Medicana Camlica Hospital Op. Dr. Nazmi Korkut Kasapbaşı talked about scoliosis, its types and treatment methods.
The human spine is not perfectly straight when viewed from the side. There is a slight depression (lordosis) in the neck and waist region and a slight hump (kyphosis) in the back region. When viewed from behind, it should be perfectly straight. Scoliosis (curvature of the spine) refers to the curvature of the spine to the right or left. Scoliosis is actually a finding, not a disease. Just as symptoms such as fever or pain can occur due to different diseases, various diseases can also cause scoliosis. Therefore, scoliosis can be defined as a formal deformity that occurs in a healthy spine structure.
Scoliosis can occur due to many diseases, as well as at different ages and in various parts of the spine structure. Scoliosis, which occurs for the same reason in two different people, does not show the same course. Scoliosis has unique treatment methods that vary from person to person.
Scoliosis is seen in approximately 2-4 percent of the society. 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, the 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.
The most common type of scoliosis; ‘idiopathic’ scoliosis, the cause of which has not been fully elucidated. The lateral bending of the spine can be ‘S’ or ‘C’ shaped. Apart from lateral bending, rotation of the vertebrae is also seen in all idiopathic scoliosis, including the mildest forms. This rotation in the vertebrae causes asymmetric protrusions in the back or waist.
The second most common type of scoliosis is neuromuscular scoliosis. Muscle or nerve diseases may be among the main causes of neuromuscular scoliosis. Nervous diseases can originate from the brain and spinal cord; Muscle diseases can be seen in childhood and later. In contrast to idiopathic scoliosis, respiratory distress and sensory defects are more common in neuromuscular scoliosis. Scoliosis brace may not be used during the treatment process due to reasons such as respiratory problems, communication disorders, sensory defects and epileptic seizures. In this type of scoliosis, younger ages may be preferred for surgical intervention. Fusion therapy can be applied.
Congenital scoliosis is the third most common. 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, the treatment process of congenital scoliosis that occurs in the early stages may require surgical intervention at a young age.
- Various rheumatic diseases
- Various connective tissue diseases such as Ehler danlos
- Various metabolic diseases such as Morquio and Gaucher disease, some genetic syndromic diseases can cause scoliosis.
The treatment process of scoliosis varies according to the disease causing the scoliosis and the scoliosis that occurs in the person. In other words, while the treatment process continues in its natural course for some patients; In some patients, the response of the person to treatment may vary depending on the type of scoliosis. Scoliosis progresses with growth during childhood and adolescence. That is, the curvature of the spine increases even more. For all these reasons, there is no single correct treatment option for scoliosis that can be applied to all situations. The age at which the scoliosis was diagnosed, the location and degree of the curvature, the causes of the scoliosis, the examination findings and the data obtained from the radiological examinations should be carefully examined, that is, the treatment to be ‘personalized’ for scoliosis should be applied meticulously, varying from patient to patient. Although each treatment option varies according to the patient, there are generally three alternative ways after the diagnosis of scoliosis. The first option is follow-up and is suitable for curvatures less than 20-25 degrees and consists of following up at certain intervals, increasing sports activities and general body condition.
Physical therapy exercises specific to scoliosis may be beneficial. But timing is important for these exercises. Exercises started at a very early age can cause early boredom in the child. As a result, the child may not want to exercise at an advanced age when exercise may be essential and rapid growth occurs.
The second option is corset treatment. It is a method that is effective in people whose curvature is between 20-40 degrees and has growth potential. A multicenter study conducted in the USA and Canada, with early results published in 2013, clearly showed that patients who use corsets are less likely to have surgery than those who do not. In other words, those who use corsets are less likely to have surgery. With this early result, the study was stopped and it was decided to give braces to all patients. Wearing the corset for 20-23 hours a day was found to be important in terms of effectiveness.
Another option is surgical treatment. Surgery generally comes to the fore in curvatures above 40-45 degrees. Correction and freezing (fixing) operations are performed in adolescents and adults whose lung development is completed. Preoperative preparation and planning are important in order to achieve the maximum improvement by operating at the lowest level possible, as movement limitation will be made in the vertebrae included in the surgery.
Medistate Hospital Physical Therapy and Rehabilitation Specialist Dr. İlker Garipoğlu gave information about childhood scoliosis and explained the symptoms of scoliosis.
