What is Scoliosis? Symptoms and Treatment Methods

Spinal curvatures exceeding 10 degrees to the right or left are called scoliosis. To answer the question of what scoliosis is, it is not merely a simple sideways bending, but a three-dimensional deformity that occurs as the vertebrae rotate on their own axes. When diagnosed early, this condition can be managed with non-surgical methods and must be carefully monitored, especially in growing children.

In Short:
It is a three-dimensional spinal curvature of 10 degrees or more.
It is most commonly seen in adolescent girls.
Shoulder asymmetry, a hump on the back, and a shifted pelvis are the most prominent signs.
With early diagnosis, it can be managed through non-surgical methods such as bracing and physical therapy.
Advanced and rapidly progressing curvatures may require surgical intervention.

What is Scoliosis? (Spinal Curvature)

Scoliosis is the term given to lateral (sideways) curvatures of the spine exceeding 10 degrees. However, this spinal curvature is not just about leaning to the right or left; the curve actually occurs across three different planes and involves the vertebrae rotating around their own axes. Widely seen in the community, this condition can affect an individual's posture, height, and, in advanced stages, the positioning of internal organs.

Although there is a congenital form of scoliosis (due to developmental defects in the womb), the term "scoliosis" generally refers to the most frequently encountered clinical picture. This picture is typically adolescent idiopathic scoliosis, which begins during adolescence and has no fully known cause. The degree of the curvature and the patient's growth potential are the two most fundamental factors that determine the course of the disease.

Causes and Risk Factors of Scoliosis

The causes of scoliosis vary depending on the type of the disease. While underlying etiological (causal) factors can be clearly identified in some types, no definitive cause has been established for the most common adolescent type. Therefore, this type is called "idiopathic" (of unknown cause).

Conditions that can accompany scoliosis or pave the way for its development include:

Maturation (developmental) disorders of the central and peripheral nervous systems.
Connective tissue diseases (structural defects in elastic and collagen fibers).
Various muscle and bone diseases (neuromuscular disorders).
Platelet (blood platelet) disorders and molecular biology abnormalities (e.g., imbalances in melatonin or growth hormone levels).
Genetic predisposition (having a family history of scoliosis).

Why is Scoliosis More Common in Females Than Males?

The exact reason why scoliosis is seen more frequently in females than in males is not entirely clear. However, gender directly affects not only the prevalence (frequency of occurrence) but also the severity of the scoliosis. Many scientific studies have reported that the angle of curvature is higher in females and shows a greater tendency to progress. Particularly when examining patients with curvatures over 30 degrees, it has been found that the female-to-male ratio is at a striking level of 10 to 1. Severe scoliosis cases are seen much more frequently in women.

What Are the Symptoms of Scoliosis?

Scoliosis symptoms can vary according to the degree of the curvature and the patient's age. While mild curves are generally not easily noticed from the outside, body asymmetry becomes more pronounced as the curve increases. It is of great importance for parents to carefully observe their children, especially during the pre-adolescent and adolescent periods.

The most frequently encountered symptoms of scoliosis are:

Inequality in shoulder levels (one shoulder sitting higher than the other).
Prominent asymmetry in the back or waist.
One shoulder blade sticking out more than the other.
A shift at the hip level, a difference in leg length, or a feeling of leg length inequality.
A hump on the back (kyphotic appearance) or a rib prominence on one side when bending forward.

If you notice one or more of these symptoms, you should consult a specialist without wasting time. For more detailed information on the subject, you can also review our article titled Posture Disorders and Scoliosis Symptoms in School-Age Children.

What Are the Types of Scoliosis?

Based on its cause (etiology), scoliosis is sub-grouped into congenital (present at birth), neuromuscular (originating from the nerve-muscle system), and idiopathic (of unknown cause). Based on age, it is classified as early-onset (before age 10) and late-onset (after age 10). Adolescent idiopathic scoliosis accounts for approximately 85% of all scoliosis cases.

What is Adolescent Idiopathic Scoliosis (AIS)?

Adolescent Idiopathic Scoliosis (AIS) is a common disease encountered in the community with a prevalence (frequency of occurrence) of 0.47% to 5.2%. It is a type of scoliosis that begins after the age of 10 and has no clear underlying disease causing its development. It is generally localized at the level of the thoracic (chest) spine. Less frequently, it occurs at the thoracolumbar (mid-to-lower back) and lumbar (lower back) levels; these cases show a distinct tendency to lead to body imbalance.

