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Scoliosis is a spinal deformity that causes the spine to curve sideways (to the right or left side), forming an S or C shape in three-dimensional view. When a body without scoliosis is viewed from behind, the spine appears straight, but a person with scoliosis develops an abnormal curvature of the spine.
What is Scoliosis (Spinal Curvature)?
Scoliosis is a spinal deformity that can cause posture disorder in which the spine is curved to the right or left by 10 degrees or more and has an S or C-shaped appearance on X-rays. This curvature can occur on both sides of the spine and in different parts of the spine. For children and adolescents, scoliosis is defined as an idiopathy of unknown cause. Several factors are thought to play a role in the development of this disease.
The specialist will examine the child or young person and diagnose the scoliosis by taking X-rays. Children and young people with mild curvatures should visit the doctor for regular check-ups. With treatment and follow-up by a doctor, most children and young people can lead a normal, active daily life.
Severe curvatures affect the lungs and are therefore treated accordingly. In addition, orthopaedic specialists can often work with patients to prevent the curves from progressing to this point.
Scoliosis curvatures are described as major and minor curvatures. The place where the curve is most pronounced, i.e. where the vertebrae rotate the most from the vertical axis and move the most away from the midline, is called the apex. Scoliosis is named according to the level of the spine where the apex is located. If the apex is in the neck region, it is defined as cervical scoliosis, if it is in the lumbar region, it is defined as lumbar scoliosis, and if it is in the back, it is defined as thoracic scoliosis. Sometimes it can be seen in more than one region at the same time: For example, when it is both in the back and lower back, it is defined as thoracolumbar scoliosis. It is usually more common in the back (thoracic) region.
Scoliosis (Spinal Curvature) Degrees
Scoliosis may progress, remain the same or rarely improve. On two or more consecutive examinations, an increase of 5 degrees or more in the spine for curves above 20 degrees and an increase of 10 degrees for curves below 20 degrees is considered progression. Double curves, curves in the dorsal region, female gender, large degree of curvature at the time of diagnosis, curvatures diagnosed under the age of 10 are prone to progression. Curves below 30 degrees have a very low rate of progression.
Chronological Classification
Infancy: 0-2 years
Juvenile period: 3-9 years
Adolescent period: 10-17 years
Adulthood: 18 years and older
Classification by Placement
When the anatomical structure of scoliosis is examined, it can be classified as cervical vertebrae, neck and upper back, regional back vertebrae, lower back and lumbar vertebrae, regional lumbar vertebrae.
Angular Classification
Magnetic resonance imaging are used for grading angular scoliosis. After the imaging method, the curvature in the spine is diagnosed in terms of angle. This method is especially useful when deciding on the need for surgical intervention in scoliosis.
Angles below 10 degrees: This degree, which is called ‘spinal asymmetry’ in medical language, does not have any effect on the health of the person. In order to treat the curvature, the curvature must be above 10 degrees. Low-grade curvatures do not pose a risk of scoliosis in the future and the patient should be examined at regular intervals. The important thing here is to determine whether scoliosis progresses or not.
Angles between 20 and 40 degrees: Curvatures of 20 to 40 degrees are mostly seen in adolescence. At this degree, which is considered as intermediate scoliosis, exercise, physical therapy and corset are very effective.
Angles at 40 degrees: 40-degree scoliosis curves have largely completed their growth and progression. In order for surgical intervention to be performed, the back curvature should be above 45-50 degrees and the curvature in the lumbar region should be 40 degrees.
What are the Symptoms of Scoliosis (Spinal Curvature)?
The symptoms of scoliosis, which manifests itself with the appearance of being tilted to one side, are as follows:
· One shoulder blade is more prominent than the other
· One hip is more dislocated than the other
· One side of the rib cage protruding forward
· Change in the shape of the spine
· Back pain if scoliosis is advanced
· Difficulty sitting or standing
· The head is not in line with the rest of the body
· Differences in the form of sagging of the arms next to the body when standing straight
· Height difference on the sides of the back when leaning forwards
· Asymmetric view of the ribs from the front or back
Symptoms of scoliosis may resemble those of other spinal disorders or deformities. It can also be the result of an injury or infection.
What causes scoliosis (spinal curvature)?
Scoliosis is an abnormal curvature of the spine. If the curvature of the spine is 10 degrees or more on X-ray, it is defined as scoliosis. The cause of scoliosis, which tends to occur in childhood or adolescence, is not known exactly.
It occurs due to various factors. These factors are listed as follows:
· Genes
· Hormones
· Changes in cell structure
In some cases, especially in children, if there is another disease or disorder, scoliosis occurs by causing the spine to curve. These conditions are explained as follows:
· Congenital factors that occur during the development of the spine when the baby is in the womb
· Genetic diseases that occur as a result of changes in genes
· Spinal injuries
· Neuromuscular diseases affecting the nerves that send messages to the muscles
· Tumours that can cause physical changes in the spine
How is scoliosis (spinal curvature) diagnosed?
For the diagnosis of scoliosis, your medical history is examined after the specialist doctor’s examination. In addition to medical history, it is determined whether there is scoliosis in the family. At this point, the specialist doctor may refer the person to an orthopaedic specialist. Specialists treat bone and muscle diseases caused by scoliosis.
The form and degree of scoliosis are revealed in the radiographs. The most commonly used method for this is the Cobb angle. Scoliosis is monitored with Cobb angle and the age of growth and appropriate treatment methods are decided. Cobb angle is measured with the help of lines drawn on the upper border of the spine where bending starts and the lower border of the spine where bending ends. The angle between the perpendiculars drawn on these lines, i.e. the axis of the vertebra where the curvature starts and the axis of the vertebra where the curvature ends, is analysed.
