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What actually is scoliosis?
Basically, there are different types of deformities of the spine. In addition to the so-called kyphosis (increased hunchback, e.g. M. Scheuermann or widow's hump in osteoporotic multiple vertebral fractures or in M. Bechterew), scoliosis (lateral bending with simultaneous twisting of the vertebrae) is probably the best known and most common deformity of the spine. True scoliosis, non-pain-related side bending, is a three-dimensional spinal deformity. The causes for this are manifold.
Scoliosis is subdivided according to the cause of its origin and the form in which it appears.
What causes scoliosis?
- idiopathic scoliosis (most common, approx. 85% of all scoliosis)
- congenital (born) scoliosis
- Metabolic scoliosis
- myogenic scoliosis
- neurogenic scoliosis
- Scoliosis in Marfan syndrome, Ehlers-Danlos syndrome, in M. Recklinghausen and others
Idiopathic scoliosis is divided into infantile (first onset between the ages of 1 and 2 years), juvenile (first onset between the ages of 4 and 6 years) and the most common form, adolescent scoliosis
In childhood, scoliosis tends to increase in curvature, especially during the main growth phases! For this reason, follow-up checks should be carried out closely during this time. One should also pay attention to times of greater growth dynamics. These include the growth spurt from infancy to the age of 6 and the pubertal growth spurt in girls between the ages of 10 and 14 and delayed by about 2 years in boys.
Common complaints
In childhood and adolescence, scoliosis, depending on the degree of severity, usually does not cause any or only very rarely symptoms in the sense of back pain.
- Back pain, rarely with referred pain
- heart problems and/or shortness of breath
Caused by the curvature and consequent narrowing of the chest - Visible deformity of the entire spine with partial rib hump formation
- cosmetic issue
Careful diagnosis is a prerequisite for successful treatment
Which procedure makes sense in individual cases depends on the diagnosis. Although the description of the symptoms usually points the way, clarity is often only brought about by imaging procedures such as computer or magnetic resonance imaging. It is important to know the degree of spinal damage and to know how many segments are affected by the narrowing. It is also important to determine whether there is already instability in the spine, whether and to what extent bony outgrowths must be surgically removed, or whether the desired relief can be achieved, for example, with the use of an implant.
In principle, any section of the spine can be affected by a narrowing; by far the most commonly affected area is the lumbar spine.
How is it treated conservatively?
Depending on the progression of the degree of curvature, corset therapy is appropriate and corrective surgery (spondylodesis) is only given in the advanced stage. If this is not carried out for a given corset indication or if optimal care is missed or delayed, a sometimes drastic increase in curvature can be expected within a very short time (approx. 3 months). For this reason, you should not wait 3-6 months for an examination during the main growth spurt. Once the indication has been made, an appropriate corset (Chenau or Milwaukee corset) should be fitted quickly.
Since the conservative as well as the surgical treatment of scoliosis is a special field, only specialists should take over the treatment.
- Conservative treatment
Scoliosis from 10-20° should be treated with physiotherapy to prevent further progression. The aim of the physiotherapeutic exercises is the active straightening of the spine with additional muscular stabilization. One of the leading conservative treatment concepts is physiotherapy according to Katharina Schroth. Priority is given to conscious posture training. Another treatment concept is the therapy according to Vojta. This therapeutic approach is based on what is known as reflex locomotion. Here the natural reflexes are trained and used. For this reason, this form of treatment is particularly suitable for infants, small children and mentally handicapped patients.
- Orthotics or corset therapy
Scoliosis in the growth age from 20° should be treated with a redressing (corrective) corset in addition to scoliosis-specific physiotherapy. Thus, the corset should have a growth-guiding effect. In this way, an increasing deterioration is to be avoided and, if possible, an already existing curvature is to be corrected and maintained.
One of the most well-known types of corsets is the Cheneau corset. The Cheneau corset is mostly used for lumbar scoliosis. In the case of higher (thoracic scoliosis), the Milwaukee corset (with or without a neck piece) is occasionally used. In order to achieve the corresponding corrections, so-called pads are incorporated into the corresponding corsets, which exert pressure on the respective lateral curvature and thus improve the correction.
In order to achieve adequate scoliosis brace therapy, close cooperation between the doctor, physiotherapist and orthopedic technician is essential. Close checks and regular X-ray follow-up checks are essential here.
How is surgery treated?
- Ventral derotation spondylodesis
This surgical procedure is mostly used for scoliosis in the area of the thoracic spine (thoracic spine). This is a purely ventral (front) procedure. During the operation, the thoracic spine is reached laterally between the ribs (sometimes a rib is also sacrificed). The intervertebral discs in the section to be operated and corrected are then removed. Screws are inserted into the corresponding vertebral bodies. A readily adapted, slightly flexible rod is inserted into these screws and the correction is carried out with nuts until the desired correction is achieved and finally tightened.
Endoscopic decompression
- The dorsal distraction spondylodesis
This surgical procedure is used for purely thoracic scoliosis, i.e. limited to the thoracic spine, as well as for lumbar and combined i.e. thoraco-lumbar scoliosis. Access here is only from the dorsal (back). In this procedure, either only hooks, which are brought under the corresponding vertebral arch, are used and / or screws. there is also the possibility to combine a hook and screw system.
The advantage of the dorsal procedure is that the thorax (chest cavity) can be enlarged by detaching ribs in the thoracic spine area. This is done by placing the previously detached ribs over the previously inserted rod and thus the chest cavity can be significantly enlarged.
The procedure takes about 2 to 4 hours and is performed under general anesthesia. The patient can get up on the 2nd or 3rd day after the operation; wearing a specially adapted corset for several months protects against incorrect movements and serves to ensure that the implants grow in.
