What Do Scoliosis Specialists Do?

Scoliosis is commonly known as scoliosis, which is a three-dimensional deformity of the spine, including sequence anomalies in the coronal, sagittal, and axial positions. A normal person's spine should be a straight line when viewed from the back, and the torso should be symmetrical on both sides. If you have unequal shoulders when viewed from the front or uneven back and back, you should suspect "scoliosis". At this time, a full spine X-ray film should be taken in the standing position. If the positive X-ray film shows a lateral curvature of the spine greater than 10 degrees, it can be diagnosed as scoliosis. Mild scoliosis usually has no obvious discomfort, and no obvious physical deformity is seen. Severe scoliosis can affect the growth and development of infants and young children, and deform the body. In severe cases, it can affect cardiopulmonary function and even affect the spinal cord, causing paralysis. Mild scoliosis can be observed, and severe cases require surgery. Scoliosis is a common disease that harms adolescents and children. The key is to detect and treat it early.

Basic Information

nickname

Scoliosis, scoliosis, curvature of the spine

English name

scoliosis

Visiting department

Surgery, orthopedics

Common locations

spine

Contagious

no

Causes of scoliosis

Scoliosis is a symptom. There are many causes of scoliosis, each with its own characteristics. In order to make the treatment effective, it should be distinguished and targeted.

Scoliosis can be divided into functional or organic, or non-structural and structural ones according to the cause.

(A) non-structural scoliosis

1. Postural scoliosis;

2. Waist and leg pain, such as disc herniation, tumors;

3. Caused by unequal length of both lower limbs;

4. Caused by hip contracture;

5. Inflammatory stimuli (such as appendicitis);

6. Hysterical scoliosis.

Non-structural scoliosis refers to temporary scoliosis caused by some reasons. Once the cause is removed, it can return to normal, but long-term people can also develop structural scoliosis. Generally, this type of patient usually disappears spontaneously when supine, and the spine bones are normal.

(Two) structural scoliosis

Idiopathic

It is the most common, accounting for 75% to 85% of the total. The cause of the disease is unknown, so it is called idiopathic scoliosis. According to the age of onset, it can be divided into three categories.

(1) Infant type (0 to 3 years old) Natural healing type; Progressive type.

(2) Juvenile (4 to 10 years old).

(3) Adolescent type (> 10 years old to mature bone).

Among the three types mentioned above, the juvenile type is the most common.

2. congenital

(1) Formation of bad type congenital hemivertebra; congenital wedge-shaped vertebra.

(2) Poor segmentation.

(3) Mixed type, combining the above two types at the same time.

Congenital scoliosis is caused by incomplete spinal segmentation, spinal bridges on one side, or incomplete development of the vertebral body on the one side of the spine or a mixture of the above two factors, resulting in asymmetric growth on both sides of the spine. Scoliosis. Other malformations are often combined at the same time, including spinal deformities, congenital heart disease, and congenital urinary tract malformations. Spinal developmental abnormalities can usually be found on X-rays.

3. Neuromuscular

It can be divided into neurogenic and myogenic. It is due to the imbalance of muscle strength caused by neurological or muscular diseases, especially the scoliosis caused by the asymmetry of the paraspinal muscles. Common causes include sequelae of polio, cerebral palsy, syringomyelia, and progressive muscular dystrophy.

4. Neurofibromatosis with scoliosis.

5. Scoliosis due to interstitial lesions

Such as Marfan syndrome, congenital polyarticular contracture and so on.

6. Acquired Scoliosis Acquired

Such as ankylosing spondylitis, spinal fractures, spinal tuberculosis, empyema and thoracotomy and other scoliosis caused by chest surgery.

7. other reasons

Such as scoliosis due to metabolic, nutritional or endocrine reasons.

Scoliosis diagnosis

(1) Early diagnosis of scoliosis

Early detection and early treatment are key to prevent the serious development of malformations. The early manifestations of scoliosis are: uneven shoulders, deviation of the spine from the midline, high and low shoulder blades, wrinkled skin on one side of the chest, and bilateral back asymmetry during anterior curvature. Early detection mainly relied on parents, school teachers, and school doctors. A simple test was a bending test: the child was taken off his shirt, his feet stood on a flat ground, and he stood upright. Put the palms of your hands together, place your hands between your knees, and gradually bend over. The examiner sits in front of or behind the child, looks up with both eyes, and observes whether the children's backs are equal. Bend is accompanied by bulge caused by vertebral body rotation. If the bending test is positive, you should go to the hospital in time.

