Q: What is scoliosis all about? A: A normal person’s spine should look like a straight line from the front or back, and both sides of the torso are symmetrical. If you see a bend in the spine from the front or back, you have “scoliosis”. In mild scoliosis, there is no obvious discomfort and no visible physical deformity. More severe scoliosis can affect the growth and development of the body deformation, in the back of the chest can be raised a “rib peak”, called “razor back”, especially when bending forward more obvious. At this time, a full frontal and lateral X-ray of the spine in the standing position should be taken. If the X-ray shows a lateral curvature of the spine greater than 10 degrees, scoliosis can be diagnosed. Q: What types of scoliosis are there? A: Scoliosis can be caused by dozens of etiologies and can be divided into two categories: functional and organic according to the etiology. Functional scoliosis refers to temporary scoliosis caused by certain causes, which can return to normal once the cause is removed, such as postural scoliosis, lumbar scoliosis secondary to unequal lower limb length, etc. Clinical scoliosis mostly refers to organic scoliosis, the most common of which is idiopathic scoliosis, accounting for about 80%. This is followed by congenital scoliosis and neuromuscular scoliosis, and other more common ones include neurofibromatosis combined with scoliosis, Marfan syndrome combined with scoliosis, and osteochondral dystrophy combined with scoliosis. Q: How do I find out that my child has scoliosis? A: Parents should suspect congenital spinal deformity if they find abnormal hair or “buns” on the child’s back after birth, and later if parents find that their child is growing slower than other children or that the upper and lower body are developing out of proportion. When children begin to walk, if they find that the shoulders are uneven or the lower extremities are not equal in length, asymmetrical on both sides of the hip, scoliosis should be highly suspected and require further examination in a timely manner. At this time, you can do some simple checks on your child, such as touching the spine’s spines with your hand to see if they are in a straight line, or having your child stand upright and bend forward to see if the back is symmetrical. If, after a simple examination, you find that your child has an abnormality, you should go to the hospital immediately. Idiopathic scoliosis is often found in adolescents between the ages of 10 and 14, because this is the second growth spurt in a person’s life, and the spine grows faster. If you find that your child has the following signs, be alert to whether he or she has scoliosis: one shoulder is higher than the other; girls with asymmetrical breast development, the left side of the breast is often larger; one back bulge; one side of the waist has a fold; one hip is higher than the other side Q: What are the dangers of scoliosis? A: Scoliosis can lead to abnormal physical appearance, such as unequal shoulders, collapse of one side of the thorax and bulge on the other side, pelvic tilt, etc., bringing psychological and mental stress and trauma to the patient and parents. Scoliosis that occurs early in life, especially when combined with anterior convexity of the thoracic spine, can seriously affect the development of the heart and lungs, causing damage to cardiovascular and pulmonary function. Severe scoliosis can also cause spinal cord and nerve compression resulting in neurological dysfunction and even paralysis. In adulthood, scoliosis patients have earlier and more severe spinal degeneration than normal people, resulting in spinal stenosis and causing pain, nerve and spinal cord compression. In addition, the curvature of the spine leads to bilateral muscle imbalance, and the muscles, ligaments, and soft tissues on both sides are under long-term asymmetric stress that can induce muscle fatigue and low back pain. Q: Why do children get scoliosis? A: Scoliosis can be caused by dozens of causes, about 80% of clinical idiopathic scoliosis, other congenital, neuromuscular scoliosis (such as cerebral palsy, etc.), neurofibromatosis combined with scoliosis, etc. Idiopathic scoliosis is a spinal deformity whose pathogenesis is unknown, and its pathogenesis is currently thought to be related to genetic factors, hormone secretion, growth asymmetry, abnormal connective tissue development, neuro-balance system dysfunction, and neuroendocrine system abnormalities. Q: What is congenital scoliosis? A: Congenital scoliosis is scoliosis caused by abnormal development of the vertebral body, which can be divided into three