1.Q: What is scoliosis?
A: Not everyone’s spine is straight. Scoliosis, as the name implies, is the curvature of the spine to the side. Normal people’s spine is straight from the front, because people are symmetrical left and right, while the spine of scoliosis patients from the front is in the shape of the letter “C” or “S” shape.
2, Q: What is the performance of scoliosis?
A: Scoliosis is divided into scoliosis of the thoracic spine and scoliosis of the lumbar spine. In appearance, scoliosis of the thoracic spine can be manifested as unequal shoulders, bilateral asymmetry of the thorax, elevation of the scapula on one side and depression on the other. Lumbar scoliosis tends to manifest as fullness of the lumbar muscles on one side and emptiness on the other, and in severe cases of lumbar scoliosis there may also be unequal height of both shoulders. Scoliosis usually only affects the appearance and does not cause symptoms. Some patients think their back pain or back pain is caused by scoliosis, but in fact, back pain and scoliosis are not very related, and people with a non-curved spine often have this symptom. Low back pain is a common symptom, mostly due to low back muscle strain, which can usually be relieved by rest, massage and topical medication.
3, Q: What is neuromuscular scoliosis?
A: Neuromuscular scoliosis refers to the imbalance of muscle strength due to neurological and muscular diseases, especially the scoliosis caused by asymmetry of the paraspinal muscles, the most common causes include post-polio, cerebral spastic paralysis, progressive muscle atrophy, etc. This type of patients due to the muscle strength of the paraspinal muscles weakened or disappeared, the patient often can not sit on their own, often need to support the hands on the side of the chair in order to sit firmly.
4.Q: What are the dangers of scoliosis?
A: Mild to moderate scoliosis does not affect internal organ function or other bodily functions. Only severe scoliosis, generally at least more than 60 degrees, can lead to a significant reduction in the space between the thoracic and abdominal cavities, resulting in cardiopulmonary and gastrointestinal stress and corresponding dysfunction. Cardiopulmonary dysfunction is defined as a decrease in activity tolerance, such as panting and rapid heartbeat after walking for a short distance, or not being able to walk up two or three flights of stairs without taking a break to continue climbing. Reduced abdominal space can lead to a decrease in meal size and, in severe cases, can affect pregnancy.
5.Q: Will scoliosis develop in adulthood?
A: After adulthood, scoliosis over 40 degrees will also develop slowly, at an average rate of 1 degree per year. And at two ages will be significantly aggravated: one is 1-2 years after childbirth: scoliosis does not generally affect pregnancy and childbirth, but pregnancy and childbirth will make scoliosis aggravated, because during pregnancy there will be ligamentous laxity, in addition to childbirth often hold the child resulting in a significant increase in spinal load, both factors often lead to significant progress in the degree of scoliosis; second is the age of 60 years after the osteoporosis period, osteoporosis can weaken the spine The strength of the original scoliosis will be increasingly curved under the action of gravity. Therefore, scoliosis patients in these two stages to consciously take measures, that is, after childbirth as little as possible to hold the child, after the age of 50 years began to supplement calcium, after the age of 60 years actively supplement calcium.
6, Q: how is the degree of scoliosis measured out?
A: The degree of scoliosis is measured by taking X-rays. X-rays usually require a full-length X-ray of the spine and are taken in a standing position. The reading is measured on the film after it is taken. The degrees of thoracic and lumbar curvature are measured separately, resulting in two degrees, one for the thoracic curvature and the other for the lumbar curvature, with the largest degree generally representing the severity of the condition.
Scoliosis causes complex factors girls are particularly susceptible to
7, Q: Why do you get scoliosis?
A: There are many causes of scoliosis, which can be broadly divided into congenital and acquired. Congenital refers to the abnormal development of the spine before birth in the fetal stage. The critical period of spinal development during the embryonic period is the fifth and sixth weeks of gestation, which is the time when the spinal column is segmented. If the fetus is exposed to drugs, viruses, physical and chemical factors during this period, it is prone to spinal developmental abnormalities.
