Monitoring
Treatment of scoliosis varies depending on the degree of curvature, the potential for the curvature to increase, and the rigidity of the curvature. The treatment decision is determined by the amount of curvature and the potential for the curvature to increase.
Curves that will not exceed 25 degrees when growth is completed are monitored until growth is completed. The doctor decides the frequency of monitoring according to the patient's age, genetic growth potential and whether there is an increase between two monitoring periods.
Patients with an increase in the curvature due to scoliosis and a curvature between 20-40 degrees are monitored at 3-6 month intervals. Depending on the rate of increase and stiffness of the curvature, monitoring, corset treatment or early surgery may be planned.
Corset
With a curvature between 20-40 degrees, 2-3 years Brace treatment (corset) can be applied to patients with greater growth potential. Patients receiving brace treatment must also be monitored. However, the success of corset treatment is limited. Considering that the patient will wear a corset for 12-23 hours a day for 3-4 years, the decision is made according to the patient's compliance.
There are different brace applications for the purpose of brace treatment. The selection, fabrication and application of the brace should be done by a doctor and should be under the control of experienced orthopedic surgeons who perform spine surgery.
In brace (corset)application, the brace must reduce the curvature to a certain extent. For example, in a patient with 30 degrees of dorsal scoliosis in the standing film, when a brace is applied, the curvature should fall below 20 degrees in the braced film. If there is no improvement, it is decided that brace treatment is not effective. Either there is a problem with the construction of the brace. The places where the brace will create a correction effect have been determined incorrectly. It should be rearranged. Or the curvature is a rigid curvature. He will not benefit from brace treatment.
Exercises and swimming given with the use of brace can ensure brace compatibility and help prevent the curvature from increasing. The daily use time of the brace for swimming, sports and daily cleaning needs is determined by the doctor. The decision is made between 12-22 hours, depending on the characteristics of the brace and the condition of the curvature.
Again, in brace treatment; the curvature of the brace is permanently removed It should be known that it does not cause any pain and that when the brace is removed, in a successful brace treatment, it will be around the same degree as when it was first applied. In other words, it stops the progression of the curvature, but does not provide correction. In some publications, it has been reported that using brace treatment prevents the bending of patients undergoing surgery from increasing, thus reducing the number of vertebrae to be operated on. For this purpose, the use of brace treatment has been recommended. It has been reported that the duration of brace wearing and brace compliance affect the outcome of brace treatment.
However, there are also publications reporting that brace treatment is not beneficial and does not significantly change the natural course of scoliosis.
Surgery decision
When growth is completed; Surgery is not considered for curvatures that do not exceed 40 degrees. However; Surgery can be performed between 30-50 degrees, depending on the doctor's opinions about the treatment and the patient's aesthetic and lifestyle preferences.
When first detected, around the age of 9-11, 30-40 degree curvatures are examined by x-rays every 3-4 months. monitored by controls. If an increase of more than 4-5 degrees is detected between two monitoring periods, early surgeries can be planned with concerns that the curvature will increase excessively.
Physical therapy - Exercise therapy
Physical therapy , exercise therapy and swimming; It has been shown that it does not change the natural course of scoliosis, that is, the curvature will remain at the same degree whether you apply this treatment or not. Therefore, these treatments have no place in scoliosis correction treatment. However, in brace treatment, it is beneficial to provide exercises and swimming to ensure compliance with the brace and to keep the back muscles strong. Again, postoperative physical therapy may be required in patients who undergo surgery.
There are publications reporting that exercises given with brace treatment have a role in reducing the curvature in cases of curvature between 10-20 degrees. In this publication, the duration of brace wearing, brace compatibility and the effect of exercises on the results were investigated.
SURGERY
When making a treatment decision, it is necessary to know what will be done with the surgery. The entire vertebra, from the vertebra 1 or 2 vertebrae above the vertebra where the curvature first begins (vertebra: one of the bones that make up the spine) to the vertebra 1 or 2 vertebrae below the vertebra where the curvature ends. It is planned to correct the angle of the bars and weld them together, that is, to turn them into a single block. In other words, the aim is to turn a structure that is at least a little mobile, stretches, can bend and straighten but is not straight, into a block / column that does not stretch, does not bend and straighten, but is smooth.
Due to these features of the surgery, how few vertebrae are transferred to the operating field in surgeries. The more flexible and mobile vertebrae we leave behind, the closer to normal a structure we will achieve. With this in mind, the vertebrae where the curvature begins and ends are determined meticulously. An attempt is made to identify vertebrae with structural curvature and vertebrae that are non-structural, that is, vertebrae that have the potential for spontaneous correction when the actual curvature is corrected. It is planned to protect the mobile segment of the spine by including the least possible number of vertebrae in the operating field.
The surgery is examined in 3 steps. First; The retained vertebrae or the vertebrae planned to be corrected are opened from the back and connected to screws and 2-sided long metal rods that make them a system. In the second step, correction is provided by Traction or other methods. During both screw application and correction, the nerves are monitored intraoperatively to prevent damage to the spinal cord (nerves). Efforts are made to eliminate any possibility of damage during the surgery. In the third step, the operated vertebrae are fused together over time, and in order to maintain the correction, fusion is applied, that is, a procedure that allows the vertebrae to fuse together.
In some curvatures, the side of the abdominal wall or the side of the abdominal wall, not the back, is applied. Different surgeries can be performed to correct the side of the chest wall and the front part of the spine. In some types of scoliosis, it can be planned to prevent or prevent the curvature from increasing at an early age with extendable nails.
A brace can be used for 6-8 weeks after the surgery. Although it varies depending on the surgery performed, standing up and walking is usually allowed within 2-3 days. Checks are made every 6-8 weeks. He/she can do light sports in 3-6 months. Although it varies depending on the degree and hardness of the curvature, almost complete correction is usually achieved. Smooth but slightly stiffer than normal and with slightly limited movements A straightened spine is obtained.
There will be no limitation in daily life after the surgery, and one can do sports as much as the spinal elasticity allows. It is not expected that there will be any problems with pregnancy or giving birth.
Surgery is recommended for curvatures above 50-60 degrees. With this degree of curvature, pain and breathing problems can be expected with advancing age.
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