Scoliosis is a back deformity in which part of the spine curves to one side in an S or C shape - with or without rotation of the vertebrae.
Scoliosis is a relatively common spine disease, especially in childhood. It affects 2-3% of the population, or an estimated six to nine million people in the United States. Symptoms and treatment vary depending on the age at which the disease appears.
He may not pretend Scoliosis of the spine With important serious symptoms that require urgent treatment, but deformation of the back shape is the main reason for performing scoliosis surgery. In this article, learn about the most important symptoms and signs of scoliosis, and the latest surgical techniques used to treat it in Turkey.
What is scoliosis?
Scoliosis, or as some call it scoliosis, is a bone disease in which Spinal deflection to one side, and it often affects the thoracic or lumbar vertebrae (or both).
Scoliosis affects all age groups, even infants, but it usually begins to appear in children from the age of 10 years to the age of 15 years. Both males and females may suffer from mild scoliosis without any difference between the sexes, but the rate of scoliosis development and its progression to the worst is eight times greater in females!
Each year scoliosis patients make more than 600,000 visits to physicians' private clinics, an estimated 30,000 children are fitted with a brace and 38,000 patients undergo spinal fusion to treat scoliosis.
Simple scoliosis is considered normal, but if the degree of scoliosis is more than 10-15 degrees on the simple radiograph, then the scoliosis is considered a pathological problem that needs treatment.
Causes of scoliosis
About 80% cases of warp or Spinal sprain The cause is unknown, but there are many expected causes of scoliosis, the most important of which are:
- heredity; Where there are some hypotheses that support the existence of a link between the genetic factor and scoliosis.
- physical deformities; Including deformity in the muscles around the spine, and the difference in growth between parts of the spine may be the possible cause.
- birth defects; Like a deformity in the development of the vertebrae (fused or missing vertebrae), such cases often begin to appear in the second year of life.
- Tumors or small abnormalities in the spine may be an important cause of scoliosis in young children.
- Spinal surgery to remove a benign tumor may increase the risk of scoliosis in the future.
- Studies have shown that the incidence of female infection is greater than that of males. This is because there is a region on the X chromosome associated with the occurrence of back scoliosis (chromosome XX in females and XY in males).
Symptoms of scoliosis
The majority of scoliosis cases are simple without symptoms, but in some cases of severe scoliosis the symptoms can be as follows:
- Pain where scoliosis occurs - especially in the lower back
- Neurological symptoms such as numbness and tingling in the leg
- Thoracic symptoms such as shortness of breath (in thoracic scoliosis)
In one study, about 23% patients with idiopathic scoliosis had back pain at the time of initial diagnosis. 10% of these patients had an underlying condition associated with the occurrence of scoliosis eg Spondylolisthesissyringomyelia, tied rope, herniated disc or Spinal tumor. If a patient with idiopathic scoliosis has mild back pain, a thorough evaluation for another cause of the pain is recommended.
Because of changes in the shape and size of the chest, idiopathic scoliosis may affect lung function; Recent reports have shown impairment in lung function in patients with mild to moderate scoliosis.
Signs of scoliosis
A scoliosis patient or a member of his family may notice one or more signs of scoliosis, these signs are:
- The scapula on one side is more prominent than the other
- One shoulder is higher than the other
- The head is not positioned centrally over the body
- Uneven clothing on both sides
- Tilt of the chest to one side
- asymmetrical waist
- Asymmetry in the front of the chest
Diagnosis of scoliosis (scoliosis of the spine)
In the beginning, we ask about the presence of scoliosis in the patient's family, because the majority of scoliosis cases are of familial origin. Scoliosis is mainly diagnosed by listening to the patient's complaint and conducting a physical examination. Where we begin to meditate on the body in general due to the possibility of revealing Spinal tilt this way.
In the event that this fails to detect scoliosis, we resort to some tests, such as the Adam test, in which we ask the patient to stand with the feet aligned with each other and bend forward (as in kneeling).
In the end, the diagnosis is confirmed by a simple X-Ray of the spine, which shows a deviation in it, as the sound enables us to measure the cobb angle, which expresses the size of the curvature in the spine, as the Cobb angle must be at least 10 degrees in order for us to say that he is ill. scoliosis In general, scoliosis is considered significant if the curvature is greater than 25-30 degrees.
Scoliosis in children
Idiopathic scoliosis includes the vast majority of cases that appear during adolescence. Depending on the severity of the scoliosis and the age of the child, scoliosis is corrected either by careful observation, bracing, or surgery.
In children with congenital scoliosis there is a proven increase in its association with other congenital malformations commonly associated with the spinal cord (20%), genitourinary system (20-33%) and heart (10-15%). Therefore, it is important to perform an evaluation of the nervous, genitourinary, and cardiovascular systems when diagnosing congenital scoliosis.
Scoliosis in adults
Scoliosis that occurs or is diagnosed in adulthood is distinct from scoliosis in childhood, as the underlying causes and treatment goals differ in patients who have already reached skeletal maturity.
