Congenital (congenital) Scoliosis: Congenital (congenital) scoliosis is not generally considered to be hereditary. However, congenital scoliosis may accompany the inherited disease with other conditions that may be inherited. Therefore, a child with only congenital scoliosis finding and no other genetic disorder (Klippel-Feil syndrome, VACTERL, Goldenhar, etc.) is not more likely to have another child whose parents have similar congenital scoliosis. This is usually due to a deformity in the spine or fused ribs due to factors such as infections in the womb, diabetes, and some vitamin deficiencies. Congenital scoliosis progresses rapidly in the first years. For this reason, the treatment process of congenital scoliosis, which occurs in the early stages, may require surgical intervention at a young age. These patients must be evaluated by a neurosurgeon.
Sometimes the body creates a second curvature of the spine to maintain balance above and/or below the curvatures caused by congenital abnormalities. This curvature may increase after a certain time and sometimes even reach more serious dimensions than congenital curvature. The brace can be used to control or delay the progression of secondary curvature in these patients. However, since it is difficult to apply a corset in very young children (0-5 years), correction body casts performed under general anesthesia can be preferred. In young age scoliosis, corset treatment can go up to 60 degrees. The aim here is to slow the progression of the spinal curvature. At this stage of scoliosis, a period called “controlled observation” is entered with examinations and x-rays at certain time intervals and how the deformity behaves is monitored. If there are curvatures above 60 degrees, the scoliosis surgery method is preferred. This curvature continues to increase after growth ends. For this reason, surgery is applied to prevent future complications and cosmetic results. Surgery can be performed at any age when early surgery is required for a congenital scoliosis patient, but surgery can usually be delayed until the patient is 1 year old.
Fusion procedure performed with scoliosis surgery at young ages is aimed at stopping the growth of the spine. If this surgical intervention is performed in children under the age of 5, it may cause the spinal canal to remain narrow, if it is performed under the age of 8, it may cause impaired lung development, and if it is performed under the age of 10, it may cause deterioration of the development of the thorax. If the thorax is not enlarged enough, lung-respiratory problems may occur. Finally, the fusion process to be applied especially under the age of 10 may cause the trunk to be short. Early surgical intervention is often the application of methods that will allow growth to continue.
As for these methods, in some cases the curvature can be removed by simply removing the abnormal vertebra (hemivertebrectomy). A body cast is applied between 3 and 6 months after the surgery. In very young children, if the curvature is appropriate, correction can be achieved without the use of plaster by means of magnetic rods attached with screws placed above and below the curvature without fusion. Then, the control of the curvature is tried to be ensured until adulthood with periodic lengthenings performed in outpatient clinic conditions every 6 months and fusion procedure is applied in adulthood. In children with rib anomalies accompanying scoliosis and inadequate chest development, ribs placed in the rib cage (VEPTR) can both correct the rib cage abnormality and control the curvature without fusion. Periodic extensions every 6 months may be required in these patients.
90% of our patients achieve results with a single operation. The next day after the operation, the patients stand up and walk. The hospital stay is about 5 days. After the third week after the surgery, it is usually possible to return to daily activities.
Neuro-muscular Scoliosis: For example, it may occur in spastic children due to brain damage, or as a result of muscle paralysis due to conditions such as Polio (polio), or muscle wasting. In the case of neuromuscular scoliosis, unlike other types of scoliosis, respiratory distress and sensory defects, as well as metabolic diseases and connective tissue diseases can be encountered more frequently. In these patients, corsets cannot be used during the treatment process and younger ages may be preferred for surgical intervention due to reasons such as respiratory problems, communication and sensory defects, and epiletic seizures. These patients must be evaluated by a neurosurgeon. Treatment of neuromuscular scoliosis is the same as for congenital scoliosis described above.
Idiopathic Scoliosis: These most frequently encountered scoliosis occur in a previously smooth spine, mostly at the age of 10, for an unknown reason. Scoliosis progresses with growth during adolescence. That is, the curvature of the spine increases even more. The cause is still unknown (idiopathic), but recent studies have revealed that some genetic factors play a role. In idiopathic scoliosis, side bending occurs as the vertebrae rotate around themselves and there is an asymmetrical protrusion in the back or waist. Idiopathic) scoliosis can be infantile scoliosis (0-3 years old) and juvenile scoliosis (3-10 years old). Early diagnosis (curvatures detected before menstruation in girls) while the patient is still growing is very important.
The purpose of using corsets in these children is to try to prevent the increase in the slope. Provided that normal activities including exercise, dance training and athletics are continued and under the supervision of a doctor, the corset should be interrupted during these activities, but the corset should be used for at least 20-23 hours a day. The corset is especially effective in children where the inclination is above 20 degrees and growth continues. The corset effect begins to decrease in curvatures above 40 degrees and in children whose skeletal development has been completed for many years.