Acquired scoliosis tends to occur in adolescence, mostly after the age of 10. The causes of scoliosis in adolescents are not known, but in general it does not occur simply because of improper sitting and sleeping posture or the wrong way of carrying a school bag. Rather, there are more intrinsic causes, related to developmental abnormalities, neuromuscular imbalances, endocrine disorders, or impaired homeostatic regulation. There is no way to predict who will develop adolescent scoliosis and who will not.
8, Q: Is scoliosis hereditary?
A: Although some patients have a family history of scoliosis, the vast majority of patients do not inherit scoliosis to the next generation.
9, Q: Is the incidence of scoliosis high?
A: The incidence of scoliosis is actually not low, the incidence rate of about 3%, that is, three out of every hundred people have the disease. What is this concept? That is, if you go out on the street and see two hundred people, then six of those two hundred people have scoliosis; or your child’s grade has three hundred people, if they all go to the film screening, you can find almost ten scoliosis. But why do we all feel that we rarely see people with scoliosis? This is because although the prevalence of scoliosis is not low, as high as 3%, the vast majority of cases are mild. Scoliosis generally has to be more than 30 degrees to be visible when wearing tight clothing, and it generally has to be more than 40 degrees to be visible when wearing less tight clothing. And the incidence of scoliosis above 40 degrees is much lower, about three per 1,000.
10, Q: Is there a difference in the incidence of scoliosis between men and women?
A: Congenital scoliosis is more common in boys, the ratio of men to women is about 4:1. And acquired scoliosis, that is, adolescent idiopathic scoliosis, girls are significantly more than boys, especially in patients with a curvature of more than 40 degrees, girls account for more than 90%.
11, Q: Why is the incidence of girls so higher?
A: The cause of its onset is not particularly clear, and we are still studying the problem, but it is true that there is such a phenomenon, a high incidence of girls, which shows that genes have a role in the development of idiopathic scoliosis.
Surgery is not considered for scoliosis of 40 degrees or less.
12.Q: What should parents do if they find that their child’s spine is not straight?
A: Parents should be alert to the possibility of scoliosis if they find that their child has asymmetry of the shoulders or low back. You should take your child to the hospital to take an X-ray of the spine to clarify whether there is scoliosis. If there is scoliosis, you should ask the doctor to measure the angle.
13.Q: If the scoliosis is really scoliosis, how should I treat it?
A: Generally speaking, within 20 degrees of scoliosis only need to exercise and regular X-ray observation; 20-40 degrees of scoliosis need to exercise plus brace treatment; and if more than 40 degrees will need to consider surgery to correct.
14, Q: I heard that some hospitals do massage traction and other conservative treatment, the efficacy is reliable?
A: Scoliosis correction is not recommended to try yoga, massage, traction or herbal treatment. These are no scientific basis. Thousands of years ago in Greek medical books can be seen in the traction bed orthopedic beds and other methods of treatment of scoliosis, but after thousands of years of verification, these simple treatment concepts have been proven ineffective and eliminated. In recent years, a large number of patients have also tried and proved ineffective, and currently all public tertiary hospitals in China do not do this treatment for this reason. Only some private small and medium-sized hospitals still do these treatments, but often for commercial purposes and with very limited results. Some small hospitals in Beijing, for example, do conservative treatments for scoliosis, which have been proven to be fraudulent. Some hospitals claim to have more than twenty patents, but they are also false propaganda. They even show foreign patients on the Internet, but in fact they are just a few foreigners posing for pictures. I hope that patients and parents who have the ability to discriminate will not be fooled again.
15.Q: Do you not need brace treatment within 20 degrees?
A: The correction effect of the brace is proportional to the degree of scoliosis, the greater the degree of brace, the greater the correction space. If the degree of scoliosis is less than 20 degrees, the corrective effect of brace is limited and may restrict the development of the child’s thorax, so it is better to wait until the degree exceeds 20 degrees before considering brace treatment.
