Scoliosis

Synonyms

Spine bending

English: scoliosis

definition

Scoliosis is a fixed curvature of the spine. In scoliosis, the human backbone is not only curved to the side, but also contains other components such as torsion and rotation.

General

The human spine is not a straight and rigid rod that holds the person upright, but a flexible and pliable structure made up of individual components that communicate with one another, the vertebral bodies. The spine has a predetermined structure with physiological curvatures in order to guarantee optimal mobility.
It is bent in an S-shape to the front and back. These curves are called lordosis (forward curve: in the neck and lumbar area) and kyphosis (backward curve: in the chest area). In addition to this normal and necessary curvature of the spine, however, scoliotic changes can also occur. These can be found to a slight extent in the majority of the population.

Scoliosis is a fixed lateral curvature of the human spine. It is referred to as fixed because it cannot be turned back into the actual starting position of the spine, as is the case, for example, with scoliotic incorrect posture (e.g. passive or active incorrect posture due to pain).
Scoliosis is not only the lateral bending of the spine, but also includes the torsion (asymmetrical growth form) of individual vertebral bodies and the rotation of several vertebral bodies relative to one another.

The causes of scoliosis

Scoliosis is usually caused by either primary or secondary asymmetrical changes in the shape of the spine. Primary causes include, for example, congenital malformations of the vertebral bodies, secondary causes are in turn circumstances that lead to a bending of the spine (weaker muscles on one side than on the other side of the spine, for example). However, the vast majority (around 90%) of scolioses or their development cannot be explained (example: why are the muscles unevenly developed?) And are therefore considered idiopathic in medical terminology.
The spine is kept under strong elastic tension throughout life, especially in the growth phase. If this tension becomes unbalanced, the forces are disproportionate and the spine deviates to the side.

Depending on the cause, a distinction is made between different types of scoliosis:

1. Myopathic Scoliosis
   Myopathic scoliosis is a curvature of the spine caused by a muscle disease such as muscular dystrophy.

2. Neuropathic Scoliosis
   Neuropathic scoliosis is based on a malfunction of the nerves. The side bending is caused by a one-sided paralysis of the trunk muscles caused by a nerve failure.

3. Osteopathic Scoliosis
   The main problem here is the symmetry of the vertebral body.

4. Idiopathic scoliosis
   The cause of this form of scoliosis is unknown.
   Scolioses can be acquired or congenital.

5. other forms of scoliosis

• Infant scoliosis (a special form of idiopathic scoliosis in infancy. This form is usually C-shaped. The children usually lie crooked in bed and turn on one side. There is a high tendency towards spontaneous healing.)
• Post-traumatic scoliosis (e.g. due to fractures of the active column, see also vertebral fracture)
• Reflective scoliosis (e.g. due to pain in a herniated disc)

The symptoms of scoliosis

The symptoms of scoliosis depend on the severity, i.e. the severity. There are very mild scolioses, as is the case with many people.
These often go unnoticed as they do not cause any complaints.
Most of the time, scolioses are discovered symptomatically during the growth spurt before puberty and around 10 to 12 years of age. The children stand out only because of the anatomical disparities (crooked spine, uneven shoulder height, etc.). Pain is rare. However, if the scoliosis has existed for a long time, it can wear and tear and thus increase pain.

Pain as a symptom

Scoliosis usually develops slowly in childhood or adolescence. Despite some clearly visible curvatures, the young people affected rarely suffer from pain caused by scoliosis. Due to the slowly developing curvature in growth, the muscles can adapt to the inequalities accordingly, so that there is often no pain at all and the scoliosis is often not even noticed by the person affected. Only from around the third decade of life does the spinal column curvature become noticeable in addition to the visually visible signs and symptoms.

