Adolescent Idiopathic Scoliosis
The spine is composed of structures (vertebrae, discs, muscles, ligaments) arranged in a complex way, with the purpose of supporting weight and offering protection. During the evolution of mankind, the postural changes acquired were being "passed on" to the shape of the column, acquiring a shape that allows the mechanics involved in our daily activities. As we begin to walk, the spine acquires the usual adult shape, with 4 curvatures in the sagittal plane (seen from the side) and an alignment without curvature in the frontal plane (seen from the front). The most frequent deformity in the spine is scoliosis, a condition that can affect patients of all ages, and sex, but more commonly affects adolescent women. The spine acquires a deviation in the natural curvatures, which can lead to functional imbalance. The most frequently observed deviation is in the frontal plane, where, when looking at the patient from the front, there is an inclination of the spine to one side.
The most frequent symptoms of scoliosis are:
Deviation of the column to one side, being generally referred to as "crooked walking", or "walking inclined to the side", or even "column in S, or C"
Difference in shoulder height, with a higher shoulder;
Increase in the ribs, or lumbar, called "hump", with local bulging
Separation of one arm in relation to the body, leaving a "space" between the arm and the trunk
Pain, where this pain is usually diffuse and mechanical (associated with exertion). It can be caused by muscle imbalance and failure in the biomechanics of the spine. Most of the time, the pain appears in the late phase, when the muscles already show changes, not being the main symptom observed.
There are several factors that can cause this deformity, such as malformation during pregnancy (congenital); muscular dystrophies and other paralyzes that cause weakness (neuromuscular scoliosis); and the most common factor, which is idiopathic, meaning "without apparent cause."Adolescent idiopathic scoliosis is more frequent when there are already cases in the family, and a doctor should be sought for analysis of the condition and adequate diagnosis when suspected. The diagnosis is more common in pre-adolescence due to the growth spurt (rapid growth phase). Generally, radiographs, tomographies and resonances are used, with radiographs being the most used. An analysis is performed with a method called Cobb, which calculates the degree of deformity and its angulation.
It is important to understand that scoliosis worsening is related to growth and the severity of the curve. Patients with a "mature skeleton" (have already completed the growth phase, or are adults) have a slow worsening of scoliosis, usually close to 1 degree per year in the most severe cases. Young patients with great growth potential, on the other hand, have a much higher risk of worsening the disease, reaching 5-10 degrees of worsening in a single year. Light curves (<20 degrees) are less likely to worsen when compared to moderate (> 20 degrees), or even severe (> 40 degrees) cases. An overall assessment of the patient is required, with analysis of the degree of curvature of the spine, shoulder inclination, postural balance in gait, quality of the musculature, bulging and deformities in the trunk such as the "costal and lumbar hips," and possible difference between the length of the legs, among other decisive factors in choosing the appropriate treatment.
Observation and rehabilitation (such as strengthening, spine schools, physiotherapy, and spine exercises) are the treatment of choice in mild cases. The vests are used in cases of moderate scoliosis, and early identification (even in pre-adolescence) is essential for treatment, as once the growth ends the vest loses its effectiveness. The time of wearing the vest is also important, recommending a minimum period of 20 hours a day, being removed during hygiene and for periods of physical activity, giving preference to aerobic activities, flexibility and strengthening. It is important to note that the vest is not intended to correct scoliosis (meaning correct the deviation and leave the spine "straight"), it will only stabilize the curvature to prevent it from getting worse during growth. This is of fundamental importance, since it is known that when reaching 40 degrees the risk of worsening the curve is high, and when reaching the 50 degree mark the vest will no longer have any function.
When the deviation worsens rapidly, or is greater than 50 degrees, surgery may be indicated. The surgery consists of osteotomies (cuts in the bones), complex muscular and ligament releases, placement of bone graft and spinal stabilization with arthrodesis, allowing the correction of the curvature and its fixation. Various techniques can be used and several fixation mechanisms exist, which should be discussed with the doctor at the time of indication, as well as the surgical benefits and risks of the chosen procedure.
The goals of scoliosis treatment are to prevent the disease from getting worse, reduce deformity (as much as possible) and restore spinal alignment and balance. The results are individualized on a case-by-case basis, and the response may vary individually (pain, ability to return to normal activities, possibility of scoliosis recurrence or new deformity).
References:
https://www.spine-health.com/conditions/scoliosis/scoliosis-what-you-need-know