16.Q: If I don’t wear a brace but just take pictures regularly, how often should I take pictures?
A: If the child is at the peak of development, that is, 10-13 years old, it should be taken every 3 months, and after 13 years old, it can be taken every 6 months.
17.Q: If the degree is 20-40 degrees, what is the brace treatment?
A: Brace treatment must be tailored by a professional technician, do not simply buy a back brace, back brace is to correct habitual hunchback, it is useless for real scoliosis. The brace must be worn 20-22 hours a day, including sleep, only when bathing, sports can not wear. As the child grows in height, the brace needs to be replaced once a year. Girls should generally wear the brace at least until 2 years after menstruation.
18.Q: What are the precautions for brace treatment?
A: After the brace is done, we should take a film to see the effect of brace correction, and we should take a film after wearing it for 1 hour, at this time the effect is the effect of brace correction, and we can also feel whether the brace is suitable, if we feel uncomfortable, we can let the technician adjust it. In the past, some patients reflected that they wore the brace after doing it in other hospitals and did not take the film to see the effect. This situation is very unwarranted, imagine if the brace does not work well or does not work at all, then wearing the brace for a year is not a waste of time, but makes the child suffer a lot.
If you take a review every other year, you need to take off the brace 4 hours in advance so that it can truly reflect the current prescription. Because the prescription will rebound after taking off the brace, but the rebound is different for each person, we need to see the real prescription after the rebound.
19.Q: If the degree is 20-40 degrees, what does the exercise therapy include?
A: Exercise mainly includes lateral bending, swallow flying and swimming. Lateral bending, suitable for the “C” shape (single bend) scoliosis, if the “S” shape is not recommended (“S” shape refers to both the chest bend and lumbar bend). Bend in the opposite direction of spinal curvature to counteract scoliosis. 50-100 per day, in 2-3 sets to complete. Swallow fly, can exercise the back muscles, increase soft tissue balance, 50-100 per day, in 2-3 groups to complete. As for swimming, freestyle and breaststroke are both available. 600-1000 meters per day.
Some people also recommend hanging a bar, but it is more difficult to adhere to, the girl itself is small strength, can not do a few groups per day, the effect is difficult to guarantee.
How does corrective surgery treat scoliosis?
20.Q: What types of corrective surgery for scoliosis are there?
A: We often refer to corrective surgery as corrective fusion surgery. Corrective fusion surgery is the placement of a metal nail bar stent in the body, which straightens and maintains the curved spine and is equivalent to a metal brace placed in the body. It is not enough to rely on the stent alone to maintain the spine, but the surgery is accompanied by bone grafting, which is the placement of granular bone on the dorsal side of the spine, which will hold the spine in place after it heals, just like welding the spine. So, in fact, the metal brace loses its role in supporting the spine about six months after surgery, and the maintenance of spinal curvature then depends mainly on the fused granular bone.
In addition to corrective fusion surgery, there are some special types of scoliosis surgery, including hemivertebrectomy, growth bars and minimally invasive navigation surgery.
21.Q: What does hemivertebrectomy mean?
A: Hemivertebrae means half of a vertebra. It is the most common form of congenital scoliosis. Normal vertebrae are symmetrical on the left and right, while hemivertebrae are only on the left or right, while the other side is not grown. Our spine contains 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae, one falling on top of the other. If one of these sections is asymmetrical on the left or right side it will affect the overall shape. A hemivertebrectomy is the removal of this abnormal vertebra and then fixing it with a nail bar, and then removing the nail bar after 2-3 years to complete the treatment.
22Q: What does a growth rod mean?
