1.What is scoliosis?
Scoliosis (scoliosis) is a three-dimensional plane deformity in which the normal human spine is straight from the front (front or back), and from the side, the normal spine shows a certain angle of anterior cervical convexity, posterior thoracic convexity, anterior lumbar convexity and posterior sacral convexity to maintain the balance of the spine. Scoliosis (scoliosis) refers to a lateral bending of the spine away from the midline in the anterior-posterior position, an increase or decrease in physiological anterior and posterior convexity in the lateral position, and a rotation of the laterally convex spine in the cross-sectional plane, resulting in such cosmetic deformities as bulging ribs on one side, protruding scapulae, unequal shoulders, and a tilted pelvis. The severity of spinal curvature is usually measured by the cobb angle, and the normal spinal cobb angle should be 0 degrees, but medical science usually only defines a spinal curvature with a cobb angle of more than 10 degrees as scoliosis (scoliosis).
2.What causes scoliosis?
The causes of scoliosis (scoliosis) are multiple, and depending on the etiology, scoliosis (scoliosis) can be classified as
(1) idiopathic scoliosis (scoliosis).
(2) congenital scoliosis (scoliosis)
(3) neuromuscular scoliosis (scoliosis)
(4) degenerative scoliosis (scoliosis), etc.
Among them, idiopathic scoliosis (scoliosis) is the most common, accounting for 79%-85%, the so-called idiopathic means that the cause is unknown. Idiopathic scoliosis (scoliosis) can be divided into infant type, child type, adolescent type and adult type according to the age of onset, of which the onset of adolescence is the most common.
3. What are the risks of scoliosis?
Mild scoliosis (scoliosis) and the early stages of scoliosis (scoliosis) do not affect the flexibility, stability, weight-bearing function and protection of the spinal cord, except for the asymmetry of the spine. However, if left untreated, some scoliosis patients will develop and worsen, and in severe cases the cobb angle may reach 90 degrees or more. In this case, it not only leads to obvious deformity in appearance, but also muscle fatigue and pain due to imbalance of the trunk, stiffness and pain of the spine due to inflammation and degeneration of the spinal joints and intervertebral discs, and abnormal cardiopulmonary function due to collapse of the trunk, such as restrictive pulmonary ventilation, pulmonary atelectasis, obstructive pneumonia, and heart and lung failure, etc. It can also cause pain, numbness, weakness, and radiating pain of the lower extremities due to nerve root compression. It can also cause pain, numbness, weakness, lower limb radiating pain and other symptoms due to nerve root compression, which can lead to paralysis in serious cases. Therefore, early diagnosis and early treatment should be emphasized.
4.What are the risk factors for the progression of scoliosis?
Some patients with idiopathic scoliosis (scoliosis) may maintain a stable scoliosis angle for a long time, while others may have a rapid progression, the cause of which, like its etiology, remains a mystery. However, a number of high-risk factors can be observed that predict rapid progression of scoliosis.
(1) Gender: the incidence and severity of scoliosis progression is higher in girls than in boys, with the rate of progression in the former being 10 times higher than in the latter.
(2) Age: The younger the age of onset, the greater the likelihood of progression. For example, a 10- to 12-year-old child with a scoliosis angle between 20 and 29 degrees has a 60% chance of progression, while a 13- to 15-year-old child with the same angle of scoliosis has a 40% chance of progression, and a 16-year-old child with the same angle has a 10% chance of progression. This is actually related to the degree of skeletal maturity of the affected child, with scoliosis (scoliosis) developing rapidly during the rapid growth that precedes bone maturation in adolescence. Females are usually 10-14 years old, while males are 13-16 years old.
(3) Degree of curvature: The greater the degree of curvature at onset, the greater the risk of progression. For example, in a child between 13 and 15 years of age, there is a 10% chance of progression if the angle is 20 degrees; between 20 and 29 degrees, there is a 40% chance of progression; between 30 and 59 degrees, the likelihood reaches 60%; and over 60 degrees, it reaches 90%.
(4) The shape and location of the bend: double bend has a greater risk of progression than single bend, and the risk of progression of thoracic scoliosis is greater than that of lumbar scoliosis.
5.How to diagnose scoliosis early?
