Primary scoliosis is a disease of unknown etiology but more prevalent in adolescents. Scoliosis occurs in adolescents aged 12-16 years, with an incidence of about 20/100,000 and a male-to-female ratio of about 1:8. 20% of patients are congenital, and the cause is unknown in 80% of affected adolescents.
Since the cause of the disease is unknown, it cannot be prevented and can only be detected early and corrected. If the disease is detected at a late stage, the skeleton is fixed and can only be corrected by surgery, and clinically about 1-2% of the patients belong to the late stage. Nationwide, about 10,000 or more young people with scoliosis need surgery each year.
How is scoliosis confirmed? The easiest initial check is to take off your shirt, unite your hands, and bend your head down 90 degrees to see if both shoulders are at the same level. children under 10 years old are checked once every six months, and children over 10 years old are checked once every three months, so that the majority of children with early lesions can be detected and the risk of late surgery can be avoided.
The goal of surgical treatment by surgeons is to correct scoliosis and restore the normal curvature of the spine while maintaining spinal balance, reducing the extent of surgical fusion of the spine, preserving as much function of the spine as possible, and preventing scoliosis from worsening. The outcome of the surgery is highly dependent on the timing of the patient’s visit. Early treatment can even completely correct the deformity and restore it to its normal shape. If treatment is late and more rigid, then good results cannot be obtained.
The best time for surgical treatment is usually between 5 and 18 years of age.
Idiopathic scoliosis is divided into 3 age groups: infants (0-3 years), adolescents (3-9 years), and young adults (10-18 years). Youthful idiopathic scoliosis is the most common, accounting for approximately 80% of idiopathic scoliosis. In late adolescent cases, the progression of curvature is related to the time of skeletal maturation. The outcome of treatment for idiopathic scoliosis depends on the age of the patient. Patients with scoliosis in infants and young children (0-3 years) most commonly have a convexity to the left, especially in boys. This convexity may be restored naturally with growth. Observation therapy requires repeated evaluation of the patient every 4-6 months. Treatment using bracing and surgical methods is generally not required at this age. Juvenile scoliosis (3-9 years) may progress more rapidly, especially in children older than 5 years, and may require bracing. If bracing does not control the curvature, it is recommended that surgical treatment be considered. Although surgery in significantly immature bones may produce some loss of spine height, a normally aligned spine height is preferable to a progressive curvature with height loss due to scoliosis. Juvenile scoliosis is the most common type of scoliosis, and progressive scoliosis is more prevalent in girls than in boys. Patients with scoliosis will have significantly altered pulmonary function at greater than 70 degrees of chest convexity.
The period of greatest risk for curvature progression in adolescent-type idiopathic scoliosis is during adolescence, the period of fastest growth. Treatment of adolescent idiopathic scoliosis depends on a number of factors, including the patient’s development, the size of the curvature, the location of the deformity, and the potential progression. Thoracic curvature is at greater risk of progression than thoracolumbar curvature or lumbar curvature. Treatment includes: observation, bracing, and surgery.
In patients with untreated or unsuccessful brace treatment for idiopathic scoliosis. Surgery is recommended when the scoliosis is greater than or equal to 45 degrees. Surgical treatment has two objectives, the primary one is to prevent the worsening of the spinal deformity and the secondary one is to reduce the degree of spinal deformity.
Adolescent idiopathic scoliosis (AIS) is defined as a structural scoliosis (Cobb’s angle >100 in the coronal plane, combined with rotation of the spine) in adolescents without other organic disease. With the further understanding of the natural course of adolescent idiopathic scoliosis and the development of material science, new treatments and therapeutic techniques have emerged, which can be generally divided into two categories: brace treatment and surgical treatment. patients with AIS can be divided into three categories: no treatment, brace treatment, and surgical treatment according to gender, age, symptoms, signs, and x-ray examination.
Patients who do not require treatment include.
(1) Adolescents with Cobb’s angle <250 and immature should be followed up every 4-6 months for dynamic observation; for patients over 18 years of age with mature development, follow-up is not required.
(2) Cobb angle of 250 to 300, if the Cobb angle increases >50 within six months, then brace treatment is required.
(3) Girls with Cobb angle of 250 to 450 need to be reviewed within one year.
Patients treated with braces.
(1) Cobb angle of 250 to 450 requires immediate application of brace treatment.
(2) Cobb angle 300 to 450, requiring application of brace therapy.
(3) Cobb angle 400-450, the effect of brace treatment is poor.
Patients treated surgically: If the Cobb angle is >450, then surgery is recommended.
The purpose of surgical treatment is to correct spinal deformity, reconstruct or maintain spinal balance. Aggressive surgical treatment is important to prevent the progression of scoliosis and to correct the deformity in the coronal and sagittal planes. However, if the trunk is well balanced, surgical treatment should be done with caution, otherwise it may lead to loss of spinal balance and instead cause significant cosmetic deformity.
Brace treatment The principle of brace treatment for scoliosis is to push the spine into a normal position by applying an external force to the deformed prominence through the internal padding of the brace. According to biomechanical theory, brace treatment reduces the load on the concave growth endplate of the vertebral body in the parietal region of scoliosis, and the growth stimulation in the concave region accelerates the reconstruction of the vertebral body structure. After treatment, scoliosis can be improved or stopped. According to the height of the corrected scoliosis, there are two types of braces: those with a cervical collar or neck brace and superstructure and those without a cervical collar up to the axillary height. In the process of treatment, attention should be paid to the correct position of the brace, and the brace should be changed in time for children with rapid growth and development.