Having scoliosis means having a crooked spine. A common type of scoliosis is because the legs are different in length, which causes the pelvis to be tilted. Then the spine straightens when sitting or lying down. In another type of scoliosis, the spine is never straightened and the cause is usually unknown.

Light scoliosis is common and very rare for anyone who has it. A major scoliosis is not so common, but for those who get there is a risk of major problems. The cause of the most common type of scoliosis in adolescents is unknown, but scoliosis may also be due to congenital injuries or illnesses and damage to the muscles and nervous system. It can cause more problems and more often leads to surgery.

Symptoms of scoliosis

The most common type of scoliosis usually means that the thoracic spine is curved in a small arch to the right seen from behind. Such a so-called functional scoliosis means that the curvature of the spine is straightened when lying down or sitting. That type of scoliosis is usually mild and the bend is usually below 15 degrees. About one in twenty schoolchildren has such scoliosis, which is usually discovered in the early teens, but it rarely causes any problems.

A structural scoliosis does not change when you sit down or lie down. Four out of five people with structural scoliosis have a curvature whose cause cannot be explained.

Risk of trouble if scoliosis is not treated

If a severe scoliosis is not treated, it can cause various types of symptoms of scoliosis, such as back fatigue and pain. Over time, the risk of back pain increases due to so-called wear changes around misaligned vertebrae and discs.

Often there is more than one bend in a scoliosis, and then one of the bends is usually much larger. If a first bend has occurred, the body tries to counteract the oblique posture by bending back the spine with a second bend. Then an S-shaped scoliosis curve occurs. Structural scoliosis means that the vertebrae are constantly twisted. With severe twisting, the chest can be pulled and there may be a hump on one side of the chest as the ribs bulge out.

When it comes to so-called neuromuscular scoliosis, the spinal curvature is often elongated and c-shaped.

When and where should I seek care?

In school children, scoliosis is usually detected by student health who can assess whether further examinations or treatment of scoliosis is needed. If scoliosis is detected in a child in the lower stage or earlier, they should always be examined by an orthopedic surgeon.

You can contact a health care center if you are an adult and have scoliosis problems.

Surveys

It is common for scoliosis to be found in low- and middle-aged children, although it rarely causes symptoms at that time. In order to detect scoliosis early, the school nurse or school doctor examines the children’s backs carefully already in the fourth grade.

The child may bend forward while the nurse or doctor looks at the back from behind. In particular, they can detect if the chest is not symmetrical, if the shoulders have different heights or if the pelvis is oblique. It is also possible to see if there are other differences between the right and left sides of the body.

In many schools, student health has access to a so-called scoliometer that measures the height difference between the shoulder blades as the child bends forward. This measurement can be translated to an approximate scoliosis degree, with moderate precision.

Orthopedic examines the spine

The school doctor usually writes a referral to an orthopedic surgeon who can examine his back and x-ray it if a scoliosis is discovered before puberty. The orthopedist can then determine the size of the scoliosis and determine what it is due to. Sometimes a magnetic camera examination may be necessary. It provides information about the soft parts in and around the pellet pillar.

If the scoliosis is detected at puberty, it often does not need to be investigated, but rather checked. When the curvature is mild, it is enough for an orthopedic surgeon to check his spine every six to twelve months. The orthopedist controls the spine until the body has stopped growing.

X-rays are taken to assess the development of scoliosis

When scoliosis is to be x-rayed , the x- rays are taken when standing up. Pictures are taken from the front and the side of the chest and lower back. The magnitude of the crookedness is measured in degrees is shown by measurements of the largest curvature. It is possible to monitor the development of a scoliosis over time through repeated measurements.

Sometimes a special x-ray examination is required to determine so-called skeletal age. It is an x-ray of the pelvis or of the hand that shows how much the skeleton is expected to grow further. The examination makes it easier for the doctor to assess the risks of continued curvature.

Treatment of scoliosis

No treatment of scoliosis is usually needed if you are an adult, as most scoliosis is light. Children of school age with scoliosis due to different long legs can sometimes get a try on a shoe or raise the heel. It can cause your back to straighten.

A malformation can prevent parts of the vertebrae from developing properly. The vertebrae grow unevenly and the spine becomes crooked. It is important that it is detected early so that the child receives treatment before the bend has become large.

