Scoliosis is a serious problem especially in young patients. A normal, intended spine is in a straight line when viewed from the front or rear in an upright position. It also has physiological curves when viewed from the side. Scoliosis is the curvature of the spine in three different planes. The first plane is a curvature of the spine to the right or left when viewed from the front or rear. The second plane is when the anterior or posterior curvatures are higher than the normal physiological limits. The third plane is the rotational movement called rotation in the spine. When scoliosis is mentioned, the deformity of the spine in three different planes should come to mind.
It can appear in different ways at different ages. It is a curvature that can be seen at any age from birth to death. Congenital scoliosis are congenital/congenital scoliosis. It occurs when a part of the spine is formed and a part is not formed during the developmental process of the spine. Sometimes half of this spinal bone is formed. Sometimes the two bones may overlap and fuse unilaterally. Sometimes, an excess bone emerges and creates curvatures above and below the spine.
Congenital curvatures are a very serious problem. In the developmental process of the child, until puberty, and even until the completion of height growth, a serious curvature picture emerges. Especially at an early age, it can cause serious problems in heart and lung problems.
The more common curvature is a type of curvature that starts at the age of two or three and continues until puberty. The most important one is a curvature of adolescence, called adolescent idiopathic scoliosis, of unknown cause. Among these three groups, it is the most common adolescent idiopathic scoliosis. There is also a curvature called degenerative scoliosis seen in adulthood, which occurs with the deterioration of small joints in the spine and continues with nerve compressions.
Could there be other underlying factors in the adolescence period scoliosis that occurs in the third group, that is, in later ages?
Adolescent scoliosis is 6-8 times more common in girls than boys. Growth failure occurs in one part of the spine due to many reasons. This is because a stimulus is transmitted from a region in our brain. This warning has consequences, but it has not yet been determined what kind of warning it is. As a result, the spine is somewhat curved and the main curvature zone is formed.
A secondary curvature table emerges in order to balance the region above and below. Causes can be genetic or hormonal. Hormonal changes during the rapid growth period, called the peak period one year before puberty, were also considered as the cause. But there is no definite reason. Research continues. I personally believe that scoliosis occurs due to a problem that arises from children’s subconscious emotions.
There are simple techniques that every family can do. Most parents realize the signs of scoliosis too late. In the curvature of the back, the ribs create a camel hump on the back due to the movement called rotation. Parents can see this protrusion on the backs of children more easily while changing their clothes or taking a bath.
It is much more difficult to detect curvatures in the waist area, especially if the child is overweight. For children, the line on the back should be in a straight line with the child in the forward leaning position of 60 degrees. Parents should feel the bony prominences with one hand while the child is bent. If the bone protrusions here are on a straight line, there is no problem. This check also applies to teachers at school. Because this can be detected earlier, especially in children who do sports.
The most important data in clinical diagnosis is the formation of imbalance in the shoulders. The second is that one of the pelvis bones, which we call the pelvis, is above and the other is below. Another is that the hips are on one side and the torso is on the other. In addition, the appearance of the camel hump on the back is the main clinical finding. The definitive diagnosis will be taken standing in the normal position; It is seen with a complete spine film that will include the neck region, back region, lumbar region and pelvis from the front and back.
Otherwise, x-rays showing only the back and sometimes the lumbar region may cause a misdiagnosis. As you can see on the X-ray, your case has scoliosis. What kind of treatment options are available according to the degree of spinal curvature and the region or type of it.
What is the place of surgery in these treatment options and in which cases do you recommend surgery?
Children with scoliosis are actually healthy children; There is only a problem in terms of posture and appearance. This problem also seriously disturbs them psychologically. The age of the child is very important in the treatment of scoliosis.
If the child has congenital scoliosis or at the beginning of adolescence, that is, if the signs of puberty have not yet appeared, this curvature may progress. Because this curvature is directly proportional to the increase in height. The earlier it can be diagnosed, the more important it is.
The approach to children with congenital scoliosis is different, and it is different to scoliosis in adolescence. While there are non-surgical treatment methods in one, surgery is in the foreground in the other. Especially in congenital corsets, sports or exercise will not help.
Parents should know that children with congenital scoliosis can be operated at any age. They should not wait for their spines to grow and waste their children’s futures. Unfortunately, these children cannot be operated in the future and many die from heart and lung problems at an early age. In children with congenital scoliosis, freezing operations are performed according to the age and size of the child’s body. The fast-growing part of the spine is sometimes slowed down.
The growth of the other side is slightly accelerated, or if there is excess bone, it is removed. Small implants suitable for him or suitable for the size of the child are placed. As age progresses, it becomes more difficult to control congenital scoliosis. However, children can have surgery at any age, and the most important thing is in the treatment method of child and adolescence scoliosis and pre-adolescent non-congenital scoliosis, if the angular measurement is above 20 degrees after the angular measurements are made and the pre-specified x-ray is taken, the corset is applied. The corset usually works according to the three-point principle. It straightens the spine by applying a force from the curved apex of the spine to one side, the opposite side and the lower side. The child should wear the corset for an average of 22-23 hours. Since it is a difficult process, not every child can use the corset. The corset is only useful for certain curvatures.
Swimming or exercises also contribute to posture by providing muscle balance. It is of great benefit in curvatures of 20 degrees and 30 degrees, that is, in the initial period. But he should not think that the child will be completely recovered both in the corset and in sports or exercises.
These should be followed for a period of 6 months to 1 year. Pilates exercises and swimming are very important in exercise in terms of providing muscle balance. If this degree progresses in the follow-ups; For example, if the back area is above 45 degrees and the waist region is above 35-40 degrees, it should be surgically corrected immediately. Parents should not forget that it should be followed strictly.
First of all, surgical treatment should not be feared. If surgery is really necessary, the problems they will encounter will be much more troublesome if they do not have surgery. In surgical treatment, the curvature of the spine is corrected with screws and rods. The screw is sent into the bone and the rod and biomechanics are provided with certain maneuvers. These surgeries are satisfying surgeries; It also affects the psychology of children positively. The important thing here is to perform the operation properly, follow the technique and performed by an experienced person.
The methods applied in Turkey are in many respects better than the methods applied in America and Europe. These children are able to stand up and walk the next day after an operation of approximately 3-3 and a half hours, and they can start swimming after a month.
Usually, children are operated on when school breaks, especially during the semester break. They can go to school three or four weeks after surgery. In classical curves, all kinds of exercises are allowed after the third or fourth month. A little more care is taken in abnormal degrees and neglected curvatures. As a result, when the scoliosis of these children improves, their psychology also improves. They gain self-confidence and their outlook on life becomes much different.