categories. (1) poor segmentation type, that is, the embryonic vertebrae occurred incomplete segmentation, the vertebrae are still partly connected, forming a bone bridge, because the connected parts are not epiphysis, can not develop, while the development of the opposite side of the epiphysis is normal, so the formation of wedge-shaped changes in the vertebral body, resulting in scoliosis; (2) poorly formed type, although the segmentation is complete, but the vertebral development is incomplete, the formation of hemivertebrae, such as a side hemivertebrae or wedge-shaped changes, can be formed Scoliosis, hemivertebral body can be single or multiple; (3) mixed type, the above two types exist at the same time, the deformity is more complex and diverse. In addition, laminectomy combined with scoliosis is also a special type of congenital scoliosis. Q: What is neuromuscular scoliosis? A: Neuromuscular scoliosis is a scoliosis caused by imbalance in muscle strength due to neurological and muscular disorders, especially asymmetry of the paraspinal muscles, the most common causes include post-polio, cerebral spastic paralysis, and progressive muscle atrophy. In these patients, because the muscle strength of the paraspinal muscles is weakened or lost, the patient often cannot sit steadily on his or her own and often needs to be supported by both hands next to a chair to sit steadily. Q: What non-surgical treatments are available for scoliosis? A: Early detection and treatment is the key. Early detection of patients can control the progression of scoliosis with many non-surgical treatments. Common non-surgical treatments include physical therapy, gymnastics, casts, braces, etc., but the primary and most reliable method is brace therapy. Generally, idiopathic scoliosis within 20 degrees can be left untreated and closely observed, and if it worsens more than 5 degrees per year, brace therapy should be performed. Scoliosis of 30 to 40 degrees should be treated immediately with bracing, because more than 60% of this group of patients will develop and worsen. scoliosis between 40 and 50 degrees is controversial, and the decision to use bracing or surgery should be based on the patient’s age, the maturity of the bones, the location of the scoliosis, the degree of rotation, and other factors. Q: What kind of scoliosis patients can be treated by bracing? A: Brace treatment is mainly used for: (1) mild scoliosis between 20 and 40 degrees, infantile and early juvenile idiopathic scoliosis, occasionally between 40 and 60 degrees can also be used brace; (2) early treatment with brace is appropriate for children with immature skeleton; (3) long segmental curvature, brace treatment effect is good, such as eight segments of 50 degrees scoliosis brace treatment effect is better than five segments of 50 degrees (4) Boston brace is most effective for scoliosis of the lumbar segment or thoracolumbar segment with good elasticity below 40 degrees. Q: What kind of scoliosis patients are not suitable for brace treatment? A: The following cases are generally not suitable for brace treatment: (1) adolescent scoliosis over 40 degrees is not suitable for brace treatment; (2) two structural bends to 50 degrees or a single bend over 45 degrees is not suitable for brace treatment; (3) scoliosis with combined thoracic anterior convexity is not suitable for brace treatment because the brace can aggravate the anterior convexity deformity and further reduce the anterior-posterior diameter of the thoracic cavity; (4) the patient and parents are not (4) Patients and parents who are not cooperative should not be treated with braces. Q: How long do I have to wear the brace every day? What are the precautions? A: The brace should be worn for at least 23 hours a day, with one hour reserved for bathing, gymnastics and other activities. If there is no contraindication, the brace should be used until the bones are mature. During the brace treatment, it is usually necessary to go to the hospital for a review at least half a year to observe the effect of the brace treatment. Orthopantomographs of the spine should be taken 24 hours after removal of the brace to reflect the true extent of scoliosis. Patients and family members should not discontinue brace treatment without authorization. Brace treatment must be performed under the guidance of an orthopedic surgeon. Q: Can corrective gymnastics treat scoliosis? A: The principle of the therapeutic effect of corrective gymnastics on scoliosis is to selectively strengthen the muscles of the spine that maintain posture. Through the convex side of the sacrospinous muscles, abdominal muscles, psoas