I. What is scoliosis?
When viewed from the front, a normal spine should be straight. When scoliosis is present, the spine is shifted to the left or right side. We can measure the angle of scoliosis by taking an X-ray (this angle is called the Cobb angle). When the Cobb angle of the spine is greater than 10 degrees, we call it scoliosis. It is most commonly found in the thoracic and lumbar portions of the spine and may occur in a single area of the thoracic or lumbar spine, or in both the thoracic and lumbar spine. The most common type of scoliosis is right thoracic curvature. Nearly 10% of people have a small curvature of the spine (less than 10 degrees) without any functional problems. This condition is called spinal asymmetry. The human spine shows a natural curvature when viewed from the side. The cervical and lumbar vertebrae project forward, showing physiological anterior convexity, and the thoracic region projects backward, showing physiological lordosis.
Second, what causes scoliosis?
There are many causes of scoliosis. But the most common is idiopathic, or “unexplained”, scoliosis. Scientists have defined idiopathic scoliosis as a genetic disorder and are constantly trying to isolate the gene that causes scoliosis. This has led to early diagnosis and the selection of the “best” treatment for each patient.
There is evidence that the different growth rates of the anterior and posterior spine columns also contribute to scoliosis.
The types of idiopathic scoliosis are divided into the following categories depending on the age of onset.
1, Infantile idiopathic scoliosis: 0-3 years old
2. Juvenile idiopathic scoliosis: 4-9 years old
3. Adolescent idiopathic scoliosis: 10-18 years old
Each age group has specific requirements and challenges for specific treatment approaches.
3. What is the prevalence of scoliosis?
The prevalence of idiopathic scoliosis in adolescents is 2-3%. Of these, 1:500 (0.2%) require aggressive treatment, and only 1:5000 (0.02%) of scoliosis progresses to the point of requiring surgery. There is no difference in the angle of scoliosis between girls and boys. However, progression of scoliosis occurs at a much greater rate in girls (8 times) than in girls.
IV. How do scoliosis patients look?
The appearance of a patient with scoliosis has the following characteristics.
1. one shoulder is higher than the other.
2. one shoulder (scapula) is more prominent than the other.
3. One hip is higher than the other.
4. One leg looks longer than the other.
5.The waist is asymmetrical.
6.The trunk and thorax are shifted to the other side.
7.The head (longitudinal line) is not located at the midpoint of the two hips (continuous line).
8. When bending forward, the clothes are asymmetrical at the waist, with one side significantly higher than the other.
Some cosmetic manifestations of scoliosis are sometimes not easy to detect, especially for people without professional training.
V. What causes the change in appearance in scoliosis patients?
Scoliosis is a three-dimensional deformity. When the angle of scoliosis is created, the spine is simultaneously twisted or rotated to the left or right side.
The degree and type of change in body appearance depends largely on the angle of scoliosis and can also vary depending on the individual’s response to scoliosis.
VI. In what cases are the manifestations of scoliosis ignored?
It is not uncommon for scoliosis to be noticed by someone other than the patient themselves and their family. The patient’s body will change rapidly during prepubescence and adolescence. During this time, children feel extra private about their bodies, so much so that their parents cannot easily notice the changes in their bodies.
Early changes in body shape due to scoliosis may be mild, and even severe scoliosis deformities may be rare.
In addition, scoliosis does not necessarily produce painful symptoms.
What should we do next after scoliosis is detected?
When scoliosis is suspected, the first step is to seek the advice of a specialist. Have your child thoroughly examined by a scoliosis specialist. X-rays are best taken at a scoliosis screening facility. The patient needs to be in a standing position during the film. The radiographs should include the entire spinal segment in order to get a better view of the overall alignment of the spine.
What are some of the things that are usually done during a consultation with a specialist?
1. questioning of the patient’s medical history and family history of scoliosis.
2. patient height measurement.
3. physical examination.
4. Adam’s anterior flexion test.
5.Taking of full spine X-ray.
