How to treat scoliosis

Abstract: What’s going on with scoliosis? The human spine has its normal and comfortable angle. When the spine is compressed, it will cause the vertebrae to shift. When the angle of movement is too large, it will compress the nerves, causing soreness, numbness and pain. This condition is scoliosis. In the following article, let’s learn about the dangers of scoliosis and how to correct it. What's going on with scoliosis? What's the danger of scoliosis? How to treat scoliosis

What's the danger of scoliosis? How to treat scoliosis

1. What is scoliosis?

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The spine, as the central axis of the human body, plays an important role in protecting the spinal cord, carrying the weight of the upper body, and maintaining human activity. The normal spine is a straight line in the front-to-back position, and takes an S-shape when viewed from the side due to the physiological curvature of the cervical, thoracic and lumbar vertebrae.

Scoliosis means that when viewed from the front, the spine curves to the left or right, deviating from the midline. Since the human spine is a three-dimensional structure, from a three-dimensional perspective, scoliosis will be accompanied by the rotation of the spinal structure, which is a three-dimensional spinal deformity.

2. At what angle does scoliosis need to be called scoliosis?

There is an international society that specializes in the study of scoliosis, called the Scoliosis Research Society (SRS), which regulates the angle of scoliosis. That is, on the full-length X-ray of the spine taken in the standing position and in the anteroposterior (anterior) position, the spine surgeon measures the angle of the scoliosis (Cobb angle). Scoliosis is defined only when the angle is greater than 10 degrees.

3. What types of scoliosis include?

Generally, scoliosis is divided into congenital (abnormality of the spine at birth), idiopathic (unknown cause) and secondary (scoliosis caused by other diseases, such as cerebral palsy, There are three types of scoliosis (neuromuscular type, etc.), and there is also a type of degenerative scoliosis based on spinal degeneration.

4. What other diseases may be associated with scoliosis?

Scoliosis is sometimes associated with other diseases, including Down syndrome (flabby, hypotonia), Willi syndrome, osteogenesis imperfecta (porcelain doll), and Marfan syndrome (Genetic connective tissue disease, combined with cardiac malformation), etc. In this case, scoliosis is called syndromic scoliosis. These are diseases that really need attention.

5. Which type of scoliosis is the most common?

Among the various types of scoliosis, idiopathic scoliosis is the most common, accounting for 65%. Congenital scoliosis accounts for 15%, and secondary scoliosis accounts for 10%.

6. What is idiopathic scoliosis?

It is called idiopathic scoliosis because there is currently no definite cause. It is currently believed that idiopathic scoliosis is caused by multiple factors, and genetic factors cannot be ignored. Currently known single nucleotide polymorphism genes (that is, genetic material variations) include CHD7, MATN1 (a cartilage matrix protein) .

7. What is the cause of congenital scoliosis?

Congenital scoliosis is a congenital malformation of the spine that occurs between the 3rd and 6th weeks of embryonic life. It can be failure of spine formation, incomplete segmentation (segments of the spine are not completely separated), or a combination of both, leading to structural abnormalities of the vertebral body, such as hemivertebral bodies and fused vertebrae, resulting in lateral curvature deformity of the spine.

8. What are the causes of secondary scoliosis?

Secondary scoliosis usually results from neurological or muscular pathology, which causes the spine to lose the support of muscle groups, resulting in a curvature on the side. Common causes include muscular dystrophy, spinal muscular atrophy, poliomyelitis (poliomyelitis), cerebral palsy, myotonia, etc. In addition to the above reasons, compensatory scoliosis caused by intervertebral disc herniation and painful stimulation are also common clinically.

9. What is the cause of degenerative scoliosis?

As the name suggests, degenerative scoliosis originates from the degeneration of the spine (especially the lumbar spine), mainly the degeneration of the intervertebral discs and articular processes, causing lateral and three-dimensional deformities of the spine. More common in older people. Recent studies show that more than 60% of people over 60 years old have scoliosis. The incidence of scoliosis increases with age. With the aging of the population and concerns about health, degenerative scoliosis has become a prominent medical problem.