Scoliosis (Spinal Curvature) Treatment
Scoliosis treatment includes non-surgical methods to control the curvature of the spine, such as bracing, physical therapy including scoliosis exercises and chiropractic care, as well as surgical procedures including spinal fusion or scoliosis with straps (no fusion). The choice of treatment method will depend on the size of the curvature of the spine. Generally, for curvatures of less than 20 degrees, the process is followed and the size of the curve is observed. If the curvature is above 20 degrees, scoliosis bracing, scoliosis exercises and, if necessary, surgical procedures with or without fusion are used.
Specialist follow-up is generally recommended if the Cobb angle is below 15 degrees, especially in children who have not started to grow. Special scoliosis exercises and rehabilitation programs should be continued for those with a Cobb angle of 15-20 degrees. For children with a Cobb angle above 25 degrees, intensive scoliosis rehabilitation programs should be applied.
Non-surgical (conservative) treatment
Non-surgical treatments for scoliosis include a scoliosis brace, scoliosis exercises and painkillers.
A scoliosis brace does not cure scoliosis or reverse the curve, but it usually prevents the curve from getting worse and progressing further.
For pain relief, over-the-counter painkillers are used to relieve the pain caused by scoliosis. In addition to prescription painkillers, prescription painkillers prescribed by a doctor can also be used.
It is possible to stop scoliosis with the help of scoliosis exercises. These exercise programs are especially effective in children with scoliosis above 15 degrees, starting from the age of 7. Scoliosis exercises can also give good results in patients with scoliosis over 40 degrees.
In addition to techniques such as “Bobath”, “Vojta”, “Katharina Schroth”, classical stretching and strengthening exercises can also be applied in exercise programs. Especially considering that psychological factors play an important role in scoliosis rehabilitation, intensive exercise programs have a significant impact on adolescents. Adolescents who act with group psychology establish a high level of communication with peers who share their problems.
Scoliosis (Spine Curvature) Surgery
Scoliosis surgery is a method applied when the curvature of the spine exceeds 50 degrees. Scoliosis surgery is a safe operation performed in scoliosis patients who do not respond to non-surgical treatment.
Basically, two approaches are adopted in scoliosis. These are posterior intervention and anterior intervention. In the posterior approach, the back region is used. The surgical goal is to follow up all patients in the early period, to stop the progression, to eliminate cosmetic problems, and to eliminate pain and neurological findings, if any.
In necessary patients, it may be possible to restore the spine with early interventions and simple surgical procedures. The most important point at this stage is to perform the right surgery at the right time and to protect the spinal cord while correcting the spine and bone structure.
With the imaging devices used during scoliosis surgery and special tools to prevent spinal cord and nerve damage, success rates have reached extremely high levels. While doing these, it is important to remember that the patient and his/her family will be in contact with their physicians for many years and that scoliosis treatment requires a long-term follow-up.
Treatment of scoliosis (spinal curvature) in children
During puberty, when the first signs of growth are seen, i.e. hair growth, voice change, increased height, breast development in girls or menstruation, great care should be taken and children should definitely be treated. Since the speed and risk of bending is higher in these children, the risk of progression should be calculated rather than the degree of Cobb angle and treatments should be planned accordingly.
Children with a high risk of progression should definitely use a brace in addition to physiotherapy and rehabilitation applications. Corset treatment should be continued between 16 hours and 23 hours a day depending on the state of growth and the degree of bending and until growth is completed. Surgical treatment can be applied if the Cobb angle is above 50 degrees in individuals with a high risk of progression in whom corset treatment is unsuccessful. In scoliosis surgery, the spine is moved to the midline with plates and screws and sometimes these metals remain in the body permanently in these children. It should also be known that surgery may cause problems in the late period.
Treatment of degenerative scoliosis (Adults)
For adults with degenerative scoliosis, physical therapy, stretches and exercises to help build muscle strength are recommended. Over-the-counter painkillers and short-term use of a brace can also help relieve pain. Epidural or nerve block injections can also provide temporary relief if the legs are causing discomfort.
In a scenario where non-surgical treatments do not work, scoliosis surgery may be the solution.
In summary, the treatment methods for scoliosis are as follows:
- Observation of spinal curvature
- Scoliosis brace
- Scoliosis exercises
- Pain medication
- Scoliosis surgery
Things to Consider After Scoliosis (Spinal Curvature) Surgery
The spine has less mobility after scoliosis surgery. In the anterior approach, intervention is performed by lifting the rib cage under the arm. The disadvantage of this operation is that it requires the use of a corset after the operation. The advantages are that the spine remains more mobile and the suture scars remain under the arm, thus looking more aesthetic.
There are some points that the patient should pay attention to after scoliosis surgery. As every surgery has risks, scoliosis surgeries also have certain risk rates. This rate is around 5%. If there are no complications, the patient can be discharged within 14 days. Undesirable results that may be observed after surgery are as follows:
- Infections can be controlled with antibiotics.
- Respiratory distress after bleeding can be relieved by blood drainage.
- Breaks in the screws or instrumentation require a second operation.
- Nerve palsies observed in less than 1% (usually reversible)
Frequently Asked Questions About Scoliosis (Spinal Curvature)
How long do scoliosis patients live?
It is not possible to comment on the life expectancy of scoliosis patients. In treated cases of scoliosis, the patient will experience relief, but if scoliosis is left untreated, there will be a serious decrease in the quality of life.
How to recognize scoliosis?
Scoliosis usually occurs when the symmetry of the spine is disturbed. However, one hip being more protruding than the other, the rib cage protruding forward and back pain are also indicators of scoliosis.
Does scoliosis cause paralysis?
In the later stages of scoliosis, there may be a small risk of paralysis.
Which sports are good for scoliosis?
Especially swimming and shoulder exercises are among the movements that are good for scoliosis and relax the spine.
