When looking at the spine from the opposite side of healthy people, it is seen that the spinal column descends straight from top to down, without twisting to the right and left. The condition that the spine bends sideways around its vertical axis with a rotation/torsion movement and is seen as the letter “S” when viewed from the opposite side is called “scoliosis”, that is, the spinal curvature.
Scoliosis is a three-dimensional spinal deformity that most commonly affects adolescents.
It occurs on 2-3% of children aged from 10-16 years. 85% of spinal curvature cases are idiopathic (unknown cause) scoliosis type that occurs during adolescence.
Idiopathic (cause unknown) scoliosis classification
Infantile scoliosis: seen in children under the age of 3-
Juvenile scoliosis: seen in children aged 3-10 years-
Adolescent scoliosis: seen in children over the age of 10
The cause of structural scoliosis seen in the adolescent age group is not known exactly. Many opinions have been put forward about the cause, but none of these hypotheses have been finalized. Current studies have focused on the effects of genetic, hormonal and environmental factors on the development of scoliosis.
Many scoliosis cases are discovered incidentally during school health screenings and routine pediatrician check-ups. In some children, curvature of the spine occurs as a result of attracting the attention of the family and applying to the doctor. In such suspected cases, the child should be examined by an orthopedic spine surgeon.
Scoliosis can develop in the back and rarely in the neck spine. In those with scoliosis, shoulder heights differ and asymmetry in the shoulder blades can be observed when viewed from behind.
There may also be asymmetry in hip heights. As a result of the curvature of the spine, the head may not be in the central position when the projection is aligned with the pelvis.
When children bend forward from the waist without bending their knees, an asymmetrical humpback occurs in the back. For a curvature in the spine to be called scoliosis, there must be a curvature of at least 10 degrees. Until the degree of curvature reaches 20 degrees, it usually does not give any obvious examination findings and may not be noticed.
After the orthopedic examination at a patient with suspected scoliosis, a scoliosis X-ray, a standing scoliosis X-ray film, in which the entire spine can be seen, is taken. Thanks to the new modern radiographic techniques, the rate of radiation exposure is reduced to very low levels.
If spinal curvature is detected, the degree of this curvature is determined by measurements to be made on the scoliosis radiograph. Most of the spinal curvatures detected in adolescence are between 10-40 degrees.
Although treatment planning is made according to the degree of curvature, there may be some margin of error between measurements. Therefore, in order to say that there is an increase in curvature, a change of at least 5 degrees between the control films must be detected.
In the following cases, further diagnostic radiological examinations such as magnetic resonance imaging (MR) may be needed꞉
Structural curvature (scoliosis)
Scoliosis is a fixed curvature that occurs in a structurally abnormal spine. If structural curvatures are not treated, they are permanent and sometimes even progressive. The causes of this type of curvature include idiopathic (cause unknown), muscle diseases, metabolic diseases, congenital causes and trauma.
Nonstructural curvature of the spine (functional curvature)
It is the curvature of a structurally normal spine caused by bending due to another reason. The condition that causes the spine curvature can be leg length inequality, the existence of a tumor around the spine or an infection. This type of curvature of the spine resolves when the underlying cause is treated.
Naming scoliosis according to the location of the curvature of the spine
Curvature of the back (thoracic curvature): It is the most common form of scoliosis of unknown cause (idiopathic). The top of the curve is 90% to the right.
Curvature in the waist (Lumbar curvature): It is a less noticeable form of scoliosis with a physical examination. The top of the curve is 70% to the left.
Double curvature: It is a form of curvature in both the back and waist. In these scoliosis, right thoracic and left lumbar spine curvature are found together, with the top of the curve on the right in the dorsal region and on the left in the lumbar region.
Patients with moderate and mild curvature generally do not complain of pain and do not experience a limitation in their daily life due to scoliosis. Severe scoliosis curves tend to progress and worsen over time. Curvatures above 90 degrees may cause problems with lung and heart functions. In addition, these patients complain about their cosmetic appearance. The main goal in the treatment of scoliosis should be to prevent the progression of spinal curvature.
Risk factors in the progression of the curvature꞉
There are basically 4 options in the treatment of scoliosis꞉
Most of the scoliosis patients can be detected in the early period and successfully treated with non-surgical methods.
If the curvature is in the range of 10-25 degrees and there is no progression, the recommended treatment is intermittent follow-up. Orthopedic outpatient examination every 6 months and control of angular evaluation in spine films are recommended. Follow-up continues until bone maturation is complete and growth stops.
The use of braces is recommended for patients whose growth continues and whose curvature is above 25 degrees. Sometimes, although the curvature is in the range of 20-25 degrees, a brace may be required if its progression is rapid. The purpose of using braces is to slow down the progression of the curvature. The brace used in the treatment of scoliosis is usually the Boston TLSO (thoracolumbosacral orthosis). Other braces used; sleep braces, Milwauke braces and Charleston braces.
Successful results can be obtained by using the corset correctly until the growth is completed. Modern braces are made of thin profile and lightweight plastic material and can be worn inside their clothes. A properly manufactured and used brace can correct spinal curvature by 50%.
-Physical therapy and rehabilitation programs are also recommended in scoliosis. Scoliosis exercises performed together with these programs are also extremely useful.
Especially the Schroth method; It comes to the forefront in the treatment of scoliosis as an exercise model that handles scoliosis not as one-dimensional but 3D. It consists of exercises that are applied in special positions and with breathing techniques to reduce the curvature of the spine and are tailored to each person’s situation.
Surgical treatment in scoliosis is recommended especially for curvatures above 40-45 degrees. The aim of surgical treatment is to correct or reduce the curvature and prevent its progression
Factors considered when deciding on the treatment of scoliosis꞉
Patient and family preferences
You can also check regularly, whether your child has a curvature of the spine. If there is an imbalance in shoulder heights, asymmetry in the appearance of the shoulder blades, or if there is a difference in hip height, it is important to take your child to a spine surgeon. Very good results are obtained when scoliosis is detected early and treated by taking the necessary precautions.