About scoliosis

Below you can find a summary of the most important information regarding scoliosis and its different treatments. For certain topics more videos and articles are available now. All the information published here is sourced from textbooks or from the articles and publications of experts.

Comprehensive and informative article on the subject

Who notices if their child usually tilts his head on one side or if clothes always slip off on one shoulder? Don’t slouch – we can often hear it from adults sometimes even if the child is physically uncapable of doing so. There are a lot of misconceptions in the public mind so we’ve asked experts to clarify the most important questions. (Author: Barbara Schuster)

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Scoliosis of unknown origin

Scoliosis of unknown origin: idiopathies scoliosis

Definition:

The generalised, three-dimensional complex deformity of the spine is called structural scoliosis in which the spine can be rotated or twisted. Thus, in addition to the scoliosis in the frontal plane, the lateral profile is also altered, typically becoming lordotic, in accordance with the three-dimensional deformity.

Scoliosis is defined by the Cobb's angle of spine curvature in the coronal plane, and is often accompanied by vertebral rotation in the transverse plane and hypokyphosis in the sagittal plane.

Types, categories:

Cases of scoliosis can be categorised as:

  • Of unknown origin (idiopathic) 80%
  • Of known origin 20%. This includes scoliosis due to congenital anomalies of vertebral development; neuromuscular (neurological) causes (e.g. ICP, SMA, Duchenne, traumatic paraplegia, etc.); and other scoliosis associated with various diseases (e.g. syndromic, connective tissue disease, metabolic disease, tumour, rheumatoid arthritis, etc.).

Most structural types of scoliosis are idiopathic, of unknown origin.

Frequently Asked Questions


Here below we tried to collect some common, day-to-day questions which professionals are often asked by their patients about scoliosis. .

The reason for its development:

The word idiopathic refers to a combination of several different causes, some of which have yet to be identified. Genetic factors, as well as bone growth, muscle, connective tissue, disorders of the central nervous system and metabolic causes, are the main reasons for the appearance of the lesion, but their exact role in its development remains to be clarified. Nevertheless, all the data refer to polygenetic and multifactorial origin.

Age profile:

Depending on the age at which the disease occurs, we distinguish the following:

  • infantile (age 0-3)
  • juvenile (age 4-9)
  • adolescent (age > 10) scoliosis

In the international literature, the definitions early onset, i.e. before the age of 9, and late onset, i.e. before the age of 9, are also used.

The different sorts of idiopathic scoliosis typically appear during adolescence, meaning that 90% of scoliosis manifests itself after the age of 10.

Frequency:

According to the different studies on the epidemiology of scoliosis of unknown origin:

  • the incidence of a small lesion below 10 Cobb degrees is 1.5-3%
  • above 20 Cobb degrees 0.3-0.5%
  • large deformities exceeding 30 Cobb degrees 0.2-0.3%

Overall, idiopathies scoliosis can be observed in 2-4% of children.

In case of smaller deformities, the proportion between boys and girls is equal, but the incidence of curvatures greater than 30 degrees Cobb is ten times higher in girls (Roach, 1999).

General treatment principles:

Therapy for scoliosis of unknown origin can be grouped according to the value of the curvature measured in the Cobb angle:

  • 0-20 Cobb degree: observation, special, individual physiotherapy
  • 20-45/50 Cobb degree: observation, special, individual physiotherapy, corrective brace is advised.

    The condition of brace treatment for idiopathic scoliosis:

    • the dimension of the curvature
    • significant progression (more than 5 degrees in half a year)
    • skeletal maturity hasn’t occurred yet (according to the Risser-sign)
    • the mobility of the spine greater than 40%

    Brace treatment can help slowing down the progression in case of curves under 40 degrees.

  • over 45-50 Cobb degrees: surgical treatment

    If for some reasons traditional treatment doesn’t go as expected or because of the patient’s age, advanced skeletal maturity doesn’t come up and the degree of scoliosis has reached a critical limit or further deterioration is expected, the surgical treatment of scoliosis is considered.

    The conditions of surgical treatment
    • for dorsal principal curvature: from 50 Cobb degrees or if the curvature is clearly progressive between 40-50 Cobb degrees;
    • for lumbar principal curve, from 45 degrees Cobb or if the curve between 40- and 45-degrees Cobb is progressively worse.
  • The aim of surgical treatment is to stop further deterioration of the scoliosis and to correct the present deformities in all three planes of space which involves terminating and decreasing rib deformity. Another goal is to create balance of the spine, to adjust ideal balance and overall to create an aesthetic, terminal, durable result. It is important to use the shortest possible fusion (arthrodesis) and to prefer selective - partial - fusion, since this is the way to preserve as many mobile segments as possible.

