Spinal Curvature (Scoliosis)
Spinal Curvature (Scoliosis) is a spinal disorder often diagnosed when concerned mothers bring their children to the doctor in a hurry.

Our spine acts like a bridge supporting about two-thirds of the body’s weight and is made up of 33 vertebrae. When looking at a normal human spine from the side, there are four natural curves: a slight lordosis in the neck and lower back regions, and a slight kyphosis in the thoracic (upper back) and pelvic regions. When viewed from the front, the spine is expected to appear straight without any curvature.

What is Spinal Curvature?
Scoliosis refers to a lateral (right or left) curvature of the thoracic and lumbar spine. It occurs with a frequency of about 2-4%. It is 8-10 times more common in girls than boys. Only about 10% of individuals with scoliosis progress to a degree that requires treatment.

There are different causes of scoliosis. The most commonly encountered scoliosis in daily life is idiopathic scoliosis, which appears in the teenage years with an unknown cause, and congenital scoliosis. Here, we will focus mostly on idiopathic scoliosis.

The spinal curvature in scoliosis can appear as a single curve shaped like the letter “C” or as two curves shaped like the letter “S.” The “S”-shaped scoliosis can occur at any age but may not be diagnosed until adolescence. Often, the first to notice the curvature is the mother.

Types of Spinal Curvatures
Spinal curvatures can arise from many different causes, but sometimes the cause cannot be determined. The most common type is idiopathic scoliosis, where the cause is unknown.

• Congenital scoliosis: Usually caused by a defect in the spine or fused ribs. It progresses rapidly.
• Idiopathic scoliosis: Accounts for more than 80% of scoliosis cases and is the most common form. It is classified by age of onset: infantile (0-3 years), juvenile (4-9 years), and adolescent (10-18 years).
• Early-onset scoliosis: Generally occurs before the age of 10.
• Neuromuscular scoliosis: Develops due to neuromuscular diseases such as cerebral palsy, polio, or muscular dystrophy.

Symptoms of Spinal Curvature

• One shoulder being forward, higher, or more prominent,
• Shoulders and hips not being level,
• One scapula appearing more prominent or protruded when viewed from behind,
• One leg appearing longer than the other,
• The torso and rib cage shifting to one side,
• When bending forward, ribs on one side appearing higher than the other,
• Asymmetry in the waist or back.

It can be difficult to predict how scoliosis will progress. The fastest progression is usually during the first 5 years of life and during the rapid growth phase in adolescence. If scoliosis is diagnosed during these periods and the curve is severe, it is more likely to progress faster. In idiopathic scoliosis, the child’s age is the primary factor when planning treatment, followed by the degree of curvature. Girls tend to have faster progression.

The younger the child at diagnosis, the more the curvature is likely to progress. In adults with mature skeletal development, scoliosis progression is generally slower and less pronounced. For this reason, scoliosis diagnosed in young children and during rapid adolescent growth requires close monitoring.

How is Spinal Curvature Diagnosed?
Early diagnosis of scoliosis is very important for successful treatment. Besides a thorough medical history and physical exam, imaging that includes the entire spine is necessary. X-rays of the full spine from front, back, and side while standing are used to measure the curvature angle called the Cobb angle. A scoliometer is another tool used to detect curvature.

In scoliosis, rotation of the vertebrae (axial rotation) is also important. The scoliometer measures this rotational deformity, which is different from the Cobb angle. In addition to X-rays, MRI and CT scans may be used for diagnosis and differential diagnosis.

How is Spinal Curvature Treated?
Treatment depends on the degree of curvature, the patient’s age, and scoliosis type. Early treatment leads to better outcomes, so early diagnosis is crucial.

Treatment must be personalized. For example, treatment for an 8-year-old child with a 30-degree curve differs from that for an 18-year-old with the same degree. The younger the child, the greater the potential for progression.

The goal of treatment is a balanced, pain-free life with a spine that is as aesthetically normal as possible. Treatment is generally divided into three categories: observation, bracing, and surgery.

• Observation: Regular monitoring every 4-6 months. This is the first treatment option. Curves under 20 degrees in patients close to skeletal maturity may only require observation and periodic check-ups. During observation, the patient should maintain physical activity to improve overall body conditioning.
• Bracing: Aims to prevent worsening of the curve. Effective for curves between 20-40 degrees in growing children. Very young children may not tolerate bracing, so casts or body casts may be used. The brace must be worn 22-23 hours per day to be effective. Bracing is not effective for congenital scoliosis.
• Surgery: Recommended when curvature exceeds 40-45 degrees, especially if the child is still growing. Surgery involves correction and fusion with implants such as rods and screws placed in the spine.

What Happens If Spinal Curvature Is Untreated?
Viewing scoliosis treatment merely as correction of spinal curvature is incomplete. When the curve reaches severe levels (80-100 degrees), it can deform the ribs and chest cage, reducing chest volume. In growing children, this can impair lung development and cause respiratory insufficiency.

Thus, scoliosis treatment not only corrects spinal deformity but also prevents chest cage deformities and protects lung function. This risk must be considered when deciding on early surgery, especially in young children.