The corset prevents the curvature from increasing

It is possible to get corset treatment if you have not grown fully and there is a risk that you will develop a more severe scoliosis. It must then be worn until the body has stopped growing, to prevent the back from becoming slanted.

The doctor is considering corset treatment if the curvature of the spine increases with repeated checks and is at least 25 degrees in a person who is estimated to have at least one year left to grow.

The scoliosis remains unchanged if the corset treatment is successful, that is, just as much after the treatment as at its start. The goal is not to make the back straight, but if the treatment is extremely successful, the back can sometimes become straight after the treatment than it was when it started.

A corset fixes the upper body and ends under the arms. The child does not need to wear the corset during sports and school gymnastics. There is treatment where the corset is used 23 hours a day and treatment with a stronger corset that is used only during the night. The effect is strongest with the corset that sits on both day and night.

It is important to be informed after a few weeks if the treatment is effective. In order for the doctor to be able to see how the treatment works, the child has to do scoliosis with the corset on. 

The treatment is continued until the child has grown completely, sometimes for several years. Getting used to wearing a corset can be cumbersome and demanding. It is often mentally stressful for children to have a corset.

Surgery is required in the case of more severe back bends

Corset treatment is usually not enough if the spine has a stronger bend, greater than 45 degrees. Surgical treatment can then be the only effective treatment.

Through surgery, a continued curvature of the spine is counteracted. The choice of treatment depends on the following:

  • age
  • type of scoliosis
  • what level in the spine the bend or bend is at.

Children who are still growing and have scoliosis that increases to over 40 degrees, despite the corset, surgery is recommended. If the curvature is between 25 and 40 degrees when the baby starts with a corset and they have a long time to grow, no surgery is usually needed.

If the bend is above 50 degrees, there is a risk that the scoliosis will increase even when the child has grown completely. The strong bends mean that the incorrect load on the back increases, which causes the bends to get worse over time. Then surgery can be the best treatment in the long term.

For children, surgery can impede growth. Therefore, it is often best to use corset therapy to postpone surgery until the child has almost grown.

Alternative surgical procedures are sometimes used

If a child gets scoliosis that requires surgery at a very early age, alternative surgical methods can be used so that the growth of the spine is not disturbed. One method involves stays that allow growth despite keeping the scoliosis in check. Another method involves bars that can be extended very slowly with the help of a magnet placed on the body.

The skeleton can be further affected if you are older and have had age changes in the spine. If you are operated on then it is often not possible to straighten the bend very much. The surgery is done instead of stabilizing the spine, that is, removing mobility that hurts. Sometimes the pressure also needs to be relieved for nerves that have been pinched. The pressure can hurt and cause muscle weakness as an extra complication.

Then the operation goes on

A surgical operation causes a number of adjacent vertebrae to move between themselves. The goal is to reduce the curvature, get your back in good balance and to prevent the curvature from increasing in the future. One endeavor is to give back a natural posture in the chest and lower back. If it is possible to maintain mobility and posture in the lower part of the lumbar, future problems in the remaining movable part of the vertebra will be counteracted. The most common is that the back surgery is done from behind by the doctor fixing the crooked part of the back with screws and metal bars. 

When the pelvis is corrected and fixed from behind, bone grafts are sometimes taken from the pelvis and placed against the pelvis. Then the body is stimulated to heal the bone mass in much the same way as a bone fracture.

Sometimes the frame operation takes place from the front. Then the disks are removed and replaced with finely divided bone from a rib.

After surgery, corsets are rarely needed. You are usually allowed to leave the hospital within a week and children are usually able to start school again after three to four weeks. It takes about six months before the stealing operation is fully healed and it is only then that it is possible to start sports and strain the back harder. 

Good with physiotherapy

Like all children, children with scoliosis need to move and be physically active in different ways. It is possible to get help from a physiotherapist with appropriate exercises that strengthen the back and abdominal muscles, but no physical therapy that affects the curvature of the spine itself. The same goes for scoliosis in adults.

complications

For children and adolescents who, apart from scoliosis, are completely healthy, the risk is very small for serious complications associated with the operation. During the operation itself, the function of the spinal cord is monitored by neurophysiological methods that quickly warn the surgeon if the spinal cord is at risk of injury.