    Correction happens with an efficient and successfully long used method: with the help of titanium screws and rods, creating arthrodesis. The surgery itself is extremely challenging for children: it’s 4-8 hour long, risky and the possibility of blood loss is relatively high. The risk of the operation: spinal cord injury which causes lower limb paralysis, bowel and urinary disorders. As a matter of fact, we use a variety of specific tools and methods to prevent this risk.
    * G(Source: Gyermekgyógyászati Továbbképző Szemle XXII évf. 2017 szeptember 167-171. o)


Further information about conservative treatment:

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The discounts and benefits associated with the treatment

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Further information about surgical treatment

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Patient information leaflet & Information

Pre- and post-operative X-rays

Contact details of spinal surgeons

Scoliosis of known origin

Congenital scoliosis is a sideways curvature of the spine that is caused by a defect that was present at birth.

Vertebra Foundation summarizes all the information connected to vertebral malformation and its treatment on an independent website. Vertebral malformation can be one of the reasons of scoliosis and spinal deformity. These days diagnoses made at foetal age are more and more common which understandably makes future parents worried and in many cases professionals force pregnant women into big decisions. Our website would like to provide support in these difficult situations with competent and reliable information:

Scheuermann's Kyphosis

A disease that develops in adolescence, the cause of which is unknown.

It was named after Danish surgeon, Holger Scheuermann who discovered characteristic vertebral abnormalities while reviewing X-rays. The disease is found mostly in teenagers and unfortunately, in its early stages it sometimes delays in diagnosis and treatment are caused by the mistaken belief that the deformity is due to poor posture. However, due to characteristic structural abnormalities on the vertebra it can be confirmed by lateral X-rays. The signs usually are first seen during or after the puberty growth spurt. Most kids are between 12 and 15 years old when they're diagnosed.

Symptoms:

The disease can occur on any parts of the spine meaning that the abnormalities can be different. This condition mostly affects the back: it makes the upper back rounded so it looks hunched over. If the disease occurs in the lumbar region, the physiological curves dissolve and a so-called flatback or a stick looking spine develops. Patients with Scheuermann's disease may also complain of inability to participate in physical exercise, work and activities of daily living secondary to pain or the presence of their deformity. Typical lesions on the X-ray: the front part of the vertebral body becomes flatter (so-called hemivertebra) and small nodes (Schmorl-nodes) are visible on X-rays due to lesions of the invertebral disc and the endplate.

Epidemiology:

It starts between the ages of 12 and 14 and ends between the ages of 17 and 18. It’s common for both males and females. The disease can occur even without having any complaints. The only thing that parents notice is poor posture, increased dorsal curvature or slumped shoulders that’s why they take their children to a medical check-up. In other cases, children suffer from severe complaints like fatigue and for them sitting for a longer period is the worst-case scenario. The patient may report pain on pressure on the affected part of the spine, but the pain can also be spontaneous. With careful examination and a thorough history, it is often possible to establish that the symptom-free period of the disease started before the age of ten.

X-rays:

If the lesions on the sagittal curvature of the spine described above are detected, a bidirectional spine imaging is indispensable. The X-ray can tell whether it’s a case of poor posture or Scheuermann’s disease. In a stationary position the recording shows clearly the dimension and position of the curvatures, while in lying position the mobility and the elasticity of the spine can be examined.

Treatment:

The diseased spinal segment can be relieved by wearing a back brace. Back braces prescribed in case of typical X-ray deviations or hunch backs can help fix pathological curvatures. These braces are made of highly thermoplastic materials after taking measurements from each patient. Besides, they must be worn all day all night and can only be taken off for cleaning reasons and physiotherapy. If the patient’s condition changes, the brace can be modified or he/she can get a new one. For dorsal processes, the Gschwend type brace is recommended, for lumbar processes Boston brace is a better option. However, if Scheuermann's Kyphosis occurs with scoliosis, Chenea brace is the winner most of the time. Luckily, if the disease is detected on time and the patient is properly treated, great results can be achieved: the deterioration of scoliosis can be stopped and moreover, significant improvement can be expected. The diseases can be easily detected with screening tests. During these tests, the patients have to take off their clothes and their spine gets examined from every angle. Scoliosis can be seen more easily when bending over. In the affected spinal segment and in the large joints, there’s a rapid reduction in movement. For patients who suffer from severe or permanent scoliosis and have major complaints, surgical treatment is also possible.

