Idiopathic scoliosis is a type of scoliosis whose cause is unknown, or whose cause has not been identified. The Scoliosis Research Society (SRS) defines scoliosis as a spinal deformity in which the spine is curved more than 10 degrees to the side during immature skeletal development over the age of 10. Idiopathic scoliosis is commonly seen in adolescents, especially in females, and often begins in adolescence, progresses rapidly, and will have serious consequences if not treated properly.
Guidelines for the treatment of scoliosis have been developed by the spine surgery community, and treatment needs to be determined by the physician based on the patient’s own condition. Each patient with scoliosis should be analyzed specifically and treated individually.
Factors that influence treatment options.
1. gender: women have a higher risk of scoliosis progression than men.
2. severity of scoliosis: the greater the degree of scoliosis at the initial diagnosis the more likely it is to progress over time.
3. type of curve: a double curve, also known as an S-shaped curve, tends to worsen more than a C-shaped curve
3. location of the curve: scoliosis deformities located in the central (thoracic) part of the spine tend to worsen more readily than deformities in the upper and lower parts of the spine
4. maturity of development: if the child’s bones have stopped growing, the risk of progression of the deformity is also reduced.
Conservative treatment
Most children with scoliosis present with only a slight curvature of the spine and do not require bracing or surgical treatment. Children with mild scoliosis need physical exams every four to six months to watch for changes in their scoliosis curvature. Observation, too, is an active and effective treatment.
Bracing is the most reliable method of conservative treatment. Generally, idiopathic scoliosis of 20 degrees or less can be left untreated for close observation, and if it worsens more than 5 degrees per year, bracing should be performed. Adolescent idiopathic scoliosis with a first diagnosis of 30 degrees to 40 degrees should be treated immediately with bracing.
Surgical treatment
Severe scoliosis is usually progressive and often requires surgery to correct the scoliosis and prevent its progression.
Criteria for surgical treatment
1. thoracic curvature greater than 40 degrees and thoracolumbar curvature/low back curvature greater than 35 degrees.
2. rapid progression of scoliosis that is not controlled by brace therapy.
3, significant low back pain or symptoms of nerve compression.
For patients with congenital scoliosis, if the progression is accelerated, surgery should be performed as early as possible (3 to 5 years old), otherwise it will be delayed and regretted.
Principles of scoliosis surgery
Prevent progression of the deformity and restore spinal balance; correct the deformity as much as possible; preserve as many mobile segments of the spine as possible; and prevent spinal nerve damage.
Specific measures for scoliosis surgery
1. three-dimensional orthopedic techniques for scoliosis: through the mechanics of surgical instruments or osteotomy of the vertebral body, the surgeon can achieve correction of scoliosis, kyphosis, and rotational deformity of the spine.
2. pedicle screw fixation technique: internal fixation screws are attached by metal rods to ensure that the spine can maintain its post-orthopedic form.
3, spinal implant fusion technique: the spine to be orthopedically fused together through local bone grafting to further ensure that the spine can maintain its post-orthopedic shape.
If scoliosis deteriorates rapidly during a period of skeletal growth, surgeons often choose to install growth rods that can be adjusted periodically as the child grows and develops, not only to achieve the goal of orthopedics, but also to preserve the growth function of the spine.