Scoliosis (Spinal Curvature Treatment)
It is the 3-dimensional curvature of the spine. The normal spine is straight when viewed from the front or back. Again, normally when viewed from the sides, the spine is inclined in the chest area, “kyphosis” towards the back, and “lordosis” towards the front in the lumbar region. In scoliosis, when viewed from top to bottom, all vertebrae are bent in one direction in the back or lumbar region. When viewed from the center of the spine from top to bottom, some of the vertebrae are bent. This results in the protrusion of the “generally right” ribs. Scoliosis can occur in more than one family member in the same or different generations. “Scoliosis cannot develop due to something the child or the family does or cannot do” Poor body posture or carrying heavy bags does not cause Scoliosis. Scoliosis is a spinal deformity that usually occurs during puberty. It is the most common deformity of the spine and its incidence is found in wide rates such as 0.3% – 15.3%.
This is due to the variety of diagnostic methods and the different rates of children examined radiologically. Although there are many different causes of formation, genetic structure and development of children play a very important role.
Careful monitoring of children, especially during developmental periods, by parents and early diagnosis play an important role in treatment. While very good results can be obtained with exercise and physical therapy at low degrees, there is no return when the degrees increase and curvatures occur. This is why school screenings are very important. Screening programs have not yet been organized in our country on this subject.
Scoliosis Classification:
Curvatures that develop due to reasons specific to the spine are called structural scoliosis. There are many causes of structural scoliosis. The most common is idiopathic scoliosis. Familial factors, factors related to the musculoskeletal system and growth. Postural mechanisms are among the reasons that play a role.
Non-structural scoliosis that develops due to the curved posture of the spine due to some reasons. It is seen due to nerve compression, abscesses, tumors. Findings:
The most common finding in idiopathic scoliosis is asymmetry. The first finding that the family or teacher notices is that one shoulder is higher. Since many of them are hidden by clothing, the findings of scoliosis are not very clear, especially in the early stages. For this reason, diagnosis and treatment are often delayed. The first finding in scoliosis that occurs after the development period is back pain. Pain is due to calcification at the peak of the curve. Back and waist pain cause a decrease in the initial work ability and psychosocial adaptation disorders in 40% of the patients. The curvature that develops together with the pain both causes the body to bend, disrupts the sitting balance and disturbs the person cosmetically.
Diagnosis and Treatment:
Scoliosis is diagnosed radiologically. X-rays are taken while standing, pain is detected and the x-rays are renewed at certain intervals with regular check-ups. Fetal ultrasonography performed before birth can reveal congenital anamonies of the spine. Magnetic resonance (MR) is performed as a whole in children under the age of 11. The treatment has two purposes. Correcting the curvature and stopping its progression. Scoliosis treatment is conservative and surgical correction or prevention.
Conservative Treatment:
- a) Observation: Generally, young patients with mild curvature are observed at 6-12 month intervals. Those with greater curvature should be evaluated every 3-4 months.
- b) Use of traction cast and orthosis: It is used to prevent the progression of the deformity. There are various usage procedures depending on the patient’s age and the condition of the scoliosis.
- c) Exercise Therapy: The patient’s awareness of responsibility and regular exercise play an important role in the success of the exercises. Exercise alone does not prevent the progression of scoliosis. It is successful when applied together with other methods.
- d) Bio-feedback: It is a device that shows the condition of the patient’s muscles. The patient, who sees which muscles are contracted and which ones are relaxed, tries to correct the signals in the device and pull the tone of their muscles in the right direction.
- e) Muscle Stimulation: It is a new method we apply in scoliosis. The muscle on one side of the curvature shortens and loses muscle strength, while the muscle on the other side lengthens and becomes stronger. It pulls the spine towards its own side. In this method, a muscle relaxant program is applied to the strong side and a muscle strengthening program is applied to the weak side. After an average of 15 sessions, significant changes are seen in the muscles and the patient’s pain complaints disappear.
Surgical Treatment:
Surgery is also applied to advanced scoliosis. In order not to undergo surgical treatment for scoliosis, all precautions should be taken early and treatment should be given importance. Parents should not let their children carry very heavy bags. In addition, they should check their spines from time to time and observe whether there is any external curvature.
- How is it noticed?
