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Scoliosis
Scoliosis is the lateral and rotational deviation of the spine.
The spine may be bent to the right or left, or the thoracic spine may deviate in one direction and the lumbar spine in the other direction (S-shaped scoliosis).
Many children suffer from physiological scoliosis of about 2°, which is absolutely normal and does not require treatment.
Scoliosis usually affects thin and slender children, mainly girls: about 80%.
The deformity occurs in childhood, but persists into adulthood; if left untreated, it can even become stronger over time, because it sometimes has a degenerative development.
Targeted and early treatment can halt the progression or improve the situation.
Scoliosis can be static, congenital or idiopathic; idiopathic means nothing else than that medicine has not yet discovered a cause, even if there are many assumptions in this regard; about 90% of all those affected belong to this group.
In the midst of numerous theories, science assumes that the causes are to be found in the area of bones, muscles and postural defects; however, some authors do not rule out the possibility that scoliosis could also be caused by neurological, hormonal disorders, malocclusion, vertebral blockage in lateral inclination or disorders of the vestibular apparatus.
If there are curvatures of the spine in the frontal plane, the vertebrae rotate convex, i.e. to the bulging side, which is proportional to the lateral degree of inclination.
In addition to scoliosis, the child may also develop a classic hump (hyperkyphosis) or lordosis of the thoracic spine, i.e. the reversal of the natural curvature between the neck and the lower back.
Scoliosis leads to some anatomical deformations of the vertebrae, ribs, intervertebral discs and ligaments.
The vertebrae increasingly take on a wedge-shaped structure, especially at the crown of curvature.
In the interior of the curve, the vertebral holes are narrower and the nerve roots running there can be squeezed and cause the symptoms of sciatica.
The ribs are deformed by the lateral bending of the vertebrae, on the convex side the vertical distance between the ribs increases, on the concave side decreases.
Due to the rotation of the vertebrae, the chest narrows on one side and widens on the other.
A hump (gibbus) is formed, which can be easily seen from the convex side.
The intervertebral disc is compressed on the concave side and decompressed on the convex side; in this way, the gelatinous core is pushed outwards.
Women can also become pregnant with severe scoliosis, from 45 ° the advice of an orthopedist should be sought.
How is the degree of scoliosis measured?
To measure the severity of scoliosis, a back X-ray of the patient should be taken.
Among the numerous classification methods, Cobb angle measurement is the most frequently used. Two lines are drawn that run parallel to the vortex plate of the two most inclined vertebrae above and below the crown of curvature. Where these two lines intersect, the angle is measured.
What are the most important aspects of scoliosis?
In the case of scoliosis, lateral bending, rotation of the vertebrae and the time of formation are mainly evaluated.
The higher the degree of deviation of the spine, the greater the probability that this will have consequences for the future of the patient.
The earlier the scoliosis occurs, the worse the prognosis, because growth is likely to worsen the curvature of the spine.
The prediction is strongly dependent on the age of appearance of the scoliosis; if the severity is below 20-30°, the condition worsens only during the growing season; however, if the inclination is greater than 40°, scoliosis worsens by about 1° per year even in adulthood.
What types of scoliosis are there?
Two opposing curvatures can occur simultaneously, one in the upper and one in the lower area, one speaks here of an S-shaped scoliosis.
Or a single, one-sided curvature can form.
Scoliosis of the cervical spine is rare, in the thoracic spine (thoracic), thoracic/lumbar spine (thoracolumbar) and lumbar spine (lumbar) they occur most frequently.
The mixed form, i.e. curvature in the lumbar region and a further curvature in the opposite direction in the area of the thoracic spine occurs frequently in adolescents.
What are the causes of scoliosis?
Numerous studies have shown that scoliosis patients have very relaxed muscles with low muscle tone or disproportionate bone growth compared to the increase in muscle tone; this would reinforce the assumption that the cause of this deformation involves a muscle-band component.
Unilateral paralysis or considerable muscle insufficiency of the abdominal and back muscles causes the spine to bend and turn to one side.
Children and adolescents often adopt a wrong, unbalanced posture, such as girls with long hair whose head and upper body are strongly bent to the side when writing.
In some cases, such postural errors can lead to scoliosis.
Heredity does not play a significant role in this context, but in practice you often see siblings who both suffer from scoliosis.
How can scoliosis be treated?
