Scoliosis: What Is It? Symptoms and Treatment

What is Scoliosis?

Scoliosis is defined as the deviation of the spine, which should normally be straight when viewed from the back, to the right or left by more than 10 degrees. Scoliosis is not just a one-dimensional angular deformity; it is a three-dimensional skeletal and structural impairment that affects the body from the front and sides.

Contents

• 1. What Is Scoliosis?
•    1.1 Types of Scoliosis
•       1.1.1 Idiopathic Scoliosis (Unknown Cause Scoliosis)
•       1.1.2 Neuromuscular Scoliosis
•       1.1.3 Congenital Scoliosis (Present from Birth)
•    1.2 Scoliosis in Adults
•       1.2.1 Adult Idiopathic Scoliosis
•       1.2.2 Adult Degenerative Scoliosis
•    1.3 What Are the Symptoms of Scoliosis?
•    1.4 How Common Is Scoliosis?
•    1.5 Scoliosis Degrees
•    1.6 What Happens in the Diagnosis Stage of Scoliosis?
•    1.7 Steps in the Treatment of Scoliosis
•    1.8 Conclusion
•    1.9 Frequently Asked Questions About Scoliosis
•       1.9.1 Who Is More Prone to Scoliosis?
•       1.9.2 How Does Spinal Deformity Occur in People with Abnormal Vertebrae?
•       1.9.3 Can Carrying Heavy Backpacks and Standing in Bad Posture Cause Scoliosis and Kyphosis?
•       1.9.4 How Is Adult Scoliosis Resulting from Aging Treated?
•       1.9.5 When Should Surgery Be Considered for Scoliosis?
•       1.9.6 To inquire about spinal deformity treatment

Scoliosis can occur at any stage of life. Genetics are implicated in the occurrence of scoliosis. If the scoliosis angle is high, the visual impact on the body is significant. This cosmetic impairment, besides being a health problem for children in early adolescence, affects self-confidence and can lead to psychological issues.

Apart from the cosmetic impairment, as the angle of spinal curvature increases, complaints such as back and waist pain arise, along with difficulties in breathing, bloating, and quick fatigue due to compression of the lungs and heart within the chest. Disruption of spinal dynamics can lead to pain. Consequently, it can negatively impact the quality of life.
Types of scoliosis:

1. Idiopathic Scoliosis (Unknown Cause Scoliosis):

This is the most common type of spinal curvature, the exact cause of which is unknown. The curvature can be lateral, forming an “S” or “C” shape. Besides lateral bending, vertebral rotation around themselves is also observed in all idiopathic scoliosis cases, including mild forms. This rotation of the vertebrae leads to asymmetric protrusions in the back or waist. Its etiology is usually focused on genetic and environmental factors and is more prevalent in adolescent girls, occurring 8-10 times more often in females.

2. Neuromuscular Scoliosis:

The second most common type of scoliosis is neuromuscular scoliosis, which occurs due to an underlying muscular or nerve disease. Nervous system diseases can originate from the brain and spinal cord, while muscle diseases can occur in childhood or later stages of life. This type of scoliosis can occur in conditions such as cerebral palsy, polio, muscular dystrophy, and tethered cord syndrome.

In neuromuscular scoliosis, there can be more frequent respiratory difficulties and sensory impairments compared to idiopathic scoliosis.
Types of Scoliosis:

1. Congenital Scoliosis:

This type of scoliosis occurs due to spinal anomalies that develop during fetal development in the womb. Congenital scoliosis progresses rapidly in the early years of life, often requiring surgical intervention at a young age due to its swift progression. There is no gender distinction, and the exact cause of congenital scoliosis cannot always be determined. Certain events during embryo and fetus development can lead to more frequent occurrences of congenital spinal deformities.

2. Adult Scoliosis:

 Adult Idiopathic Scoliosis:

This condition starts painlessly in childhood but may manifest symptoms such as pain and postural deviations in later years. Severe pain can occur due to degeneration in the facet joints. Excessive deformity in the chest area can affect respiratory functions, leading to quick fatigue and breathing difficulties in patients.

