WHAT IS SCOLIOSIS?

Scoliosis is a lateral curvature of the spine that can be seen in the thoracic or lumbar regions of the spine. In a normal and healthy spine, when viewed from the back, the vertebrae extend from top to bottom in a straight line, namely in the neck, back and lower back regions.

With scoliosis, the vertebra moves to the right or left and rotates around its axis. Therefore, it is defined as a three-dimensional deformation.

Scoliosis can be caused by various reasons, but in most cases the cause is unknown (idiopathic scoliosis). Idiopathic scoliosis is divided into infantile scoliosis in children under three years of age, juvenile scoliosis between 4 and 10 years of age, and adolescent scoliosis after 10 years of age.

In addition, there is also scoliosis caused by other etiologies such as congenital malformations of the bones and ribs (congenital scoliosis), nerve and muscle diseases (neuromuscular scoliosis), and tumors or metabolic diseases.

Scoliosis prevalence varies between 0.2% and 6%. It is more common in girls and progression is greater.

WHAT ARE SCOLIOSIS SYMPTOMS?

Scoliosis may not show symptoms in the early stages. Even if scoliosis symptoms appear, the person does not complain much because it does not cause severe discomfort. For this reason, it is detected by chance on an X-ray taken for another reason or as a result of screening at school. The first finding that brings the family to the doctor is usually the visual deformity. The first difference noticed in scoliosis of unknown cause is that one shoulder is higher than the other. Asymmetry is the first visual disturbance in the hip, chest level, or where the waist or body folds. 40% of patients have back and low back pain.

SCOLIOSIS DEGREES

Stage I: 1 to 10 degrees (170°)
Stage II: 11 to 25 degrees (155°)
Stage III: 26 to 50 degrees (140°)
Stage IV: Over 50 degrees

Depiction methods are used to grade scoliosis. Following the imaging method, the spinal curvature is diagnosed in degrees. This method is particularly useful when deciding on the need for surgical intervention in scoliosis.

• Angles below 10 degrees: Termed “spinal asymmetry” in medical language, this degree does not have any effect on the person’s health. For the curvature to be treated, it must be over 10 degrees. In order for low-degree curvatures not to pose a risk of scoliosis in the future, the patient needs to be examined at regular intervals. The important point here is to determine whether the scoliosis is progressing.
• Angles between 20 and 40 degrees: Curvatures of 20 to 40 degrees are mostly seen during adolescence. In this degree, which is considered moderate scoliosis, exercise, physical therapy, and bracing are usually highly effective.
• Angles at 40 degrees: Scoliosis curves of 40 degrees have largely completed their growth and progression. For surgical intervention to be performed, the thoracic curvature must be over 45-50 degrees; the curvature in the lumbar region must be 40 degrees.

CLASSIFICATION OF SCOLIOSIS BY LOCATION

• Cervicothoracic scoliosis (level of curvature at III – IV thoracic vertebrae)
• Thoracic scoliosis (level of curvature at VIII – IX thoracic vertebrae)
• Thoracolumbar scoliosis (level of curvature at XI – XII thoracic/lumbar vertebrae)
• Lumbar scoliosis (level of curvature at I – II lumbar vertebrae)
• Lumbosacral scoliosis (level of curvature at V lumbar vertebra and I – II sacral vertebrae)

WHAT ARE SCOLIOSIS CAUSES?

• In 80% of scoliosis patients, the cause of the curvature cannot be determined. However, some of the structural defects causing scoliosis are listed below:
• Congenital scoliosis caused by congenital defects in the spine bone structure.
• Infantile and juvenile scoliosis in early childhood.
• Neuromuscular causes, muscular dystrophy.
• Scoliosis caused by connective tissue diseases such as Marfan syndrome, Ehlers-Danlos syndrome.
• Polio, inflammatory diseases, and injuries causing scoliosis.
• Scoliosis due to leg length discrepancy, hip, and knee joint problems.

SCOLIOSIS DIAGNOSIS

Clinical examination is extremely important for diagnosis. If the patient bends forward, you can see the scoliotic deformation clearly (Adams forward bend test). The rib hump size and degree of curvature are measured using a Scoliometer. An X-ray is taken first in the diagnosis of scoliosis. The aim is to confirm the curvature of the spine, determine its size and location, and determine if there is an associated hereditary disorder of the bone structure. Very rarely, it requires MRI.

SCOLIOSIS TREATMENT

Patients should be monitored by an experienced orthopedist who knows this pathology. This is possible at our Private Ekol Hospital with Professor Dr. Erol Yalnız. We provide excellent diagnosis and treatment of scoliosis. Possible rapid progression and the impact of the curvature on the state of internal organs require treatment. The choice and method of treatment depend on the patient’s age and the degree of curvature (Cobb angle).

If there is a Cobb angle of 45°, surgical treatment is usually recommended. The purpose of the operation is to correct the deformation. In this case, the procedure should be performed at the end of the growth period. During the operation, the spine is stabilized with implants and loses its mobility. As a result, the mobility of the spine is lost in the fused part, but at the thoracic level, this does not cause any special restrictions on the patient. To correct the deformation, rod screws are attached to the pre-set upper and lower ends of the spine. The operation time is 5-6 hours.

WHAT ARE THE GOALS OF SURGICAL TREATMENT?

• Safety of spinal growth;
• Epiphysiodesis (alignment, articulation) of the spine on the convex side of the main curvature;
• Preservation and restoration of physiological curves of frontal and sagittal spine and trunk balance;
• Minimizing the loss of surgical correction during the patient’s growth period (prevention of further deformation);
• Curvature correction in 3 planes and polysegmental stabilization between metal structures (special instruments) using the spine.