SCOLIOSIS

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Scoliosis (Spine Curvature)?

Our spine is like a bridge that runs between our head and legs and carries two-thirds of our body weight. Our spine consists of 33 bones, 23 of which are movable, called vertebrae.

These bones are connected to each other by connective tissue, joints and cushions we call discs. We also have strong spinal muscles that provide movement and attach to each of the vertebrae. The spinal cord, one of the most important parts of the central nervous system, is also located in the spine. The spine houses and protects the spinal cord.

The spinal cord consists of nerve tissue that provides the connection between the brain and the arms, trunk and legs and carries orders from the brain to these regions. By acting just like an electrical cable; It enables our hands and arms, feet and legs, and our sensory function to work.

The spine also helps us breathe and controls urinary and stool functions. Our spine allows us to turn our bodies and turn our heads. It protects the internal organs. For a healthy spine, it is important to stand upright, not lift heavy loads and sit correctly.

Frequency of Scoliosis

Scoliosis occurs in approximately 2 to 4% of the population.
Most of these are low-grade curvatures. It can be seen 8-10 times more frequently in girls than boys.
In only 10 percent of people with a curvature of the spine , scoliosis progresses to a degree that requires treatment.
Regular exercise, keeping the back muscles strong, increasing the condition and being more fit are indispensable elements in almost every step of scoliosis follow-up and treatment.

Types of Scoliosis

idiopathic scoliosis ( scoliosis of unknown cause )

The most common type of scoliosis ; it is ' idiopathic ' scoliosis , the cause of which has not been fully elucidated . The lateral bending of the spine can be 'S' or 'C' shaped. Rotation of the vertebrae, other than lateral bending, can also occur in all idiopathic forms, including the mildest forms. seen in scoliosis . This rotation in the vertebrae causes asymmetric protrusions in the back or waist.

neuromuscular Scoliosis

The second most common type of scoliosis is neuromuscular is scoliosis . neuromuscular Muscle or nerve diseases may be among the main causes of scoliosis . Nervous diseases can originate from the brain and spinal cord; Muscle diseases can be seen in childhood and later.

neuromuscular in scoliosis , idiopathic Contrary to scoliosis , respiratory distress and sensory defects are more common. Scoliosis brace may not be used during the treatment process due to reasons such as respiratory problems, communication disorders, sensory defects and epileptic seizures .

scoliosis, younger ages may be preferred for surgical intervention. Fusion therapy can be applied.

congenital Scoliosis

Thirdly, congenital scoliosis is seen. 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, congenital The treatment process of scoliosis may require surgical intervention at a young age.

Apart from these, neurofibromatosis , various rheumatic diseases, osteogenesis imperfecta , marfan Syndrome , various connective tissue diseases such as Ehler Dsanlos , spinal fractures, spinal infections, various metabolic diseases such as Morquio , Gaucher disease and some genetic syndromic diseases can cause scoliosis .

Congenital Scoliosis

congenital spinal What is deformity ?

congenital means that it is present from birth and that the problem occurs while in the mother's womb. Deformity is a structural deformity. So congenital spinal The term deformity refers to spinal deformities that occur while in the womb and progress with age.

The spine development of the child in the womb is completed in the first three months, along with the development of its organs. During this period, the growth of the vertebrae becomes asymmetrical as a result of the abnormal formation of the spine structure or staying together, and as a result, curvatures develop. The type of deformity seen depends on where and in which direction the abnormal vertebra is located in the spinal column.

A normal spine is straight when viewed from behind, but curved when viewed from the side. These folds are in the form of a slight hump in the back ( kyphosis ) and a depression in the lumbar region ( lordosis ). In congenital cases, scoliosis occurs if the asymmetric growth is sideways , and increased kyphosis occurs anteriorly .

How does spinal curvature occur in people with abnormal vertebrae?