A: Growth rods are used for early onset scoliosis, which is a significant scoliosis before the age of 10. Children before the age of 10 should not have corrective fusion surgery because once corrective fusion surgery is done, the length of the child’s torso is fixed, and the torso of the child at this age has growth potential until the age of 18. The ratio of the trunk to the lower extremities can also be out of proportion. To address this problem, doctors have developed the growth rod technique. This is a surgical procedure in which a metal stent is placed through three small incisions in the upper and middle of the body. This metal stent corrects scoliosis and allows for a minor surgery to lengthen it every year. This buys valuable time for the child to undergo the final corrective fusion surgery after the child is 12 years old, greatly improving the outcome.
23.Q: What about minimally invasive navigation surgery?
A: Minimally invasive navigation is a breakthrough achieved in recent years. It is based on the latest navigation equipment, combined with innovations in surgical techniques, and requires only three 5 cm incisions to complete a surgery that previously required a 40 cm incision, for acquired scoliosis of 90 degrees or less.
Previously, scoliosis orthopedics was considered a highly invasive and risky procedure. The advent of navigation devices has significantly changed this situation. First of all, traditional surgery is very invasive because the spine has to be clearly exposed before the screws can be placed, because traditional surgery relies on anatomical landmarks and the surgeon’s experience to place the screws. In contrast, navigation surgery does not have to rely on intraoperative CT for screw placement, which does not require direct visualization of the anatomical landmarks of the spine, thus greatly reducing the incision and the damage to the back muscles. In addition to the risks, spine surgery was previously considered high risk because of the dense neurovascularity near the spine. The advent of navigation devices has greatly increased the safety of surgery, as the screen of the navigation device shows exactly where the blood vessels are and where the nerves are, reducing the chances of injury to the vessels and nerves. Therefore, the application of navigation makes the scoliosis surgery less damaging and safer.
In addition, minimally invasive navigation can also correct cervical scoliosis because navigation can place the cervical arch nail, which was difficult to do before without navigation, so cervical scoliosis can also be corrected.
What patients know before scoliosis surgery
24.Q: How much correction of scoliosis can be obtained through surgery?
A: The degree of correction of scoliosis depends mainly on the flexibility of the scoliosis itself. The better the flexibility of the scoliosis, the greater the degree of correction. Usually the younger the flexibility, the better the correction, so the best age for scoliosis surgery is 13-15 years old. At this age, the flexibility of the spine is good, the correction effect is good, and the body is close to developmental maturity, comprehensive consideration of the most suitable for this age correction. Small age of mild to moderate scoliosis correction 80-90% are not a problem, severe scoliosis, very stiff scoliosis is more difficult, but the correction of 50% should not be a problem.
25.Q: The best age for scoliosis surgery is?
A: The best age for hemivertebrae is 3-5 years old, in other words, if the scoliosis is obvious at the age of 3 years old more than 40 degrees can be operated, if the degree is not too big at the age of 3 years old, such as only 10-20 degrees, then you can wait a few more years to 5-6 years old before surgery. In any case, you can receive surgery after the age of 3. The best age for surgery for adolescent idiopathic scoliosis is 13-16 years old, when the bones are close to maturity and still relatively soft, which is the best age for correction.
26.Q: Do I need any preparation before scoliosis surgery?
A: Current surgical techniques do not require special preparation before surgery, but of course, if you supplement nutrition for a period of time before surgery, physical exercise for a period of time, such as swimming, running or climbing stairs, these are beneficial for faster recovery after surgery. Patients with severe scoliosis will need to do lung capacity training under the guidance of a doctor.
27.Q: When do I need pre-surgical traction?
A: Generally speaking, severe scoliosis requires traction, severe means more than 100 degrees, and in addition to the scoliosis there is a backbone, and very stiff, the doctor feels that a correction risk is difficult to guarantee the effect of traction first. Traction is generally cephalopelvic ring traction. The disadvantage of traction is that it is time-consuming, often taking several months, and the patient suffers more. But the advantage is high safety and good final results.
28.Q: What is neuromonitoring?