(Two) imaging examination

(1) X-ray examination is the most important. Generally, the cause, classification, curvature, location, rotation, bone age, compensatory degree, etc. of scoliosis can be distinguished with the help of X-ray films.

Conventional radiographs should include a full-length frontal and lateral view of the spine in the standing position, with the upper end including the lower cervical spine and the lower end including bilateral lumbosacral joints and sacral wings. Other special X-ray films include supine lateral flexion, traction, etc., which can evaluate the flexibility of scoliosis.

(2) CT scan can show bone deformities very well, especially 3D reconstruction of spine CT can show congenital vertebra deformities well, CT scan of myelography can also be done, in some complex spinal deformities can show the spine and Neural relationship, with or without spinal deformity, guides surgical treatment.

(3) Magnetic resonance (MRI) is a non-invasive test compared with myelography. It has a high resolution of soft tissues and can show spinal cord lesions well.

(Three) nervous system examination

Every patient with scoliosis should undergo a detailed and comprehensive neurological examination. On the one hand, pay attention to whether there is scoliosis that leads to spinal cord compression and paraplegia. In the early stage, there is hypertenous reflex and pathological reflex. Spinal cord abnormalities such as spina bifida, spinal cord fissure, and spinal cavity.

Scoliosis Treatment

The treatment of scoliosis can be divided into two categories, namely non-surgical treatment and surgical treatment.

Common non-surgical treatment methods include physical therapy, gymnastic therapy, plaster, braces, etc., but the most important and reliable method is brace treatment.

Generally, idiopathic scoliosis within 20 degrees can be left untreated and closely observed. If the annual increase is more than 5 degrees, brace treatment should be performed. Idiopathic scoliosis in adolescents with a first diagnosis of 30 to 40 degrees should be treated immediately with braces, as more than 60% of patients in this group will develop aggravation. Adolescent idiopathic scoliosis requires surgical treatment in the following cases:

(1) Those with a chest curve greater than 40 degrees and a thoracolumbar curve / waist curve greater than 35 degrees;

(2) those who can't control the brace treatment and the rapid progress of the scoliosis;

(3) Those with obvious low back pain or symptoms of nerve compression.

For patients with congenital scoliosis, if the scoliosis is a type that easily progresses or the scoliosis progresses significantly during the observation period, surgery should be performed as soon as possible. Generally 3 to 5 years is a good time for surgery.

Due to the complex etiology of scoliosis, there are many types. Whether surgery is needed is not simply based on the patient's age or degree of lateral curvature. The type, characteristics, segment, rate of progression, age of the patient's bone, and deformity on the patient's body should also be considered. Factors such as the degree of influence. Progressive surgery for congenital scoliosis has been agreed early, because it not only worsens deformity with age, but also becomes stiff and difficult to correct. However, if idiopathic scoliosis undergoes posterior correction and fusion early in childhood, it may affect its spinal growth and development, and it is likely that the deformity will increase in the long run. In addition, factors such as spinal balance and the effect of surgery on spinal growth and mobility must also be considered. Therefore, each patient with scoliosis should be specifically analyzed and individualized treatment measures taken.

The purpose of scoliosis surgery is to prevent the progression of the deformity; restore the spinal balance; correct the deformity as much as possible; keep as many active segments of the spine as possible; and prevent nerve damage. With the current three-dimensional orthopedic technology and pedicle screw fixation technology, scoliosis can obtain good surgical orthopedics, but it cannot be corrected 100%, because the surgery also takes into account the tolerance of the spine and spinal cord of the patient, and excessive correction It is easy to cause internal fixation failure, increase the incidence of surgical complications, and even cause nerve damage and paralysis. Different ages, different degrees, and causes of scoliosis correction are different. Generally, the correction rate of idiopathic scoliosis can usually reach 60% to 80%.

Scoliosis prevention

Scoliosis is a common disease that harms adolescents and children. If it is not detected and treated in time, it can develop into a very serious deformity, which can affect cardiopulmonary function, and even cause severe paralysis.

School-age children should pay attention to maintaining a good sitting and standing posture, strengthening muscle exercises, and the most important factor in the prevention and treatment of scoliosis are early detection, early diagnosis, and early treatment. School scoliosis prevention and control knowledge should be promoted in schools, and scoliosis screening check.