What is scoliosis? Scoliosis means “curvature” in Greek and was first described by Galen, an ancient Greek physician. Scoliosis is a three-dimensional deformity in which the normal spine is straight when viewed from the front (front or back), and the side of the scoliotic spine is tilted to one side, or one section is tilted to one side and the other section is tilted to the other side; when viewed from the side, the normal spine exhibits an angular cervical scoliosis, thoracic scoliosis, lumbar scoliosis and sacral scoliosis to maintain spinal balance, and a loss of normal curvature or even a reversal of normal curvature is often observed with a scoliotic spine. Loss of normal curvature or even reverse curvature is observed; in cross-section the scoliotic spine undergoes rotation, resulting in cosmetic deformities such as bulging ribs and protruding scapulae on one side. The severity of spinal curvature is usually measured by the Cobb angle, and the normal spinal Cobb angle should be 0 degrees, but medically only spinal curvature with a Cobb angle of more than 10 degrees is usually defined as scoliosis (sideways curvature of the spine). This disease is not uncommon, and the incidence rate is between 1% and 2% in China. What are the types of scoliosis? The causes of scoliosis are multiple. Depending on the cause, scoliosis can be categorized into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, and degenerative scoliosis. Idiopathic scoliosis (scoliosis) is the most common, accounting for 79% to 85% of the cases. The so-called idiopathic scoliosis means that the cause of the disease is unknown. Idiopathic scoliosis can be categorized into infantile, childhood, adolescent and adult according to the age of onset, with adolescent onset being the most common. What are the risks of scoliosis? Mild scoliosis and the early stages of scoliosis do not affect the flexibility, stability, weight-bearing function and spinal cord protection of the spine 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 can reach over 90 degrees. This not only leads to obvious appearance deformity, but also muscle fatigue and pain due to the imbalance of the trunk, stiffness and pain due to inflammation and degeneration of the spinal joints and intervertebral discs, and cardiopulmonary function abnormalities due to collapse of the trunk, such as restrictive pulmonary ventilation disorder, atelectasis, obstructive pneumonia, and cardiopulmonary and pulmonary failure, etc. It can also cause pain, numbness, weakness, and radiating pain in lower limbs due to the compression of the nerve roots. It can also cause pain, numbness, weakness, radiating pain in the lower limbs and other symptoms due to the compression of the nerve root, which can lead to paralysis in severe cases. Therefore, early diagnosis and treatment should be emphasized. 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 period of time, while others may experience rapid progression and worsening of the scoliosis angle. However, a number of risk factors have been observed that predict rapid progression of scoliosis: (1) Sex: 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 of 20 degrees to 29 degrees has a 60% likelihood of progression, while a 13- to 15-year-old child with the same angle of scoliosis has a 40% likelihood of progression, and a 16-year-old child with the same angle has a 10% likelihood of progression. This is actually related to the degree of skeletal maturity of the child, with scoliosis (scoliosis) developing rapidly during the rapid growth that precedes bone maturation at puberty. This is usually 10 to 14 years of age in females and 13 to 16 years of age in males. (3) Degree of curvature: The greater the degree of curvature at onset, the greater the risk of progression. For example, in a 13- to 15-year-old child, an angle of 20 degrees has a 10% chance of progression; 20 degrees to 29 degrees has a 40% chance of progression; 30 degrees to 59 degrees has a 60% chance; and over 60 degrees has a 90% chance. (4) The shape and location of the curvature: double curvatures have a greater risk of progression than single curvatures, and thoracic scoliosis has a greater risk of progression than lumbar scoliosis. How to diagnose scoliosis early? The earlier idiopathic scoliosis is diagnosed, the more likely it is to be treated non-surgically. Early detection and proper treatment of scoliosis can prevent the development of serious secondary symptoms. However, in the early stages, mild scoliosis is often hidden by clothing, and the most common scenario at the time of the first visit is that the scoliosis has progressed to about 40 degrees and is discovered by parents, classmates, or by chance. By this time the opportunity for non-surgical treatment has often been lost. Therefore, it is highly recommended that school-age children be screened for scoliosis. Schoolteachers or health examiners are trained to perform tests such as the bend test, and with the help of certain instruments such as a scoliometer or cloud photographer, scoliosis can be detected at about 10 to 20 degrees. Although screening at school age does not reduce the incidence of scoliosis, it can reduce the number of patients with severe scoliosis through early detection and treatment. This measure has been practiced in developed countries in Europe and the United States, where the severity of scoliosis (scoliosis) and the number of patients requiring surgery have decreased very significantly in recent years. Domestic efforts in this area are lacking. For every parent of a school-age child, whether or not the school is screening for scoliosis (scoliosis), it is important to pay more attention to your child and not wait for the school or the doctor to recognize the signs of scoliosis (scoliosis). Observing for some degree of asymmetry is the key to diagnosing scoliosis. You should take advantage of your child’s nudity, such as bathing, to look at him/her from the front and back of the body, and be on the lookout for signs such as the following: (1) one hip is higher than the other, there is an asymmetry in the lumbar region, and the concave side of the curve appears higher than the convex side; (2) one shoulder is more prominent or “enlarged” than the other; (3) one shoulder is more pronounced than the other; and (4) one shoulder is more pronounced or “enlarged” than the other. (2) One shoulder is significantly more prominent or “enlarged” than the other, with the right shoulder usually being more common; (3) The neckline is uneven, with one shoulder being higher than the other; and (4) The girl’s breasts are unevenly developed, with the left breast tending to be larger. However, 30% of normal women have asymmetry between the two breasts, which should be differentiated. Although the presence of the above asymmetries does not necessarily mean scoliosis, if any of the above asymmetries are found, you should go to the orthopedic department of the hospital for further examination (e.g., X-ray examination) if necessary. It is important to note that idiopathic scoliosis (scoliosis) is hereditary and clustered in families, so if there is a scoliosis patient in the family, parents should be on high alert for the possibility of their children suffering from scoliosis (scoliosis). How is scoliosis treated? 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 can avoid or delay surgery with non-surgical treatments such as bracing. Treatment for scoliosis can be broadly categorized as surgical or non-surgical. The only recognized effective non-surgical treatment is bracing. Other non-surgical treatments such as chiropractic therapy, electrical stimulation therapy, and water bath therapy are not as effective. Gymnastic exercises, although not able to stop the progression of scoliosis, are of great value in treating muscle fatigue and secondary pain. Exercise is recommended for patients who are on brace therapy, as brace therapy can cause stiffness and atrophy of the back muscles, and exercise improves muscle tone throughout the body and helps maintain flexibility and strength. The treatment plan depends on a number of factors, and it is generally recognized that (1) scoliosis of less than 20 degrees without significant progression usually does not require treatment. Children with growth potential should be followed regularly. Adult patients with a scoliosis angle of 40-50 degrees or less also do not require treatment if there are no accompanying symptoms, and should be followed up regularly according to the size of the angle and skeletal maturity. (2) Children with scoliosis angles between 20 degrees and 40 degrees and the presence of growth potential should be treated with bracing. In particular, patients with Risser’s sign (Note: Risser’s sign is an indicator for evaluating the patient’s bone maturity, which is categorized into 5 degrees) less than 2 degrees and those who have not yet begun to menstruate should be braced if the Cobb angle has reached 30 degrees at the time of initial diagnosis, and should also be braced for those with a Cobb angle of 20-30 degrees if a 5-degree progression has been demonstrated. (3) Patients with a Cobb angle of 40 degrees or more, whose progression of Cobb cannot be controlled by bracing, and who have obvious deformity in appearance and loss of balance of the trunk, should undergo timely surgical treatment.