Scoliosis: symptoms, corset, which operation?

Scoliosis is a spinal deformity. Adolescence is a risky period because it is during this phase that it evolves rapidly during this period. We find a spinal rotation in about 2-3% of adolescents. Girls are more affected than boys with a more significant evolution of scoliosis too. What is scoliosis? What are the symptoms and what are the causes ? Can we cure scoliosis? With a corset? What operation? Can we do sports?

Definition: what is scoliosis?

scoliosis East a three-dimensional deformation of the rachis, i.e. the spine. It preferentially affects the thoracolumbar spine but can be on the cervico dorsal spine. It can appear at any age, but adolescence is a risky period because it is during this phase that it evolves rapidly. It differs from the scoliotic attitude which finds a postural origin or inequality of limb length for example. For there to be scoliosis, the spinal deviation must be greater than 10°. Most of the time, scoliosis is single curvature but double curvature forms exist. It exists different types of scoliosis :

• There idiopathic scoliosis (the most common about 80% of cases)
• There congenital scoliosis (at birth)
• There syndromic scoliosis (of neuromuscular origin)
• There secondary scoliosis (following trauma or cancer)
• There de novo scoliosis which follows a degeneration of the spine with age.

What are the symptoms of scoliosis?

Scoliosis does not cause any particular spinal pain. “Contrary to what one might think, patients with scoliosis do not have more spinal pain than the general population (for the most numerous cases).” says Jérôme Madeira. The main symptom is spinal deformity more or less visible, which can lead only in the most extreme cases loss of vital respiratory capacity, neurological damage even psychological disorders. Most often parents report during the consultation that the child stands “crooked”, with a asymmetry in posture.

What causes scoliosis?

“The majority of scoliosis are idiopathic which means that we don’t know for sure what causes scoliosis.” explains Jérôme Madeira, physiotherapist. And to continue: “It is multifactorial, nothing explains it 100%. However research seems to show that the root cause is of genetic origin.“Other research indicates central biochemical and neurological factors, for example. The subject is still under discussion. Jérôme Madeira challenges received ideas: “Scoliosis is in no way caused by “bad” posture. or by carrying a satchel.“

Only a doctor can make the diagnosis. He first performs a clinical examination to rule out the scoliotic attitude. In order to diagnose scoliosis, he mainly seeks to observe a humpback (a deformation of the rib cage visible by a “bump” in the back) by asking the patient to lean forward after taking care to horizontalize the pelvis (adam’s test). He observes the trunk as a whole: more or less accentuated physiological curvature, balance of the shoulders, balance of the trunk, unequal lengths of the lower limbs… The doctor can then ask A radiograph in order to have a more precise image of the spinal deformity and to adapt the treatment accordingly.

Can scoliosis be cured?

The treatment of scoliosis depends on a certain number of factors such as bone age, the amplitude of the major curve of the spine, expressed in degrees and called the Cobb angle, scalability, etc. The treatment depends on each individual. Scoliosis is a personal condition, the treatment must be adapted to the specificities of each. There is a therapeutic range for the treatment of scoliosis ranging from conservative treatment (physiotherapy, corset, etc.) to surgery. These treatments can be associated with a psychological care if that is necessary. “Each scoliosis is unique because each patient is unique, says Jérôme Madeira. However, the earlier the scoliosis is detected, the more the management will be optimal..” And to add: “The key to successful care is joint work and good intelligence between rehabilitator, doctor, surgeon, patient and family.”

When to wear a brace for scoliosis?

The effectiveness of corset treatment no longer needs to be demonstrated : it makes it possible in many cases to avoid surgery. This efficiency depends on many parameters. The end result is based on the reducibility in corset : it is therefore the radiological angulation in the brace that determines the effectiveness. An angular correction of more than 50% in corset is desirable. The corset must be adapted to the patient in its shape, type, exposure time, etc. Brace treatment is most often associated with physiotherapy and physical activity in order to increase the patient’s chances of avoiding surgery and having the best possible functional and aesthetic result.

What is the benefit of physiotherapy for scoliosis?

Unfortunately, physiotherapy does not stop the evolution of progressive scoliosis but allows it to be reduced. It is useful alone (in the least risky cases) or in addition to a corset and after surgery. There is a substantial body of evidence showing the interest of physiotherapy specific to scoliosis. “The physiotherapist can show you exercises specific to scoliosisexplains Jérôme Madeira Indeed, the exercises to be performed are very specific to each patient and each type of scoliosis.“. He will regularly reassess the patient and the exercises performed. The role of the physiotherapist does not only lie in carrying out specific exercises, he is the health professional who will be seen most often by the child and the family. “As suchemphasizes Jérôme Madeira, he often plays a role in the link between the family and the doctor, he also monitors that the corset is still suitable to the patient and participates in the acceptance of the treatment. In any case, there is no wrong move, we can never repeat it enough, emphasizes Jérôme Madeira. However, he states that “during the corset treatment phase, there may be adjustments to be made in terms of movement in order to optimize its effect.”

When should you have scoliosis surgery?

Surgery is often needed for scoliosis non-idiopathic and very progressive idiopathic scoliosis with an angulation of more than 50°. As a general rule, theSurgery is only a last resort in the history of scoliosis when all treatments have failed and the progressive worsening of the deformity becomes either painful or aesthetically disabling. When surgery is the last possible resort, it allows a significant improvement in spinal deviation, an increase in respiratory capacity, better aesthetics and also an improvement in self-esteem. It also allows, in the longer term, to resume normal activity with resumption of sport. The most common intervention in scoliosis surgery is vertebral arthrodesisit consists in doing merge all the vertebrae responsible for the deformation spine, by blocking the joints between the vertebrae. Metal rods will be used to maintain the column until the fusion of the vertebrae in order to improve the deviation. Like all operations, it can present risks even if they are rare: neurological injury, surgical site infection. It can also happen that the graft does not take and that it is necessary to operate again.

It is not possible to prevent scoliosis. Indeed, it is idiopathic, that is to say that we do not know its origin in the majority of cases. One can, on the other hand, monitor a little more the families where scoliosis is frequent and consult his doctor so that he makes an early diagnosis so that the management is done as soon as possible and is thus optimal.

Is scoliosis serious?

Sport is not only allowed but also highly recommended

The evolution of scoliosis depends on several factors and in particular on the young patient’s bone age (i.e. its skeletal maturation which makes it possible to assess for how long it will continue to grow) as well as the angulation of the scoliosis:

► Below 20°: there is 80% chance it won’t get worses but regular monitoring (approximately every 6 months) is essential.

► Between 20 and 30°, all scenarios are possible: at this stage depending on bone maturity, wearing a corset is usually offered.

► Greater than 30°: the risk of evolution is very important hence the interest of diagnosing scoliosis as early as possible to be able to stop its evolution and avoid surgery

► In adulthood, if the angulation of the scoliosis is greater than 45°, it continues to evolve by around 0.5 to 1° per year.

What is the best sport for scoliosis?

Sport is not only allowed but also highly recommended : indeed, patients performing regular physical activity have a decrease in the evolution of scoliosis. Moreover, the sport reduces the number of cases where the use of a corset is necessary. Often wearing a corset is not compulsory during physical activity, which allows the child an appreciable additional time not to wear a corset. “Scoliosis does not impede athletic performance” insists Jérôme Madeira. All sports are allowedpreferably dynamic sports: the spine is made to move. Jérôme Madeira specifies that “Some authors proscribe wearing sports like acrogym” and emphasizes that “swimming has not shown any beneficial effects superior to other sports“.

Thanks to Jérôme Madeira, physiotherapist.