Scoliosis: Surgical treatment and Therapy

The goal of treatment for scoliosis is to prevent further progression of moderate curves, and to correct and maintain deformity in severe curves to…

Physical Therapy for Scoliosis – Schroth Method

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Summary

The word scoliosis is derived from the Greek word skolios, which means curved. That is, when the spine is viewed from the front or back, the head and legs should form a straight line, but it is curved to the side (scoliosis). This disease is a three-dimensional deformity accompanied by rotational deformation of the vertebral body, which can cause not only cosmetic problems but also dysfunction of surrounding organs if the deformity is severe.

Causes and Symptoms

Scoliosis occurs in 2~3% of the total population and there are various types. The most common form is idiopathic scoliosis of unknown cause, accounting for about 85% of all scoliosis. It can be divided into juvenile type. In addition, congenital scoliosis, in which an abnormally shaped spine is formed during fetal development, and a curvature of the spine due to neuromuscular diseases such as polio or cerebral palsy or muscular diseases such as muscular dystrophy, neuromuscular scoliosis, in which the spine is curved or other tumors, infections, metabolic diseases, and scoliosis caused by arthritis. Adolescent idiopathic scoliosis develops slowly, so it usually goes unnoticed and deforms considerably, causing the back to bend to the side, the height of the shoulder or pelvis, and the side to bend, the height of the shoulder or pelvis, or one chest or hip In most cases, the protrusion is discovered by accident and a hospital is visited. Occasionally, you may complain of back pain or fatigue, but it is usually not painful. However, if the degree of curvature is severe, the ribs may compress the pelvis and cause pain, and after becoming an adult, back pain due to degenerative arthritis of the vertebral joint may appear.

Diagnosis

If the body is tilted to one side, the center line of the waist is bent, or the height of the shoulders is different, if the pelvis is not parallel and inclined, try to suspect it first. Secondarily, a backbone examination is performed to determine whether the torso is bent, and even if the waist is not bent, it may look strange on the backbone examination. Even in normal conditions, if one of the muscles around the waist is more developed, the height of the torso may look different, and even if the posture is wrong, it may come out as if you have scoliosis. When taking an X-ray, the whole spine is taken in a standing position, and after taking the picture, the Cops’ method is used to measure the degree of curvature based on the upper and lower vertebrae, which are the most inclined.

Therapy

The goal of treatment for scoliosis is to prevent further progression of moderate curves, and to correct and maintain deformity in severe curves to achieve balance in the body. Treatment of scoliosis can be divided into three categories: regular observation, wearing braces, and surgery. When starting treatment, the patient’s gender, age at which the curve occurs, maturity level of growth, angle of curve at the time of discovery, type of curve, and deformation of the shape of the vertebral body should all be taken into consideration. At the age of 17 or 15 years in women, the progression of the curvature stops. Therefore, it can be expected that the relatively modest curves that are found after the end of growth or in adolescence near the end of growth are not progressing much. On the other hand, the curves found in children who have several years left until the end of growth are likely to be larger. However, even after growth is over, the curvature can proceed very slowly due to degenerative changes in the spine, especially when the angle of curvature is 35-40 degrees or more or there is a curvature of the lower back. When the angle of curvature is less than 20 degrees, it can be corrected by observing it every 3 to 6 months while exercising and maintaining flexibility. However, surgery is required if the scoliosis exceeds 40-50 degrees, which is highly likely to impede growth, or if the curvature exceeds 50 degrees and indirectly affects the heart or lungs. In particular, in the case of excessive curvature of 50 or more, the curvature of the spine must be corrected with surgery, because the waist can continue to bend even after growth is over and adults become adults.

Surgical treatment

Surgery is similar to correcting a bent tree. In other words, if there is a tree that grows bent sideways, it is the same principle as putting a straight stick next to it and tying it with a rope. A straight iron rod with a diameter of about 7mm is used for the curved waist, and it is corrected by tying the curved waist to a straight iron pole. The average correction power by surgery is about 60-70%. The curved back does not become straight as normal after surgery. For example, if you have surgery at 50 degrees, only about 30 degrees will be corrected, and the remaining 15-20 degrees will remain uncorrected and curved. However, if detected early and the degree of curvature is not severe and undergoes surgical correction at a young age, it will be corrected close to normal. If surgery is performed in a severe condition at a late age, the spine becomes stiff and cannot be properly corrected. Therefore, if you have to undergo surgery, you should not miss the timing of the surgery.

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