One of the most common symptoms of scoliosis is the protrusion of the shoulder blade that becomes apparent on the right side. One shoulder may be higher than the other and the child tends to lean to one side. The hip bones may not be symmetrical and one appears to be higher than the other. Scoliosis should not be confused with poor posture. Often, one of the first symptoms of scoliosis is that previously worn clothes do not fit the body properly. This becomes apparent in girls when the lines of the skirt or dress are asymmetrical. One of the most striking findings is the appearance of rib protrusion when a child with scoliosis leans forward.
Factors affecting the general course and progression:
Gender: General literature information indicates that progression is more common in girls.
Age: Progression is highest in children and adolescents during periods of rapid growth. Progression is higher in young children than in adults.
Maturation: The more mature the child, the less progress is expected, and the less mature the child, the more progress is expected.
Type of curve: Double curves progress more than single curves, and thoracic curves progress more than lumbar curves.
Size of curve: As the size of the curve increases, the incidence of progression also increases.
An increase of 5 degrees or more in two or more consecutive examinations is defined as progression.
Spine examination:
Palpation of spinous processes:
Provides a much better understanding of the dimensions of the curve in the presence of rotation in the frontal and sagittal planes.
Curve; The length (vertebra where the curve starts and ends approximately), shape (C or S shaped), direction of the curve vertex should be specified.
Radiographic evaluation:
Assessment of vertebral integrity
Measurement of the angle of curvature
Assessment of rotation
Detection of bone development
Terapötik egzersizler:
- Yapılan araştırmalar terapötik egzersizlerin idiyopatik skolyozda eğriliğin progresyonunu durduramadığını göstermiştir.
- Etkisiz olması sadece egzersiz programlarına uyum problemlerine bağlanamamıştır.
- Egzersizler sekonder morbitiye yol açan risklerden korunmada önemlidir.
Hafif idiyopatik skolyoz tedavisinde egzersizler:
- Gövde kaslarının gücünü ve postural kontrolü iyileştirmek
- Gövdenin gergin yapılarının mobilitesini artırmak
- Postürü düzeltmek amacıyla,Abdominalleri ve gövde ekstansörlerini güçlendirme
b. Eğriliğin konkav tarafındaki yapıları germe
c. Eğriliğin konveks tarafında gövdenin lateral fleksörlerini güçlendirme
d. Artmış lomber lordozla ilişkili olarak erektör spina ve kalça fleksör kaslarını germe
e. Postür eğitimi
f. Pulmoner fonksiyonu iyileştirmek için derin solunum egzersizleri
Cerrahi tedavi:
- Spinal cerrahinin amacı
- Rijid cerrahi materyallerle omurgayı mümkün olduğu kadar yeniden normal konumuna getirmek
- Vertebra füzyonuyla en sağlıklı pozisyonu almasını sağlamak
- Omurganın stabilitesi için gerekli füzyon miktarını dengeli bir biçimde belirlemeli ve hareket mümkün olduğu kadar korumalı
Therapeutic exercises:
Research has shown that therapeutic exercises cannot stop the progression of the curve in idiopathic scoliosis.
Their ineffectiveness cannot be attributed solely to problems complying with exercise programs.
Exercises are important in protecting against risks that lead to secondary morbidity.
Exercises in the treatment of mild idiopathic scoliosis:
Improving the strength of the trunk muscles and postural control
Increasing the mobility of the tense structures of the trunk
Strengthening the abdominals and trunk extensors in order to correct posture
- Stretching the structures on the concave side of the curve
- Strengthening the lateral flexors of the trunk on the convex side of the curve
- Stretching the erector spinae and hip flexor muscles associated with increased lumbar lordosis
- Posture training
- Deep breathing exercises to improve pulmonary function
Surgical treatment:
The aim of spinal surgery
To bring the spine back to its normal position as much as possible with rigid surgical materials
To ensure that it takes the healthiest position with vertebral fusion
The amount of fusion required for the stability of the spine should be determined in a balanced manner and the movement should be preserved as much as possible
Postoperative rehabilitation:
The first goal is to restore all functions of the patient as early as possible before spinal fusion develops
Early mobilization
Postoperative orthosis treatment is needed until the surgeon is convinced that the instrumentation is solid and safe
Rehabilitation goals:
To ensure return to normal daily life functions
Prevention of secondary deformities (contractures due to decreased mobility)
To provide adaptations that will allow the patient to perform daily life activities in the best way during the period when the orthosis is used or mobility is restricted
To determine the possible underlying pathologies and their functional consequences
To ensure reconditioning immediately after the spinal fusion develops