What is scoliosis?
Scoliosis is a deformity of the spine that causes a curve in the frontal plane and also in the lateral plane (it is three-dimensional). It is accompanied by rotation of the vertebrae located in the area of the curve.
In some cases, the deformity is caused by a disease (such as a neurological or muscular problem) or in the context of malformations of the spine itself. However, in most cases it occurs in healthy boys or girls without a cause that can be established.
One of the characteristics of this deformity is that it usually progresses during the growth stage and can lead to large deviations. Fortunately, only 10% of patients develop high-grade curves.
Although it can appear at any age, 85% of scoliosis occurs in adolescence, being much more frequent in girls.
What are the symptoms of scoliosis in children and adolescents?
The deformity causes an aesthetic alteration that is proportional to the degree of deviation. Small curves may go unnoticed and larger curves cause an identifiable deformity when we look at the child’s back.
Scoliosis generally does not cause pain and, therefore, sometimes it is not diagnosed until the esthetic alteration is very noticeable. In a quarter of the patients, it can produce a sensation of muscular fatigue in the back and, only in scoliosis with a high magnitude of curve, can it produce more marked discomfort.
What should parents look for?
Parents should check that the child’s back does not present asymmetries in the waist, one scapula more protruding than the other or one shoulder higher than the other.
Due to the rotation of the vertebrae in scoliosis, when the child bends forward, a prominence of the spine clearly appears to one side, which is called a hump. Its presence is indicative of scoliosis.
How is scoliosis treated?
Throughout the history of medicine, scoliosis has been treated with exercises, stretching, braces, electrical stimulation, etc. None of these treatments have been proven to decrease the degree of deviation. Today we know that we can only slow down its worsening and, for this purpose, an external support called a brace is placed.
Furthermore, the trauma treatment of scoliosis depends on the degree of deformity and the degree of skeletal maturation of the patient.
Below 30º, controls should be carried out every 3-6 months until bone maturation, to check if it evolves and requires further treatment. 90% of scoliosis will never exceed 30 degrees.
Around 30º in a child with poor bone maturation, we must closely monitor the evolution because it has many possibilities of worsening. If it does, we will place a brace to slow down the evolution as much as possible. If the child is already at the end of bone maturation (girls from 13-14 years of age or boys from 15-16 years of age) it is not necessary to place a brace because the curve will no longer evolve significantly.
In severe curves, above 50º, surgical correction of the deformity is indicated.
In which cases of scoliosis is intervention necessary?
Surgical correction of scoliosis is indicated in deformities above 50 degrees. There are basically two reasons. The first is that above that magnitude, there is a greater incidence of back pain and the quality of life of the patients is diminished. The second is that, above that magnitude, there is a progressive worsening of the deviation throughout life.
Scoliosis surgery means reducing the curve as much as possible and fixing the vertebrae in that position. To do this, we place metal anchoring systems and fill the entire operated area with bone graft.
With the operation we achieve a spine with much less deformity, but on the other hand, the whole operated segment will be rigid and will not have mobility.