In addition, scoliosis exercises can be applied at home to strengthen body posture, regain trunk alignment, strengthen muscles.
Before starting scoliosis exercises, it is important to evaluate the whole body in detail and to plan the exercise program accordingly. Scoliosis exercises should be done carefully and with appropriate technique. Always consult your doctor before starting any home scoliosis exercise program.
Physical therapy in scoliosis; It can help relieve scoliosis pain, improve spinal mobility, and prevent the curvature from worsening. Your physical therapist will show you exercises to strengthen the muscles that support your spine and improve body posture. However, scoliosis exercises that you can do daily at home may be recommended.
Scoliosis exercises and physical therapy are important for relieving scoliosis pain, improving spinal mobility, and preventing worsening of the curvature.
The Schroth method, which is based on the principle of evaluating and treating the spinal curvature in 3D, is a non-surgical treatment method for the treatment of scoliosis. In the Schroth method, special exercises are applied for each patient in order to bring the curved spine into a more natural position. These exercises are;
– Keeping the body standing, sitting and lying down,
-Working with wall ladders, exercise bands and therapy balls,
-Doing breathing exercises
It consists of activities such as learning posture correction techniques.
Surgical treatment is usually applied if the degree of curvature of the spine is above 45 degrees. Failure to perform surgical treatment in severe curvatures may cause deterioration in respiratory functions. The purpose of scoliosis surgery; is to restore the impaired body movement to the spine. Scoliosis surgery methods may vary from patient to patient. If scoliosis surgery is decided in children who are still growing and in the early stages of bone maturation, extendable systems or string scoliosis surgery can be applied.
In extendable systems; In children, the curvature is tried to be corrected with screws and rods placed on the spine. As the child grows, rods are attached to the spine to help maintain the curvature of the spine. Every 6 to 12 months, another surgery is performed to adapt to the growth of the spine and lengthen the rods.
In string scoliosis surgery; The vertebrae are screwed through the small incisions made with the surgical procedure. Curvature is corrected by stretching special threads from these screws. Thus, the spine of children in the developmental period continues to develop.
The advantage of these systems is that they are systems that allow the child to grow and adapt. In a child who has left the rapid growth period behind and approached the end of bone maturation, fusion surgeries that allow the vertebrae to fuse together can be performed.
What Happens If Scoliosis Is Not Treated?
Mild cases of scoliosis may not always need treatment. However, if moderate and severe scoliosis is not treated, it can cause pain, increased deformity, body posture disorder, and damage to the heart and lungs by decreasing the amount of space in the chest.
Scoliosis in children often develops during the growth period, just before puberty. If the curvature of the spine is small, it may be recommended to follow up with regular controls without the need for treatment. If the curvature of the spine is between 20 and 40 degrees, it is important to plan the appropriate scoliosis treatment and apply it without delay.
Idiopathic scoliosis is both the most common and the most overlooked type of scoliosis. It can be very difficult to notice, especially in cases where spinal curvature is low. You can also do a simple scan at home, checking for body asymmetries. If you suspect scoliosis, the area you should apply is the Orthopedics and Traumatology department. Early diagnosis of scoliosis and applying appropriate treatment at the right time are of great importance for the future of developing children.
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