In approximately 10% of cases, adolescent scoliosis is "S" shaped and contains two separate curves. It is almost always accompanied by partial lordosis (swayback) and always involves rotation of the vertebrae. This rotation leads to a typical deformity in the spine and ribs. It is mostly seen in girls and affects approximately 2% of adolescent girls. In AIS patients, an excessive and rapid growth spurt in the spine is observed during adolescence.

How is Scoliosis Diagnosed and Which Degrees Are Dangerous?

Scoliosis is diagnosed through physical examination and detailed radiological imaging methods. Fundamentally, during the initial diagnosis, the degree and location of the curves, as well as the patient's growth potential, are of great importance. A bone maturation metric called the "Risser Scale" is used to predict how much and over what period the patient will grow.

Patients at Risser Stage 0 and 1 are at an extremely high risk for curve progression because their skeletal growth potential is very high. Risser Stage 4 indicates the end of spinal growth, while Risser Stage 5 marks the end of height growth. The earlier AIS is detected, the earlier treatment should begin, running parallel to the Risser stage.

What Factors Influence the Progression of the Curve?

The primary factors in the progression of the curve are the age of onset and the amount of curvature initially detected. The risk of the curve increasing can be predicted according to the Risser scale. In patients where the curve is small and the Risser grade is high (growth is almost complete), the probability of progression is low. In contrast, in patients where the initial curve degree is high and the Risser grade is low (high growth potential), the probability of the curve increasing is much greater. For example, between the ages of 10-12, the progression rate is 25% for patients with an initial curve of less than 19 degrees, whereas this rate rises to 90% for those with an initial curve over 30 degrees.

Which Degrees of Scoliosis Are Dangerous in Children?

Situations where scoliosis is considered dangerous in children are not limited solely to the degree. Atypical (unexpected) curve shapes, curves progressing rapidly such as 1 degree per month, conditions accompanied by night pain, and curves accompanied by neurological deficits (loss of strength, numbness) are quite risky. Furthermore, closely monitoring and treating curves that are detected as high-degree initially and begin in the early period between ages 4-9 is of vital importance.

What Are the Treatment Types for Scoliosis?

Scoliosis treatment is planned individually according to the patient's age, the degree of the curve, growth potential, and the type of curve. Fundamentally, there are two main treatment methods: conservative (non-surgical) and surgical. It is essential to go through a complete and detailed diagnostic phase before making a treatment decision.

The main scoliosis treatment methods applied are:

Regular Monitoring: If the curve is under 20 degrees and the patient's growth potential is low, they are followed up at regular intervals.
Physical Therapy and Rehabilitation: Special exercise programs that strengthen the muscles around the spine are applied.
Brace Treatment: Used to stop progression in patients who are still growing and have a curve between 25-40 degrees.
Surgical Treatment: Surgery is preferred in cases where the curve is over 40 degrees and the risk of progression is high.

For your treatment process, you can receive support from our hospital's Orthopedics and Traumatology and Physical Therapy and Rehabilitation departments.

How is Scoliosis Treated in Children?

Scoliosis treatment in children is planned based on skeletal maturity and curve degree. For patients with AIS, the most common approach for moderate deformities with a curve angle under 25 degrees is observation. Depending on the degree of skeletal maturity, patients are evaluated by a specialist in the clinic every 4-6 months to monitor curve progression. Curve progression is defined as an increase of more than 5 degrees in deformity magnitude during consecutive follow-ups, in which case the treatment plan is updated.

What Can I Do to Prevent the Progression of Scoliosis?

In cases that do not require surgical treatment based on the onset and age of the curve, the goal is to stop or slow down the progression. For this, the use of a brace recommended by your doctor is of great importance. Additionally, physiotherapy and rehabilitation applications aimed at strengthening the muscles around the spine, increasing flexibility, and ensuring correct posture are integrated into the treatment. Exercising regularly reduces muscle imbalances, lightening the load on the spine.

Is Bracing an Effective Method in Scoliosis Treatment?

Yes, brace treatment is a scientifically proven, effective method that reduces the progression of the curve. Bracing has formed the foundation of non-surgical treatment for idiopathic scoliosis for nearly 50 years. A scoliosis brace is strongly recommended at the initial evaluation for patients with a 25-45 degree curve who are in their fastest growth phase (Risser stage 0 or 1). The current recommendations of the Scoliosis Research Society include starting brace treatment in patients whose skeletal development is incomplete and who have a curve greater than 30 degrees, or those with a curve greater than 25 degrees showing more than 10 degrees of progression.

Braces are divided into three categories according to their usage times: part-time braces are used for 12-20 hours a day, full-time braces for 20-24 hours a day, and night braces are primarily used while lying down for 8-12 hours. For a successful outcome, the brace must be used regularly until the end of the growth period.