major, lumbar square muscle, adjust the balance of muscle strength on both sides. The contracted muscles, ligaments and other soft tissues on the concave side are tractioned to achieve orthopedic goals. Corrective gymnastics has different effects on different stages of development and different types of scoliosis, especially for children or preadolescents with mild idiopathic scoliosis, good flexibility and no obvious structural changes, gymnastics therapy can achieve certain therapeutic effects. In the case of obvious structural changes and congenital scoliosis, it is difficult to correct the scoliosis by gymnastics alone, and it needs to be combined with other non-surgical treatments, especially brace treatments. Therefore, gymnastic therapy can be used as a necessary adjunctive therapy to prevent muscle atrophy and other disuse changes caused by braking. Q: When does scoliosis require surgical treatment? A: Surgery should be considered in the following cases: (1) scoliosis of more than 40-50 degrees; (2) scoliosis that cannot be controlled by brace treatment and is aggravated by more than 5 degrees per year; (3) adult scoliosis with significant pain or nerve compression symptoms. Q: What is the goal of scoliosis surgery? What kind of expectations can I have for the surgery? A: The goals of scoliosis surgery are: to prevent progression of the deformity; to restore spinal balance; to correct as much of the deformity as possible; to preserve as many mobile segments of the spine as possible; and to prevent nerve damage. The greatest expectation of the patient and family is usually an improvement in appearance, a flattened back, and no more bulging. Using current surgical techniques, the surgeon should be able to achieve this and most patients will be discharged more satisfactorily. But this is all done in a safe manner, while the spine surgeon considers deeper issues such as the patient’s overall balance, pelvic level, gait regulation, and prevention of nerve damage. Q: How much correction can be obtained through surgery for scoliosis? A: Scoliosis is generally not 100% corrected because surgery also takes into account the tolerance of the patient’s spine and spinal cord, and excessive correction can lead to nerve damage or even paralysis. The degree of correction of scoliosis varies by age, degree and etiology, and the correction rate for general idiopathic scoliosis can usually reach 60 to 80%. The degree of correction of scoliosis depends mainly on the flexibility of the scoliosis itself. The more flexible the scoliosis, the greater the degree of correction. There are various methods of predicting the degree of correction, and the common method is to take various special X-rays, such as hanging position films, supine convex bending position films, and pivot bending position films. By measuring the angles of these special x-rays, the surgeon estimates the expected orthopedic effect of the surgery. Q: Is scoliosis surgery very invasive? A: Scoliosis surgery is generally more traumatic, depending on the patient’s condition, the surgical plan, the type of internal fixation, and the surgeon’s experience and surgical skills. Although some surgical complications are impossible to avoid, a highly qualified and experienced spine surgeon should be able to prevent most of them and be aware of the few unavoidable ones, pay attention to prevention during surgery, observe closely after surgery, and take immediate and decisive measures to minimize the damage caused once they are detected. Q: How big will the incision be for scoliosis surgery? A: The surgical incision will vary depending on the choice of access and the length of the deformity involved. Scoliosis surgery can be divided into anterior and posterior approaches. The posterior surgical incision is usually a posterior median incision, the length of which is basically equal to the length of the scoliosis to be fused, and slightly longer than the length of the line connecting the upper and lower ends of the scoliosis. The anterior incision varies depending on the site. Nowadays, with the advancement of minimally invasive surgical techniques, the anterior orthopedic surgery can even be done through a few small 1 cm holes under the thoracoscope in suitable patients. Also with the use of intradermal suturing techniques, postoperative scarring is significantly improved compared to before. Q: Can I see or feel the implant through the skin after surgery? A: Due to the abundance of back muscles, the implant is not usually felt after posterior spinal orthopedic surgery, but in particularly thin patients, the implant may be palpable. With