Scoliosis Treatment and Surgery

Scoliosis is a spinal condition characterized by a curvature of the spine that has become increasingly common in recent times.

It is crucial to receive timely treatment to mitigate the detrimental effects of scoliosis.  The condition is typically diagnosed during growth periods, and without early treatment, it can have a profoundly negative impact on an individual’s life.

Scoliosis occurs when the spine bends either to the right or left, affecting the hip, rib cage, and shoulder blade. We have provided a detailed compilation of the causes, symptoms, and treatment methods for scoliosis, a medical condition that is more common in girls.

What is scoliosis?

Our spine can be thought of as a strong bridge that does much of the work of supporting our body weight. Our spine, which runs from our legs to our head, is made up of bones called vertebrae. These bones are held together by joints, discs, or connective tissue. The spinal cord, considered the key element of the central nervous system, is also located in this region. A healthy spine positively affects our movements and quality of life.

Our spine should be straight when viewed from front to back or from back to front. When viewed from the side, it has a physiological or normal curve. Curvature of the spine in both the front and back views is called scoliosis.  The most common type of scoliosis is adolescent idiopathic scoliosis. In this condition, the spine is externally described as looking like the letters C or S, but we do not prefer to use these terms today.

This is usually recognized by the parents. This obvious lateral curvature of the spine begins in adolescence. Approximately 3 out of 100 adolescents worldwide have this problem. The causes of adolescent scoliosis are often difficult to pinpoint.

Scoliosis is a curve of more than 10 degrees. In a healthy spine, the vertebrae in the back extend downward in a straight line. In scoliosis, this straight line is disrupted and the vertebrae begin to shift left and right over time. In addition to the spine, structural scoliosis, which occurs when the vertebrae rotate around their axis, causes shifts in the chest, ribcage, and even the hip area.

Scoliosis, which affects posture as well as vision, becomes more severe with age. It is currently estimated that approximately 150,000 to 200,000 children in our country have scoliosis. The incidence in girls is at least 3-4 times higher than in boys, although it varies according to age and degree of curvature. If left untreated, the curve can progress too far. With early diagnosis, it is also possible to benefit from modern methods developed in the historical process.

Scoliosis Symptoms

In general, scoliosis is not a serious health problem in its early stages. Therefore, although there may be visible deformities during adolescence, quality of life is not yet fully compromised. The symptoms and effects of scoliosis become more apparent in adulthood. In the early stages, some back pain may be experienced, although this is very rare.

It is not always easy, even for attentive parents, to recognize this deformity. Therefore, it is important to be careful and aware of spinal problems. One of the main symptoms of scoliosis is that one shoulder is slightly higher than the other. The shoulders may shift to the right or left. The same is true for the hip area itself. Asymmetry of the lumbar curve and rib protrusion at the back are among the most important findings. On the other hand, the posture of the shoulder blades may also show certain problems in terms of equality.

Parents should have their children bend forward with their backs uncovered, especially during adolescence, and carefully check that the spinal line is straight. This should be done routinely. If the child has scoliosis, there will be an elevation in the lumbar spine. This elevation will also take the form of a lump. Sometimes skin discoloration may also occur during this condition.

Other symptoms may include

• Curvature of the spine that is clearly visible to the naked eye
• Asymmetry of the shoulders and hips
• Shortness of breath (in very advanced curves)
• Back and shoulder pain
• Clothing that does not fit the body

Curvatures greater than 50 degrees can cause breathing problems. If a condition suspicious for scoliosis is detected, a doctor should be consulted immediately. If not diagnosed early, other health problems may develop.

Causes of Scoliosis

The exact causes of idiopathic scoliosis, which is common in everyday life, are unknown. However, there are several theories about how the condition develops.

Scoliosis that occurs at an early age is thought to be due to factors in the womb. This is because it has been found that they give different results from birth. What kind of process the expectant mother goes through during pregnancy is very critical at this point.

For example, some infections that occur during pregnancy, diabetes or direct vitamin deficiencies can trigger this condition. Patients with congenital scoliosis should also be screened for spinal cord, heart, kidney, and bowel problems.

In the majority of scoliosis patients, the primary cause cannot be identified. However, it has been observed that one in three patients has a family history of similar problems. This may lead us to some genetic factors. For example, parents who were diagnosed with idiopathic scoliosis in their youth are likely to have similar problems in their children.

Therefore, it is beneficial for people with scoliosis to be much more careful with their children. In addition, if scoliosis is present in one of their children, it is a good idea to check the other children.

On the other hand, nerve and muscle diseases are also said to be effective on this disorder. These include muscle diseases and polio. On the other hand, postural problems and differences in the height of the legs can also cause this problem.