The constant bad posture promotes the development of muscle tension.In addition, signs of wear and tear such as structural changes in the vertebral bodies occur much earlier. People with straight backs often develop these symptoms too. With scoliosis, however, the risk is increased and symptoms appear at a much younger age. In addition to pain in the back itself, pain in the shoulders and head are common. Regular exercise and targeted strengthening of the back muscles can often prevent or alleviate the pain of scoliosis.

Surgery as the only possible causal treatment for scoliosis-related pain is only considered in rare cases. This treatment option is especially an option if it can improve the function of internal organs such as the lungs or heart.

more on the subject Pain associated with scoliosis can be read here.

Symptoms of the cervical spine

The cervical spine (cervical spine) is rarely directly affected by scoliosis. Nevertheless, symptoms often manifest themselves in the cervical spine due to a curvature in other parts of the spine. Due to the misalignment of the back, the shoulders and the posture of the head are often inclined. As a result, tension often occurs in the back, neck and shoulder muscles. The result is pain in the regions described.

In addition, radiation is common, which can result in headache and arm pain in particular. Other symptoms that can have their origin in the cervical spine in scoliosis are dizziness, ringing in the ears and unsteady gait. The symptoms usually only arise in adulthood.

Symptoms of the thoracic spine

In scoliosis, the curvature of the spine is mostly localized in the thoracic spine (thoracic spine). Often there are no symptoms for a long time. Alone the visually visible changes such as a one-sided rib hump when bending over and a crooked position of the shoulders can be noticed. It is not uncommon for mental disorders to be triggered or exacerbated as symptoms due to reduced self-esteem and dissatisfaction with one's own body.

Physical symptoms of the thoracic spine in scoliosis, on the other hand, often only arise from the third decade of life. The focus is on pain due to muscular tension that occurs due to constant poor posture and premature wear. In the case of a very pronounced curvature, symptoms due to impairment of the heart and lung function such as shortness of breath during exercise and reduced performance are possible.

Lumbar spine symptoms

Scoliosis of the lumbar spine (lumbar spine) in children, adolescents and young adults often only shows up through visual or cosmetic abnormalities. When bending forward, for example, a lumbar bulge shows up on the side opposite the curvature of the spine. In addition, there may be a visible inclination of the pelvis.

As you get older, complaints like Pain in the lower back as symptoms. The poor posture caused by scoliosis promotes muscle tension and wear and tear on the bones and joints of the spine. In addition, the oblique position of the pelvis results in a functional difference in leg length, which in turn leads to incorrect loading of the knee or hip. Here, too, early pain-related pain occurs without treatment.

In the case of severe curvature of the spine in the lumbar spine, symptoms can also arise due to impaired function of internal organs. The abdominal organs are most likely to be affected, which can manifest itself through constipation and difficult bowel movements.

Diagnosing scoliosis

A simple test is suitable for diagnosing scoliosis: the so-called forward bending test.
The standing patient bends forward with the undressed upper body and, for example, places his hands on his knees. When viewed from behind, a protrusion appears in the area of ​​the ribs, the so-called rib hump. The so-called thoracic scoliosis (thorax = chest) is the most common type of scoliosis. The rib hump is created by the torsion of the vertebral bodies. Since the ribs attach to the vertebral body and this is twisted, the ribs are pushed upwards on one side when bending forward. This hump is always created on the convex side of the curvature of the spine.
If the scoliosis is in the lumbar spine, the so-called lumbar bulge develops. In addition, the waist triangles are unevenly high.
Scoliosis can also be diagnosed by paying attention to the patient's shoulder or shoulder blade elevation.
The extent of the curvature of the spine can be measured well in the X-ray image. The so-called Cobb angle is used for this. This is determined with the help of certain structures. At the upper and lower end of the curve are the neutral vertebrae, which, in contrast to the vertebrae that are directly involved in the curve, no longer have a wedge-shaped deformation. Starting from these neutral vortices, elongated lines are drawn from the base, on which a perpendicular plumb line is drawn and the angle between these two meeting lines is determined.
An angle of less than 40 ° is a mild scoliosis, moderate scoliosis is in the range of 40-60 °, and an angle of 60 ° or more is called severe scoliosis.
Here you can look at an x-ray of scoliosis.

