Acıbadem Comprehensive Spine Center
SPINAL DISORDERS WHAT IS SCOLIOSIS?

Scoliosis

Scoliosis (Spinal Curve)

skolyoz Omurga Eğriliği Nedir? Scoliosis (curve of the spine) is a curve of the spine to the right or left, and is not a disease by itself, but rather a structural deformity in a healthy spine. (Figure 1).

Scoliosis can occur in due to numerous diseases and may be seen in different areas of the spine.

The treatment process depends on the disease causing the scoliosis and on the type of scoliosis. This means that while the treatment continues in the natural course as expected in some patients, whereas in others it can have different outcomes depending on their reaction to the treatment and the type of scoliosis. scoliosis progresses in the period of increased growth during puberty. In other words, the spinal curve increases further.

What are some of the different types of scoliosis?

There are three types of scoliosis which are seen most frequently. These are:

Idiopathic Scoliosis (Scoliosis of unknown cause)

This is the most frequent type of scoliosis. In idiopathic scoliosis, the spine curves to the side in an S-shape or a C-shape. The vertebrae rotate around their own axes leads to a lateral bending. The rotation of the vertebra causes an asymmetric hump in the back or the waist. Since research studies could not explain the causes of idiopathic scoliosis, it is also named as scoliosis "of unknown cause".

Neuromuscular Scoliosis

This is the second most frequent type of scoliosis. The main reasons for neuromuscular scoliosis are diseases of the muscles or nerves. Neural diseases may originate from the brain or spinal cord, and muscle diseases can occur during childhood or later.

In contrast to idiopathic scoliosis, shortage of breath and sensory disorders occur more frequently in neuromuscular scoliosis. During the treatment process, braces may not be used due to respiratory problems, disorders of communication, sensory disorders and epileptic seziures. Younger ages may be preferred for operations in this type of scoliosis. A fusion may be used.

Congenital Scoliosis

This is the type of scoliosis which occurs due to anomalies of the spine which arise during development of the child in the uterus. Congenital scoliosis shows a rapid progression during the first years. Therefore the treatment process for early congenital scoliosis may necessitate surgical intervention at a young age.

Other diseases which cause scoliosis are:

Neurofibromatosis
Rheumatic diseases
Fractures of the spine
Spinal infections
Metabolic diseases
Syndromic diseases

*As can be seen from the above mentioned diseases, there are a large number of diseases which can cause scoliosis.

Treatment of Scoliosis:

The treatment process for scoliosis differs according to the disease that has caused the scoliosis and the scoliosis that occurs in the individual. In other words, the treatment process follows a natural course in some patients, while in others the response to treatment changes according to the patient’s response to treatment. Scoliosis shows a progression and advancement in childhood and adolescence. Therefore the spinal curvature further increases.

As a result of all these causes, there is no single and correct treatment option that can address all conditions. The treatment of scoliosis should be made in a manner that cahnges from one patient to another after meticulous analysis of the age when scoliosis was diagnosed, the location and degree of the curve, physical examination findings, and the results of radiologic studies. Stated in other words, the treatment for scoliosis is “individualized”.

Although there are variations within each treatment option that depend on the individual patient, there are generally 3 alternative routes to take once a patient is diagnosed with scoliosis. The first option is follow up, it is suitable for curves under 20-25 degrees and consists of follow up at certain intervals, performing sports, and increasing overall physical fitness. Physical therapy exercises specific for scoliosis may be useful. However, timing is crucial for these exercises. Exercises initiated to early may lead to frustration in the child. When this happens, the child may not desire to make exercises at later ages when there is rapid growth and the exercises are really needed.

The second option is brace treatment. This is effective in patients with curves between 20-40 degrees and have a growth potential. A multicentric study conducted in the USA and Canada had its early phase results published in 2013. The results showed that patients using braces had lower rates of undergoing surgery compared to those who did not use braces. In other words, the possibility of undergoing surgery is lower in patients using braces. Based on these early results, the study was terminated and a decision was made to prescribe braces to all patients. Using the brace for 20-23 hours every day was found to be significant for adequate efficacy.

Another option is surgical treatment. Surgery is often considered in curves above 40-45 degrees. In adolescents and in adults who have completed their lung development, correction and fusion operations are performed. Because the movement of the vertebrae incorporated into the fusion will be limited, a preoperative work up and planning is important to achieve the maximum correction by operating on the minimum number of levels.

Innovation in scoliosis treatment:

Since cryosurgery can obstruct growth and lung development in children with scoliosis under 10 years of age, such surgeries should not be undertaken. The classical surgery method in children involves placing rods in the spine which are extended every 6 months without cryosurgery. In this classic method rods would be placed in the body and repeat surgeries at 6 month intervals would extend the rods. The stress that these surgeries created on the patients and their families not to mention complications and the economic burden directed doctors to search for new solutions. As a result magnetic rods were invented so that the extensions could be made every 2-3 months in a clinical setting without surgery and without pain using remote control. 

Another important concern in surgical treatment for scoliosis is the risk of paralysis during surgery. Previously it was not possible to see the effects of the surgery on the spine during the surgery. Whether the patient was paralyzed or not could only be seen at the end when the patient was woken up. This was not only a concern for the patient but since the situation could only be seen at the end of the surgery it was too late to intervene.

The Neuromonitorization process during surgery only came to our country 4-5 years ago and is now being used everywhere. This enables any effect caused by nerve damage during surgery to be seen immediately and therefore enable the necessary intervention to be made.

The neuromonitorization technique has increased the safety of surgeries that could have resulted in paralysis in the past and made it possible to continue with operations that were avoided in the past because of the risk of paralysis. It is now possible to repair complicated curvatures with this technique. 

One of the most important problems in scoliosis operations is that the spine is immobilized and spine movement is eliminated in a certain portion of the spine. The research doctors have been conducting on a repair technique that can allow the spine to grow and be mobile without having to freeze it, is gradually beginning to bear fruit. A method called the “stretching method” has been developed for patients with scoliosis who still have a potential to grow. In this method endoscopic intervention is used to place screws in the sides of the outward curve of spinal curvatures, then these screws are tied with thick string which is tautened to prevent the curvature from growing outwards. Thus while the inner curve side continues to grow the outer curve side is mobilized with screws to correct the curvature over time. Another advantage of this method is that the structure holding the screws is not platinum but string so the part that is operated on can remain mobile. Since this method achieves correction of curvature without cryosurgery, does not eliminate mobility or prevent growth, it is a revolutionary method in scoliosis treatment. It has been implemented for the first time in Turkey at the Acıbadem Maslak Hospital Comprehensive Spine Center after being used in the U.S. Since the first case was treated successfully the application is now offered as a treatment option.

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