Scoliosis

Scoliosis is a spinal growth disorder which leads to the curving of the spine. A healthy spine, viewed from the front, is straight, i.e. it is shaped like the letter “I”, while a scoliotic spine is shaped like the letter “S” or “C”.
According to the time of occurrence, the shape of the curve and the period of development, there are several forms of scoliosis.
Inborn (congenital) scoliosis is present from the time of birth and occurs due to the irregular embryonic development of one or more vertebrae. This type of scoliosis is often accompanied by other congenital anomalies, while the speed of deterioration varies. 
Newborn (infantile) scoliosis occurs before the age of three, mostly with boys. The whole spine has the shape of the letter “C”, and these curves usually correct spontaneously.         
Juvenile scoliosis occurs between the age of 3 and10, and it is very similar to adolescent scoliosis, but it is more severe since the end of the growth period is further away, and the level of the final curve is therefore also greater.   
Adolescent scoliosis is the most often occurring type of scoliosis (almost 80% of all scoliosis patients) and occurs before and during puberty, i.e. after the age of 10. It mostly occurs with girls. The reasons for its occurrence are unknown, although it is certain that there is certain genetic predisposition, and that the carrying of backpacks, diet, (non-)practicing of sports or exercises, or bad posture does not influence its occurrence.                                                                                                             
Adult scoliosis is very rare and these cases are mostly cases of not-treated scoliosis from childhood or new scoliosis which occurred due to degenerative deterioration of the lumbar spine.    
Scoliosis is a growth disorder which is not painful, but leaves behind spinal deformities. It is therefore necessary to perform, from the age of eight or nine, until the end of the growth period (around the age of 14) physical examinations of children’s spines every 6 to 12 months, in order to note possible deformities in time.
A quality physical examination by an expert who can spot the deformity in the initial stage is very important. An examination consists of an analysis of shoulder symmetry, balancing or inclination of the torso, horizontal position of the pelvis, the form of the chest, leg length measurement, “bending” test in which the patient, naked from the waist up, bends forward so that the hands and head are lowered as far as possible towards the ground while the doctor observes the back from behind and from the side. Besides that, a competent person can recognize the factors relating to the deterioration of the curve, determine the type of scoliosis, and possible other states resembling scoliosis. Every type of scoliosis has different prognoses and different treatment therapies.
If the existence of a deformity is established during the physical examination, a RTG picture of the spine needs to be taken in the standing position. One should keep in mind that a quality physical examination reduces the number of RTG pictures and therefore also the level of radiation for the patient. The RTG picture determines the form, location, and level of the curve, the type of scoliosis or other deformities, as well as the Risser sign (time of remaining bone growth). Scoliosis is mainly located in the thoracic part of the spine which is curved to the right. The level of the curve (Cobb angle) is defined based on the angle formed by the line of inclination of the upper and lower most curved vertebra.  
In order to diagnose scoliosis, the Cobb angle must be greater than 10°. At the moment of the first physical examination it is not possible to foresee whether the curve will become worse. It is therefore necessary to repeat the examination in 4 to 6 months, when the RTG picture will be retaken. 
The usual form of treatment of scoliosis is monitoring until the end of the growth period (two years after the first menstruation for girls or significant pubic hair growth for boys; Risser ≥ 4). Once the Cobb angle becomes larger than 20-25°, and if the child has not yet stopped growing, then the wearing of a corset (orthotics) is prescribed until the end of the growth period.  
The aim of the orthotics treatment is to prevent further curving, and to, thereby, avoid an operation. It is used for the treatment of idiopathic scoliosis with a Cobb angle between 25°and 40° and an established progression (increase in the Cobb angle by more than 5°compared to the previous test) for children who have not stopped growing.
Kyphosis
Kyphosis is an increased bowing of the spine forwards. Viewed from the side, a healthy spine is bent in the thoracic segment by 20°to 40°, and in the lumbar segment it is bent backwards by 40°to 60°, looking like an elongated letter “S”. If the curve of the thoracic spine is larger than 40° we are talking about kyphosis, and viewed from the side the spine then looks like a “?”.   
The most common form of kyphosis is Scheuermann’s kyphosis, caused by a growth disorder of the cover plates of vertebrae with a resulting wedging shape of the vertebrae, occurring mostly after the age of 14, progressing slowly, more often affecting boys, and it is followed by a small level of scoliosis, with minimum or no pain.
The difference between kyphosis and bad posture is that in cases of bad posture the patient can straighten his spine (left picture), while in cases of kyphosis he cannot straighten his spine (right picture). As with scoliosis, the “bending” test is decisive, while the RTG picture just confirms the diagnosis.
The treatment of kyphosis is performed under the same principles as the treatment of scoliosis. The orthotic is worn before the end of the growth period when the angle of the curve is 40°-60°, while an operational correction is advised for angles larger than 60°.
 
TLSO ortoza
Opis: Za tehnike izrade kod TLSO ortoza za skoliozu i kifozu koriste se termoplastični materijali polethilen ili poliprophilen. Radi se timski i uz obavezno prisustvo ljekara-ortopeda koji aktivno učestvuje kod uzimanja otiska.
Termoplastični materijali mogu biti korišteni po debljinama od 4-6 mm. Moguća izrada sa posebnim dezenima.
Rade se sa pristupom od jedne do četiri uporišne pelote ovisno o stepenu zakrivljenosti i stepenu rotacije.
Napomena: Kod navedene problematike veoma bitno da pacijent posjeduje odgovarajuću dokumentaciju RTG snimke sa utvrđenim stepenom krivine.