I. Definition of scoliosis
Scoliosis refers to one or more segments of the spine deviating from the midline of the body in the coronal plane and bending to the side, forming a spinal deformity with curvature, usually accompanied by rotation of the spine and an increase or decrease in the posterior or anterior protrusion in the sagittal plane, as well as unequal height of the ribs, rotational tilt deformity of the pelvis and abnormalities of the paravertebral ligaments and muscles, which is a symptom or X-ray sign and can be caused by a variety of diseases . Scoliosis usually occurs in the cervical, thoracic or thoracic spine or in the spine between the thorax and the lumbar region, or it can occur in the low back alone. Scoliosis appears on one side of the spine in a “C” shape, or on both sides in an “S” shape. Yang Cao, Department of Orthopedics, Wuhan Union Medical College Hospital
The typical manifestations of scoliosis are
Inequality of the two shoulders.
Unequal scapulae on both sides.
Deviation of the spine from the midline.
Folded skin pattern of the lumbar region on one side.
Asymmetry of the back on both sides in forward bending.
Second, the classification and symptoms of scoliosis
1, what are the types of scoliosis?
According to the etiological classification, scoliosis is divided into two types.
One is postural scoliosis
Postural scoliosis: mostly seen in preschool children (6-7 years old), caused by incorrect posture. When standing, a section of the spine is often convex to the left, and after bending forward or lying down, the scoliosis disappears on its own.
Another type of scoliosis is structural scoliosis, and the main subtypes are
Congenital scoliosis: spinal hypoplasia, hemivertebral deformity, etc. can cause scoliosis, and its onset at a younger age.
Idiopathic scoliosis: it occurs around the age of 10, with more obvious symptoms, high shoulders on the convex side and low shoulders on the concave side. The disease progresses more rapidly at this stage.
Neurological or paralytic scoliosis: Patients who have suffered from poliomyelitis, polyneuroma, spinal cord cavitation, cerebral palsy or cerebrospinal bulge, due to muscle paralysis on one side of the trunk and imbalance of muscle strength on both sides, resulting in a protrusion of the spine to the affected side or the healthy side.
2, what are the symptoms of scoliosis?
Appearance deformity: including razorback, hunchback, pelvic tilt, unequal height of both shoulders and unequal length of both lower limbs, as the patient’s spine itself is unbalanced, height development is also often limited.
Pain: The side of the patient without scoliosis is subject to greater forces and accelerated joint degeneration, making it particularly susceptible to bone spurs, joint wear and tear, and soft tissue strain, which in turn leads to lumbar spine pain.
Flat back syndrome: refers to the loss of normal forward bending of the lumbar spine or the loss of normal bending of the thoracic spine and the straightening of the spine, with flat back syndrome, patients usually have difficulty standing up straight.
Scoliosis of the thoracic spine can also affect the thorax, so that the ribs cannot expand normally, resulting in a smaller thoracic cavity, affecting cardiopulmonary function, respiration and blood circulation, and in severe cases, cardiopulmonary dysfunction or failure can occur.
Lumbar scoliosis, on the other hand, can compress the internal organs and easily cause indigestion or menstrual disorders.
The appearance deformity caused by scoliosis often makes many patients have low self-esteem, so it is often accompanied by psychiatric symptoms.
Third, the causes and dangers of scoliosis
1, why do I have scoliosis?
There are many reasons why scoliosis occurs, and the causes of different types of scoliosis vary.
Postural scoliosis is mostly caused by incorrect posture.
Congenital scoliosis is mainly caused by spinal underdevelopment, unbalanced spinal development at the developmental stage, mostly due to asymmetric development of the spinal muscles on both sides.
Patients with flat feet or long and short feet can also be induced to produce scoliosis because of biomechanical changes.
In adults, scoliosis is most often caused by a mild scoliosis in adolescence combined with acquired factors or deepened.
Acquired factors of scoliosis include
Unilateral work: habit of carrying handbags unilaterally, unilateral extraction of heavy objects such as briefcases, etc.
Sports trauma: Soft tissue injuries or joint displacements caused by sports trauma.