In order to determine the course of action, it is first necessary to analyze exactly what type of scoliosis it is, how great the severity is and whether respiratory complications may occur.
It must be known in which cases corrective gymnastics can be helpful and in which not.
The static or functional scoliosis is caused by leg length differences (heterometry), congenital scoliosis is caused by deformations of the vertebrae, which have a wedge-shaped structure instead of a cylindrical one.
For the treatment of static scoliosis, an elevation is applied to the shorter leg under the foot.
Natural remedies include physiotherapy and osteopathy.
In static scoliosis, gymnastic exercises do not have a direct effect, but in some cases can help not to worsen the clinical picture.
The exercises, which are intended to correct the deformity or prevent the progression of mild or severe scoliosis, have the aim of strengthening weak muscles and stretching shortened muscles.
Children with scoliosis have poorly developed muscles, often girls, so the exercises in the gym are basic here, even if other forms of treatment are used (e.g. osteopathy).
The muscles on the convex side of the spine are weak, they can be strengthened in the quadruped position.
The upper back can be corrected by lifting the arm (weighed down by a small weight); for the lower back muscles, the stretched leg must be raised.
Isometric training exercises to strengthen the abdominal muscles are part of the exercise program.
A posture correction is useful, but not enough to achieve a good result.
The mattress does not need to be replaced unless the child only has back pain at night or in the morning when waking up.
Which sports can be practiced?
Swimming is not suitable for scoliosis, because here the muscles are strengthened symmetrically, but the deformity is asymmetrical.
Tennis can be helpful, especially if the arm used to play is on the convex side.
Volley and basketball are not suitable sports.
When should surgical intervention to correct scoliosis be considered?
If the lateral bending is more than 90°, surgery is currently the only solution; In the past, numerous surgical correction methods were used, today the procedure consists mainly in the insertion of metallic implants.
A metal rod is attached to the vertebrae below and above the curvature.
By a slow and progressive straightening, the curvature can be almost completely straightened; the result depends on how mobile the spine is.
The patient loses some of his mobility because a piece of the spine is formed by a rigid rod, but many operated patients are still able to bend the upper body so far forward with their legs pressed through that practically the tip of the foot can be reached.
The operation to correct scoliosis must be prepared by months or even better years of physiotherapy, because in this way the spine becomes more mobile and malleable for the surgeon.
The procedure carries the following risks:
- Non-fusion of the vertebrae.
- Infection.
- Possible formation of a herniated disc above or below the stiffened vertebrae.
What can a corset do?
The corset is used for severe but not too strong scoliosis; on the advice of the orthopedist, a model made of plaster or plastic or metal is used.
The plaster corset is put on and replaced at regular intervals (max. 5-6 months).
After the plaster corset, a support made of plastic or metal is changed, in the case of lighter scoliosis, the latter alone may be sufficient.
When applying the plaster corset, the patient is first brought into traction and extension and the corset is then modeled on the patient.
Plastic and metal corsets come in different versions, the most commonly used are the “Lyon corset”, the “Corset Milwaukee” and the lumbar corset “Lapadula”.
The Lyon corset consists of a support belt running at armpit height and a support belt at pelvic level; here a rod is attached at the front and back, which reaches up to the height of the collarbone.
Two rigid strips are attached to the vertical bars, pressing on the protruding part of the hull and on the hump.
Once the corset is on, an X-ray is used to check whether the scoliosis is effectively corrected.
The Milwaukee model consists of a lap belt from which three rods spring that reach up to the patient’s chin; here a chin rest provides traction of the spine.
A side panel presses against the ribs in the protruding area of the body.
The head is not passively tensioned in relation to the pelvis; on the contrary, the support under the chin encourages the patient to actively tract himself.
This type of orthosis is not particularly popular among children and adolescents, because the upper part is clearly visible and it must be worn 24 hours a day; only for showering it may be taken off briefly.
The lapadula corset exerts only lateral pressure on the lumbar spine when stretched, so it is used only in these cases.
The corset is an aid that corrects scoliosis, but as soon as it is removed, the situation of the spine may well deteriorate again.
While the corset is worn, an appropriate strengthening of the muscles must be done so that the muscle tone is maintained and the muscles are not too weak when removing the corset to support the back sufficiently.
The corset must be worn for as long as the orthopedist deems it necessary; this is often the case until the growth period of the adolescent is completed; thereafter, wearing is gradually reduced so as not to jeopardize the outcome of treatment.