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Treatment for scoliosis

In the best case scenario, scoliosis does not require any treatment. This is especially true for mild forms, which are found, for example, as an incidental finding in adulthood. Even in children with a very mild form of scoliosis, only the further development is initially observed.

As a rule, therapy is recommended from an angle of curvature of 20 or more degrees determined in the X-ray image. The type of treatment depends on the severity of the scoliosis.
The first stage of therapy is usually physiotherapy or physiotherapy. This must be carried out regularly and usually over a period of years. If the scoliosis is more pronounced or if the curvature of the spine has deteriorated rapidly, treatment with an individually adapted corset should also take place at an early stage. As a result, in the best case scenario, a decrease in the angle of curvature can be achieved in further growth or at least further deterioration can be prevented.

In rare, very severe cases in which there is a pronounced curvature of the spine, surgical treatment of scoliosis should be considered. However, it is a major intervention and the decision to do so must be carefully considered.
On the other hand, if severe scoliosis is not treated in good time, there is a risk of long-term damage such as chronic back pain and impaired lung function, which can severely impair physical performance in everyday life.

Basically, the appropriate treatment of scoliosis is very demanding and should only be carried out by doctors who have sufficient experience in this area. Otherwise there is a risk of damage from both excessive and insufficient treatments.

Find out all about the topic here: Therapy for scoliosis.

Special exercises

Scoliosis usually develops in childhood or puberty and can still be influenced in the adolescent phase. In adults, neither exercises nor a corset can treat an existing scoliosis. The only promising form of therapy to correct the curvature of the spine is surgery, which is reserved for very severe forms.

Children and adolescents, on the other hand, can use special exercises to positively influence the course of scoliosis so that the curvature does not increase any further or even decreases again as it grows. Physiotherapy is usually prescribed for this purpose, but exercises should also be performed regularly at home. One example is the so-called “Superman” exercise. To do this, lie on your stomach and stretch your arms forward. Now the arms are lifted a little off the floor and the whole body is tensed. This position is held for about five seconds. The exercise should be repeated a total of five times after every one minute break. It serves to stretch the entire spine and strengthen the back muscles.
Another of the numerous possible exercises is called a "head lift". Here, too, you lie flat on your stomach. The arms rest next to the body. Now you try to lift your upper body without using your arms. Here, too, the position is held for a few seconds and the exercise is repeated after a short break. If the implementation is too difficult, the arms can be used for support. However, the back muscles should be tense and the neck should be kept straight.

Even if no improvement in the curvature of scoliosis is to be expected in adults with scoliosis, these exercises are still recommended because trained back muscles are particularly important here, for example to prevent or alleviate scoliosis-related pain.

The op

In severe scoliosis with large angles of curvature, treatment with physiotherapy and a brace is often not sufficient to achieve a good treatment result. In such cases, surgical treatment is often the last option. Surgery is indicated from an angle of curvature of 50 degrees and if further deterioration is expected. However, the decision for or against the intervention must always be made individually depending on the age of the person affected, a possible restriction or risk to the function of internal organs such as the heart and lungs and the previous development of the curvature of the spine.

After detailed consultations with the doctors, the wishes of the person affected and, if applicable, of the parents, are decisive after clarification of all risks of the procedure and if it does not take place. There are different surgical procedures that differ, among other things, in the access route to the spine. The operating area can be reached either from the front, from the rear or a combination of both sides. The general principle of surgery for scoliosis is to stiffen the affected part of the spine in an improved position. The aim is to correct the curvature as best as possible while maintaining as many flexible vertebral segments as possible.