In this case, we prefer “a short and straight spine to a short and curved spine” and we may inevitably have to perform fusion in the early period. Because the surgical treatment of scoliosis is the freezing of the spine, eliminating the movement and stopping its growth, namely “fusion”. The most difficult to treat are neglected curvatures above 70-80 degrees. In these curvatures, correction of the deformed spine with or without removal and fixation of the vertebrae with titanium rods and screws is possible with modern techniques and experience gained today. Both anterior and posterior fusion may be required to control the scoliosis curvature. In order to achieve spinal fusion, it may be necessary to use either autograft (the person’s own) or allograft (someone else’s) bone, bone analogs, or a combination of many of these sources.
Apart from this, in some cases, we may prefer short fusion in scoliosis that can be completely corrected by applying fusion to a very short spinal region. In this case, since the fusion will only be performed in a limited area, it may not seriously affect the growth of the spine and rib cage. In adolescence, since the spinal canal, lungs and thoracic cage are sufficiently developed, the fusion process does not cause potential problems in children, as the lengthening is also completed to a great extent.
A short-term (3 months) corset can be applied to some patients during discharge. Children can return to school in about 3 weeks. Exercises such as walking and swimming are allowed after three months, but contact sports (karate, football, basketball, etc.) are prohibited until the end of the first year. At the end of the first year, they are allowed to return to their normal lives.
Adult degenerative scoliosis: It is a type of scoliosis that occurs in any of the neck, back and waist regions of the spine as a result of aging and wear and bone loss (osteoporosis) of the spine structure, usually over 50 years of age. In these individuals, the stability and balance of the spine may deteriorate, causing the spine and trunk to tilt sideways in the anterior-background, and the trunk to tilt to the fore-east due to a decrease in the anatomical angle of the lumbar region. In addition to adult degenerative scoliosis, an additional deformity that may occur in the spinal structure is called spondylolisthesis, a posterior shift is called retrolisthesis, and a lateral shift is called lateral listesis. Vertebral slippage in the spinal structure may cause pain, nerve and/or spinal cord compression may cause leg pain and muscle weakness, or severe pain may occur due to degeneration of the facet joints. As a result, with a slow progression, the patient’s spinal cord and nerves are under pressure, and their mobility is affected. These patients must be evaluated by a neurosurgeon.
In adult scoliosis patients, corset treatment can be applied together with exercise. However, corset treatment, exercises to increase physical condition accompanied by a physiotherapist, and as an auxiliary method to physical therapy; should be considered for a short period of time. Along with physical therapy and exercise, pain relievers may also be given for patients with pain. In addition, non-steroidal anti-inflammatory drugs can be added to the treatment to relieve irritation (inflammation) especially in the facet joints or as a result of nerve compression. If the source of pain is frayed facet joints or radicular pain caused by nerve compression, spinal injections may be a good alternative treatment method for these patients.
For adult scoliosis, pain, loss of function and balance are more prominent than the degree of curvature and the deformity it creates. However, although it is painless, surgery may be necessary to stop the further progression of scoliosis that has clearly progressed. Scoliosis surgery can be an important alternative method for patients who do not respond to treatment despite all non-surgical methods and whose pain increases and disability occurs during this period (6 weeks-6 months).
In addition to spinal curvature, if patients have urinary incontinence due to severe narrow canal or nerve compression, loss of stool control or loss of muscle strength, scoliosis surgery can be selected for treatment. Adult scoliosis surgery is more challenging than pediatric and young age scoliosis surgeries. The duration of surgical intervention and the number of scoliosis operations performed on the person may also be higher. On the other hand, heart, lung, diabetes and osteoporosis diseases are among the important information that should be reported to the doctor for scoliosis surgery.
The aim of scoliosis surgery is to correct the curvature to balance, fusing the vertebrae (fusion) and eliminating nerve compression (decompression). Your doctor will decide how much and how wide these should be done. After adult scoliosis surgery, the patient can usually stay in the intensive care unit overnight. On the first day after scoliosis surgery, the patient is seated by the bed and leg exercises can be performed. On the same day or the next day, the patient stands up and walks one or two steps. The patient is kept in the hospital for 1 week to 10 days for the recovery and rehabilitation process. After discharge, he is given an exercise program. The results of the treatment are evaluated by the doctor’s regular check-ups. In this whole process, it is aimed to return the person to his normal life as soon as possible.
In the case of scoliosis, some other diseases such as rheumatic diseases, spinal fractures, spinal infections can also be caused.
