DIAGNOSIS:
In the physical examination of a child with suspicion of scoliosis; The alignment of the spine is examined by standing upright, bending forward and sitting. Head placement, shoulder symmetry, and chest wall symmetry are checked. Findings such as measurement of leg lengths and limping while walking are recorded. In curvatures up to 20 degrees, the deformity may not be obvious and may be overlooked. The presence of those with a family history of scoliosis is questioned. An x-ray of the patient who is thought to have scoliosis is taken to determine the degree of scoliosis, if any.
X-RAY
Scoliosis films should be taken to cover the entire spine. Otherwise, it may lead to inadequate evaluation. For this purpose, a 2-way radiograph (X-ray film-direct film) is taken in anteroposterior and lateral positions, including the entire spine while standing upright.
During the treatment regulation period; Films with different features, such as side bending or traction, fulcrum bending, covering the entire spine may be requested.
The degree of soliosis is determined in the films taken. The most commonly used method for this purpose is the Cobb angle. The Cobb angle is determined by your doctor(Orthopaedist/Radiologist). Cobb angle measurement method; In the spine radiograph taken in AP (anterior-posterior) position; The angle between the line drawn from the upper edge of the vertebra where the spinal curvature begins and the line passing through the lower edge of the vertebra where the spinal curvature ends is the Cobb angle (Curvature angle). In order to easily measure this angle, a perpendicular line is drawn to these two lines and the angle between these perpendicular lines is determined as the scoliosis angle or Cobb angle. Scoliosis usually occurs as a wide C-shaped single curvature or an S-shaped double curvature. The angle of each curvature is calculated separately.
In addition, it is investigated whether these curvatures are structural or a temporary curvature created by the body in order to balance the existing curvature, which will correct itself when correction is achieved. For this purpose, side bending radiographs are taken to reveal the amount of correction of the curvature and whether the curvature is structural.
After the scoliosis angle is determined, a decision is made regarding the treatment according to the child's age, degree of curvature and possible growth potential.
EVALUATION:
All adolescent idiopathic scoliosis� It has been pointed out that the curvature does not progress, that progression is seen in approximately 20% of cases, and that very strict monitoring, especially of curvatures below 20 degrees, causes unnecessary X-rays, unnecessary examinations and the use of corsets.
Curves up to 10 degrees are considered variations of the normal.
Curvatures up to 20 degrees are evaluated according to the age of the patient. For patients aged around 9-11 years with 20 degree curvatures, the patient should be monitored at 4-6 month intervals. Curvatures that do not exceed 20 degrees in a 16-17 year old girl who has completed her growth do not need to be monitored. Boys may need to be monitored for a while longer. The monitoring interval for patients whose curvature does not increase between two monitoring periods is increased to 6-12 months.
Growth; It is largely completed between the ages of 16-17 in girls and 21-22 in boys. Therefore, if the curvature has not exceeded 40-50 degrees and is a balanced curvature, the degree of curvature will not increase. In other words, once growth is completed, the progression of scoliosis will stop.
In scoliosis; The spine and the head above it must remain balanced in the anteroposterior and lateral planes and must not deviate forward or to the side. This applies to both untreated patients and operated patients. An increase in curvature may occur when an unstable structure, such as a Pisa tower, causes mechanical stress to maintain balance.
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