What is scoliosis?
Scoliosis is a three-dimensional curvature of the spine. Depending on the cause, we distinguish between congenital scoliosis (associated with vertebral defects), neuromuscular scoliosis (occurring in patients with severe neurological defects, such as cerebral palsy or meningeal hernias), syndromic (e.g. in Marfan's syndrome) and idiopathic (curvature occurring in in otherwise healthy patients, the cause of which is unknown).
Make an appointment now - with a doctor specializing in the treatment of scoliosis at our hospital
[title]
[image-intro]
[readmore text="Read more"]{/article}
What are the causes of scoliosis?
Idiopathic scoliosis, as the name implies, does not have a clearly described cause. The genetic factor is definitely important, but it is not described in detail, we only know that there is a family predisposition to the development of scoliosis.
Environmental factors do not matter - true scoliosis cannot be generated through bad habits or carrying a heavy backpack to school, but it cannot be prevented even by the most hygienic lifestyle. If the spine is "programmed" to curve, it will curve.
Depending on the age when the first visible symptoms of scoliosis appear, we can distinguish early childhood (already in several years old children), childhood and adolescent scoliosis (in this case, clear symptoms appear during the growth spurt). The development of idiopathic scoliosis is a dynamic process, the rate of growth of deformities is called progression. This is a very important factor in assessing the entire disease process and qualification for treatment.
Types of scoliosis, their classification and proposed treatment
Scoliosis can also be classified according to the morphology (shape) of the curvature. Currently, Lenke's classification is widely used, which provides much information about the morphology of scoliosis and gives some guidelines for surgical treatment. The indications for treatment, however, depend primarily on the degree of exudation and the aforementioned progression. It is assumed that scoliosis is diagnosed when the lateral curvature exceeds 10 degrees according to Cobb, and the deformity of the spine is three-dimensional. Below this value, some people diagnose low-grade scoliosis, scoliotic postures, but this does not translate into reasonable indications for treatment. We usually observe patients with this degree of curvature, with a check every 6 months or a year. Some people propose rehabilitation treatment, but there are no data unambiguously confirming the effectiveness of rehabilitation in preventing the progression of scoliosis. When scoliosis progresses and exceeds 20 - 25 Cobb degrees, indications for corset treatment begin. He uses stiff corsets made of plastics - such as Cheneau, Boston or Milwaukee. The so-called dynamic corsets should rather not be used, as there are no objective data confirming their effectiveness. In corset treatment, of course, apart from the correct execution of the corset itself, the patient's cooperation is of key importance. The corset has to be worn approximately 20 hours a day and treatment often takes several years until skeletal maturity is reached. During the corset treatment, physical activity should not be abandoned, even regular sports training is recommended, and rehabilitation is also carried out as supportive treatment. The effectiveness of corset treatment is mainly assessed on the basis of data from a radiological examination. If scoliosis does not progress, we consider the corset treatment effective.
When the angle of curvature exceeds 40-50 degrees, the eligibility criteria for surgical treatment are met. The very selection of the operating method depends primarily on the age and weight of the patient. In children with a high growth potential, we use the so-called growing instrument, i.e. one that provides a satisfactory correction of the curvature while maintaining the possibility of growth.
In the youngest children, several years old, weighing less than 20 - 25 kg, we use instruments consisting of four rods mounted on screws or hooks, which are periodically moved apart. An undoubted drawback of the method is the necessity to anesthetize the patient each time for the lengthening procedure. An innovative solution in this regard are magnetic bars, which have been present on the market for several years, i.e. equipped with an electromagnet-driven motor that causes the bar to be extended. In principle, this method relieves the necessity of cyclic anesthesia, but the downside is the lack of the possibility of a significant remodeling of the bar, and the number of complications related to the loosening of the material is comparable.
In slightly older and larger children, self-growing instruments are used quite commonly, i.e. those that allow growth without the need to extend, using the possibility of "sliding" on the rod, and the base are transpedicular screws. This can be called a guided growth. This method has been used in Poland in several centers for 10 years. The procedure, in the absence of complications, ensures a longer period of calm during the growth period, but most often requires a final procedure, i.e. final rigid stabilization with provocation of bone union, i.e. spondylodesis. Then you can still improve the correction.
Briefly about surgical treatment
In patients qualified for surgery at the end or after the end of the growth period, the method of simultaneous curvature correction with spine stabilization and spondylodesis is used. As in most procedures, the base for stabilizing the spine are traspedicular screws - quite massive and long screws inserted into the vertebrae from the back, through the base of the vertebral arches, to the vertebral bodies. They form a very solid structure, but also allow for corrective maneuvers, such as correction of curvature or vertebral derotation - that is, correction of three-plane deformation.
Scoliosis correction surgery is a serious orthopedic procedure, one of the most extensive scheduled procedures. It requires very careful anaesthesiological supervision, the operation itself lasts 3-5 hours, requires blood supply, although there are procedures that can be performed without the need for transfusions. Currently, in order to improve safety, it is routine to observe the functioning of the nervous system during the entire surgical procedure (the so-called neuro-monitoring). After the operation, the patients are usually upright in the 2nd or 3rd day, and after a week they go home. Further improvement has a more individual course, it is ultimately believed that patients may be allowed to return to full activity (including sports) after a period sufficient to achieve bone union, i.e. 6 - 12 months.
If you want to see what are the possibilities of surgical treatment of scoliosis, click on the link below:
- EARLY CHILD SCOLIOSIS
- CHILD'S COLLOSISES
- IDIOPATHIC SCOLIOSIS OF ADMINIENTS
Author: lek. Med. Szymon Oleksik, spec. orthopedics