10. Why should we pay attention to the early detection of scoliosis?

In adolescence, children are in the period of puberty and development, which is also the stage when scoliosis is most likely to progress and worsen. Parents should pay special attention to it. Try to provide early diagnosis and treatment before this happens to avoid serious deformity exceeding 45 degrees and requiring surgical treatment.

11. What are the dangers caused by scoliosis?

Scoliosis not only brings cosmetic problems, but more importantly, the normal physiological structure of the spine changes after scoliosis, which on the one hand causes the intervertebral disc to easily degenerate and cause back pain or low back pain. On the other hand, severe scoliosis affects the thorax and has the potential to affect lung respiratory function and heart function, thereby affecting the patient's study, life and work. Therefore, scoliosis should attract sufficient attention from parents and patients.

12. What is adolescent idiopathic scoliosis?

Idiopathic scoliosis is classified according to different ages and can be divided into infantile type (0 to 3 years old) , children's type (4 to 10 years old), adolescent type and adult type (over 18 years old).

Among them, adolescent idiopathic scoliosis is the most common and refers to scoliosis in adolescents aged 11 to 18 years.

13. What is the incidence of adolescent idiopathic scoliosis?

Adolescent idiopathic scoliosis affects 1% to 2% of adolescents. The age group usually affected is between 10 and 15 years old.

14. What are the characteristics of adolescent idiopathic scoliosis?

Adolescent idiopathic scoliosis has the following characteristics: girls outnumber boys, with a ratio of 10:1; the most common type is a right-sided curvature of the thoracic spine.

15. What are the clinical manifestations of adolescent idiopathic scoliosis?

Clinical manifestations include: uneven shoulders, asymmetric folds of the skin on both sides of the waist after taking off clothes, bulging of the chest, typical scoliosis with a "razor back", high back on one side when bending over, One side is low.

16. How should scoliosis be diagnosed?

The diagnosis of scoliosis is made by an experienced spine surgeon. A firm diagnosis is made based on medical history, detailed physical examination, and necessary imaging studies. During the physical examination, it includes whether the patient's gait is normal, whether the shoulders appear to be flat, whether there is hair, pigmentation, or masses on the back (except for spina bifida), whether there are creamy café-au-lait spots on the skin, and whether the feet are inverted or high. For deformities such as cavus foot, a physical examination of the nervous system is also very important. The abdominal wall reflex is more sensitive to possible abnormalities in the nervous system. An important and commonly used physical examination for scoliosis is the Adams forward flexion test, which asks the child to bend forward to see if the back on both sides is symmetrical. Typical scoliosis causes "razor back". If so, scoliosis is a possibility and imaging should be performed.

17. What are the commonly used imaging tests for scoliosis?

For patients with suspected scoliosis, standing spine full-length anteroposterior and lateral X-rays are standard imaging methods. Through this examination, the following conditions can be clarified:

(1) Whether scoliosis exists

(2) Whether scoliosis is congenital or idiopathic

(3) The degree of scoliosis

(4) Whether there is kyphosis

(5) The maturity of the skeleton, that is, the possibility of future progression of scoliosis sex.

18. What is the significance of CT and MRI in the diagnosis and treatment of scoliosis?

The development of modern imaging technology has greatly promoted the diagnosis and treatment of diseases. CT, especially three-dimensional CT reconstruction, can restore the three-dimensional deformity of scoliosis and provides good preoperative evaluation data for scoliosis surgery. MRI can accurately evaluate spinal cord abnormalities associated with scoliosis, such as tethered cord and diastematomyelia, which are often associated with congenital scoliosis (the latter two will lead to more spinal cord dysfunction and various symptoms). It is worth noting that idiopathic scoliosis is rarely associated with spinal cord abnormalities, and MRI examination is generally not required.

