What is Scoliosis (Spine Curvature)?

The curvature of the spine, defined as scoliosis in the medical language, is a lateral and rotational three-dimensional curvature of the spine that can be seen in the thoracic and/or lumbar regions, resulting from the right or left displacement of the vertebrae and their rotation around their own axis. Scoliosis is a condition, not a disease.

What is Scoliosis?

Spinal curvature, which can occur in various parts of the spine in all age groups, is usually seen just before the growth spurt in people between the ages of 10 and 15.
In a normal and healthy spine, the vertebrae extend in a straight line from top to bottom when viewed from the back. The healthy spine system consists of 33 bone parts, 12 of which are mobile. The spine is a structure where bones are connected to each other by connective tissue, joint and disc tissues. The spine, located between the head and legs, appears in a straight line when viewed from the front and back. When viewed from the sides, it has a natural curve that goes forward on the neck, backwards on the back, and finally forwards again in the waist area. When viewed from the side, it is in the shape of the letter "S" and has physiological folds.
Physiological folds:

• Forward on the neck (lordosis),
• Back on the back (kyphosis),
• Forward on the waist (lordosis).

In the presence of scoliosis, a 3-dimensional deformity is seen in the spine. Spinal curvature, which usually occurs just before puberty, is mild. Mild cases often cause no symptoms. However, in some cases, the severity of the curvature increases with the growth of the person. In severe cases, internal organs are suppressed due to curvature. In these cases, especially in which the heart and lungs are affected, organ functions may be impaired.

What Causes Spinal Curvature?

Scoliosis can occur due to structural or in other words, problems arising from the spine itself, or it can develop reactively, that is, due to different causes related to the spine. As it may develop due to congenital or muscle and nerve diseases, spinal curvature may occur in some people for an unknown reason.
The cause of scoliosis, which is more common in girls during adolescence, is not clear. Pregnancy Infections, diabetes, and some vitamin and mineral deficiencies are thought to play a role in the formation of scoliosis. Although it cannot be proven definitively, it is also known that genetic factors play a role in the formation of the disease.
In addition to all these, neuromuscular diseases such as cerebral palsy and muscular dystrophy, congenital defects affecting the development of the spine, spinal traumas and infections affecting the spine are thought to cause scoliosis.

What are the Types of Curvature of the Spine?

The deformity that occurs in the spine may also occur with an increase in humpback or lumbar cavities in some cases. Scoliosis can occur for many different reasons.
Although there is no sufficient evidence that the disease is genetic as a result of limited studies, it should not be ignored that hereditary factors have an effect on the formation of the disease. Classification of spinal curvature is also done depending on the cause of the disease. Although this type starts at an early age, it develops without any symptoms in the form of pain or posture disorder. However, as the age progresses and growth continues, the problems caused by the curvature of the spine begin to appear, and the patient may notice balance disorders and degenerations in their bodies. At the same time, the patient also develops pain complaints that were not seen in childhood. Generally, scoliosis occurs in the thoracic or rib cage part of the spine during adolescence. Patients complain of respiratory distress due to deformities in this region. The patient complains of low back pain and decreased mobility due to the deterioration in the small joints that connect the vertebrae at the back of the spine and play an important role in the movement of the spine.

• Congenital Scoliosis: Although there is no clear data on the incidence of congenital scoliosis, it is known that it is less common than idiopathic scoliosis. In addition, studies carried out to date have not proven the existence of genetic predisposition in congenital scoliosis.

Congenital scoliosis develops while in the womb. secret. Different causes of congenital scoliosis are shown, such as infections in the womb, diabetes, heart diseases, hyperthermia, alcohol use, valproic acid use, and vitamin and mineral deficiencies in the body. However, it can be seen that some hereditary diseases accompany congenital scoliosis. It often progresses rapidly in the first years after birth.
Structural disorders can cause congenital scoliosis in several ways. Structural problems that occur while in the mother's womb manifest themselves in the form of formation defects and separation defects in the spine. In some patients, it is possible to see both defects together. The curvature of the spine, which occurs due to a developmental defect in the mother's womb, is usually seen in the form of fused ribs.
Another important feature of congenital scoliosis is that it is associated with spinal cord, kidneys and heart anomalies. In congenital scoliosis, accompanying abnormalities can be seen in the spinal cord (41%), heart (7-12%) and kidney (20%). Often the curvature manifests itself with continued growth. In some cases, the course of the curvature progresses very slowly until the rapid growth phase in adolescence.
Therefore, parents should be extremely careful in terms of early diagnosis of congenital scoliosis. Families should consult a physician immediately when they notice any imbalance or difference in the baby's neck, back, waist. The treatment process of congenital scoliosis, which occurs in the early period, may require surgical intervention at a young age. In fact, since this curvature can reach even larger dimensions than the primary curvature over time, the curvatures should be followed regularly after diagnosis. e It is necessary to monitor the development of the deformity more frequently.
It is necessary to decide on the treatment method according to the potential to increase the deformity.
Symptoms in congenital scoliosis:

