Scoliosis prevention and treatment The weather is getting warmer, people’s clothes are getting thinner, and sometimes parents will find that their children are more convex on one side of the back or asymmetrical on both sides, which is likely to be an early manifestation of scoliosis. 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, and the original mild scoliosis aggravates faster during this period, so special attention should be paid to adolescents in this age group. Early scoliosis abnormalities are not obvious, especially when wearing clothes, so most adolescents with scoliosis are discovered by parents when their child takes a bath or wears fewer clothes. If you find that your child has the following signs, you should be alert to whether he or she has scoliosis: uneven neckline, one shoulder higher than the other; asymmetrical development of both breasts in girls, with the left breast often larger; bulging back on one side; folds on one side of the waist; one hip higher than the other; unequal length of the lower limbs on both sides. If you find any of these abnormalities in your child, you can do some simple checks yourself, 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. Professional doctors often examine patients with scoliosis, starting with a medical history and physical examination. Some medical histories are helpful in making a diagnosis, such as scoliosis in patients with neurofibromatosis, which is a genetic disorder, and congenital scoliosis, which is often associated with congenital heart disease, urinary malformations, and neurological pathology. In addition to routine cosmetic examination, neurological examination is essential to observe the presence of sensory and motor deficits. Sensory separation usually indicates the possibility of spinal cord hollowing. Abdominal wall reflexes and pathological reflexes examination are items that every scoliosis patient should check, and neglecting these examinations can sometimes have disastrous consequences. X-rays are taken for the following purposes: 1. to get a preliminary idea of the type of scoliosis, whether idiopathic, congenital or otherwise; 2. to measure the size of the scoliosis, currently measured by the Cobb’s angle, the larger the angle, the more severe the scoliosis; 3. to assess the balance and flexibility of the scoliosis; and 4. to provide an objective basis for comparison at follow-up. A formal radiograph is a full spine view in the standing position, both orthogonal and lateral, to understand the right and left curvature of the spine in the coronal position, the anteroposterior convexity in the sagittal position, and the axial rotation of the spine. a CT or MRI examination can help to understand the vertebral structure and the intraspinal canal. Sometimes parents find their children have scoliosis very nervous, and even overwhelmed, and often go around to doctors, there are calcium supplements, massage orthopedic, with brace undershirt, in short, heard what works, take the child to treatment, the results have little effect. So, what exactly should be done after having scoliosis? There are three main methods of treatment for scoliosis, namely 1. regular follow-up; 2. brace treatment; and 3. surgery. The most common clinical condition is idiopathic scoliosis, the so-called idiopathic, which means that the cause is not clear, which is different from the congenital scoliosis of vertebral deformity and neuromuscular scoliosis caused by neuromuscular lesions. For idiopathic scoliosis, Cobb’s angle within 25-30° usually does not require bracing and surgery, and is followed up every 3 or 6 months depending on age, with continued observation if the angle does not increase significantly, and bracing may be considered if the increase exceeds 5°. A brace is different from a brace in that it corrects scoliosis by applying support in the direction of the scoliosis. Once brace therapy is started, it should be worn 23 hours a day until skeletal maturity, usually 17-18 years for males and 15-16 years for females. If scoliosis is found to worsen during brace treatment, then surgery needs to be considered. Domestic surgical treatment of scoliosis began in 1976, and in 1982, Professor Wu Zhikang of the Department of Orthopedics at Peking Union Medical College Hospital took the lead in holding the first International Scoliosis Symposium in China, and the treatment of domestic scoliosis gradually entered a new era. The indications for surgical treatment are mainly scoliosis greater than 50° with trunk imbalance or unequal shoulders, and sometimes scoliosis with faster development with retrognathism or flat back and Cobb’s angle of 45° or more should also be considered for surgical treatment. Age is another important factor for the surgeon to consider. If the patient is younger than 12 years old, surgery is likely because of the high likelihood of scoliosis aggravation; if the patient is 15 or 16 years old and has good trunk balance, surgery may not be considered. The surgical approach can be posterior, anterior or combined anterior and posterior depending on the patient’s condition. What are the risks associated with scoliosis? In general, scoliosis occurs mostly in the thoracolumbar region, and pulmonary dysfunction may occur when the Cobb’s angle exceeds 60°. Most scoliosis above 90° has restrictive ventilation because of the severity of the chest deformity, and cardiac dysfunction may occur as the scoliosis worsens. Some patients with scoliosis have significant trunk deviation and unequal shoulders, which seriously affects aesthetics. Idiopathic scoliosis is generally unlikely to cause paralysis, but only when the Cobb’s angle exceeds 100°. Therefore, parents should ask more questions during the process of seeking medical treatment. What will happen without surgery? What will happen if surgery is performed? In the past 20 years, I have often met patients with scoliosis who had a Cobb’s angle of 30 degrees or so at the age of 15 or 16, but were told by other doctors that they should have surgery immediately, or they would be paralyzed and disabled, so the parents sold all their furniture and even their house to raise 30,000 to 40,000 yuan for the surgery, which also caused the child to be out of school for a year. The author believes that this approach is not desirable. In fact, the likelihood of scoliosis worsening in such patients is very small and does not require immediate surgery. 2003 National Orthopaedic Congress, a scholar asked: whether all scoliosis requires surgery? In fact, scoliosis is in most cases a benign lesion that develops slowly, and most can be treated with elective surgery when the child is on summer or winter break, and after four to six weeks of postoperative recovery, the child can continue to go to school and avoid delays in learning. So how risky is the surgery? Will having the surgery cause paralysis? These are usually the main concerns of parents. At the Peking Union Medical College Hospital, where I work, the likelihood of paralysis after scoliosis surgery is almost zero. The incidence of complications such as wound infection is only 0.5-1%. Some parents are too worried about the surgery and delay treatment, so that a scoliosis originally about 40° develops to more than 120 degrees, along with cardiopulmonary dysfunction. At this point, not only does the surgery become more difficult and risky, but the prognosis is also worse. Does scoliosis surgery bleed a lot and require a lot of blood transfusion? According to the author’s experience, the general bleeding during surgery for simple thoracic or lumbar curvature is about 100-400 ml, and most do not require blood transfusion. Blood transfusion can also be avoided by taking blood from the body before surgery and transfusing it back during surgery. Usually, patients with scoliosis can be discharged from the hospital within 3~4 days after surgery and within 1~2 weeks. With the current medical technology, most patients can do exercises such as swimming 4-6 weeks after surgery, jogging in 3 months, and non-contact confrontational sports activities in about a year. In conclusion, scoliosis surgery should be an effective and safe procedure for an experienced medical professional.