The criteria that determine the treatment of scoliosis in children depend on the degree and location of the scoliosis curvature and rotation in the patient. For curvatures below 20 degrees, physical therapy, exercise therapy and home program are predominantly preferred. Conservative treatment with physical therapy as well as the use of a rigid corset is recommended for angles above 20 degrees. If the angle is above 40 degrees, the aim is to reduce it below 40 degrees with serial plastering or the use of a rigid corset. For progressive degrees of 60 degrees and higher, surgical intervention followed by physical therapy is preferred.
Early diagnosis is of great importance in childhood scoliosis. Treatment of cases that are diagnosed early is often successful, and children whose scoliosis is detected by small tests that can be done by families should apply to physical therapy clinics as soon as possible.
- Are the heights of the shoulders different when the back is against the wall in the standing position?
- Are their backs at different heights when the child’s knees are bent straight forward?
- Is one shoulder blade more prominent than the other?
- Is there asymmetry in the hip bones?
- Is there more distance between the arm and the body on one side compared to the other when the arms are slowly draped forward while standing?
- Does the child have a prominent back hump?
- Are the tissue folds asymmetrical when the waist pits are compared?
- Does the child lean to one side while sitting or standing?
prof. Dr. Murat Bezer stated that scoliosis detected in childhood is a progressive disease.
prof. Dr. Murat Bezer’s information on the subject is as follows:
Scoliosis treatment varies according to the age of the person with scoliosis, the degree and shape of the scoliosis. The aim of the treatment of scoliosis in growing children is to prevent the degree of scoliosis from increasing until the spine growth is completed, and even to improve in some cases. Two intertwining rods are placed on the spine to cover all spines with curvature. With an average of 6 months intervals, the rods are extended in the operating room by opening over the lengthened part. This process continues until the spine growth ceases. Patients are admitted to the hospital every 6 months on average and the rods are extended in the operating room. In this process, which continues until the development of the spine is completed, an average of 15-20 lengthening surgeries are performed.
Due to the large number of early age scoliosis surgeries performed with extensible rods, both children and families experience financial and moral difficulties. In the last few years, a new treatment has been applied that eliminates the difficulties of this surgery. In this treatment, a magnetic bar, that is, a non-surgical tool used externally, is used in the surgery for children with scoliosis who have not grown yet. Thanks to these rods, there is no need for extensions that were previously performed every 6 months, and the patient has only one operation during this growth process. There are many differences in the application of this non-surgical extending rod technique compared to previous techniques.
In this technique, we generally do not insert the rods from the nape of the spine to the lower lumbar crease, as is commonly used in magnetic rod surgeries. Although it varies according to the type of scoliosis, such a long level is not included in the scope of surgery, we put a stick at the lowest possible level. In this way, in the final surgery to be performed after the spine growth is completed, fewer levels are operated, fewer vertebrae of the person are attached to each other and welded together, so we provide the person with a more mobile and near-normal spine. In addition, we apply these sticks, which are used to reduce the rate of increase of scoliosis in the actual growing age, primarily to provide correction in the spine. In this way, scoliosis enters the growth period of the spine, the degree of inclination is closer to normal, and we also provide correction in the spine with the lengthenings we make at certain periods. In this way, we ensure that growth and lengthening take place in a healthier way.
The rods used in the surgery performed with both the old technique and the new magnetic rods are kept until the child’s growth is completed, and these temporary rods are removed in the final operation, the vertebrae are attached to each other and fused.
prof. Dr. Murat Bezer listed the advantages of these rods, which can be extended without the need for surgery, as follows:
- Patients who are applied magnetic sticks are called for 3-month controls and after the x-ray taken, lengthening is performed on the examination table, in polyclinic conditions, according to the degree of scoliosis and the age of the patient.
- The amount of extension is made with a completely electronic apparatus by entering the computer environment in a sensitive way according to the measurements and the age of the child.
- During the lengthening, patients do not feel pain, only a little tickling sensation. In fact, this feeling is welcomed by most children.
- With this method, patients are lengthened every 3 months instead of 6 months, so more frequent and more appropriate lengthening is provided compared to the old method, thus contributing more to spine growth.
- Extending the patients without the need for surgery prevents the child from constantly taking narcosis.
- Since the operation area is not constantly opened, wound problems are prevented, thus preventing infections.
- Considering the stress experienced by children before each lengthening surgery performed with the old technique, almost none of the problems experienced by families and children in this long process with the old method are experienced with this new technique.
- The rods must be placed at the appropriate level and at the appropriate angle during the surgery, otherwise the person may suffer from posture disorder. This may also require corrective surgery. Such undesirable problems can be prevented by the application of these rods by experienced spine surgeons.