Daily posture: incorrect posture in daily life causes soft tissue strain or joint misalignment.
Sleeping environment: the mattress and pillow are not suitable for softness, or the sleeping posture is prone to sleep.
Physical factors: disease in the body organs, the body tends to develop on the healthy side
2.What is the impact of scoliosis on my work and life?
Scoliosis occurs in adolescents, especially in women, often in pre-puberty, progresses rapidly throughout adolescence, and progresses slowly in adulthood. The hazards are as follows.
Causing asymmetry in shape and affecting aesthetics.
Causing displacement of internal organs and affecting development.
May cause related symptoms such as myopia, neck pain, memory loss, poor concentration, and heartburn and chest tightness
Affects physical health in adulthood. Many chronic diseases in adults are related to the spine, such as migraines, insomnia, dizziness, cervical spondylosis, low back pain, stomach ulcers, etc.
May affect mental health in severe cases.
May have an impact on future employment, marriage, social interaction, etc.
Physical factors: diseases in internal organs, body development tends to be on the healthy side.
Fourth, how to carry out self-examination and consultation of scoliosis?
1, how to carry out self-examination and consultation of scoliosis?
Most adolescents with scoliosis are discovered by parents when the child is taking a bath or wearing fewer clothes.
If you find that your child has the following signs, be alert to whether he or she has scoliosis: uneven neckline, one shoulder is higher than the other; asymmetric development of both breasts in girls, the left side of the breast is often larger; bulging back on one side; folds on one side of the waist; one hip is higher than the other; unequal length of the lower limbs on both sides.
There are a number of different “warning signs” that you can look for to help determine if you or the person you care about has scoliosis.
An asymmetrical back with unequal height of the shoulders or pelvis from side to side.
The head is not centered over the pelvis.
The presence of elevated and protruding hips.
Differences in the height of the thorax.
alteration of the appearance or musculature of the skin outside the spine (appearance of depressions, small handfuls of hair and change in color).
tilting of the body to one side.
If after a simple examination you find an abnormality, you should go to the hospital immediately. Professional doctors examine patients with scoliosis, often starting with a medical history and physical examination. Therefore, you should actively cooperate with your doctor during the visit and try to provide him/her with detailed information about your condition, including the progress of the condition and family history.
Five, the prevention of scoliosis
1, how to prevent scoliosis?
The prevention of scoliosis should first of all clarify its cause, for some diseases that may lead to scoliosis, such as lumbar disc degeneration, spinal stenosis, lumbar instability, etc. should be actively treated. For idiopathic scoliosis, attention should be paid to prevent further development of scoliosis, and certain braces can be used for orthopedic protection.
After the initial understanding of scoliosis, we will then make the right prevention plan for scoliosis.
Correct poor posture, including standing, sitting, sleeping posture and posture for studying, watching TV and computer, and carrying school bags.
Scientific exercise, to avoid acute or chronic injury from sports. Such as long-term unilateral force to play table tennis, badminton may cause scoliosis, try to exercise bilaterally.
Regularly participate in outdoor activities to strengthen muscles and increase joint flexibility to prevent bone aging and slow calcium loss.
Do some effective, easy to do exercise therapy, such as goldfish tail movement, supine bending leg inverted knee movement.
Sleep in a soft and firm bed, pillow design should be in line with the structure of the neck, do not sleep on high pillows.
Take sufficient calcium to prevent osteoporosis, calcium-containing foods such as cheese, buttermilk, collard greens and tofu.
Six, which exercises are good for spinal health
1, which sports are good for spinal health?
Proper physical exercise, such as exercising the muscles of the lower back, can enhance the support structure of the spine, increase the stability of the spine and prevent or reduce the possibility of scoliosis.
Hand pulling ribwood body lateral flexion two side to the ribwood standing, one hand pulling the ribwood, the other hand up, do body lateral flexion, practice 3 groups, each group 30 to 50 times.
Requires head up, chest up, abdomen, upper body can not lean forward.
Prone, both arms bent in front of the body to support the ground, the scoliosis side of the leg force upward, while the other side of the arm straight forward, hold 3 to 4 seconds, and then restore. Exercise 3 groups, 10-15 times per group.