19. When examining scoliosis, why should we judge the maturity of the skeleton?

This issue is of great concern to parents: many parents care about how tall their children can grow. By judging the maturity of the bones, you can know whether you can continue to grow taller. Skeletal maturity is usually determined by the degree of ossification of the pelvis, the so-called Risser sign. X-rays of the pelvis are taken and judged by a professional physician.

20. How should parents detect scoliosis early?

Parents can detect their child's spinal condition early from the following aspects:

(1) After the child is born, pay attention to whether there are brown spots on the child's body, which are medically called cream coffee. If there are spots, you should go to the hospital for further examination to see if you have neurofibromatosis, so that early detection, early diagnosis and treatment can be achieved;

(2) Pay attention to whether there is hair and pigmentation in the child's lumbosacral area, and whether there are cysts If there is a block, it is best to go to the hospital for further examination to exclude meningocele and spina bifida;

(3) During the birth and growth of the child, especially after the child can stand and walk, parents can Pay attention to whether the child's spine is straight. The method is very simple. Use your fingers to gently follow the protruding bone (spinous process) in the middle of the spine at the back of the neck, and touch the entire spine down to the lumbar spine to see if it deviates from the midline. Scoliosis discovered in infants and young children is mostly congenital scoliosis, with spinal deformities such as hemivertebral bodies, which require early diagnosis and treatment.

(4) When the child is standing, check whether the shoulders are the same height from the front, whether the shoulder blades on both sides are the same height from the back, and whether the wrinkles and wrinkles on the waist are symmetrical. If any of the above three situations occurs, it is recommended to go to the hospital for further treatment.

(5) Let the child bend forward to see if the back on both sides is symmetrical. Typical scoliosis results in a "razor back", with one side high and one side low. This condition confirms the presence of scoliosis.

(6) Observe whether the child’s chest (front and back) development is symmetrical. Scoliosis of the thoracic spine is often accompanied by rib abnormalities.

(7) Scoliosis is more common in girls (girls have a growth and development peak before bone maturity, that is, before and after menarche). The most common one is the right curvature of the thoracic spine. Parents should pay attention to it.

21. What are the treatment principles for adolescent scoliosis?

The specific treatment method for adolescent scoliosis must be comprehensively judged by a spine surgeon based on the severity of the scoliosis, flexibility, and skeletal maturity (which indicates whether the scoliosis will continue to worsen).

Parents should be aware that the primary treatment is to prevent further worsening of the scoliosis.

22. How should mild adolescent scoliosis be treated?

For mild adolescent scoliosis (the scoliosis angle is less than 30 degrees), just observe and perform back muscle exercises at the same time, that is, prone position, with the head and feet raised at the same time (swallow flying); both shoulders and the upper limbs alternately extend backward; the hip joints and lower limbs alternately extend backward. However, you should go to the hospital for regular check-ups to monitor whether the scoliosis becomes serious. Scoliosis below 30 degrees has a low risk of worsening and other health problems in adulthood.

23. How should moderate adolescent scoliosis be treated?

For moderate adolescent scoliosis (with a scoliosis between 30 degrees and 45 degrees), brace treatment is generally recommended.

24. What braces are commonly used to treat adolescent idiopathic scoliosis?

For adolescent idiopathic scoliosis, the most commonly used brace is the thoraco-lumbar-sacral brace, also known as the Boston brace, which looks like a corset and stretches from the armpit to the hip joint. It is made of Fiberglass or plastic, works by putting pressure on the side bends. Another commonly used brace is the Milwaukee brace, which is fixed from the cervical spine to the hip joint. It is generally used for upper thoracic scoliosis, or scoliosis that exceeds the correction range of the Boston brace. Generally, the brace is required to be worn for 20-23 hours (ideal conditions). Braces generally need to be customized. In terms of material, braces are generally divided into two types: hard and soft. Hard braces are made of fiberglass, and soft braces are made of plastic.

