How to recognize scoliosis (which does not give symptoms at the beginning), how to treat it, and when to wear a brace

Unlike other musculoskeletal diseases of the spine, scoliosis does not have the typical alarm bell ache (if not in the advanced stage in the adult due to degenerative causes). At its onset, this spinal deformity almost never gives symptoms and must therefore be sought, also because an early diagnosis can make the difference. This was recalled by the greatest Italian and foreign experts who recently attended the congress organized to celebrate the 50th anniversary of the Scoliosis Center of the Gaetano Pini Orthopedic Institute in Milan. The event was an opportunity to make an excursus on vertebral deformitiesfrom their recognition to the latest therapeutic frontiers.

What

Scoliosis is the most common spinal deformity: it affects 3 percent of the population, with a male to female ratio of 1 to 4. Fortunately, the severe forms are quite rare, about one in 2,000. The rapid growth phase of puberty, in which there is a real hormonal storm, the one in which, if there is scoliosis, it explodes and tends to get worse – he explains Bernardo Misaggi, director of the Complex Operative Unit of Traumatology and Pathologies of the Vertebral Column of the Gaetano Pini Institute in Milan, President of the Italian Society of Spinal Surgery and the Italian Scoliosis Group (Sicv-Gis) —. In 85 percent of cases juvenile scoliosis is defined as idiopathic, as the causes are not known. Suspicion must always arise when there is familiarity: if the mother has had scoliosis, her children must be checked. A first exam, always recommended, regardless of familiarity, can be done by the parents themselves. The maneuver consists in making the boy bend forward with his legs stretched out to highlight whether one side of the trunk is higher than the other and therefore the so-called “hump” is highlighted.

The slight deformities

The first step in dealing with it correctly is to rely on a specialist in the field, usually a physiatrist or an orthopedic surgeon. To establish whether treatment is needed and the most suitable type of approach, it is necessary to evaluate not only the degree of spinal deviation (which on the X-ray of the entire spine is measured in Cobb degrees), but also lage of the patient and the age of bone growth, as well as the course of scoliosis over time, ie its potential to worsen (the further back the bone growth the more scoliosis can worsen). In the slight deformities of the spine, around 10-15 Cobbs, gymnastics is the host – Misaggi points out -. There are various postural re-education strategies, but what matters most is the practice of exercises that strengthen the muscles and lengthen the spine: good muscles help scoliosis not get worse. However, it remains essential to carry out periodic checks because, if there is a deterioration, other measures must be taken.

When the corset is needed

When scoliosis reaches or exceeds 20 Cobb, the use of an orthopedic plastic corset is in fact appropriate. It is necessary to give the correct correction based on the registry and bone age, the stage of development and the extent of the curve. Depending on the severity of the scoliosis, an indication is then given how many hours to keep the corset during the day, in some cases it may be necessary to keep it 24 hours a day, other times the night is enough, still others in the afternoon and at night, explains the expert. More complex to cure are scoliosis between 40 and 45 Cobb. In our institute we still have the opportunity to do pinstriped corsets which, however, are not easy to accept by the young person and by the family due to the physical and psychological discomfort that can derive from them – continues Misaggi -. However, some data that we have published show that, in severe scoliosis (40 and 45 Cobb), the use of the plaster corset allows in many cases to avoid surgery. In general, two or at most three plaster casts are made, to be changed every two or three months, with a total duration of six to nine months. If after the first three months the curve has already dropped below 35, continue with plaster casts. The treatment with the plaster corset allows to obtain a correction of about 50%, which is an excellent result. To maintain the benefit, once the last plaster has been removed, the boy must wear the plastic corset until the end of bone growth (usually 17-18 years), if the correction with the orthopedic corset is maintained, the risk of worsening it’s gone. Once the critical phase has been overcome, with the plastic corset one can be more understanding, perhaps making it used only at night. In any case, each case must be evaluated as Misaggi reports. If, on the other hand, with the conservative treatment, both with the plastic and plastered corset, there has been no benefit because the curve is very stiff and the scoliosis tends to get worse, the surgical indication takes over.

When is surgery needed?

And when surgery When the deformity of the scoliotic curve exceeds 45-50 – explains the specialist -, surgical techniques can be used to correct the deformity of the spine with metal bars and vertebral arthrodesis, or with the “fusion” of the vertebrae with bone (which can be autologous or from a donor).