anterior surgery the implant is deep in and will not be felt or touched A: Low-aged patients are sometimes forced to fuse their spine due to their condition and will sacrifice some height, there is a set formula to calculate this, usually between 3-4 cm. Of course the more mature the development at the time of surgery, the less likely this loss of height will occur. It is also important to see that without surgery, scoliosis in patients with scoliosis will further worsen as the spine grows, rather than simply translating into an increase in height. Q: If the spine is partially fused, what will be the height difference compared to if it is not fused? A: The specific formula is as follows: Number of possible spinal growth = 0.07 cm × number of spinal segments fixed by surgery × growth period (years) For example, a girl is 9 years old with idiopathic scoliosis, T5 to T11 need to be fused, calculated on the basis that the spine basically stops growing when a woman reaches maturity at age 16. This girl has a growth span of 7 years. Therefore, the spine within the scope of this surgery, calculated as normal should be able to continue to grow, can expect the number of growth: 0.07cm x 7 (sessions) x 6 (years) = 2.96cm. Q: What should be done to treat pain after surgery? A: Nowadays, there is advanced PCA technology (Patient Controlled Analgesia) in the anesthesiology department. Patients can control the use of painkillers by themselves according to the pain situation, and patients usually recover quickly after surgery under this technology, which greatly reduces the painful feeling after scoliosis surgery. Q: How soon after surgery can I get up and walk on the floor? A: Scoliosis patients 2 to 3 days after surgery, the drainage tube is removed, the condition is stable, you can practice sitting up, and then stand, after both lower limbs are strong, no dizziness, weakness and other abnormalities, generally 3 to 5 days, you can practice walking under the protection of the support. Q: How long can I drink and eat after surgery? A: Scoliosis orthopedic surgery usually has no effect on diet. It is usually required to drink and eat only after the anesthesia is fully awake, the nausea and vomiting reaction disappears, the anus is exhausted, and the bowel sounds are restored. Q: What types of surgery are available for scoliosis? A: In general, they can be divided into anterior surgery, posterior surgery, and combined anterior and posterior surgery. The choice of surgical approach is made by the spine surgeon after analysis of imaging data such as series of X-rays, MRI or CT, careful physical examination and other auxiliary examinations, according to the patient’s age, type of scoliosis, angle, and involvement of the site, as well as combining the surgeon’s own clinical experience and skill level. Q: When can I take a shower after surgery? A: You can take a shower after the wound heals, usually about 10 days after surgery. A shower is recommended, along with family protection to avoid falls. Q: How long after surgery can I go back to school? A: About one month after scoliosis orthopedic surgery, after satisfactory recovery of physical strength, you can return to school under the protection of a brace, but you need to follow the doctor’s instructions to protect yourself. Q: Do I need to remove the staples from my body later? A: If there is no foreign body rejection, broken nails, broken rods, infection and other special circumstances, generally do not need to remove the body nail rod. The implant serves as an orthotic and fixes the spine, but we also perform spinal fusion surgery, so the final maintenance of the orthotic requires the patient’s own spinal fusion. Q: Do I need any special diet after scoliosis surgery to help with recovery? A: There is generally no special diet required after scoliosis surgery unless a specific condition requires it. Q: Will my activities be limited after scoliosis surgery? A: Since scoliosis surgery involves the fusion of the scoliotic spine, the mobility of the spine is affected to varying degrees after scoliosis surgery, but the mobility of the human spine is mainly concentrated in the lumbar segment, especially the lower lumbar segment. The overall mobility of the spine is preserved to a large extent. Q: Can I still get pregnant if I have scoliosis surgery? A: Orthopedic spine surgery generally does not affect pregnancy unless there are reproductive complications. On the contrary, some scoliosis can affect pregnancy due to trunk collapse and reduction in pelvic and abdominal volume. Scoliosis orthopedic surgery can also improve trunk collapse and increase pelvic volume.