Scoliosis Treatment (Spine Curvature Treatment)

Health Guide

Idiopathic scoliosis (scoliosis of unknown cause)
The most common type of scoliosis; It is 'idiopathic' scoliosis, the cause of which has not been fully elucidated. The lateral bending of the spine can be 'S' or 'C' shaped. Apart from lateral bending, rotation of the vertebrae is also seen in all idiopathic scoliosis, including the mildest forms. This rotation in the vertebrae causes asymmetric protrusions in the back or waist.

Neuromuscular Scoliosis
The second most common type of scoliosis is neuromuscular scoliosis. Muscle or nerve diseases may be among the main causes of neuromuscular scoliosis. Nervous diseases can originate from the brain and spinal cord; Muscle diseases can be seen in childhood and later.

In neuromuscular scoliosis, unlike idiopathic scoliosis, respiratory distress and sensory defects can be seen more frequently. Scoliosis brace may not be used during the treatment process due to reasons such as respiratory problems, communication disorders, sensory defects and epileptic seizures.

In this type of scoliosis, younger ages may be preferred for surgical intervention. Fusion therapy can be applied.

Congenital Scoliosis
The third most common is congenital scoliosis. It is a type of scoliosis due to spinal anomalies that occur during the development of the child in the mother's womb. Congenital scoliosis progresses rapidly in the first years. For this reason, the treatment process of congenital scoliosis that occurs in the early stages may require surgical intervention at a young age.

Apart from these, neurofibromatosis, various rheumatic diseases, various connective tissue diseases such as osteogenesis imperfecta, Marfan syndrome, Ehler Dsanlos, spinal fractures, spinal infections, various metabolic diseases such as Morquio, Gaucher disease and some genetic syndromic diseases may cause scoliosis.

Congenital Scoliosis
What is congenital spinal deformity?
The word congenital means that it is present from birth and that the problem occurs while in the mother's womb. Deformity is a structural deformity. In other words, the term congenital spinal deformity refers to spinal deformities that occur while in the womb and progress with age.

The spine development of the child in the womb is completed in the first three months with the development of its organs. During this period, the growth of the vertebrae becomes asymmetrical as a result of the abnormal formation of the spine structure or remaining united, and as a result, curvatures develop. The type of deformity seen depends on where and in which direction the abnormal vertebra is located in the spinal column.

A normal spine is straight when viewed from behind, but curved when viewed from the side. These folds are in the form of a slight hump on the back (kyphosis) and a depression on the waist (lordosis). In congenital cases, scoliosis occurs if the asymmetric growth is sideways, and increased kyphosis occurs anteriorly.

How does spinal curvature occur in people with abnormal vertebrae?
The most important factor leading to curvature of the spine is the asymmetric growth of abnormally formed vertebrae. The problems that occur in the mother's womb in the vertebrae can be seen as formation defects and decomposition defects. There are also more complex cases where both defects occur together.

Curvature occurs mostly with growth. But despite growth, many of the spines affected in this way may have little or no curvature at all. Even in vertebrae containing more than one abnormal vertebra, if these abnormalities are distributed in such a way that they balance each other, the result may be decreased trunk growth rather than increased curvature.

The curvature may increase very slowly until the rapid growth stage of puberty. In cases where one side of the vertebrae cannot separate and remains attached, the attached side cannot grow; the free side continues to grow and scoliosis occurs.

In cases where both sides of the vertebrae are attached, there is little or no growth in this region. As a result, scoliosis does not develop, but this region may be short. If the vertebrae are attached from the front, a hump (kyphosis) occurs because growth will continue from behind.

If the vertebrae are attached from the back, a cupping (lordosis) occurs because growth will continue from behind. Half or insufficiently formed vertebrae cause one side of the spine to grow more than the other, creating a curvature.

Is Congenital Scoliosis Genetic?
Congenital (congenital) scoliosis is not generally considered to be hereditary. But with other conditions that may be inherited, congenital scoliosis can accompany an inherited disease.

Therefore, a child with only congenital scoliosis finding and no other genetic disorder is not more likely to have another sibling with a similar finding (Congenital scoliosis) in the family.

The exact cause of congenital scoliosis cannot be explained. Some conditions may be seen more frequently with congenital spinal deformities due to a number of events occurring during the developmental stage of the embryo and fetus.

Congenital Scoliosis and Patient Monitoring Process
At this stage of scoliosis, a period called "controlled observation" is entered and how the deformity behaves is monitored. This is done with regular examinations and x-rays at certain time intervals. If the curvature continues to increase regularly or if other functional problems occur, appropriate surgical intervention should be performed.

Congenital Scoliosis and Brace Treatment
One of the biggest differences between congenital scoliosis and idiopathic scoliosis is that braces are not effective in congenital deformities. Sometimes the body creates a second curve to maintain balance above or below the curves caused by congenital abnormalities.