Adult Degenerative Scoliosis:

   Adult degenerative scoliosis results from wear and tear on the spine due to aging. It typically occurs in individuals over 50 years old. Osteoporosis, which becomes more common in these years, can be one of the causes, and it can also contribute to the worsening of the curvature. Degenerative changes due to aging can occur in any region of the spine – neck, upper back, or lower back – but it is most commonly observed in the lower back region.
Spinal stability and balance can be compromised in individuals with advanced degenerative changes in adulthood. This condition can cause the spine to tilt sideways and the anatomical angle in the lower back to decrease, leading to a forward lean of the body. These imbalances can exacerbate the severity of the curvature and impact the patient’s mobility, often resulting in pain.

In adults with degenerative changes, back pain, lower back pain, pain radiating along the nerve distribution area (radiculopathy) due to nerve compression, and muscle weakness supplied by the affected nerves can be observed. Deformities in the spine structure can lead to spondylolisthesis, where the vertebral bone slips forward. Non-surgical treatment methods are generally preferred. Physiotherapy programs involving stabilization, strengthening, and stretching exercises can alleviate muscle spasms and reduce pain.

In adults diagnosed with rheumatic diseases, osteoporosis (bone loss), and following trauma or infections…

What Are the Symptoms of Scoliosis?

Scoliosis, or curvature of the spine, typically does not cause health problems in its early stages and rarely results in back pain. Therefore, unless careful attention is paid, it might be challenging for families to notice.

Symptoms of scoliosis include uneven shoulders, hips shifting to one side, or one hip appearing higher than the other, and unevenness in the position of the shoulder blades.

An essential step for parents is to regularly have their child bend forward with their back exposed to check if the spine aligns in a straight line. Upon inspection, if there is scoliosis, a protrusion or elevation may be noticeable on the right or left side of the spine or in the lower back. Skin discoloration might accompany scoliosis in some cases.

The symptoms mentioned in the literature can be summarized as follows:

• Spinal curvature
• Asymmetry of the shoulders
• Asymmetry of the hips
• Back or lower back pain
• Rotation of the spine
• Fatigue and quick exhaustion
• Shortness of breath
• Irregular positioning of clothes
• Headaches

An important note for parents is that scoliosis can occur between the ages of 10 to 16, and due to the uncertainty of its onset, spinal checks should be done regularly during this period. Extra attention should be given to children displaying signs of adolescence. If scoliosis is suspected, it is crucial to consult a physician promptly.

Prevalence of Scoliosis:

Scoliosis is a prevalent spinal deformity worldwide, affecting about 2% to 3% of the population. It often emerges during adolescence but can also develop due to congenital or acquired causes throughout life. Scoliosis occurs equally among males and females, although its severity and the need for treatment can vary from person to person. Early diagnosis and appropriate treatment can control the progression of scoliosis, significantly improving patients’ quality of life. Regular health check-ups and awareness play a vital role in the early diagnosis and effective intervention of scoliosis.

Scoliosis Grades:

Scoliosis grades are used to indicate the severity of the spinal curvature. The degree of curvature is expressed using a measurement called the Cobb angle. The Cobb angle measures the most significant curvature between the upper and lower points of the spine. Here is a general classification based on the degree of scoliosis:

Mild Scoliosis (10-25 degrees): Mild scoliosis is usually a condition that is regularly monitored. Progression can be controlled through exercises, physiotherapy, and regular check-ups.

Moderate Scoliosis (25-40 degrees): Moderate scoliosis shows a more pronounced curvature. At this stage, a custom brace can be worn. Physiotherapy and regular check-ups are important in the treatment process.

Severe Scoliosis (40-50 degrees): Severe scoliosis is considered a significant curvature. More aggressive treatment options such as physiotherapy, brace therapy, and surgery can be evaluated.

Very Severe Scoliosis (More than 50 degrees): Cases with this degree of scoliosis are rare but can lead to serious health issues. Surgery is often the most effective treatment method.

The degree of spinal curvature should be properly evaluated by a doctor, and treatment options should be determined under the supervision of a specialist team. The treatment approach varies based on individual differences and the patient’s overall health.

Diagnostic Stages for Scoliosis:

After a detailed history is taken and a clinical examination is conducted by the physician, imaging techniques are employed. Standing spine X-rays can accurately diagnose scoliosis. In rare cases, advanced radiological examinations of the spine (such as MRI scans) might be requested to differentiate other causes. In recent years, non-X-ray body topography analysis systems, which allow monitoring of curvature without X-rays, have become more commonly used.

