Scoliosis: What It Is, Symptoms, and Treatment

Scoliosis is the curvature of the spine to the right or left. Although it is often associated with developmental disorders, the exact cause is not fully understood. It is usually diagnosed during childhood. The first signs include asymmetry in the shoulders and hips, and a bulge in the patient's back. Sometimes, the condition is detected incidentally during a chest X-ray. Scoliosis can also cause displacement in the hips, shoulder blades, and rib cage. Scoliosis is more common in girls.

What is Scoliosis?

Scoliosis refers to conditions where the normal curvature of the spine is disrupted. In scoliosis, the outward appearance of the spine can resemble the letter "S" or "C." The sideways curvature of the spine typically occurs during pre-adolescence and early adolescence. It is estimated that 3 out of every 100 adolescents have this condition. In 4 out of 5 scoliosis patients, the underlying cause remains unidentified.

What Are the Types of Scoliosis?

In medical literature, when the causes of a disease are not clearly identified, it is referred to as idiopathic. Therefore, the most common type of scoliosis is called "idiopathic scoliosis." Idiopathic scoliosis is further classified into 4 groups, with age limits ranging from 0 to 18 years.

The term "infantile idiopathic scoliosis" is used for patients aged 0 to 3 years, "juvenile idiopathic scoliosis" is used for those aged 4 to 10 years, "adolescent idiopathic scoliosis" is used for patients aged 11 to 18 years, and "adult idiopathic scoliosis" refers to scoliosis detected after the age of 18. Considering the age group most commonly affected, it can be concluded that a large majority of scoliosis patients are those diagnosed with adolescent idiopathic scoliosis.

Scoliosis detected after birth is classified as congenital scoliosis. This type of scoliosis can sometimes be detected during ultrasound examinations performed while the baby is still in the mother's womb. It results from a problem that occurs during the development of the skeletal structure of the spine, and may be accompanied by developmental defects in other systems such as the nervous, urinary, and cardiovascular systems.

What Are the Causes of Scoliosis?

In the majority of scoliosis patients, the underlying cause cannot be identified. However, in about 1 in 3 scoliosis patients, the presence of family members with the same condition may indicate a genetic transmission. Therefore, it is important for parents who were diagnosed with idiopathic scoliosis during their youth to be aware that their children may also develop this conditio

What Are the Symptoms of Scoliosis?

The symptoms of scoliosis vary depending on the degree of the spinal curvature. Various signs and symptoms can help in recognizing the condition:

• Asymmetrical shoulders, shoulder blades, and pelvis when viewed from the outside
• One hip appearing higher than the other
• Lateral curvature of the spine
• Persistent neck, back, and lower back pain over a long period
• The chest cavity may shrink as a result of changes in the spine, potentially causing breathing difficulties, as the lungs may not be able to expand fully during inhalation.

How Is Scoliosis Diagnosed?

The first step in diagnosing scoliosis is to investigate known conditions that could potentially cause scoliosis. Determining the cause of scoliosis is especially important when scoliosis starts before the age of 10, when the curvature progresses rapidly, or when there are symptoms related to the nervous system.

During the examination, the skeletal system of the affected person is assessed. In scoliosis patients, persistent back pain (reported in about a quarter of patients) may be among the complaints. However, most scoliosis patients do not have any other conditions apart from scoliosis and are often active in athletic activities for their age group.

The presence of scoliosis can be determined through various radiological examinations. Low-radiation X-rays taken from different angles are the first imaging method used. If deemed necessary by the physician, additional diagnostic imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) can also be employed.

Imaging methods help assess the degree of spinal curvature. In order for scoliosis to be diagnosed, a curvature of at least 10 degrees must be detected.

How Is Scoliosis Treated?

Treatment for scoliosis rarely involves bracing or surgical intervention. The treatment principle is based on observation, appropriate exercises, sports activities, and regular follow-up. Although various factors are considered in the treatment planning, the degree of curvature is the most important factor. In patients diagnosed with adolescent idiopathic scoliosis, if no intervention is made, the curvature can increase by an average of 0.5 to 1 degree per year. Additionally, scoliosis that appears during adolescence tends to progress more aggressively than scoliosis seen at younger ages. Therefore, scoliosis cases in later ages may require more aggressive surgical interventions compared to adolescent scoliosis.

In untreated scoliosis patients, back pain, nerve damage, and problems affecting organs such as the lungs and heart may occur in later stages. In addition, negative thoughts about the person’s external appearance should also be addressed during treatment planning.

For individuals with spinal curvature between 10 and 25 degrees, follow-up and evaluation with X-ray images taken at intervals of 3, 6, and 12 months are generally recommended. In cases where the curvature is greater than 25 degrees but does not exceed 40-45 degrees, bracing (a method known as orthosis) may be tried if deemed appropriate by the doctor. The use of braces, which are similar to corsets, aims to prevent the progression of spinal curvature. However, this method has become quite rare in recent years.

In some early-detected cases, bracing may be the main treatment approach. Braces need to be worn for 16-23 hours a day during the growth period. Regular use is crucial in orthosis treatment.

For those with spinal curvature exceeding 40 degrees, surgical intervention to straighten the spine may be considered. Spinal fusion surgery is a technique in which the bones of the spine are fused using long rods, bone grafts, and screws to correct scoliosis. The rods help straighten the spine, and the screws stabilize the structure. The use of bone tissue strengthens the structure. In growing children, adjustments to the rods and screws may be needed over time.

In conclusion, for most scoliosis patients, appropriate exercises, sports activities, and regular follow-up form the foundation of both the condition and its treatment.