Scoliosis (Pediatric Orthopaedic Clinic)
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The ''AGIOS LUCAS'' Clinic announces the opening of the Scoliosis Pediatric Orthopaedic Clinic. The scientific head of the clinic is the Orthopaedic Surgeon for Adults and Children, Dr. Themistocles K. Tzatzairis, MD, MSc, PhD.
Scoliosis is a developmental disorder that causes the vertebrae to deform, twist and tilt sideways, resulting in an S or C-shaped spine. The term comes from the ancient Greek word scolios meaning crooked, (not straight, not straight)
Practically speaking, it causes lordotic posture and tilting of the trunk to the right or left, tilting of the pelvis in the opposite direction, asymmetry of the shoulders (one shoulder is higher than the other), forward leaning of one or the other shoulder blade and one or the other breast.
When the scoliosis is large the asymmetries it causes in the body are very obvious, but in the early stages it may not be visible to the casual observer and may be missed, as it usually causes no pain and the small asymmetries are covered by the clothes worn by otherwise healthy children.
Important parameters in the treatment of scoliosis are early diagnosis, a personalised approach and the right treatment, where necessary.
In 2-3% of school-age children have scoliosis. It occurs more often in adolescent girls and in some families it is more common.
In 85% of cases we do not know the cause and we call scoliosis idiopathic, but we do know that bad posture, a heavy bag, a slight imbalance or flat feet do not cause scoliosis. We also know that single standing, special exercises, swimming, special insoles and special splints do not completely correct scoliosis (but they can significantly delay its progression).
Today we believe that idiopathic scoliosis has a genetic basis and occurs in people with multiple gene inheritance. This does not mean that if a parent has scoliosis their child will have it too. But the incidence of scoliosis in certain families is increased, so children from these families should be screened more often.
Other known causes of scoliosis include congenital anomalies, chromosomal syndrome, connective tissue disorders and diseases of the nervous system and muscles such as cerebral palsy, Duchene's myopathy, neurofibromatosis, Marfan syndrome, etc.
Spinal deformity can occur at any age even in adults (de novo adult scoliosis). Scoliosis in children and adolescents involves the developing skeleton and therefore requires a different approach.
Today we distinguish scoliosis according to the age of onset in:
1. early onset scoliosis before the age of 10 years and
2. late-onset scoliosis, after the age of 10 years.
Early onset scoliosis is the most severe form of scoliosis for the developing child's skeleton. Because it occurs early, the deformity increases as the child grows skeletally, leading to significant deformities. If the deformity worsens as the child grows, it affects not only the shape of the spine but also the shape of the thorax and the development of the lungs in a domino effect.
In older children, deformity usually occurs during the period of rapid development just before puberty, from 9 to 12 years in girls and 13 to 14 years in boys.
The deformity of the trunk is usually discovered by the parents, the paediatrician or the orthopaedic surgeon. The only accepted way of diagnosis is a spinal x-ray, which is always taken in an upright position in a specific way and with a special radiological technique (whole spine x-ray).
It is important that the X-ray is done correctly so that it does not need to be repeated because then the child will be subjected to unnecessary radiation. The size of the scoliosis is measured in degrees (Cobbangle) and is one of the elements that determines the severity of the condition and appropriate treatment. Through these measurements, the progression of the scoliosis can also be monitored.
There are many "devices" nowadays that claim to be able to measure the degree of scoliosis without the use of x-rays. The subjective measurement and the high degree of error that can occur with the use of these devices have limited their usefulness.
The treatment of scoliosis includes monitoring, guardian, physiotherapy and surgery. The goal is to stop the progression and maintain body balance. It should be understood that scoliosis is not treatable in the traditional sense of the term. On the one hand, because it often does not cause disease and, on the other hand, because there is, to date, no way to straighten the spine while maintaining full mobility. The only way to straighten the spine is surgery performed by a qualified orthopaedic surgeon (spinal specialists) using a special technique, but sacrificing the mobility of part of the spine. For this reason, scoliosis surgery is performed when necessary and always at the right time to minimise the length of the spine that will be anchored. Age is not a limitation. Surgery should be performed early when it appears that the scoliosis cannot be arrested in any other way. The child will then have a normal life without any restrictions.
Scoliosis guardians are special splints that are applied to the child's torso - which has sufficient growth potential - to stop the progression of scoliosis. They do not correct the spine permanently and the result of their application is considered successful, by some when the scoliosis remains at its original size, and by others when it does not grow enough to require surgery. By one or the other criterion, the success of the guardian reaches 80% if the child agrees to wear it 23 hours a day, 24 hours a day.
Finally, an important part in the treatment of the progression of scoliosis has been proven to be physiotherapy with the Scroth method. Physical therapy sessions combined with proper guardian application seems to have impressive results.
There is currently no way to prevent the onset of scoliosis. Early diagnosis, however, is of great importance, because we can modify the natural history either by reducing the size of the deformity with orthopaedic guards or by correcting the deformity with surgical interventions. Early and early diagnosis can be achieved through organised screening programmes at school or by informing and raising awareness among the paediatricians who carry out the compulsory pre-school screening.
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All children should be screened at the age of 6 years. If there is a family history of scoliosis they should then be screened every year until the onset of puberty. Without a family history, all girls should be clinically screened twice, at age 10 and age 12, and all boys should be screened once at age 13. If scoliosis is suspected in the epilepsy test, the child should be referred to a specialist paediatric orthopaedist.
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