The most important factor leading to curvature of the spine is the asymmetric growth of abnormally formed vertebrae. The problems that occur in the mother's womb in the vertebrae can be seen as formation defects and decomposition defects. There are also more complex cases where both defects occur together.

there may not be much curvature at first. Curvature occurs with more growth. But despite growth, many of the spines affected in this way may have little or no curvature at all. Even in vertebrae containing more than one abnormal vertebra, if these abnormalities are distributed in such a way that they balance each other, the result may be decreased trunk growth rather than increased curvature.

The curvature may increase very slowly until the rapid growth stage of puberty. In cases where one side of the vertebrae cannot separate and remains attached, the attached side cannot grow; the free side continues to grow and scoliosis occurs.

In cases where both sides of the vertebrae are attached, there is little or no growth in this region. As a result, scoliosis does not develop, but this region may be short. If the vertebrae are attached from the front, a humpback ( kyphosis ) occurs because growth will continue from behind .

lordosis ) occurs because growth will continue from behind . Half or insufficiently formed vertebrae cause one side of the spine to grow more than the other, creating a curvature.

congenital Is Scoliosis Genetic?

Congenital ( congenital ) scoliosis is not generally considered to be hereditary. But congenital with other conditions that may be inherited Scoliosis may accompany a hereditary disease.

Therefore, only congenital A child with scoliosis and no other genetic disorder has a similar finding in his family ( Congenital There is no increased likelihood of having another sibling with scoliosis .

congenital The exact cause of scoliosis cannot be explained. Due to a number of events occurring during the developmental stage of the embryo and fetus , some conditions may be seen more frequently with congenital spinal deformities .

congenital Scoliosis and Patient Monitoring Process

of scoliosis, a period called "controlled observation" is entered and how the deformity behaves is monitored. This is done with regular examinations and x-rays at certain time intervals. If the curvature continues to increase regularly or if other functional problems occur, appropriate surgical intervention should be performed.

congenital Scoliosis and Corset Treatment

congenital scoliosis and idiopathic One of the biggest differences between scoliosis is that corsets are congenital. It is not effective in deformities . Sometimes the body creates a second curve to maintain balance above or below the curves caused by congenital abnormalities.

These curvatures may increase after a certain time and sometimes reach more serious dimensions than congenital curvature. The brace can be used to control or delay the progression of secondary curvature in these patients.

congenital In scoliosis, it is aimed to slow down or destroy the asymmetrical growth of abnormal vertebrae . For this, spinal fusion process (freezing the spine, eliminating movement) can be applied.

Surgery may need to be performed when the child is young to control an increasing deformity . Parents understandably fear that early fusion (as the fused portion is stopped growing) may inhibit stem growth.

Although it is true to a certain extent, the trunk may not be recovered by correcting a very severe deformity after the growth is over, and delaying the surgical treatment of the patients just because of this concern may cause very serious problems for the patient in the future.

congenital Early surgery can be performed at any age when the patient with scoliosis is required, but it can usually be delayed until the patient is 1 year old. After this age, if surgical procedure is necessary for scoliosis , it is recommended to be done without waiting. Although early surgery is performed, additional procedures may be required for scoliosis if the initial surgery does not fully control the curvature .

Actively growing children may require both anterior and posterior fusion to control the scoliosis curvature. These techniques can be applied in both scoliosis and kyphosis . In order to achieve spinal fusion , it may be necessary to use either autograft (the person's own) or allograft (someone else's) bone, bone analogs, or a combination of many of these sources.

If other related organ problems are detected, their treatment should also be planned. The treatment of these anomalies , especially those in the spinal cord, should be done together with spinal curvatures.

While some spinal cord abnormalities do not require treatment, others are treated with surgery before or simultaneously with curvature treatment.

ONLY SOME NEED TREATMENT

The diagnosis can be frightening and will raise many questions. But there is no need to worry ., Many people diagnosed with scoliosis do not require treatment.

Those with a curve of 15 degrees or less may find that the small curve in their spine does not get worse over time. The condition must be monitored, but usually does not require treatment.
A child who has a 20 to 40 degree curve and has two more years of growth often uses a corset as a means of treatment.
Patients with curves of 40 degrees or more will most likely need surgery to treat their condition. Spinal fusion is the standard procedure for correcting scoliosis . However, among other treatments, anterior vertebral body attachment, growing rods or instrumentation , and fusion.

