The most common type of spinal curvature is adolescent idiopathic scoliosis. Adolescent is an expression used for the period of adolescence after childhood, but still continuing to grow. Therefore, the skeletal system in adolescents is not fully mature. This disorder, which is more common in girls and causes more curvature, usually affects children around the age of 10. Idiopathic scoliosis affects 2-3% of children and adolescents aged 10-18 years.
The exact cause of idiopathic scoliosis is unknown. However, this disorder is thought to be caused by genetic reasons. Adolescent idiopathic scoliosis (AIS) is usually first noticed by parents or patients. With the rapid growth of the spine, the probability of progression of the degree of curvature increases with the entry of adolescence. Usually, a crooked back is detected when the shoulders are not aligned or the belt is not placed evenly on both hips. Rough estimates can be made of the rate of progression of the curve based on the peak (apex) of the curve, the gender, and the degree at which it was first detected. If it is detected in the early period, the progression of the degree of curvature can be prevented with necessary exercises and corsets prepared for the patient. However, in patients with a curvature greater than 50 degrees, surgical treatment can be considered.
If advanced scoliosis is not treated, the following problems may occur, as well as deterioration in aesthetic appearance:
• Lung and respiratory problems
• Decreased and disappearance of the ability to move
Spinal cord compression and paralysis
Psychological problems and depression
Adults may experience numbness and pain in the lower back and legs.
In the elderly patient group, aging occurs in the bones and cartilages of the spine. The main trigger of adult scoliosis is the loss of water content of the cartilage tissue. With the calcification of the disc and losing its height, the nerves to the legs are compressed. There are complaints of pain and numbness in the legs and feet. The deteriorated disc disrupts the load distribution and puts extra load on the facet joints at the back, which increases the strength of the spine. The ligaments between the facet joint and the vertebrae thicken to withstand the increased loads. The spinal canal narrows with the growth of the anterior disc tissue, posteriorly the yellow ligament (Ligamentum flavum) and the facet joint. The walking distances of the patients become shorter. Since the stability of the spine is impaired with these changes in the spine, there may be a shift between the vertebrae forward, backward and sideways. As a result, existing low back pain complaints increase even more. Looking at the patient’s anterior-background X-ray, it is seen that the spine curves sideways. When the nerves on the side where the spine is curved are exposed to pressure and on the other side, more pain and numbness may occur in the legs and feet.
Patient history is very important for correct diagnosis.
Since adolescent idiopathic scoliosis is a genetic disease, the patient’s family history is very important during diagnosis. In adults, age, lifestyle, physical activity status, and diseases are important parameters. Physical testing includes a complete neurological examination and the use of a special measuring device called a scoliometer. This device is used to measure the asymmetry of the spinal cord when the spinal cord is bent forward. For a definitive diagnosis, an X-ray of the entire spine should be seen to evaluate the anteroposterior and lateral inclination. The degree of scoliosis is determined by measuring the angle between the most bent vertebrae in these radiographs. Necessary follow-up and treatments are planned by measuring the Cobb angle. Technologies such as MR and Computed Tomography are also used in the diagnosis of scoliosis.
It is possible to get rid of scoliosis with modern treatment methods.
Many patients with adolescent idiopathic scoliosis have small curves that do not require serious treatment. For patients with small curves of 10-20 degrees, observation is sufficient.
Corset treatment: For patients with curvature above 25 degrees, the progression of the curvature can be prevented by using a corset. For patients who need a brace, a light-weight TLSO brace may be beneficial. The corset, which is made in accordance with the curvature of the patient, can be worn under the clothes. In order for the corset to be effective, it must be used 23 hours a day.
Surgery: Adolescent idiopathic scoliosis surgery is generally considered in the patient group where the curvature exceeds 50 degrees. Before making a decision for scoliosis in AIS, it is necessary to conduct a detailed interview with the patient and family after a careful evaluation and inform accordingly.
Can scoliosis be prevented?
It is wondered whether scoliosis seen in childhood is usually caused by sports injuries, carrying heavy backpacks, postural disorders, and excess weight. However, although these factors can increase the degree of existing scoliosis, they are not considered as a definite cause. In addition, paying attention to the correct posture, doing exercises to strengthen the back muscles, activities such as yoga or pilates also prevent scoliosis, but can relieve symptoms in people who already have scoliosis. However, there are also preventable conditions such as osteoporosis-induced scoliosis. This condition can cause the bones to become weak and brittle, leading to abnormal curvature of the spine. A healthy diet and regular exercise can help prevent the risk of developing osteoporosis and scoliosis with advancing age.