25. How effective is the brace in treating scoliosis?

Parents need to note that the effectiveness of brace treatment depends largely on the teenager’s wearing compliance (whether they wear it as prescribed by the doctor). Weared for 10 or 14 hours a day, the brace can substantially reduce a child's risk of surgery, allowing 1 in 3 to avoid surgery. Others with high compliance do not benefit from brace treatment because they will not progress to surgery even if they do not use braces. It should be noted that the brace must be worn for more than 10 hours a day to be effective.

26. How should severe adolescent scoliosis be treated?

In the past, it was believed that severe adolescent scoliosis (with a scoliosis of more than 45 degrees) was almost certain to worsen in adulthood and cause other health problems (affecting cardiopulmonary function) due to the severity of the deformity, so surgery was generally recommended. . However, scholars from the Department of Orthopedics at the University of Iowa in the United States followed patients with adolescent idiopathic scoliosis for 51 years. The patients lived happily without treatment. Some scholars currently believe that there is no increased risk of mortality for adolescent idiopathic scoliosis patients with non-severe thoracic curvature. Patients with severe scoliosis, whose chest curve is greater than 80°, may eventually develop shortness of breath or other lung problems. Moderate to large curves (above 45°) progress slowly.

27. Are braces effective for severe scoliosis?

For parents who do not want surgery, they can also try using braces. A recent review study showed that braces improved 71% of patients with curves above 45 degrees. The latest prospective research shows that braces are effective in treating idiopathic scoliosis above 45 degrees. Effective treatment here refers to the use of braces to prevent the patient's scoliosis from developing to the point of requiring surgical treatment when the patient's bones mature. Conservative treatment with braces and appropriate exercises can be used as an alternative treatment for patients with idiopathic scoliosis above 45 degrees who refuse surgical treatment.

28. Why do some scoliosis patients wear braces ineffectively?

Scoliosis is treated with a brace, and the effectiveness depends on how long the brace is worn. Most patients use thoracolumbar braces. Under the supervision of parents, if they are worn for enough time every day, better results are desirable; for high scoliosis positions, a brace for the neck needs to be included. On the one hand, wearing it will hinder the appearance, and on the other hand, On the one hand, the comfort level is low and the wearing time cannot be guaranteed; on the other hand, the cooperation between patients and parents is low. The above reasons make it difficult or ineffective for some patients with scoliosis to wear braces.

29. What is the purpose of surgical treatment of adolescent idiopathic scoliosis?

The purpose of surgery is not to completely straighten the spine, but to correct the deformity and stabilize the spine based on the flexibility of the spine. The so-called stabilization of the spine, in layman's terms, means to fix certain segments of the spine, such as a scoliosis spine, so that it cannot move, which means that it will not continue to bend.

30. How is the surgical treatment of adolescent idiopathic scoliosis performed?

Different conditions require different surgical plans. The overall principle is to correct deformities and achieve fusion and stability while retaining as many active segments of the spine as possible. The choice of surgery depends on the specific location and severity of the scoliosis. Before surgery, the spinal segments that need to be fixed are determined based on the degree of scoliosis. During the operation, the muscles and other soft tissues of the spine are separated to expose the bony structure of the spine, and then internal fixation instruments (the most commonly used pedicle screw rod system) are inserted to correct the scoliosis deformity through different techniques. After correction, the bony structure is properly processed to prepare the bone grafting surface, and autogenous bone is grafted onto the bone grafting surface. Ultimately, it is hoped that the spinal segments that are surgically fused will become one through bone growth and fusion. After surgery, the appearance of the scoliotic spine can be improved to varying degrees.