DETERMINING THE TREATMENT PLAN

The child's age, health, and medical history

scoliosis type
The extent of the condition and the curvature
Tolerance of the child to certain methods of treatment
The foreseeable course of their special circumstances
parent's opinion
If Untreated

Ultimately, the goal of a child's treatment plan will be to stop and correct the spinal curve. If a child with moderate or severe scoliosis does not receive the necessary treatment, the curvature of the spine will increase one degree each year or with each growth period. They develop a significant deformity , back pain, and sometimes difficulty breathing, as their rib cage puts pressure on their heart and lungs.

TREATMENT OPTIONS

The treatment plan that is right for your child is determined on a case-by-case basis. However, scoliosis that requires treatment is usually managed by:

Scoliosis and Corset Treatment

with scoliosis , brace treatment is applied in patients with moderate curvature (20-40 degrees), skeletal development has not yet been completed, and the angle of curvature is increasing. Brace treatment is not effective in adult individuals or in patients over the age of 17 whose growth and bone development have been completed. It gives more effective results with programmed exercises. In order for the corset to be useful, it is generally recommended to wear it for at least 20, if possible 22 hours a day, depending on the particular situation of the person.

Scoliosis and Exercise

to normalize the spinal sections affected in scoliosis and to activate the shortened and weak muscle groups together with the rotational breathing technique while preserving the respiratory capacity.

Scoliosis limits the movements of the spine in forward angles. The waist and hip movements of the person are less than normal and they lose their flexibility, which also causes posture disorder.

One of the treatment methods with the highest level of evidence in scoliosis is the exercises that are specially programmed for the person and curvature known as Schroth . The cornerstone of the Schroth Method is Katharina, who also has scoliosis . She was kicked out when Schroth began to treat her own deformity. Later, Christa, the daughter of Physiotherapist He developed special scoliosis exercise programs together with Schroth and started to apply them on patients.

The most important point in scoliosis exercises is to evaluate each individual with scoliosis separately and in detail, to analyze the affected body segments and spine movements, to determine the location and angle of the curvature and to organize the appropriate exercise program. Scoliosis creates different effects in each person.

On the other hand , in scoliosis Although the positive effects of swimming, pilates and yoga sports are stated, there is not enough scientific evidence on this subject. Although the age of the individual with scoliosis depends on the type, location and degree of the curvature, sportive movements are supported in order to increase and protect the spine mobility.

Scoliosis and Surgical Treatment

idiopathic, reaching noticeable levels in the pre-adolescent period In the vast majority of scoliosis, brace treatment can prevent the increase in curvature. However, surgical treatment is the most ideal option for a group of patients for whom bracing is not successful or who are diagnosed late.

are used according to the patient's age, growth stage, degree, location and type of curvature. The standard practice in surgical treatment is to fix the vertebrae included in the curvature with screws or hooks, then straighten the spine and freeze the spine in its corrected state.

All types of surgery involve risks and dangers. However, today, with the possibilities of modern medicine, idiopathic medicine applied in experienced hands. Scoliosis surgery produces excellent results in a generally healthy adolescent with no congenital defects in the spine. When discussing the risks of any treatment, it is necessary to compare the odds with untreated patients, not healthy individuals. After a successful scoliosis surgery, patients can return to their normal lives within 1 month, and after 4-6 months, they can do all the activities they could do before the surgery. Scoliosis surgery does not prevent pregnancy, having children, or having a job in the future.

It is not necessary to operate on the curvatures of children who have completed their growth, which do not cause aesthetic problems. However, it is not an acceptable behavior to leave curvatures that have reached a level that will make the child and his family unhappy or that have the risk of progression, by considering the possible risks of surgery. The treatment decision should be made in consultation with a surgeon experienced in pediatric spine diseases.