In one 20-year study, about 40% adult scoliosis patients experienced an increase in scoliosis severity, while 10% showed very significant progression, and the other 30% had a moderate worsening of scoliosis severity (usually less than 1 degree per year).
Degenerative scoliosis occurs in the lumbar spine (lower back) and this condition most commonly affects people over the age of 65. This type of scoliosis is often accompanied by narrowing of the spine or narrowing of the spinal canal This leads to pressure on the spinal nerves.
Back pain associated with degenerative scoliosis usually begins gradually and is associated with activity. The curvature of the spine in this type of scoliosis is often relatively mild, so surgery may only be recommended when conservative methods fail to relieve pain associated with degenerative scoliosis.
severity of scoliosis
Gravity dependent Deflections of the spine On many factors that may affect the daily life of the patient, the most important of these factors are:
- The magnitude of the scoliosis or curvature of the spine, where the prognosis is considered poor in thoracic scoliosis of 45 degrees and lumbar scoliosis of 35 degrees.
- The location of scoliosis and its impact on neighboring organs.
- The age of the scoliosis patient and the size of the remaining growth of the patient's spine to anticipate the prognosis in the future, as scoliosis in adults is less dangerous than in children.
Spinal deformity treatment without surgery
In the event that the degree of scoliosis is less than 25 degrees in children, we can only monitor through periodic radiographs, while more severe curves can be monitored in older patients. During that, the doctor may recommend placing a scoliosis brace or performing special exercises.
Treatment of scoliosis with belt and braces
Some doctors may recommend, if the scoliosis is between 20-25 degrees in adults and 40-45 degrees in children, to use some belts and braces that can be worn for several hours a day in order to prevent and prevent the development of scoliosis as the child grows.
Some of the most popular braces are Boston brace, Providence brace (at night only), Charleston brace as well as flexible spine brace.
There is evidence that a scoliosis patient who wears an appropriate brace for at least 13 hours per day has a 56% decrease in the likelihood of future spinal surgery.
Treating scoliosis with physical therapy
There are some studies that recommend exercises such as yoga, which may help in automatic correction of posture by strengthening the muscles surrounding the spine and straightening the spine, but so far there is no proven evidence about the benefit of these exercises in treating scoliosis.
Scoliosis operation in Türkiye
We perform a scoliosis operation, or as it is called a scoliosis operation, in case of failure of stent therapy and the patient’s condition deteriorates (thoracic scoliosis greater than 45-50 degrees or lumbar scoliosis greater than 35-40 degrees).
The best and most common surgical treatment for scoliosis is fusion of the vertebrae into the spine (arthrodesis), as is the case for most orthopedic diseases such as Lumbar slippage Where the surgeon makes flaps (slices) to expose the vertebrae that make up the warp.
The surgeon removes the articular facets, the bony joints along the vertebrae that allow the spine to bend. Finally, he places the bone graft across the exposed surface of each vertebra and then folds the flap back to its original position covering the bone grafts.
before the scoliosis operation
The patient undergoes a complete physical examination in order to determine the length of the legs and muscle strength and to detect other abnormalities. In addition to examining the lung function, one should also look for burns and ulcers in the area of operation as they increase the risk of infection.
The patient should be trained on deep breathing and effective coughing to avoid lung congestion after the operation, as well as training him to roll over in bed with one movement called logarithmic rollover.
The bone grafts used in the scoliosis operation are taken from the person himself (the thigh, for example), or they may be taken from the bone bank to relieve pain after the operation, as the pain is higher if the graft is taken from the patient’s body.
Interventional method on the spine in scoliosis surgery
There are two ways to access the spine for scoliosis surgery, the posterior method (by opening the patient's back) and the anterior method (by opening the chest or thoracoscopy) in addition to the combined approach in which both methods are used (especially in young patients).
The posterior method is the gold standard in treatment curvature of the spine Lower (lumbar scoliosis), this method requires many devices and takes less time than the front method, but the lower back pain and the amount of bleeding is usually greater.
While the anterior method involves making an incision in the chest, emptying the lung, and removing the rib (commonly used for bone grafts), this method allows the surgeon to preserve the fusion of the lower vertebrae. The anterior approach is often performed using modern techniques and is called an anterior approach Video-assisted thoracoscopic surgery Or VATS for short.
Minimally invasive scoliosis surgery in Türkiye
Small incisions called portals are made in the side of the chest. The surgeon uses binoculars, cameras, and video monitors to see the spine, which makes the amount of bleeding less and the recovery period is about two days after surgery, while in the case of open surgery (opening the chest), the surgeon makes a single large incision that enables him to perform the operation.
These modern devices help make spine surgery less invasive for the patient while providing equal or better results. There is little effect on lung function with VATS as shown in some studies. After surgery, small incisions are hidden under the patient's arm. The scars are much smaller cosmetically than standard open procedures.
Spinal fusion can sometimes be done through smaller incisions with this technique. The use of advanced fluoroscopy (intraoperative X-ray imaging) and camera endoscopy has resulted in smaller incisions and device placement, which reduces tissue trauma. It is important to keep in mind that not all cases can be treated in this way and that a number of factors contribute to the surgical method used.
