Is kyphosis repairable

Scoliosis: the spine on the wrong track

Simple diagnosis: scoliosis can often be identified at a glance.
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In scoliosis, the spine is bent to the side, usually in the thoracic area. In addition, the vertebral bodies twist, a so-called rotation around the longitudinal axis of the spine. The body's important support deviates from its normal, healthy position in several directions. The bending and twisting create tension and pressure forces between the individual vertebral bodies.

The spine can be tilted to the right or to the left. Scoliosis that requires treatment is when the so-called Cobb angle is more than ten degrees. It is a measure of how much the spine is bent. The angle can be determined using an X-ray image.

Scoliosis is often seen at first glance

The symptoms depend on how much the spine is bent to one side. A slight curvature of the spine is hardly noticeable and does not cause any discomfort. The situation is different with a greater lateral inclination, in which the scoliosis shows a typical appearance: the rib hump, in which the rib cage arches on the back, bulges on the loins, shoulders at different heights or a crooked pelvis.

How common is scoliosis?

Scoliosis most often develops during the growth phase in children and adolescents. You are usually ten to twelve years old when doctors discover the crooked spine. Girls are four times more likely to be affected than boys. The more severe the bending, the greater the proportion of female patients compared to the male sex. The reasons for this are unclear. Doctors estimate that around three to five percent of the population suffer from this deformity of the spine. These numbers include all degrees of severity - from mild to severe misalignments of the spine. Overall, mild scolioses are much more common than severe bends that require surgery.

Scoliosis - surgery is rarely necessary

In up to 90 percent of all cases of scoliosis, no cause can be found. Doctors call this "idiopathic". The bending does not have to be dealt with in every case. Often, non-surgical measures such as a corset or physiotherapy are sufficient to alleviate the symptoms. Surgery is only really necessary if you have severe scoliosis.

Symptoms of Scoliosis

Scoliosis develops slowly, especially as children and adolescents grow older. However, scoliosis can also affect babies. If it is discovered early, the prognosis is favorable, because good results can be achieved with babies through appropriate positioning and physiotherapy.

Young people often do not notice the curvature of their spine; they feel no pain. The misalignment is sometimes noticeable when children move with their upper bodies bare, for example when changing clothes before sports class or when swimming. The diagnosis of scoliosis is usually made between the ages of ten and twelve. Symptoms depend on how severe the spine flexion is. The following visual signs usually only appear from the third decade of life:

  • Rib hump: The spine in the thoracic area is crooked. This creates a hump in the ribs with the ribs protruding on the back. Depending on the severity, this curvature can already be seen with the naked eye.
  • In severe scoliosis, the shoulders are at different heights (one hangs lower than the other).
  • The pelvis is crooked and one shoulder blade protrudes further than the other.
  • Lumbar bulge on the opposite side of the curve

Over time, other ailments develop, including:

  • Back pain due to poor posture and muscle tension
  • Shoulder, neck and headache
  • Signs of wear and tear on the spine, structural changes in the vertebral bodies
  • Restrictions on mobility
  • Shortening of the trunk, stress on the internal organs, for example the digestive organs
  • Disorders of the heart and lung function, reduced breathing capacity

Without treatment, scoliosis continues to progress. It is therefore important to recognize the curvature of the spine at an early stage and to treat it.

The cause of scoliosis is mostly unknown

In the majority of cases, the cause of scoliosis remains in the dark. In up to 90 percent of patients, doctors cannot find a reason for the curvature of the spine. Doctors call a disease without a known cause "idiopathic". However, there are some indications that hormonal, nervous or muscular disorders can trigger scoliosis. The genes, i.e. a hereditary predisposition, probably also play a role.

The following causes are possible in around ten percent of scoliosis cases:

  • Congenital malformations of certain areas of the spine, for example deformed vertebral bones
  • Changes in the structure of the bones, for example due to radiation therapy or bone loss (osteoporosis)
  • Muscle disorders such as the inherited muscle weakness called Duchenne muscular dystrophy
  • Disturbances in nerve function, e.g. due to inflammation of the spinal cord or muscle groups that are no longer activated by electrical stimuli
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Diagnosis: Scoliosis is often easily recognized

GPs and orthopedic surgeons can often recognize scoliosis at first glance. It all starts with a conversation between the doctor, the patient and the parents, who are usually the first to discover the misalignment in their child. The doctor asks about the medical history and the complaints (anamnesis) in order to track down a possible cause of the scoliosis. But: In up to 90 percent of all cases, no reason can be found.


Forms of Scoliosis: Which Part of the Spine is Twisted?