A: Nerve monitoring can monitor nerve signals in real time, so that if there is a trend of nerve damage, it can be detected at the first time, and the surgical strategy can be changed early to avoid permanent nerve damage.
29.Q: Do I need blood transfusion for corrective fusion surgery?
A: Many hospitals currently have blood transfusion techniques and teams, and unless the scoliosis is on a hundred degrees orthopedic, there is generally no need to transfuse someone else’s blood.
30.Q: Imported spinal internal fixation materials and domestic materials, which is better?
A: This question is not too important, domestic Weigao is very suitable for scoliosis orthopedic, perfect tools, accessories are also complete, on the contrary, many imported brand screws do not have this advantage.
The details that patients are most concerned about after scoliosis surgery.
31.Q: How should I treat pain after surgery?
A: Now there is advanced PCA technology (Patient Controlled Analgesia) in the anesthesiology department. Patients can control the use of pain medication according to the pain situation, and patients usually return to normal soon after surgery under this technology, which greatly reduces the painful feeling after scoliosis surgery.
32.Q: How long after surgery can I drink and eat?
A: Scoliosis orthopedic surgery usually has no effect on diet. Generally, you can eat 6 hours after you are fully awake from anesthesia.
33.Q: How long can I get up after surgery and how long can I walk on the ground?
A: Generally 3-5 days after surgery can walk on the ground under the protection of braces, 7-10 days after surgery can be discharged from the hospital, when the discharge of basic self-care life, you can sit up to eat and go to the bathroom.
34.Q: When can I take a bath after surgery?
A: You can take a bath after the wound heals, usually about 10 days after surgery. It is recommended to take a shower and be protected by family members so as not to fall down.
35.Q: How long after surgery can go back to school or work?
A: About one month after scoliosis orthopedic surgery, after satisfactory recovery of physical strength, under the protection of braces, you can go to work and school.
36.Q: How long after the scoliosis surgery can be strenuous exercise?
A: Generally six months after surgery can be vigorous exercise. Because the granular bone has healed by this time, the spine is already very strong, and strenuous exercise will not have any effect.
37.Q: Can I bend my back after scoliosis surgery?
A: It depends on the scope of the surgery. If the surgery involves only the thoracic spine, there is almost no effect on bending. Because the normal human thoracic spine is also no mobility due to rib fixation, the thoracic spine is also no mobility after scoliosis surgery, and the same as normal people. If the surgery involves the lumbar spine, it will have a certain impact on the bending, but there will not be a situation where you can’t bend your back. Because people bend mainly by the hip joint, only a small part relies on the lumbar spine, so even if all five lumbar vertebrae are fixed, still able to bend the waist.
38.Q: Can I still get pregnant if I have scoliosis surgery?
A: Orthopedic spine surgery generally does not affect the patient’s ability to become pregnant. On the contrary, scoliosis surgery can also improve trunk collapse and increase pelvic volume, which is beneficial for pregnancy, so it is better to have scoliosis surgery first and then get pregnant.
39.Q: When will the wound stitches be removed?
A: At present, many hospitals use absorbable intradermal sutures, the wound surface is invisible sutures, and do not need to remove the stitches.
40.Q: How long do I need to wear the brace?
Generally, the brace can be worn for 3 months after the surgery, if there is no abnormality, you can stop wearing it.
41.Q: Do I need to take out the metal stent inserted after surgery?
A: Since the stent is made of titanium alloy and has no interaction with its own tissue, it does not produce any adverse reaction in the body and can therefore not be removed for life. Even if the stent is removed for some reasons, the corrected spine will not be bent again because of the removal of the stent, because the fused granular bone maintains the shape of the spine.
42.Q: How long after surgery do I have to return to the hospital for follow-up?
A: Generally, we will take a film once at 3 months, 1 year and 2 years after the surgery for the doctor to see. If it is inconvenient for patients from other provinces, you can send the films after taking them locally, or send them by WeChat or QQ.