These curvatures may increase after a certain time and sometimes reach more serious dimensions than congenital curvature. The brace can be used to control or delay the progression of secondary curvature in these patients.

In congenital scoliosis, it is aimed to slow down or destroy the asymmetrical growth of abnormal vertebrae. For this, spinal fusion process (freezing the spine, eliminating movement) can be applied.

Surgery may need to be performed when the child is young to control an increasing deformity. Parents understandably fear that early fusion (as the fused portion is stopped growing) may inhibit stem growth.

Although it is true to a certain extent, the trunk may not be recovered by correcting a very severe deformity after the growth is over, and delaying the surgical treatment of the patients just because of this concern may cause very serious problems for the patient in the future.

While some spinal cord abnormalities do not require treatment, others are treated with surgery before or simultaneously with curvature treatment.

Congenital Scoliosis and Treatment Options
Controlled Monitoring
It is done with periodic physical examinations and x-rays and continues until the skeletal system reaches maturity without any special treatment unless there is an increase in curvature (it should also be done after surgical treatment).

Surgical Treatment
Today, in most of the surgical treatments applied for the treatment of congenital spinal deformity in a growing child, the curvature is tried to be controlled without fusion of the spine or by fusion to a limited area.

Restricted Fusion Operations
Hemivertebrectomy
In some cases, the curvature can be removed by removing the abnormal vertebra (hemivertebrectomy). A body cast is applied between 3 and 6 months after the surgery.

Curvature Control with Growing Rods If the
curvature is appropriate in very young children, correction can be achieved by means of rods attached with screws placed above and below the curvature without fusion. Then, with periodic lengthenings performed every 6 months, the control of the curvature is tried to be ensured until adulthood and fusion process is applied in adulthood.

Thoracic Cage Expansion Operation (VEPTR)
Rib abnormalities and inadequate chest development are observed in some patients with congenital scoliosis. In these children, ribs placed in the rib cage can both correct the rib cage abnormality and control the curvature without fusion. Periodic extensions every 6 months may be required in these patients.

Instrumentation and Fusion, Osteotomies
Congenital scoliosis, which are the most difficult to treat, are neglected curves above 70-80 degrees. In these curvatures, correction of the deformed spine with or without removal and fixation of the vertebrae with titanium rods and screws are performed.

Scoliosis, which starts at a young age and is seen especially under the age of 10, has different characteristics from the older child scoliosis. Scoliosis that starts at a young age usually continues to progress. The most important factor determining the progression of scoliosis is the child's physical development rate.

The surgical treatment of scoliosis is the stopping of spine growth, that is, the "fusion" process. In growing children, it is not recommended to perform the "fusion" procedure, which is defined as fixing the spine, destroying the movement and stopping the growth in order to prevent the spine from being short.

If this surgery is performed on children under 5 years of age, it may cause narrowing of the spinal canal, if it is performed under 8 years of age, lung development may be impaired, if it is performed under 10 years of age, it may cause deterioration in the development of the rib cage. If the thorax is not enlarged enough, problems with the lungs and breathing may occur. The fusion process, which will be applied especially under the age of 10, may cause the trunk to be short.

In adolescence; The fusion process does not cause any problems that may be experienced in children, since the development of the spinal canal, lung, thoracic cage and lengthening is completed to a large extent.

If Minor Scoliosis is Untreated, What Health Problems Can It Cause in the Future?
-Lung and respiratory problems
-Heart problems
-Disability loss
-Rarely, spinal cord compression and paralysis in very advanced deformities
-Serious cosmetic and psychological problems

What are the Causes of Scoliosis Appearing at a Young Age?
Scoliosis that occurs at a young age can be infantile (0-3 years old) and juvenile (3-10 years old) scoliosis, which are types of scoliosis of unknown cause (idiopathic). While congenital (congenital) scoliosis shows its symptoms at an early age, it progresses rapidly. Early-onset scoliosis may occur in some syndromic patients.

Other causes are scoliosis due to muscle and nerve diseases (neuromuscular) and metabolic diseases (mucopolysaccharidosis, etc.), connective tissue diseases (osteogenesis imperfecta, etc.).

Why Is Young Onset Scoliosis So Important ?
Two important problems can be encountered in scoliosis that starts at a young age. The most important factor determining the progression of scoliosis is the physical development of the child. The growth rate of the child is directly proportional to the progression of scoliosis. This type of spinal curvature can be difficult to control with corset treatment, which is another treatment method.

For such reasons, the necessity of scoliosis surgery is higher for young patients than for adolescents. The second difference is; In the surgical treatment of juvenile scoliosis, fusion surgery, which means the growth of the spine and stopping its movement, is the negative side of the application.