Depending on the place where the scoliosis developed, doctors differentiate between the following forms of scoliosis:

  • Thoracic spine area: thoracic scoliosis
  • Lumbar spine area: lumbar scoliosis
  • Transition area between thoracic and lumbar spine: thoracolumbar scoliosis
  • Thoracic and lumbar spine area: thoracic and lumbar (double-arched) scoliosis

Physical examination

During the physical examination of the spine, the lateral curvature in the thoracic or lumbar vertebral area and the rotated vertebral bodies can usually be felt well. The deformation of the spine is also noticeable visually, for example through:

  • The shoulders are crooked, they are not at the same height.
  • Waist symmetry and outline of the trunk: Scoliosis in the lumbar vertebra area is noticeable as a lumbar bulge. This is located on the opposite side of the curve of the spine.
  • Difference in leg lengths
  • Inclination of the pelvis

If the cause of the scoliosis lies in the spinal cord, certain clues can sometimes be found on the skin, for example dimples or increased hairiness.

Prevention test (Adams test)

Most of the time, the scoliosis is in the thoracic spine area. The so-called forward bending test helps here, in which the patient bends forward from a standing position. The curvature of the spine is now clearly recognizable as a rib hump: the ribs on the back protrude strongly. The doctor can also determine the thickness of a lumbar bulge with a scoliometer (inclinometer). Values ​​above five degrees require a radiological examination.

Test of flexibility and strength

The doctor tests how far down you can get your fingers to the floor with your knees straight. The forward and sideways inclination shows how flexible the spine is. Muscle strength and the function of the reflexes are also checked.

X-ray examination

An X-ray examination makes the entire spine, any kinks and bends visible. The X-ray is taken while standing. To compensate for possible differences in leg lengths, doctors place thin boards under one foot until the pelvis is straight in the horizontal plane. Doctors can use the X-ray to determine the extent of the curvature, known as the Cobb angle. The exact shape of the bend is also visible.

Magnetic resonance imaging (MRI)

Magnetic resonance imaging is used when damage to the spinal cord is suspected, such as malformations or tumors.

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This is how scoliosis is treated

Scoliosis treatment depends on the severity of the curvature of the spine, the causes, symptoms, age and physical health. The aim of the therapy is to alleviate the symptoms, to correct the existing curvature, to maintain this regression and to slow down the progression of the scoliosis. In many cases, non-surgical (conservative) measures are sufficient; surgeons only have to operate on the scoliosis in severe cases.

Physiotherapy for mild scoliosis

An incipient, mild scoliosis can usually be treated well with physiotherapy. It strengthens the muscles, improves posture, promotes body awareness and trains balance and movements. Physiotherapy is an integral part of therapy at every stage of the disease.

Corset in the growth phase

In moderate scoliosis, wearing a sturdy corset (orthosis), which stabilizes the spine, helps. The problem: Children have to wear it almost around the clock (more than 22 hours a day) until they have finished growing, which can also be uncomfortable. Because when romping around and playing, the corset is a hindrance and restrictive. Only after completion of the growth phase will the wearing time be shortened. Those who do not wear the corset consistently endanger the success of the treatment. The corset is usually of no use to adults because the bone growth has already been completed. The corset is always combined with physiotherapy.

When is an operation necessary?

Sometimes physiotherapy and the corset are not successful enough. Patients also need patience and staying power for therapy - which not everyone has. In some cases the curvature is very pronounced right from the start or it progressively worsens. If other organs such as the heart or the lungs are affected, an operation is necessary. Doctors operate on scoliosis in children - if possible - not before the age of ten to twelve.

Surgery is designed to correct the curvature of the spine and then stabilize the new shape. Doctors stiffen part of the spine (spinal fusion). There are clinics that specialize in scoliosis therapies and have a lot of experience with this clinical picture. The surgical procedure is usually followed by rehabilitation (rehab), in which patients in turn receive physiotherapy. They should consolidate the success of the treatment.

Course and chances of recovery in scoliosis

Scoliosis can regress to a certain extent or slow its progression. The prognosis is good, especially in infants, if doctors discover and treat the spinal curvature in good time. The earlier therapy begins, the better the prognosis for scoliosis. The following often applies here: the younger the person affected, the greater the possibility of correction.

You, too, can positively influence the course of scoliosis. The more motivated and consistent you are in your therapy, such as wearing a corset or doing physiotherapy exercises, the better the spinal disease will progress. The symptoms also decrease with regular therapies.

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Can you prevent scoliosis?

As a rule, you cannot prevent scoliosis because the causes are unknown in up to 90 percent of all cases. In this way, the potential triggers cannot be specifically switched off. It is important to diagnose and treat scoliosis early to prevent possible effects on the heart, lungs and digestive organs. So apply the therapies consistently for as long as they are necessary - then the scoliosis can be corrected and this condition can be maintained for a long time.