6. a specialist will explain to you what is detected on the x-rays
7.Answering your questions about the basic condition of the disease.
8.Giving treatment recommendations.
9. What kind of scoliosis is observed on the X-ray?
Scoliosis refers to a bend or multiple bends in the spinal region (upper thoracic, thoracic or lumbar) Scoliosis may occur in one or more regions of the spine, which we call single, double or triple bends. The direction of scoliosis may be to the left or to the right.
1. How is the angle of scoliosis measured?
The size of the scoliosis angle is measured by the angle of the part of the spine where the scoliosis occurs on an x-ray, which we call the Cobb angle or Cobb measurement.
2. Does the angle of scoliosis increase?
Although many factors may contribute to the progression of scoliosis, it is difficult to predict whether the angle of scoliosis will increase further.
Progression of scoliosis most commonly occurs during the adolescent developmental sprint, where the angle of scoliosis increases at a rate of 1-2 degrees per month.
Two factors are critical in predicting the progression of scoliosis.
(1) The size of the angle.
(2) Whether the spine will continue to grow.
X. What are the potential determinants of bone growth?
At each hospital visit, a professional will measure your height. When two values measured many months apart do not increase, this indicates that bone growth is complete. In addition, skeletal maturity can be assessed by observing the Risser sign of the skeleton under an X-ray. Of course, it can also be determined by pubertal manifestations. For girls, skeletal growth can be judged by menarche and breast development. In boys, the growth of beard and changes in voice can also be used as criteria for judgment. Some signs to judge skeletal maturity are sometimes not always accurate, and can also be judged by observing the bone growth center of the hand through X-ray film.
What is the Risser’s sign?
Risser’s sign is an indicator used to measure skeletal maturity.
When the skeleton is fully mature, the cartilage will cover the surface of the iliac bone (iliac wing) like a “cap” and harden into what is called a skeleton. This process occurs during puberty. Once the cartilage has matured into bone, we can see it on an x-ray (cartilage does not show up on x-rays). When the skeleton begins to mature, the cartilage cap initially appears at the lateral edge of the iliac wing (Risser 1) and grows medially along the iliac wing during the 18-24 months. The degree of skeleton is classified as Risser 0-5 according to the Risser sign, with degree 0 cartilage appearing before the iliac wing; degree 4 refers to cartilage completely covering the iliac wing. Complete fusion of cartilage over the iliac wing (Risser 5) means that spinal growth is complete.
XII. What will we see in the fingers and wrists from the radiographs?
After skeletal maturation, we can observe the closure of the growth plates in the fingers and wrist on radiographs. The growth plates remain open during the growth phase of the spine and close when the spine matures. This assessment is more reliable than observation through the Risser sign.
A hand x-ray allows the physician to compare the patient’s physiological age (actual age since birth) with the skeletal age (the true age of the heel may not exactly match the actual physiological age) and facilitates the determination of skeletal maturity.
XIII. What treatment options are available after a determination of scoliosis?
Scoliosis can be treated either non-surgically or surgically, depending on the angle and severity of the scoliosis.
Non-surgical treatment includes observation of the progression of the scoliosis angle or external bracing. When the scoliosis reaches a certain level, if the scoliosis continues to progress, we need to treat it surgically even if the spinal development is complete.
14. Why is clinical observation necessary?
Observation means that the patient returns to the hospital every 4-12 months for continuous examinations, including radiographs and physical examinations.
The frequency of follow-up visits depends on the degree of growth and development of the child. Since there is a measurement error (up to 5 degrees) in the daily measurement of the scoliosis angle on radiographs, radiographs should not be examined too frequently, and it is generally recommended that they be examined no less than once every 4-6 months. Since the angular change in progressive scoliosis increases by 1-2 degrees per month, radiographs less than once every 4 months are not reliable for determining the progression of scoliosis.
Observation alone is recommended in two cases.
1. the spine is still in the growth phase and the scoliosis angle is less than 20-25 degrees.
2. the spine is finished growing and the scoliosis angle is less than 40-50 degrees.