In the sections on scoliosis and its treatment we quoted – literally or substantively – from the following books and articles: dr. Orosz Mária: Az idiopathias scoliosis konzervatív kezelése (in:Gyermekgyógyászat, 56. évfolyam 6. szám) Nagy Szilvia: Az idiopathias scoliosis korszerű, komplex mozgásterápiája (in:Gyermekgyógyászat, 56. évfolyam 6. szám) dr. Csernátony Zoltán: A scoliosis-csapda – tévedések, tévhitek és tévutak. Biomechanika, terápia, prognosztika és egy kis pszichológia (in:Gyermekgyógyászat, 56. évfolyam 6. szám) Udvarhelyi Iván által szerkesztett Fejezetek a felnőttkori ortopédia gyakorlatából, kiadta: Medicina 1998 dr. Vízkeleti Tibor: Az ortopédia tankönyve, Springer Könyvkiadó, Budapest, 1996., Az ortopédia tankönyve, szerkesztette dr. Barta Ottó, Medicina Könyvkiadó, Budapest, 1983 A Scheuermann-kyphosis és konzervatív kezelése (dr. Orosz Mária – dr. Tomory István cikke) in: Orvosi Hetilap 1982. 123. évfolyam, 46. szám A kongenitális scoliosis (dr. Orosz Mária – dr. Tomory István cikke) in: Orvosi Hetilap 1986. 127. évfolyam, 13. szám 10 kérdés a Scheuermann-féle betegségről (dr. Orosz Mária cikke, in: PRAXIS, 1994. 3. évf. 5. szám) Köszönjük dr. Orosz Mária, dr. Temesszentandrási Hedvig és Marlok Ferenc segítségnyújtását a szakmai oldalak összeállításában.



Article of National Centre for Spinal Disorders on the subject:



Speech from dr. Nikoletta Horváth, orthopaedic specialist, on the subject:

Posture problems

We speak of postural dysfunction or postural deformities when the natural curves of the spine are altered.

The spine may curve laterally, and the physiological curves of the body may increase or decrease. However, the reasons in the background can differ. Most of the time, the symptoms are usually due to an imbalance between the muscles responsible for the posture.

In case of postural deformities, there are no fixed deformities, the structure of vertebrae is intact, there are no structural abnormalities and the defective functional abnormalities can be corrected at any time. By doing sports on a regular basis the muscles can be strengthened and the posture can be normalized.

During school and adolescence, sedentary lifestyle can cause the lack of the development of the muscles compared to the speed of the body growth, therefore the muscles can’t correspond to increased physical loads.

Children with underdeveloped musculature develop a peculiar sloppy posture and a crooked back. The dorsal curvature is increased, the shoulders are slumped and slightly forward, the chest is flat often with a slight chest-deformity. These children are more tired than others and they can’t achieve decent results in P.E classes or in different sports.

Irregular physical load on the spine can also lead to posture deformities, mostly in sportsmen or in people who work in asymmetrical posture for a long time e.g. beauticians or dentists. People with sedentary jobs are often characterized by slumped shoulders or moved-forward head and neck. This daily, static load that goes on for hours has consequences and causes a huge pain after a while. The muscles of the neck, shoulders and back cannot tolerate the overload anymore and muscle spasms, myogelosis might occur.

The high degree of homogeneity of the lumbar arch is also due to the altered statics. The trunk is supported not only by the back muscles, but also by the abdominal muscles at the front. In case these muscles are weak or overloaded by overweight or pregnancy, the stomach falls forward, the lumbar vertebrae and the sacrum are also pushed in this direction.

In order to prevent postural deformities and to correctly restore the posture and load by strengthening the muscles, we place a "muscle brace” around the trunk, which is able to take a large part of the load, preventing pain and premature wear and tear on the joints. Let’s not forget that postural dysfunctions are not illnesses, but if they aren’t treated for long, the irregular physical load on the spine favour the risks of developing several diseases. That’s why it’s considered crucial to continuously raise awareness, to provide the necessary preventions and treatments.

ATTENTION!

The myriad of diseases that affect the spine deform it and the resulting abnormal curves create abnormal posture in it. It’s the professional’s task to clarify the exact pathology of lesions of different origin, but of similar appearance and to prescribe the appropriate treatment.