Legs open, side bend side of the arm natural down, the other side of the arm shoulder lateral flexion head, the upper body to the side of the side bend, hand to not reach to the lowest, hold for 3 seconds, restore. Exercise 3 groups, 10 to 15 times each group. Or side-bending one arm to carry a heavy object (such as dumbbells, school bags, etc.) for practice.
Lying sideways in the direction of scoliosis, both arms bend arm to support the ground, the outer leg kicked hard to the side of the shoulder to the maximum, and then restore, practice 25 to 30 times. Requires the body to be positive when kicking the leg, the kick amplitude to be large.
Seven, the treatment of scoliosis
1.How to regain the joy of life?
Some parents find their children have scoliosis is very nervous, and even overwhelmed, and often go around to the doctor, there are calcium, massage massage orthopedic, wearing a brace undershirt, in short, heard what works, take the child to treatment, the results have little effect.
So, how exactly should I treat scoliosis?
Generally speaking, early detection, timely and correct treatment is the best way to avoid major physical and psychological injuries caused by scoliosis. The less scoliosis there is, the greater the chance of correction. However, if the spine is in an incorrect state for a longer period of time, the nearby muscles, soft tissues, ligaments and tendons will be affected, reducing the effectiveness of treatment.
When treating scoliosis, we should follow the following treatment principles.
Soft tissue treatment.
Correction of joints.
Correction of daily poor posture.
Appropriate exercise.
The treatment of scoliosis is mainly divided into non-surgical and surgical treatment. The decision of which treatment to choose should be made after full communication with your doctor, and it is important not to take it upon yourself to adopt inappropriate treatment, thus leading to missed treatment before improvement or even deterioration of the condition.
It is worth mentioning that with proper treatment, about 70-80% of scoliosis patients can improve their scoliosis after treatment.
Eight, non-surgical treatment of scoliosis
1, what are the non-surgical treatment methods for scoliosis?
Early detection of scoliosis generally begins with non-surgical treatment, commonly used non-surgical correction methods include corrective gymnastics, observation and regular follow-up, brace orthoses, etc.
Posture training: Most scoliosis patients are caused by poor posture, so correct posture training is essential.
Pelvic tilt training: Reduce lumbar lordosis by tilting the pelvis. During training, the patient lies supine with hips and knees flexed, and the lower back is held close to the surface of the treatment bed and maintained in this position. Then the hip is lifted smoothly and rhythmically from the bed surface, while taking care that the lower back does not leave the bed surface. When the patient has mastered the above, continue to straighten both lower extremities until both hips and knees are fully extended.
Observation and regular follow-up: usually applied to patients with mild scoliosis, every few months or using the annual summer and winter vacations, go to the hospital for X-rays, etc., to measure and observe the changes in the angle of scoliosis.
Brace fixation: Brace treatment is the main and most reliable non-surgical treatment. The literature at home and abroad shows that bracing can effectively control the progression of early scoliosis, especially in mild idiopathic scoliosis, and can avoid surgery or reduce the severity of scoliosis in patients undergoing surgery. The principle of bracing, i.e., correction with a scoliosis orthosis, is based on the application of an external force to the deformed prominence by means of a liner inside the brace, which pushes the spine into a normal position. It is worth mentioning that while wearing the brace, you should contact your doctor regularly to check the spine X-ray and closely observe the changes in the degree of spinal curvature.
IX. Surgical treatment of scoliosis and indications for surgery
1.What are the surgical options for scoliosis?
When your condition is severe, your doctor may recommend surgery. The specific surgical procedure may vary depending on your condition, and the common surgical procedures are as follows.
Thoracoplasty: to make the chest symmetrical, improve the appearance of the chest and relieve the pain caused by protruding ribs.
Anterior surgery: used to correct scoliosis and kyphosis for scoliosis of the thoracolumbar segment.
Posterior approach: the most traditional approach in spine surgery, where the patient’s back is approached and operated on.
Combined anterior-posterior approach: for severe scoliosis, rigid scoliosis, and scoliosis with failed fusion.