How is Surgical Treatment Planned for Scoliosis Patients?

Surgical indications (the necessity for surgery) in idiopathic scoliosis depend on many factors. A high risk of deformity progression based on gender, bone age, and the magnitude of the curve brings the surgical treatment option to the forefront. Generally, surgical intervention is recommended in cases where the curve is over 40 degrees. The surgery is planned by evaluating factors such as the patient's age, whether lung development is complete, and the flexibility of the curve through a multidisciplinary approach.

Risks and Complications of Scoliosis Surgery

As with any surgical intervention, scoliosis surgery carries certain risks. Generally, the complication rate related to scoliosis surgery is reported to be between 5.2% and 15.4%. The rate of neurological complications (nerve damage) is generally observed to be below 1%. Today, the use of "neuromonitoring" (real-time tracking of nerve conduction) during surgery has significantly reduced the risk of neurological deficits.

Non-neurological complications can include bleeding, infection, mostly temporary eye and peripheral nerve deficits due to surgical positioning, rarely developing pseudoarthrosis (failure of bones to fuse), and continued progression of the curve (2-13%).

Does Untreated Scoliosis Cause Other Health Problems?

Untreated scoliosis that continues to progress can have serious negative effects on the respiratory and cardiovascular (heart-vessel) systems. Particularly back curves that can reach up to 90-100 degrees have the effect of reducing respiratory capacity and lowering the body's rate of oxygen utilization. Spinal curvature causes a decrease in the front-to-back diameter of the rib cage. This condition can lead to pulmonary hypertension (high blood pressure in the lungs) and restrictive lung disease. In those with advanced curvature, it can cause heart enlargement due to increased resistance against the heart's pumping action.

The psychosocial dimension in patients with AIS can vary greatly. The resulting decrease in quality of life and psychosocial status are closely related to the degree of the deformity. According to scientific studies, approximately 21% of patients experience mild psychological issues and may act reluctantly, especially in situations like wearing beachwear. It has been found that the patient group experiencing problems most frequently is girls with thoracic (back) curves. Since the general body posture of patients with early-onset and advanced curves will deteriorate, it is likely they will struggle with jobs requiring physical strength.

When to See a Doctor?

Any situation carrying a suspicion of scoliosis should be evaluated by a specialist physician. If you notice an asymmetry in your child's posture, inequality in their shoulders, or a hump on their back, you should consult an orthopedics specialist without wasting time.

You may need to seek emergency medical support or call 112 in the following situations:

Sudden onset of severe shortness of breath or chest pain related to spinal curvature.
Sudden loss of strength, numbness, tingling, or loss of sensation in the arms or legs (suspicion of neurological compression).
Development of severe pain along with a visible deformity in the spine following trauma.
Sudden loss of bladder or bowel control.

Scoliosis Diagnosis and Treatment Process at BHT CLINIC

At BHT CLINIC İstanbul Tema Hastanesi, the scoliosis diagnosis and treatment process is carried out through the coordinated work of our Orthopedics and Traumatology and Physical Therapy and Rehabilitation departments. In our hospital, the degree of the curve is measured with precision using advanced radiological imaging techniques, and the most accurate treatment plan is created suitable for the patient's growth potential. When necessary, we stand by you with our 24/7 emergency department and fully equipped operating rooms.

If you are experiencing symptoms of scoliosis or are concerned about your child's spinal health, you can visit our BHT CLINIC appointment page or contact us 24/7 via our call center at 0850 811 34 00.

Frequently Asked Questions

Is a definitive cure for scoliosis possible?

Yes, with early diagnosis and the correct treatment choice, it is possible to fully correct scoliosis or completely halt its progression. Accurately determining the patient's risk of curve progression and starting brace or surgical treatment on time is the key to success.

Can scoliosis patients do sports?

There is generally no harm in scoliosis patients engaging in sports; on the contrary, swimming, pilates, and core-strengthening exercises support spinal health. However, a physician must definitely be consulted before heavy sports that place excessive vertical load on the spine, such as weightlifting.

Is a scoliosis brace visible under clothes?

Modern scoliosis braces produced today are generally not visible under everyday clothes because they are made of thin materials that conform to body contours. Patients can go to school with the brace and comfortably continue their daily social lives.

Does scoliosis progress in adults?

The risk of progression for mild scoliosis in adults whose growth is complete is very low. However, curves over 50 degrees can continue to progress slowly (1-2 degrees per year) during adulthood due to the effects of gravity and age-related spinal wear and tear.

This article is for informational purposes only; always consult your physician for diagnosis and treatment.