The diagnosis of scoliosis

A simple test is suitable for detecting scoliosis: the so-called preventive test. The standing patient bends forward with the undressed upper body and puts his hands on his knees, for example. When viewed from behind, a bulge appears in the area of the ribs, the so-called rib hump.

The so-called thoracic scoliosis (thorax = chest) is the most common type of scoliosis.The rib hump is caused by the torsion of the vertebral bodies. Since the ribs are attached to the vertebral body and the vertebral body is twisted, the ribs are pressed upwards on one side when bending forward. This hump is always created on the convex side of the spinal curvature.

If the scoliosis is located in the area of the lumbar spine, the so-called lumbar bulge is formed. In addition, the waist triangles are unevenly high. Scoliosis can also be diagnosed by looking for a shoulder or shoulder blade elevation in the patient.

The extent of the spinal curvature can be measured well in the X-ray image. The so-called Cobb angle is used for this purpose. This angle is determined with the help of certain structures.

At the upper and lower end of the curvature are the neutral vertebrae, which, in contrast to the vertebrae directly involved in the curvature, no longer have a wedge-shaped deformation. Starting from these neutral vertebrae, extended lines are drawn from the base, on which a vertical perpendicular is taken and the angle between these two meeting lines is determined. Angles below 40° are considered mild scoliosis, moderately severe scoliosis is in the range of 40-60°, and from an angle of 60° onward one speaks of severe scoliosis. Here you can view an X-ray image of a scoliosis.

The treatment of scoliosis

In the best case of scoliosis, no treatment is necessary at all. This is particularly true for mild forms, which are found, for example, as a chance finding in adulthood. In children, too, only the further development of a very mild form of scoliosis is initially observed.

As a rule, therapy is recommended if the angle of curvature in the x-ray image is 20 degrees or more. The type of treatment depends on the severity of the scoliosis. The first stage of therapy is usually physiotherapy.

This must be carried out regularly and usually over a period of years. If the scoliosis is more pronounced or if the spinal curvature deteriorates rapidly, treatment with an individually adapted corset should also be carried out early on. In the best case, this can achieve a reduction of the angle of curvature in further growth or at least prevent further deterioration.

In rare, very severe cases, in which there is a pronounced curvature of the spine, surgical treatment of scoliosis should be considered. However, this is a major procedure and the decision to do so must be carefully considered. On the other hand, if high-grade scoliosis is not treated in time, there is a risk of long-term damage such as chronic back pain and reduced lung function, which can severely impair physical performance in everyday life.

In principle, the appropriate treatment of scoliosis is very demanding and should only be carried out by physicians who have sufficient experience in this field. Otherwise, damage can result from both excessive and too little treatment. Scoliosis usually develops in childhood or puberty and can be influenced during the adolescence phase.

In adults, neither exercises nor a corset can be used to treat an existing scoliosis. The only promising form of therapy to correct the spinal curvature is surgery, although this is reserved for very severe forms. Children and adolescents, on the other hand, can positively influence the course of scoliosis through special exercises, so that the curvature does not increase further or is even reduced again with growth.

As a rule, physiotherapy is prescribed for this purpose, but exercises should also be performed regularly at home. One example is the so-called “Superman” exercise. This involves lying on your stomach and stretching your arms forward.

Now the arms are lifted slightly off the floor and the whole body is tensed. This position is held for about five seconds. The exercise should be repeated five times after every one minute break.

It serves to stretch the entire spine and strengthen the back muscles. Another of many possible exercises is called “head lift”. Here too, you lie flat on your stomach.

The arms rest beside the body. Now you try to lift the upper body without using your arms. Again, hold the position for a few seconds and repeat the exercise after a short break.If the feed-through is too heavy, the arms can be used for support.

However, the back muscles should be tensed and the neck should be kept straight. Even though no improvement in the curvature of scoliosis is expected in adults with scoliosis, these exercises are still recommended because trained back muscles are particularly important here, for example to prevent or alleviate scoliosis-related pain. In severe scoliosis with large angles of curvature, treatment with physiotherapy and a corset is often not sufficient to achieve a good treatment result.

In such cases, surgical treatment is often the last option. From a curvature angle of 50 degrees and if further deterioration is expected, surgery is indicated. However, the decision for or against surgery must always be made individually, depending on the age of the person affected, a possible restriction or endangerment of the function of internal organs such as the heart and lungs, and the previous development of the spinal curvature.

After detailed consultations with the physicians and after the patient has been informed about all risks of the intervention and if the intervention is not performed, the wish of the patient and, if applicable, of the parents is decisive. There are different surgical procedures that differ, among other things, in the way the spine is accessed. The surgical area can be reached either from the front, the back or a combination of both sides.

The general principle of surgery for scoliosis is the stiffening of the affected section of the spine in an improved position. The goal is to achieve the best possible correction of the curvature while preserving as many mobile vertebral segments as possible. In the posterior approach, the patient lies on his stomach and the spinal column is exposed from the back.

The affected vertebrae are released, brought into the corrected position and connected by two metal rods. The vertebrae are also connected with bone chips from the iliac crest or from a bone bank so that they grow together and stiffen. In the anterior approach, surgery is performed through a lateral incision from the abdomen and thorax.

The actual surgical steps on the spine are similar to those for the posterior approach. However, after opening the thorax, a tube must be inserted for a few days, through which suction is used to ensure that the lungs can unfold again. Combined posterior and anterior access is only performed in very severe cases and then on two different days if necessary.

The choice of procedure must be made individually for each patient, depending on the form and extent of the scoliosis. Scoliosis surgery is the most technically and time-consuming surgery in orthopedics. It is not possible to say in general how long the procedure will take, but it can be expected to take at least a few hours.

Although the surgeon may be able to make an estimate of the duration based on the individual circumstances in advance, no reliable prediction can be made. Sometimes difficulties arise only during the operation, which could not be seen in advance and then lead to an extension of the duration of the operation. Just as with the duration, it is not possible to make a general statement about the costs of an operation to treat scoliosis.

Depending on the effort, clinic and possible difficulties, these will amount to at least several thousand Euros. This can even result in five-digit amounts. However, if medically indicated, the costs are fully covered by both statutory and private health insurance companies.

How large the remaining scars will be, how many there will be and where they are located, depends mainly on the extent of the operation. Every skin incision that has to be made leaves a scar. Depending on the chosen surgical procedure, scars may remain on the back as well as on the front of the lateral thorax or abdomen.

If scoliosis is so severe that treatment with physiotherapy or physiotherapy alone is no longer sufficient, but the spinal curvature is not so extreme that surgery is required, treatment with a so-called corset is usually indicated. This is a fixed orthosis that supports the spine when worn externally. The problem is that the corset must be worn for at least 22 hours a day for it to have any effect.For the children and young people concerned, this means that it must generally be worn during all leisure activities and in school lessons.

Especially when playing, the children are restricted in their movements. In addition, the corset is visible to everyone in the swimming pool, for example, so that offending looks or comments can occur. Nevertheless, it is important to wear the corset consistently and regularly, as otherwise the success of the treatment is endangered and long-term consequences and restrictions in adulthood are imminent.

If scoliosis becomes increasingly worse, effective treatment can only be achieved through surgery from a certain point on. The corset must generally be worn until the end of the growth phase. After that, the wearing time can be slowly reduced. The corset treatment is never carried out alone but is always combined with physiotherapy. For adult adolescents as well as adults, wearing a corset usually does not help any more, because the bone growth is completed and a possible curvature has manifested itself.