Minimally invasive surgery: Treatment with endoscopic surgery is less invasive and has a shorter postoperative recovery period.
Through surgical treatment, we can achieve the goal of correcting scoliosis and preventing further development of scoliosis. Relatively speaking, the possibility of complete correction of scoliosis in children is greater, while adults can prevent further development of scoliosis through surgery.
2. Who should choose surgical treatment?
Brace treatment does not control the development of the deformity and the degree of scoliosis continues to increase.
Those with pulmonary dysfunction and those with adolescent scoliosis with trunk asymmetry and severe deformity requiring plastic surgery.
Older patients or those with neurological symptoms that cannot be controlled by conservative treatment.
Adolescent scoliosis with a Cobb’s angle >45 degrees.
Cobb’s angle <45 degrees, but with severe anterior chest convexity and obvious rib bulge.
Preoperative preparation for scoliosis, surgical procedures, and common complications
1.What should I do before surgery?
Psychological preparation: First of all, we should clarify the necessity of surgery, understand the advantages of orthopedic surgery, the treatment process and postoperative precautions, and treat the surgery with a positive and optimistic attitude.
Physiological preparation: because scoliosis is often accompanied by chest deformity, resulting in reduced lung capacity, preoperative lung function should be actively exercised such as deep breathing, blowing large air ball and chest expansion exercises, 6 to 8 times a day, 5 to 15 min each time, to feel fatigue.
2, what are the steps of scoliosis surgery?
Scoliosis surgery is mainly performed through internal spinal fixation devices to correct the deformity. The general procedure of surgery is as follows.
Upon entering the operating room, you will first receive anesthesia. Once you are fully under anesthesia, the anesthesiologist will insert a catheter to assist your breathing and monitor your heart function, blood pressure, fluid status, and depth of anesthesia.
Next, the surgeon will make the incision and insert the appropriate internal fixation devices (screws, rods, etc.) to correct the deformity according to the surgical plan agreed upon with you prior to surgery. As needed, bone graft fusion is performed.
After all of this, the surgeon will close the incision and place a drainage tube.
3.What are the common complications in the early postoperative period and how to prevent them?
Due to the large incision in scoliosis, pain may occur in the early post-operative period, for which analgesics may be given for pain relief.
Patients with scoliosis are prone to decubitus ulcers at the rib bulge and at the sacrococcygeal area when they are bedridden for a long time. In addition, the respiratory tract should be kept open after surgery to prevent infection.
XI. Postoperative rehabilitation principles and points to note in daily life
1.What principles should be followed in the initial postoperative rehabilitation?
Scoliosis postoperative rehabilitation should follow the principle of gradual progress, do not pursue the speed of recovery and do excessive rehabilitation exercises, which not only can not improve the speed of recovery, but may break the brace, increasing the possibility of recurrence.
Postoperative day 1: Under the condition that the pain is tolerable, perform straight leg raising exercise and dorsal foot extension and flexion exercise, 3 times a day, 10-15 times each time, and gradually increase the number later.
Postoperative day 2: Perform pulmonary function training (blowing big air ball or blowing water bubble, the bigger the better, to promote lung reopening) to improve breathing exercises.
Postoperative day 3: Active movement of limbs in bed can reduce bedridden morbidity. Improve respiration and blood circulation, enhance limb muscle strength, and prepare for early wearing of back brace to get out of bed.
12 days after surgery: remove the stitches, if you find hard nodes in the incision, redness, swelling or heat, feeling pain in the back, and foreign body sensation, you should consult a doctor in time.
2.What are the points of attention in daily life after discharge from hospital?
Maintain a good state of mind.
Eating more high-protein, high-vitamin, nutrient-rich diet.
To prevent dislocation of the open hook or fracture of the orthopedic rod, maintain correct sitting posture.
refrain from upper body forward bending movements, prohibit lifting and pulling heavy objects on the upper limbs, and reduce body weight bearing for six months.
minimizing spinal activities and paying attention to the prevention of trauma.
Wear a brace for more than 3 months, except for showering and sleeping.
Review once in 3-6 months.