• Increased hair growth, especially in the waist area,
• Changes in skin color,
  
• Bone protrusion that can be detected by hand in the back region,
  
• The trunk is shorter than the legs,
  
• The spines are not aligned properly when viewed from the back,
  
• Balance disturbances are observed.

Congenital scoliosis cases are followed by physical examinations and x-rays at regular intervals unless there is an increase in the curvature. This follow-up continues until the skeletal system reaches a certain maturity and after the procedure if the surgical procedure has been performed.
Surgical treatment is the only option for cases with a high probability of progression and progress in the follow-up process. Surgical treatment is the most frequently used treatment method, since the curvature increases in the majority of cases and the brace treatment is not successful. . In addition to tilting sideways, a person's spine can also rotate around its axis. Due to the rotation of the vertebrae around their own axis, asymmetric protrusions occur in the back and lumbar region of the person.
Idiopathic scoliosis, which is characterized by the unexplained bending of a healthy spine, is defined by different names depending on the period of its onset. In other words, spinal curvatures between the ages of 0-3 are defined as infantile-onset, juvenile-onset scoliosis between the ages of 4-9, and adolescent-onset idiopathic scoliosis. It is the most common type of spinal curvature.

• Neuromuscular Scoliosis: Muscle and/or nerve diseases are among the main causes of neuromuscular scoliosis, which is the second most common type of scoliosis. In addition to muscle diseases mostly seen in childhood and later, it can also develop due to nerve diseases originating from the brain and spinal cord. Respiratory distress and sensory defects are more common in neuromuscular scoliosis patients.

pain and weakness in the lumbar region. However, despite the development of pain, most adult cases of scoliosis do not cause symptoms. In some cases, changes in the body, loss of height and imbalance in the body occur. The patient usually notices the symptoms of scoliosis such as the clothes not being suitable for his body or not standing properly, shortening of the neck, deformation on his back when he bends.
Some of the common symptoms in the presence of scoliosis disease (curvature of the spine) can be listed as follows:

• The presence of a clearly visible curvature of the spine when viewed from the opposite side,
• curvature or inclination towards the right or left side,
  
• Differentiation in hip and shoulder levels,
  
• Different distance between the body and arms,
• Imbalance of the body,
• Disproportionate appearance of the ribs,
  
• Irregularity of symmetry in the rib cage,
  
• The presence of a hump in one of the shoulder blades,
  
• One shoulder being forward while walking,
  
• One leg being longer than the other while walking feeling,
  
• Back and/or low back pain,
  
• shortness of breath,
  
• Weakness, fatigue,
  
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• The clothes do not fit the body properly.

As the pressure on the nerves increases due to scoliosis, leg pain, a feeling of fatigue, and spasm in the back and waist muscles can be seen. In patients whose condition progresses and nerve pressure intensifies, complaints of weakness, numbness and pain in the legs increase. If the rib cage is deformed due to scoliosis, heart and respiratory problems are also encountered.

What are the Grades of Scoliosis?

Low-grade curvatures constitute the majority of scoliosis cases, the incidence of which is between 2% and 4% in the community. In other words, only 10% of spinal curvatures are large enough to require treatment. Curvatures exceeding 30 degrees are approximately 10 times more likely to be seen in girls compared to boys.
Spine curvatures are evaluated by geometric grading. Spinal curvatures less than 10 degrees are called spinal asymmetry and are not defined as scoliosis. In other words, the curvature of the spine must be 10 degrees or more in order to be diagnosed with spinal curvature. Scoliosis grades, mild, moderate and severe

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