Scoliosis

If you look at someone in the back, you will see that his spine stretches straight in the middle. When a person has scoliosis, his spine bends on one side. The angle of the curve can be small, large or somewhere in between. But anything over 10 degrees is considered scoliosis. Doctors can use the letters "C" and "S" to describe the curve of the dorsal back. You probably do not look directly at too many thorns, but what you may notice in a person with scoliosis is the way she stands. They may lean a little or have shoulders or hips that look uneven. What are the causes of scoliosis? In no less than 80% of cases, doctors do not find the exact reason for a curved spine. Scoliosis without a known cause is what doctors call "idiopathic". Some types of scoliosis have clear causes. Physicians divide these curves into two types: structural and non-structural. In non-structural scoliosis, the spine functions normally, but appears curved. Why does this happen? There are a number of reasons, such as the longer length of a leg, muscle spasms and inflammations such as appendicitis. When these problems are treated, this type of scoliosis often disappears.

The causes  

• cerebral palsy
• Muscular dystrophy
• Congenital malformations
• infections
• tumors
• genetic conditions such as Marfan's syndrome and Down's

syndrome Congenital scoliosis

 begins when the baby's back develops before birth. Problems with the tiny back bones, called vertebrae, can cause a curvature of the spine. The vertebrae may be incomplete or not divide properly. Doctors can detect this condition at the birth of the child. Or, they may not find it before adolescence.

Family history and genetics may also be risk factors for idiopathic scoliosis. If you or any of your children have this condition, make sure your other children are examined regularly. Scoliosis occurs most often during growth spurts, usually when children are between 10 and 15 years old. About the same number of boys and girls are diagnosed with minor idiopathic scoliosis. But curves in girls are 10 times more likely to get worse and may require treatment. Scoliosis diagnosed during adolescence can continue into adulthood. The greater the angle of the spine curve, the more likely it will increase over time. If you have scoliosis, ask your doctor to check your back regularly.

Degenerative scoliosis affects adults. It usually develops in the lower back when the discs and joints of the spine begin to wear with age. Scoliosis normally appears as early as childhood or adolescence.

Risk factors

 Risk factors for scoliosis include:
• Age: Signs and symptoms often begin with a growth spurt just before puberty.
• Sex: Women have a higher risk.
• Genetics: People with scoliosis may have a close relative with the disease.

Symptoms

Symptoms in adolescents

The most common form of scoliosis occurs in adolescents. It is known as idiopathic scoliosis of the adolescent. This can affect children from 10 years old. Idiopathic means that there is no known cause. Symptoms may include:
• the head is slightly off center
• the rib cage is not symmetrical - the ribs can be at different heights
• one hip is more protruding than the other
• clothes do not hang properly
• one shoulder or scapula is taller than the other
• the individual can lean to one side
• unequal lengths of the legs

Symptoms in infants

In childhood, symptoms may include:
• a bulge on one side of the chest
• the baby can always lie on one side
• in more severe cases, heart and lung problems resulting in shortness of breath and chest pain Some types of scoliosis can cause back pain, but they are not usually very painful. Back pain is not uncommon in older people with chronic scoliosis.

If scoliosis is not treated, problems can occur later in life, such as impaired cardiac and pulmonary function.

Diagnosis

A doctor will perform a physical examination of the spine, ribs, hips and shoulders. Using a tool called an inclinometer or scoliometer, the doctor can measure the degree of scoliosis. The patient can be referred to an orthopedist. Imaging analyzes such as X-rays, CT-scan, and MRI can help evaluate the shape, direction, location, and angle of the curve.

X-ray: scoliosis before and after arthrodesis





Treatment

Exercices

Various exercises are suggested for scoliosis and different schools offer different strategies. However, they all aim to realign the spine, rib cage, shoulders and pelvis for a "normal" posture.

In 2016, researchers noted that it was increasingly evident that exercise could help treat scoliosis, but additional efforts were needed to determine which exercises were most effective.

Surgery

In severe cases, scoliosis may change over time. In these cases, the doctor may recommend a vertebral fusion or vertebral arthrodesis. This operation reduces the curve of the spine and prevents it from getting worse. Scoliosis surgery involves the following:
• Bone grafts: two or more vertebrae (bones of the spine) are associated with new bone grafts. Sometimes metal rods, hooks, screws or wires are used to keep a portion of the spine straight while the bone heals.
• Intensive care - the operation lasts 4 to 8 hours. After surgery, the child is transferred to an Intensive Care Unit (ICU) where he will receive intravenous fluid and pain relief. In most cases, the child will leave the ICU within 24 hours, but may need to stay in the hospital for a week to 10 days.
• Recovery - Children can usually return to school after 4-6 weeks and can exercise approximately one year after surgery. In some cases, a back splint is needed to support the spine for about 6 months. The patient will have to return to hospital every 6 months to extend the stems - this is usually an outpatient procedure so that the patient does not spend the night. The stems will be removed surgically once the spine has been developed.

A doctor will only recommend spinal fusion if the benefits outweigh the risks.
Risks include:
• Stem Displacement: A stalk can move from its proper position, requiring additional surgery.
• Pseudarthrosis: One of the bones used to fuse the spine in place does not stick properly, resulting in mild discomfort and unsuccessful correction of the spine. Additional surgery may be necessary.
. Infection: If this happens, it will usually be treated with antibiotics.
• Nerve damage: The nerves of the spine are damaged, resulting in mild symptoms, such as numbness in one leg or both legs, serious problems, such as paraplegia, loss of all lower body functions.

A neurosurgeon may be present during surgery for scoliosis.

























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