World of back health 

Scoliosis is nobody's fault

Professor Dr. Michael Akbar is a spine specialist. We spoke to him about the topic of scoliosis. In this interview, the orthopaedic surgeon explains how the disease is diagnosed and what treatment options are available.

Professor Dr. med. Michael Akbar
Expert for diseases of the spine in children and adults at two private clinics in Berlin and Heidelberg

Professor Akbar, what is scoliosis?
Akbar: Scoliosis is a three-dimensional deformation of the spine that is accompanied by a lateral deviation. This growth disorder leads to simultaneous deformation and rotation of the vertebral bodies. In contrast to a pure postural weakness, the curvature of the spine cannot be straightened on its own, i.e. by its own strength. We diagnose scoliosis when the lateral curvature of the spine reaches 10 degrees. An estimated 0.5 to five percent of the German population have scoliosis. A distinction is made between idiopathic scoliosis, whose triggers are unknown, and secondary scoliosis. The latter develops due to other diseases such as changes in the bones or a muscle or nerve disease. Most scoliosis, around 85 percent, are idiopathic.

What are the risks of developing idiopathic scoliosis?
Why a normal spine suddenly becomes twisted is still not fully understood. But we know that the occurrence of scoliosis is related to body growth. It has nothing to do with a poor diet or incorrect exercise - sport or work also have no influence on the disease. Neither the patient nor the parents can do anything about it, nobody is to blame. However, there appears to be a genetic predisposition, as scoliosis tends to run in families: 97 percent of all patients with idiopathic scoliosis have a positive family history. Girls are affected four to five times more frequently than boys. Malformations can be treated well in childhood and adolescence, as the spine is still elastic and malleable. The older the patient and the more pronounced the curvature, the more difficult and complex the treatment becomes.

What other symptoms are there apart from postural changes?
Akbar: Depending on where the curvature is located and how large it is, the asymmetries may actually only be an optical problem. But the twisted spine can also put a lot of strain on the intervertebral discs, vertebral joints and the corresponding muscles - resulting in back pain and later osteoarthritis. In severe cases, scoliosis can even restrict heart and lung function. The psychosocial strain caused by a hump or crooked posture should not be underestimated either.

How is scoliosis diagnosed?
Akbar: Affected children usually have no pain or other complaints due to the onset of scoliosis. The diagnosis is therefore more likely to be made by the parents or as an incidental finding during a visit to the doctor. Typical signs of scoliosis are a visibly curved spine, a clearly protruding shoulder blade or ribs and a shoulder or pelvic obliquity. It makes sense when parents go swimming with their children to be aware that even minor changes in posture are more noticeable in swimwear. As doctors, we usually use the Adam test for the initial diagnosis: The patient bends the upper body forward and deviations are noticeable in this position. However, additional x-rays and an MRI scan of the entire spine are necessary for a definitive, reliable diagnosis.

What happens after the diagnosis of "idiopathic scoliosis"?
Akbar: This depends on various factors: the age of the patient, the severity of the curvature and its progression. As scoliosis can worsen, especially during growth, it is important to be able to estimate how long the affected person will continue to grow. Let's take the example of a not yet fully grown twelve-year-old girl with a ten-degree curve, which means a slight scoliosis. This patient would initially be prescribed sports and physiotherapy. Symmetrical sports such as horse riding, ballet dancing, climbing or swimming as well as strengthening the abdominal and back muscles are useful. The aim is to strengthen and stabilize the spine by building up muscles, thereby largely correcting the misalignment of the spine and preventing it from progressing.

What is the treatment for advanced scoliosis?
Akbar: With a scoliosis of 20 to 50 degrees, the patient would be advised to undergo corset therapy in addition to physiotherapy. This is very stressful for adolescents, as the corset has to be worn consistently - around 18 hours a day. It fixes the pelvic and shoulder girdle against twisting and can bring about a passive correction of the scoliosis. However, it is only effective in patients who are still growing significantly in the area of the spine.

When is an operation necessary?
Akbar: Severe scoliosis with a progressive curvature of 40 to 50 degrees or more usually requires surgery. For higher degrees of curvature, a corset is anatomically and technically not possible nor effective. Physiotherapy and sport alone would not lead to desired outcomes. The last option is then surgery. Fortunately, such severe cases are extremely rare. It is also important to know that previous conservative treatments have no negative influence on the success of an operation. The aim of scoliosis surgery is to straighten the curvature, eliminate the rotation and fix the spine with implants. The chance of success with such an operation is usually very good but involves a relatively long rehabilitation period.

Tips for those affected

Scoliosis patients should definitely pay attention to their weight. Being overweight puts additional strain on the spine. Hard physical work is also counterproductive. Instead, those affected can focus on healthy muscle building. Good abdominal and back muscles relieve pressure on the spine. Regular exercise is important for this. Scoliosis patients are also entitled to lifelong physiotherapy. You should take advantage of this offer. Scoliosis patients can also find help from the Bundesverband Skoliose-Selbsthilfe e. V. (German Scoliosis Self-Help Association).