Scoliosis
WHAT IS SCOLIOSIS?
In a normal and healthy spine, when the vertebrae are viewed from behind, there should be a straight line from top to bottom in the neck, back and waist regions. Scoliotic spine is tilted to the side by more than 10 degrees and rotated around its own axis (rotation). Therefore, scoliosis is defined as a three-dimensional deformity.
HOW FREQUENT IS SCOLIOSIS?
Idiopathic (unknown cause) scoliosis, the most common type of scoliosis, is thought to be present in 2 to 3 percent of adolescents. In one in 5,000 patients, the curvature progresses to a degree that requires surgery. While boys and girls are equally affected in small-degrees, the probability of progressive curvature is 8 times higher in girls than in boys.
WHAT ARE THE CAUSES OF SCOLIOSIS?
There can be many cause for the scoliosis. To mention some of them; It can occur in congenital spinal bone disorders, disorders in the rib cage (such as pectus), spine, rib cage surgeries, brain or dushen muscular dystrophies such as cerebral palsy, blood diseases and many different conditions. However, the most common form is idiopathic scoliosis. "Carrying a heavy bag", which is widely known among the people, does not cause scoliosis.
HOW WE DETECT SCOLIOSIS?
Before puberty and during puberty, rapid changes occur in the body. Body shape changes due to scoliosis may be vague. Despite a significant curvature, the external deformity may be very minor and may not be noticed by the family. In addition, scoliosis can be overlooked because it is not usually painful.
WHAT ARE THE CHANGES THAT MAY BE SEEN CLINICALY?
• One shoulder is higher than the other.
• One scapula is protruding.
• One hip is higher than the other
• One leg may appear longer.
• There is asymmetry in the waist.
• The trunk and rib cage have shifted to one side.
• The head is not centered at the level of the hips.
• Dresses appear asymmetrical and one side appears higher when the child is bent down from the waist.
HOW IS SCOLIOSIS DIAGNOSED?
In cases where scoliosis is suspected, the diagnosis can be made on x-rays. An orthorontgenogram should be taken specially for scoliosis patients. Scoliosis is defined according to the area where the curvature or curvatures occur, and the dimensions of the curvature are measured in degrees as an angle on the x-ray film. This is called the "Cobb Angle" or "Cobb Measurement". In the measurement of the Cobb angle, differences of up to 5 degrees can be seen in the measurements between the doctors on the same graph.
WHEN IS MRI EXAMINATION RECOMMENDED?
Additional examinations may be recommended in the presence of an uncommon type of curvature (eg, curvatures on the left side of the chest) or other signs of disease. MRI or CT is used in the detailed diagnosis of spinal cord problem.
WHAT ARE THE RISKS FOR PROGRESSION?
It is not always easy to know whether scoliosis will progress or not. The most risky period for the progression of scoliosis is the rapid height growth period in adolescence. In general, the younger the person, the less skeletal maturity, and the greater the curvature at the time of diagnosis of scoliosis, the greater the potential for progression.
WHAT ARE THE TREATMENT OPTIONS?
Scoliosis can be treated with surgical or non-surgical methods, depending on the size and severity of the curvature. Non-surgical methods; Only follow-up, physical therapy methods such as schroth or in addition to these, the use of corset can be counted.
WHAT IS SCHROTH?
SCHROTH includes scoliosis-specific three-dimensional exercises. Re-establishment of normal postural alignment; consists of sensory, motor, postural and respiratory exercises. Schroth exercises; It has been seen that it has positive results on posterior muscle group strength, thus improving Cobb angles and reducing the need for surgery. Schroth treatment is personalized. It is planned and applied by a Physiotherapist who is an expert in his field.
HOW TO MAKE OBSERVATION (FOLLOW-UP) IN SCOLIOSIS?
In the follow-up of scoliosis, examination and x-ray control are required every 3 to 12 months, depending on the type and characteristics of the patient's curvature. Frequency of visits; It depends on what stage of growth the child is in. Observation alone is recommended for curves less than 20-25 degrees in individuals who are still growing, and for curves less than 40-45 degrees in individuals whose growth is complete. Getting x-rays too often can damage a person's other organs.
HOW IS BRACE FOLLOW-UP?
Bracing is often preferred in cases where the curvature exceeds 20-25 degrees and there is sufficient time to prevent surgery with corset application. The purpose of corseting; is to stop progress. There are various corset shapes; some of them are designed to be worn all day, some only at night. The scoliosis corset is a rigid plastic corset that wraps the body and hips and applies pressure in the opposite direction to the curvature.
WHEN IS SURGERY NEEDED?
Surgical decision; It varies according to the age of the patient, the location and shape of the curvature. If a curvature reaches 40 degrees, surgery may be recommended even if growth is not complete. Curvatures less than 40-45 degrees in the dorsal region have a low tendency to progress, but curves above 50 degrees have a risk of progression even in adulthood. These curves progress at a slower rate and surgery is likely to be recommended. Physician and patient should decide together according to the patient's expectations and complaints for treatment.
WHAT IS THE PURPOSE OF SURGERY?
The aim of the surgery is preventing further scoliosis progression. With surgery we will prevent patient from serious health problems associated with severe scoliosis in the later years of life. Some of the problems that may be associated with large curves are breathing difficulties, heart problems, muscle weakness and pain.
In younger patients who still have growth potential; Growth-friendly surgical methods are preferred. There are different variations of these methods. Among these is the magnetic rod (rod) method, which is extended by an external control. And another is the Shilla method, where the screws can slide over the rod by themselves.
When the growth has been completed, surgical procedures will be applied to correct and fused the spine. During the surgery; curvature is corrected as much as possible to make safe. Screws in the spine are acts as an inner brace to keep the spine in the corrected position until a solid bone fusion had been achieved. This takes about 6-12 months until the spine fuse and becomes a rigid structure. As a result; the fusion of the bones, the growth potential in this region of the spine is eliminated. And this bone-fusion also stops the movement of the spine. Generally, this loss of flexibility is slight and only restricts minimal trunk function. During all these surgical procedures; We use a computerized device called neuromonitorization, which continuously controls the function of nerves during surgery and minimizes the risk of paralysis.
WHAT ARE THE SURGERY OPTIONS?
There are two general methods in the surgical approachs to the spine: Back (posterior) and front/side (anterior) surgical procedures. The most commonly used approach is back (posterior) interventions. In this process; An incision is made along the spine and screws are attached to the vertebrae from back of the patient. Afterwards, the spine are fixed with rods and fixed. Anterior interventions are performed with an incision made on the side of the abdomen or chest. One or two screws are placed in the anterior part of each vertebrae to be fused. These implants keep the spine in the corrected position.
VERTEBRAL BODY TETHERING ( VBT )
In scoliosis patients who have not yet completed their growth; It is a surgical method in which scoliosis is corrected by placing screws in the anterior (corpus) part of the spine. In this technique we are using close or open surgical methods and attaching a stretchable band (rope) to these screws instead of a rigid rod. In vbt scoliosis surgery, the curvature is slightly corrected with the first intervention. Afterwards, the remaining curvature it will correct spontaneously itself as the patient grows. This surgical method has become popular in recent years. Then long-term surgical results are not yet clear.