Scoliosis

Scoliosis:

Scoliosis is simply defined as  the coronal deformity of the spine. It can be faced upon 2 – 4% of the population. Most of the scoliosis patients do not require surgical intervention. There is a female predilection 8 – 9 times when compared to males.

It is crucial to perform paravertebral muscle strenhtening exercise program to prevent the manifestation or the progression of the scoliosis. Pilates which is guided by trained and certified instructors are very heplfull in this condition.

The most commonly seen scoliosis subtype is ‘Adolescent Idiopathic Scoliosis’. In this type spine can be in S or C shaped with accompanying rotation of the vertebrae. This causes the deformity and asymmetry which can be present at the thoracic or lumbar region which also can be recognisable physically. In this scoliosis subtype bracing can be helpfull to prevent the progression.

The second most commly seen scoliosis subtype is ‘Neuromuscular Scoliosis’. In this type the main reason which causes the deformity is the neural or muscle induced problems. On the contrary to the adolescent idiopathic scoliosis; pulmonary or sensory problems are more commonly seen. The surgical treatment must be performed as early as possible and fusion is the first treatment choise.

Third most commonly seen subtype is ‘Congenital Scoliosis’. This situation becomes evident in the antenatal period and the reason of the deformity is the vertebral anomalies. This subtype also needs early surgical intervention.

Besides, some rheumatological problems and connective tissue disorders such as osteogenesis imperfecta, Marfan Syndrome, Ehler Danlos Syndrome and fractures or infections which affect spinal alignment can cause scoliosis.

The spinal development occurs in the first 3 months in the antenatal period. In this time period, spinal anomalies or unsegmented vertebral portions can cause asymmetry and lead progressive deformity. The unsegmented part do not enlarge and the segmented portions continues to grow resulting in the asymmetric deformity.

In some circumstances such as the unsegmented portions of the vertebrae is present on the both sides; the growing rate is very little or none.  As a result there is not an evident scoliosis but the spine remains shorter than expected. If the vertebrae are fused at the anterior portion than the posterior part continues to  grow resulting in kyphosis. If the vertebrae are fused at the posterior portion and the anterior portion continues to grow than the condition that becomes evident is the lordosis.

The main reason that causes congenital scoliosis is not evident. But, in a patient with congenital scolisos other malformations must be checked out. The second most commmly seen accompanying anomaly with congenital scoliosis is in the urinary system.

In the patients with congenial scoliosis non-fusion or growing friendly treatment options are the first choise. These include; magnetically controlled growing rods or other growing rod techniques. The main aim is to gain as much time as possible for  the child to mature and grow enough to perform permanent fusion.