Various procedures in the scoliosis process
The goal of these procedures is to immobilize the spine so that the fusion can heal and to balance the spine after the fusion. These procedures include:
Harrington procedure
The surgeon uses a steel rod extending from the bottom of the scoliosis to the top, connects the rod with hooks suspended from pegs that are inserted into the bone, then the rod is lifted and locked in place to securely support the spine, after that the surgeon is ready to fuse the vertebrae together.
One of the disadvantages of this procedure is that it is difficult to apply in the treatment of scoliosis in adults, as it does not correct the rotation of the spine, in addition to that the duration of staying in bed after it is 3-6 months.
Flat back syndrome (disappearance of the internal curvature of the lower back) is a common complication after this procedure that presents as dull lower back pain that does not affect daily activities.
Crankshaft phenomenon is a condition that may occur in children younger than 11 years old (whose skeleton is immature) undergoing the Harrington procedure in which the front part of the fused spine continues to grow, causing them to develop a new curvature.
Cotrel-Dubousset procedure
In this procedure, two parallel rods are connected instead of one rod for better stability of the fused vertebrae, as it is about 95%. The results are very good, in addition to the fact that patients return to their homes usually after 5 days. Therefore, this method is most often used in the treatment of spinal sprains in adults. The child may go to school after about 3 weeks.
The Cottrell-Dupocet operation helps to correct the curvature and also the rotation of the spine, where the incidence of flat back syndrome is less than in the Harrington operation, but the duration of this operation and the amount of bleeding in it is greater than in the Harrington operation.
Third generation and hybrid devices
These devices have led to an improvement in the quality of spinal deformity correction operations, as the use of cervical screws has become much better than hooks in stabilizing and correcting the rotation of the spine, and the use of screws allows the surgeon to reduce fusion of the vertebrae (especially the lumbar) so this technique has become preferred among children and adolescents .
Sublaminar wires are frequently used with a single rod in the correction of neuromuscular scoliosis or scoliosis caused by cerebral palsy or spinal cord injury.
The use of screws avoids any anterior intervention to free the spine and avoids thoracotomy to correct the deformity of the rib cage because it is very effective in correcting scoliosis and kyphosis as well.
With time, titanium implants are increasingly used in the scoliosis process because of their strength and compatibility with the bones of the human body, in addition to that they do not prevent an MRI scan in the future, like other metal implants.
front way
Screws can be placed at the front of the vertebrae and connected to a corrective rod in case the entry is made from the front in order to correct scoliosis.
Tips for patients with scoliosis after the operation
There are a set of tips and things that you must adhere to after scoliosis surgery in order to reach a lifestyle free of complications and risks. These tips are:
- Do not carry heavy things, because it will increase pressure on your spine, which will lead to poor health.
- Do not sleep on your stomach. This position is the worst because it flattens the thoracic spine, which can exacerbate scoliosis.
- Change your body position frequently, because sitting or standing for a long time increases pressure on the spine.
- Do regular exercise, as it strengthens the muscles of the spine, which leads to increased stability.
Complications of scoliosis surgery
As is the case with most surgeries, scoliosis surgery is not devoid of many complications that the patient faces, but their percentage is rather low (1-3%). The most important of these complications are:
- Bleeding, especially in open surgery.
- Pain after surgery Morphine is usually given immediately after the operation for pain relief via an intravenous pump and then we switch to oral painkillers (such as paracetamol) a few days after the operation.
- Infection or infection, especially since the metal materials used to stabilize and correct scoliosis increase the possibility of infection.
- Nerve damage, the percentage of nerve injury is low, but it is higher in adults.
- Pseudoarthrosis where a false joint develops at the site of the vertebral fusion.
- Spinal disc degeneration and low back pain.
- Dislocation of hooks or fracture of fused vertebrae.
The success rate of scoliosis surgery in Türkiye
This percentage depends on many factors that greatly affect the success of the scoliosis operation, the most important of which is the experience of the surgeon and the method used in the surgery, in addition to the extent of the development of the medical center in which the surgery is performed.
The success rate for scoliosis or scoliosis surgery is about 70%, especially for those performed on children under 11 years old, as the possibility of complications is very low.
The cost of scoliosis surgery in Türkiye
The cost of scoliosis surgery depends on many factors, including the method used in performing the operation and the patient's health condition. In addition, the quality of the devices available in the specialized medical centers may affect the price, as the cost of the operation varies from one hospital to another in Istanbul/Turkey. In general, the price of scoliosis surgery in Turkey ranges between 10-15 thousand US dollars.
Although scoliosis can negatively affect your health, lifestyle, and appearance in front of people, it is not an inevitable fate that you have to live with. Many scoliosis patients have been treated in Turkey and regained their normal appearance.
With the help of trained professionals and a combination of non-surgical or minimally invasive techniques we'll be able to help you manage your condition, finding relief can be a lot easier than you think. If you have scoliosis or are concerned you might have scoliosis, seek treatment today.
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