Early diagnosis is crucial in scoliosis. Therefore, parents should regularly examine the spines of their children between the ages of 10 and 16 and should consult a doctor immediately if there is suspicion of scoliosis.

Treatment Steps for Scoliosis:

There are established algorithms for treating scoliosis. If detected early and if the curvature is low, it qualifies for conservative treatments. Treatment options for scoliosis include observation, physiotherapy and rehabilitation applications, bracing, and surgery.

The treatment of scoliosis depends on the degree of curvature and at what stage of growth the individual is. Currently accepted non-surgical treatment methods include scoliosis-specific exercises, specialized scoliosis programs, and bracing. The main goal of scoliosis treatment is to prevent the progression of the curvature, maintain the child’s spinal mobility, control cosmetic deterioration, and prevent surgery.

Exercises in Scoliosis:

Exercise programs tailored to the specific affected body part, known as three-dimensional spinal exercises or Schroth exercises, are crucial in scoliosis management. These exercises aim to control the pelvis and the muscles and ligaments surrounding the affected spine, ensuring postural control and cosmetic appearance. Mobilization, spinal traction, flexibility, and correct posture control are the foundation for controlling the spine in daily activities.

Regular exercises, along with proper biomechanical control and wearing the appropriate brace for an adequate duration, enhance the child’s postural balance and control the progression of scoliosis angle. Breathing techniques are also incorporated into scoliosis exercise programs. Recently, computer-assisted programs that integrate spinal exercises into a game-like environment have gained prominence, offering opportunities for interactive exercises in various positions, including standing, sitting, and plank positions.

Ideal Timing for Bracing:

The ideal time for bracing is after the age of 10, during Risser stages 0-2 (early stages of bone development), with a Cobb angle between 20-40 degrees, and within the maximum of one year before or after menarche (the onset of menstruation).

Surgical Intervention:

Surgical treatment is applied when conservative methods fail and in individuals with a high risk of progression, especially if the Cobb angle is above 40 degrees. In scoliosis surgery, the spine is corrected by using spinal plates and screws, and the progression of the spinal curvature is controlled. In younger children, the operation might need to be repeated at certain intervals to ensure the spine’s proper growth.

Frequently Asked Questions about Scoliosis:

1. Who is More Prone to Scoliosis?

Yes, scoliosis can occur due to other diseases or conditions. For example, conditions like congenital spinal anomalies, muscle weaknesses, neuromuscular diseases, neurological disorders, or spinal injuries can lead to scoliosis.

2. How Does Scoliosis Develop in Individuals with Abnormal Vertebrae?

Abnormal vertebrae, including congenital or acquired structural abnormalities, spinal weakness, or spinal injuries, can create uneven pressure on the spine over time, leading to scoliosis. These abnormalities or weaknesses in the natural structure of the spine can cause the spine to curve sideways. Such conditions should be evaluated by doctors, and an appropriate treatment plan should be developed.

3. Can Carrying a Heavy Backpack and Poor Posture Cause Scoliosis and Kyphosis?

Carrying a heavy backpack and maintaining poor posture can exert prolonged repetitive stress on the spine. While these situations do not directly cause conditions like scoliosis or kyphosis, they can negatively impact spinal health. Incorrect posture and carrying heavy loads can adversely affect spine health in the long term, leading to muscle weakness, pain, and other posture-related issues. However, spinal curvature conditions like scoliosis or kyphosis typically develop due to genetic factors, congenital issues, or other health conditions. Regular exercise, proper posture habits, and appropriate techniques for carrying weights are essential for maintaining spinal health.

4. How is Adult Scoliosis, which Develops with Aging, Treated?

The treatment of adult scoliosis depends on the severity of symptoms, the degree of spinal curvature, and the patient’s overall health. Treatment methods may include physiotherapy, exercise programs, specialized braces, pain management, spinal manipulation, and epidural injections. In severe cases, surgical intervention might be necessary. The treatment plan should be individually tailored, evaluated by a specialist doctor, and customized based on the patient’s specific needs.

5. When is Surgery Considered for Scoliosis?

The decision to undergo surgical treatment for scoliosis depends on factors such as the severity of the curvature, the patient’s age, growth potential, pain levels, and overall health.