31. What precautions should be taken after scoliosis surgery?

After scoliosis surgery, the drainage tube is removed, the X-rays are reviewed, and you can get out of bed and walk around under the protection of a brace, usually three to five days after the surgery. Since cosmetic skin sutures are mostly used at present, the incision does not need to be removed and the patient can be discharged from the hospital 1 week after the operation. After discharge, you should move appropriately under the protection of a brace. It is taboo to sit for a long time and exercise strenuously without protection within three months of the bone healing period to avoid affecting bone healing. In addition to activities on the ground, you should perform functional exercises of the body muscles while lying in bed. , to prevent muscle atrophy; the dressing on the incision is usually removed after two weeks, and it is usually not until 1 month after the operation that the incision is completely healed before you can take a bath. Take X-rays for review three months after surgery. After the bone heals, the brace protection can be removed and the amount of activity can be gradually increased.

32. What are the complications of surgical treatment of adolescent idiopathic scoliosis?

The complications of surgery are related to the surgeon, team and hospital. You can refer to a case review in the United States of 575 cases of adolescent scoliosis that underwent posterior fixation and fusion. The complication rate was 23.5 %, including neurological injury, respiratory, gastrointestinal, instrumentation or surgical site related complications. Specifically, ***184 postoperative complications occurred, with minor complications including minor nerve damage (18%), respiratory complications (24%), and incision-related complications (17%). Among the 11 cases of severe nerve injury complications, 9 were nerve root complications: 1 had severe headache and was treated in the emergency room, and 1 developed epilepsy 2 years after surgery.

33. What are the risks of adolescent idiopathic scoliosis surgery?

First of all, for any surgery, there are risks of anesthesia. Scoliosis uses general anesthesia. In addition to anesthesia risks, surgery-related risks include: incision infection and prolonged healing; neurological damage; excessive blood loss; bone non-union or delayed healing; internal fixation fracture, etc.

34. Are there any potential problems in the long term with surgical treatment of adolescent idiopathic scoliosis?

What are the long-term complications? These are problems that may arise ten, twenty, or even 50 years after the surgery. After scoliosis surgery, because certain segments of the spine are fixed inactive, adjacent segments may be overstressed, which may lead to degeneration and early-onset intervertebral disc degeneration (aging).

35. Are there risks in surgical treatment of adult degenerative scoliosis?

The purpose of surgical treatment for degenerative scoliosis is to decompress and restore the normal physiological curvature of the spine. Surgery-related complications can be catastrophic, including heart attack, stroke, blindness, and even death. Patients over 65 are at higher risk. The complication rate of posterior fusion and fixation for lumbar degeneration is as high as 40% to 80%. Although the literature reports that the complication rate is 49% and the reoperation rate is 15.3%, surgery is still an effective method to treat degenerative scoliosis and can improve clinical symptoms and scoliosis angles.

36. How to prevent scoliosis in adolescents?

For congenital scoliosis, which is a congenital deformity of the spine, during the 3rd to 6th week of pregnancy, this requires the majority of couples of childbearing age to correct their body and mind, quit smoking, drinking and other unhealthy diets, and supplement folic acid ( Green leafy vegetables), avoid contact with toxic and harmful substances, and achieve good health and good health. For idiopathic scoliosis, there are many causes, including genetic factors, so it can only be discovered and diagnosed early. For postural scoliosis, educate children to sit upright, avoid sitting for long periods of time, and pay attention to changing postures and exercising outdoors. No matter what kind of scoliosis, early detection and diagnosis will give teenagers precious opportunities for treatment, and parents need to pay attention to it.

37. What will happen if adolescent idiopathic scoliosis is not treated?

For a disease, long-term follow-up of the natural course is undoubtedly the most powerful basis. In 2003, an authoritative research report showed that although patients with the most common adolescent idiopathic scoliosis (late-onset scoliosis) have not been treated, their lives are basically normal and energetic, with minimal physical damage and only Back pain and appearance problems. The ones that really need attention are congenital, secondary scoliosis and early-onset idiopathic scoliosis.

38. Will adolescent idiopathic scoliosis worsen with age?

Adolescent idiopathic scoliosis will worsen after skeletal maturity, that is, in adulthood, but more slowly. If the scoliosis is greater than 45 degrees at skeletal maturity, it will progress to an average of 23 degrees in adulthood.