In general, the main causes of scoliosis can be summarized as follows

• Congenital problems in the bone structure of the spine
• Infantile, juvenile, occurring in childhood
• Presence of various muscle diseases (cerebral palsy, muscular dystrophy, etc.)
• Some connective tissue diseases
• Imbalances in the legs
• Hip and knee problems

Meanwhile, the reason why scoliosis is relatively more common in girls is not fully known. In particular, the treatment process should be started as early as possible to prevent future problems related to the chest.

Scoliosis Treatment

Early detection is crucial for successful scoliosis treatment.

Regular follow-ups and appropriate rehabilitation, including scoliosis-specific physical therapy exercises, can effectively manage scoliosis without surgery if there is no progression.  Thus, regular screenings are critical.

Physical exercise is an effective treatment method; however, it should not be considered the sole treatment option. It is inappropriate to merely prescribe exercise programs to patients and send them on their way. Orthotics can be utilized based on the degree of curvature, and can significantly reduce the need for surgical intervention with success rates exceeding 50%.

During an examination, the degree of spinal curvature can be approximated using “Scoliosometer” measurements taken from the protruding ribs. Complementary diagnostic tests such as X-rays, MRI, or CT scans are also used. Scoliosis radiography measures the degree of curvature by calculating the angles between the vertebrae, using the Cobb method.

Treatment options hinge on the patient’s growth potential and medical history, taking into consideration age and degree of curvature.  Additionally, evaluating wrist radiographs and peak growth rate can determine the remaining growth in the child’s curve type. An MRI might be needed to identify additional spinal issues. Any pathologic discoveries linked to the spinal cord will be examined. Hence, it is inaccurate to discuss a standard and uniform treatment approach for all cases.

There is no singular treatment option for all scoliosis disorders in practice. The primary approach is tailored, patient-specific treatment. Curvatures of less than 20-25 degrees are generally simpler to manage. Children usually receive scoliosis corsets, unless a unique curvature is present. For individuals with curvatures over 40 degrees, surgical intervention is required.

Scoliosis Surgery

is an important treatment option, but it is only used when necessary. If exercise methods and braces do not improve the patient’s condition within a specific timeframe, surgery may be considered based on the degree of curvature. Grades between 40 and 50 begin to affect the quality of life in the future, and surgery is considered when these levels are reached.

However, the angle of curvature is not the only factor that determines the need for surgery. Surgical decisions are also based on the patient’s age, mood, and other specific health problems. Curvatures during adolescence generally do not harm the heart or lung systems; however, the situation is different for later stages in life.

There are two surgical approaches, posterior and  anterior intervention, that can be taken before addressing scoliosis.  During posterior intervention, the focus is on utilizing the back to stop the curve’s progression and achieve the best possible cosmetic results. A neuromonitor is necessary for this procedure.

Patient-physician communication persists for many years following scoliosis treatment. Post-surgery, spinal flexibility is reduced. The anterior approach involves more work under the arms and intervention is executed by lifting the rib cage. A corset must be used for the remainder of the operation. However, the spine can maintain a more mobile structure, providing a crucial advantage as the suture scars stay hidden under the arm.

There is no specific age range for this surgery, the decision should be made by a specialist only. Typically, the surgery lasts between 4 and 7 hours, depending on the patient’s condition. However, longer surgeries are sometimes necessary to meet the patient’s needs. Furthermore, it is crucial to adhere strictly to metrics and units when discussing surgical procedures. Finally, it is essential to use precise technical vocabulary, where applicable, to ensure clear communication of complex information. After surgery, a consistent exercise program is established, and the patient’s progress is tracked for several years.

Types of Scoliosis

Scoliosis formations are classified into four categories based on their causes: idiopathic scoliosis, neuromuscular scoliosis, congenital scoliosis, and degenerative scoliosis.

Idiopathic Scoliosis: Idiopathic scoliosis is one of the most common types, with an unknown cause.  The vertebrae’s rotation in idiopathic scoliosis causes asymmetrical protrusions in the back or waist regions.  This type is particularly common in girls during puberty.

Neuromuscular Scoliosis: The second most common type, neuromuscular scoliosis, is caused by muscular or neural diseases. The most likely causes originate from the spinal cord or brain. Sensory defects occur more frequently in neuromuscular scoliosis. A corset may not be preferred for some patients during the treatment phase due to special reasons, such as epileptic seizures. Surgical procedures can be performed at a relatively earlier age for this type of scoliosis.