In the rear approach, the patient lies on his stomach and the spine is exposed from the back. The affected vertebrae are loosened, brought into the corrected position and connected by two metal rods. The vertebrae are also connected with bone chips from the iliac crest or from a bone bank so that they grow together and stiffen. In the anterior approach, surgery is performed through a lateral incision from the abdomen and chest. The actual surgical steps on the spine are similar to those of the posterior approach. After the thorax has been opened, however, a tube must be inserted for a few days through which suction is used to ensure that the lungs can expand again.
The combined access from the rear and front is only carried out in very severe cases and then possibly on two different days. The choice of the procedure must be made individually for each patient depending on the form and extent of the scoliosis.

Scoliosis operations are the most technically and time-consuming operations in the field of orthopedics. How long the procedure will take cannot be said in general, but it will take at least a few hours. The surgeon can, if necessary, give an estimate of the duration in advance based on the individual circumstances, but ultimately no reliable prediction can be made. Sometimes difficulties arise during the operation that could not be seen in advance and then lead to an extension of the duration of the operation.
As with the duration, no general statement can be made about the costs of an operation to treat scoliosis. Depending on the effort, clinic and possible difficulties, these will amount to at least a few thousand euros. This can even result in five-digit amounts. However, if there is a medical indication, the costs are fully covered by both statutory and private health insurances. How big the remaining scars will be, how many there will be and where they are located, depends primarily on the extent of the operation. Every incision that has to be made leaves a scar. Depending on the selected surgical procedure, scars can remain on the back as well as the front of the chest or abdomen.

Find out more about the topic here: Surgery for scoliosis.

The corset

If scoliosis is so severe that treatment with physiotherapy or physiotherapy alone is no longer sufficient, but the curvature of the spine is not so extreme that an operation is necessary, then treatment with a so-called corset is usually indicated.
It is a fixed orthosis that supports the spine when worn from the outside. The problem is that the corset has to be worn for at least 22 hours a day for it to be effective. For the children and adolescents affected, this means that it usually has to be worn during all leisure activities and in school lessons. Children are restricted in their movements, especially when playing. In addition, the corset is visible to everyone in the swimming pool, for example, so that offensive looks or comments can arise. Nevertheless, it is important to wear it consistently and regularly, as otherwise the success of the treatment is jeopardized and long-term consequences and restrictions in adulthood threaten.

If scoliosis worsens, effective treatment can, from a certain degree, only be carried out through surgery. The corset usually has to be worn until the end of the growth phase. After that, the wearing time can be slowly reduced. The corset treatment is never done alone but is always combined with physiotherapy.
In adult adolescents and adults, wearing a corset is usually of no use, since the bone growth has ended and any curvature has manifested itself.

Read more about the following topic here: Brace treatment for scoliosis.

The prognosis of scoliosis

Usually, mild to moderate scoliosis does not get worse after the growth is complete. However, if the curvature is more than 30 °, the symptoms can worsen even in adulthood.

If scoliosis has been going on for many years, signs of wear and tear can occur on the vertebral bodies and intervertebral discs, which are often noticeable in pain.

Summary

Scoliosis is a curvature of the side Spine. The human spine is naturally curved back and forth. In addition to the curvature, scoliosis also includes the rotation of the entire spine and the torsion of individual vertebral bodies.The peak of the disease, i.e. the frequency of the initial diagnosis, is between the ages of 10 and 12.
There are different forms of Scoliosis, mostly divided according to their cause (more by bony components or more by Muscle weakness etc.), can be congenital or acquired.
Pain is rare and more likely to occur over a long period of time. Scoliosis is through X-rays where the Warp angle (Copp angle) can be measured, but can also be diagnosed with a simple forward test.
Treatment for scoliosis is based on its severity. In mild scoliosis can physiotherapy to Muscle strengthening help, operations are necessary for severe scoliosis. The treatment of severe scoliosis from around 40 ° mostly consists of surgical straightening of the spine with subsequent stiffening with implants. However, each individual case must be assessed and cannot be assessed across the board.

Prevent can one Scoliosis Unfortunately not. With children, however, care should always be taken to ensure adequate and correct growth of the entire body.