The risks of complications in spinal surgery increase with increasing age.

The chest of adults grows stiffer with age, while the lumbar spine retains much of its mobility to high age. The lumbar spine is also subjected to greater strain. A surgical operation that is limited to the chest causes less risk of later on in life compared to if the surgery goes down to the lower part of the lumbar spine.

What happens in the body?

The spine is made up of the spine and surrounding muscles. The spine in turn consists of 24 vertebrae. Between the vertebrae are discs, intervertebral discs. In order for the spine to hang together, but also be movable, there are joints between the vertebrae. The joints are held together by ligaments and short muscles. The core of the counter consists of a soft mass while the outer part is a firmer capsule. The discs are important for the mobility of the back and at the same time act as shock absorbers.

The upper part of the spine is called the neck spine. It is followed by the chest and further down the lumbar. The vertebrae of the pelvis form the sacrum and the tibia.

Scoliosis develops as the body grows

A scoliosis develops, that is, increases in degree, almost always in connection with periods of rapid growth, especially during puberty. For girls, scoliosis grows fastest during the years around the first period.

A smaller proportion of the scoliosis that is already discovered between the ages of three and ten can increase especially rapidly. Which scoliosis will increase is difficult to predict. Therefore, it is important that young people with scoliosis are regularly checked by doctors.

The change of spine continues until the cot pillar has stopped growing and sometimes another time after that. A scoliosis that is less than 35 degrees when the body has stopped growing is usually not worsened, and it usually does not cause any problems. If a larger bend occurs, above 45 degrees, it is common for scoliosis to continue to increase even after the body has stopped growing.

Adulthood in adulthood

In some cases, scoliosis can occur in adulthood, usually after the age of 40. This may be because a scoliosis that you have had since adolescence worsens and that you get pain from the lumbar spine below the scoliosis. You may also get scoliosis due to age changes and wear changes. At high age it can then start to hurt the lumbar spine and also radiate down the legs.

The younger you are when you have a curvature of the spine and the greater the curvature then, the greater the risk of the spine becoming very crooked if not treated.

There is a risk that scoliosis will increase after the body has finished growing if you have a bend above 50 degrees. The strong bends mean that the load on the back increases, which causes the bends to get worse over time. If the curve increases a further ten degrees in the chest, the function of the lungs can be impaired. Similarly, the changes that occur due to wear in the lower back increase if the bend becomes larger.

In a neuromuscular scoliosis, the chest is affected and the lungs function worse. Stomach space can decrease and gastrointestinal function deteriorates. The sloping back can cause the ribs to eventually push against the pelvis. There is then a risk of pressure ulcers and it can be difficult to manage the hygiene if the back falls down. This involves major problems in keeping the balance and preventing pressure ulcers while sitting.

Common with scoliosis

Almost every tenth person in the country has a scoliosis, even if the smallest bend is counted. A small scoliosis is just as common in boys as in girls. Larger bends, on the other hand, are four times more common among girls than among boys.

Surveys have shown that of the children born many countries each year, about three in thousands who later receive a scoliosis require treatment.

What does scoliosis depend on?

One reason for a functional scoliosis may be that the legs are different in length, or that the pelvis is slightly oblique.

Serious causes of scoliosis are extremely rare. But sometimes it can be due to a congenital factor such as changes in the sphincter, growth disorder or disease of the muscular or nervous system.

The most common type of scoliosis, called idiopathic scoliosis, is the one that has no apparent cause. Scoliosis may also be due to various changes in the spine that affect the spine as you grow. It can be a fracture of a vertebra or a benign tumor, which causes the vertebrae to grow unevenly and make the vertebrae crooked.

There is a great risk of having scoliosis as a small child if you have neurological damage, such as cerebral palsy , CP. Spinal cord injuries and polio can also cause the risk of scoliosis. Those who are injured in the spinal cord before the age of ten have an increased risk of developing a scoliosis later in life.

Diseases of the muscles or nervous system can lead to a crooked back, which is usually called neuromuscular scoliosis.

The risk of getting scoliosis is greater if you have a close relative with scoliosis.

In otherwise healthy people, scoliosis is never due to having been heavy or asleep, standing or sitting with poor posture.

Ehtisham Nadeem

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