The earlier idiopathic scoliosis (scoliosis) is diagnosed, the better the chances of treatment through non-surgical methods. Early detection of scoliosis (scoliosis) and proper treatment can prevent serious secondary symptoms. However, early mild scoliosis (scoliosis) is often covered by clothing, and the most common scenario at the first visit is when the scoliosis has progressed to about 40 degrees and is discovered by parents, classmates, or by accident. At this point, the opportunity for non-surgical treatment is often lost.
Therefore, screening for scoliosis (scoliosis) in school-age children is highly recommended. After a brief training by a school teacher or health screening physician, tests such as the bending test, and with the help of certain instruments such as a scoliosis (scoliosis) meter and a clouded photographic camera, scoliosis (scoliosis) of about 10 to 20 degrees can be detected. Although screening at school age does not reduce the incidence of scoliosis (scoliosis), it can reduce the number of patients with severe scoliosis through early detection and treatment.
For every parent of a school-aged child, whether or not the school conducts screening for scoliosis (scoliosis), it is important to pay more attention to your child and not wait for the school or doctor to detect the signs of scoliosis (scoliosis). Observing for some degree of asymmetry is the key to diagnosing scoliosis (scoliosis), and you should take advantage of opportunities to observe your child from the front and back of the body when he or she is naked, such as in the shower.
You should be alert for scoliosis (scoliosis) if you notice the following signs.
(1) One hip is higher than the other, the lumbar region is asymmetrical, and the concave side of the curve appears higher than the convex side.
(2) One shoulder is significantly more prominent or “enlarged” than the other, usually more common with a high right shoulder.
(3) Uneven neckline, with one shoulder higher than the other.
(4) uneven development of both breasts in girls, the left side of the breast tends to be larger. However, 30% of normal women have asymmetrical breasts on both sides, which should be differentiated.
Although the presence of the above asymmetries does not necessarily mean scoliosis (scoliosis), if you find any of the above asymmetries, you should go to the orthopedic department of the hospital and have further investigations (such as x-ray, etc.) if necessary. It is important to note that idiopathic scoliosis (scoliosis) has family heredity and aggregation, so if there have been patients with scoliosis (scoliosis) in the family, parents should be highly alert to the possibility of their children suffering from scoliosis (scoliosis).
6.How to treat scoliosis?
Scoliosis does not necessarily mean surgery. In fact, a large percentage of patients do not need treatment because the scoliosis is small and stable, and some patients can avoid surgery or delay surgery through non-surgical treatment such as bracing. Treatment for scoliosis can be broadly divided into surgical and non-surgical treatments. The only non-surgical treatment that is recognized as effective is bracing. Other non-surgical treatments such as chiropractic therapy, electrical stimulation, and hydrotherapy are inaccurate. Gymnastic exercises cannot stop the development of scoliosis, but they are of greater value in treating muscle fatigue and secondary pain. Gymnastic exercises are recommended for patients undergoing brace therapy because brace therapy can cause stiffness and atrophy of the back muscles, and gymnastic exercises can improve general muscle tone and help maintain flexibility and strength.
The treatment plan depends on many factors, but it is generally accepted that
(1) Scoliosis with an angle of less than 20 degrees and no significant progression usually does not require treatment. Children with growth potential should be followed up regularly. Adult patients with a scoliosis angle of 40-50 degrees or less do not need treatment if they have no accompanying symptoms, and should be followed up regularly according to the size of the angle and the degree of skeletal maturity.
(2) Children with a scoliosis angle between 20 and 40 degrees and with growth potential should be treated with bracing. In particular, patients with Risser’s sign (Risser’s sign is an index to evaluate the bone maturity of patients, which is divided into 5 degrees) less than 2 degrees and those whose menstruation has not started, if the cobb angle has reached 30 degrees at the initial diagnosis, bracing treatment should be started immediately, and for patients with a cobb angle of 20-30 degrees, if a 5-degree progression is proven, bracing treatment should also be performed.
(3) Patients with a scoliosis angle of 40 degrees or more, whose scoliosis progression cannot be controlled by brace treatment, whose appearance of deformity is obvious, and whose trunk is out of balance, should be promptly treated by surgery.