Congenital scoliosis: Congenital scoliosis may occur during fetal development due to spinal anomalies.  This condition tends to progress rapidly in the early years of life, which warrants consideration of surgical intervention even at a young age. Gender is not a factor in the decision-making process for surgical treatment. The etiology of congenital scoliosis remains poorly understood, although it is linked to embryonic development processes.

To design an effective treatment plan, it is crucial to differentiate between the three distinct types of scoliosis in both children and adults. Proper classification of your scoliosis type is paramount.

Degrees of Scoliosis

Degrees of scoliosis are not a standard measure of the curvature of the spine. Scoliosis degrees can change over time, depending on a number of factors. For instance, the spinal curvature may unfortunately worsen or in rare cases, remain the same.

For scoliosis, the curvature of the spine is influenced by factors such as double curvatures, gender, and the curvature of the back.  Curvatures below 30 degrees generally progress slowly. The treatment periods for scoliosis are determined by age:

• Infantile Scoliosis: Period up to 3 years of age
• Juvenile Scoliosis Age range 3 to 10 years
• Adolescent Scoliosis Age range 10 to 16 years
• Adult Scoliosis 16 years and older

The anatomical structure of scoliosis includes classifications such as cervical vertebrae, upper and lower back, and lumbar vertebrae. To determine the degree of angular scoliosis, imaging methods are utilized, which identify the angle of curvature within the spine. This measurement is critical in determining whether a surgical intervention is necessary.

For instance, angles that measure 10 degrees or less typically have no adverse effects on a person’s health. At this level, it is considered a curvature rather than scoliosis. Nonetheless, it is still important to monitor the patient regularly to prevent potential risks.

Mild scoliosis, also known as angles between 10 and  40 degrees, are commonly found in adolescents.  Curvatures reaching 40-70 degrees signal a moderate level of curvature, while those exceeding 70 degrees are deemed serious. Surgically intervening in curvatures above 40 degrees is considered appropriate.

Frequently Asked Questions

Is there a risk of death in scoliosis surgery?

The risk of death in scoliosis surgery is almost negligible. This possibility is possible, albeit very, very rarely, due to a failure in the surgical intervention.

Does vitamin d deficiency cause scoliosis?

It is seen that such values are low in individuals with scoliosis; however, the vitamin or mineral alone does not cause scoliosis.

Does scoliosis get better with exercise?

An exercise program is definitely given in scoliosis treatment processes. The need or intensity of exercise is entirely related to the progression of the disease. Exercise therapy provides support in stopping and slowing down the progression.  Exercises alone do not stop the progression of scoliosis.

What should scoliosis patients avoid?

Scoliosis patients should avoid heavy activities or exercises due to the curvature of the spine. It is important to create exercise programs under the control of a doctor. Weightlifting, gymnastics and wrestling are not recommended. While swimming has not been shown to have a good effect, recent publications have reported that it may have a bad effect.

Does scoliosis progress over time?

Unfortunately, scoliosis shows a certain increase with growth. Since it is not at a level that threatens the quality of life most of the time in childhood, surgical intervention is not necessary, but the curvature may increase over time. Curvatures above a certain degree continue to progress in adulthood.

When should scoliosis be operated?

Scoliosis is a disease that can be intervened at any age. Surgical intervention can be performed at any age depending on the progression. While surgery is generally recommended for curvatures over 40 degrees, surgery can be performed regardless of the degree of curvature in patients with rapid progression.

Does scoliosis progress after the age of 18?

The degree of curvature may increase as the load on the spine increases with age. This process should be closely monitored by the physician.

What is mild scoliosis?

Scoliosis is defined as curvatures of 10 degrees and above. Curvatures below 10 degrees are not called scoliosis. Curvatures of 10-40 degrees are defined as mild curvatures.

How should scoliosis patients eat?

Scoliosis is generally not related to nutrition. But you should know that in order to lead a healthy life, it is necessary to eat a balanced diet and exercise regularly. There is no nutritional recommendation for the prevention and treatment of scoliosis progression in people with a healthy diet. Recent publications have reported that vitamin D levels are low in scoliosis patients. However, it is not known whether it is a cause or a consequence. In children with early-onset and neuromuscular scoliosis, nutrition and vitamin D supplementation are very important before and after surgery.

How should scoliosis patients sleep?

Sleeping on the wrong bed can make you uncomfortable. Sleeping on the right mattress can improve your quality of life. Sometimes scoliosis can cause pain and stiffness. In these cases, the choice of mattress becomes important. If the mattress keeps the body posture in the ideal position, there is no excessive strain on the joints that make up the spine and pain can be reduced. If the pressure due to lying on the protrusions of the body is less, the pain will also decrease. Mattress comfort varies from person to person. But generally, it will be beneficial if the mattress relieves pressure points and supports the spine alignment.