Idiopathic Scoliosis

　　As idiopathic scoliosis accounts for the majority of scoliosis cases, understanding its etiology is of great significance for prevention and treatment. Therefore, for many years, people have been committed to exploring the etiology of idiopathic scoliosis, but to this day, the exact cause has not been found.

　　In 1979, Herman proved that patients with idiopathic scoliosis have labyrinthine dysfunction. In 1984, Yamada also conducted balance function tests on patients with idiopathic scoliosis, with 79% showing significant balance dysfunction, while only 5% in the control group did. Wyatt also found that patients with scoliosis have obvious vibration imbalance, suggesting central disorders in the posterior column pathway of patients with scoliosis. However, these studies did not clarify the relationship between idiopathic scoliosis and balance disorders, nor did they explain the etiology of idiopathic scoliosis itself.

　　Observations have found that patients with idiopathic scoliosis are taller than their normal age-mates, and the author's 1984 survey also yielded the same results, thus prompting people to understand the relationship between growth hormone and idiopathic scoliosis. The conclusions of different authors are not uniform, with the content of growth hormone still being a controversial issue. More literature discusses the relationship between paravertebral muscles and idiopathic scoliosis, including the detection of muscle spindles, muscle fiber morphology, muscle biochemistry, electromyography, calcium, copper, and zinc content, etc. Although abnormalities have been found, none have directly clarified the etiology. People have also investigated issues related to genetic genes from family surveys and studies of patients with twin scoliosis. However, more patients cannot be explained by a single genetic gene abnormality, and therefore, the etiology of idiopathic scoliosis remains an important topic for future exploration. The pathological changes of idiopathic scoliosis mainly include the following contents:

　　1. Changes in vertebrae, spinous processes, vertebral plates, and small joints The vertebrae on the concave side of the lateral curvature become wedge-shaped and rotate, with the vertebrae and spinous processes on the main lateral curvature rotating towards the concave side. The pedicles on the concave side become shorter and narrower, the vertebral plates are slightly smaller than on the convex side, the spinous processes tilt towards the concave side, making the vertebral canal on the concave side narrower. On the concave side, the small joints thicken and harden to form osteophytes.

　　2. Changes in ribs The rotation of the vertebrae causes the ribs on the convex side to move towards the back, making the back protrude and form a hump (hump), and in severe cases, it is called 'razor-back'. The ribs on the convex side are separated from each other, the gaps between them become wider, the ribs on the concave side are pressed together, and they also protrude forward, causing the chest to be asymmetrical.

　　3. Changes in intervertebral discs, muscles, and ligaments The space between the vertebrae on the concave side becomes narrower, while on the convex side it becomes wider. The small muscles on the concave side can be seen to have mild contractures.

　　4. Changes in internal organs Severe chest deformity compresses and deforms the lungs, due to atrophy of the alveoli, the expansion of the lungs is restricted, and the tension within the lungs is excessive, causing obstruction of the circulatory system, and in severe cases, it can lead to pulmonary heart disease.

　　Scoliosis not only causes deformities, collapse, and pain in the trunk, reducing the ability to work and participate in normal work, but also greatly harms the mental health of children with the disease and can lead to disabilities, reducing the quality of life for patients throughout their lives. It also causes some social issues, such as 76% of female patients being unmarried. Early or severe scoliosis can also lead to underdevelopment of the lungs, atelectasis, incomplete cardiovascular function, and paraplegia, reducing the lifespan of patients below that of normal people, with an average lifespan of 46.4 years according to statistics.

　　Idiopathic scoliosis is mostly postural, commonly occurring in girls aged 6-7 years, and boys are less common. Early deformities are not obvious, nor are there changes in spinal structure, which are easy to correct, but are often overlooked. After the age of 10, the second vertebra of the vertebral body develops rapidly, and the curvature becomes obvious in 1-2 years, with the convex shoulder higher and the凹 shoulder lower, which is easy to identify and seek medical attention. Severe cases may lead to chest deformity, reduction of thoracic cavity volume, causing shortness of breath, palpitations, poor digestion, loss of appetite, and other visceral dysfunction. If scoliosis is not treated effectively for a long time, symptoms such as traction or compression of the spinal cord nerves may occur.

　　1. Infantile idiopathic scoliosis

　　Infantile idiopathic scoliosis (infantile idiopathic scoliosis) is a structural spinal deformity found within 3 years of age. In Europe, this type is relatively common, while in the United States, it accounts for less than 1% of idiopathic scoliosis patients. Early diagnosis of infantile idiopathic scoliosis is very important, and parents and pediatricians should be vigilant, because early treatment can affect the prognosis, so it should be treated as soon as possible. Infantile idiopathic scoliosis is divided into self-limiting and progressive types. Self-limiting infantile idiopathic scoliosis accounts for 85% of all infantile idiopathic scoliosis. Double thoracic curvature is prone to progression and may develop into severe deformity. Female patients with right thoracic curvature also usually have poor prognosis, and often associated with deformities (flat head deformity, bat ear deformity, congenital torticollis, progressive hip dysplasia, etc.).

　　2. Juvenile idiopathic scoliosis

　　Juvenile idiopathic scoliosis (juvenile idiopathic scoliosis) is a scoliosis deformity found between the ages of 4 and 10, accounting for 12% to 21% of idiopathic scoliosis. The cause is unknown. Compared with infantile and adolescent idiopathic scoliosis, the characteristic of juvenile idiopathic scoliosis is that it progresses during the relatively static growth period of the spine. Scholars know very little about its type and natural history, and it is diagnosed only by the age of discovery of the deformity, rather than by symptoms or signs. Patients diagnosed with juvenile idiopathic scoliosis are likely to be late-onset infantile idiopathic scoliosis or early-onset adolescent idiopathic scoliosis, which are artificially diagnosed as juvenile idiopathic scoliosis by age.

　　Juvenile idiopathic scoliosis is more common in girls, with a ratio of female to male of about 2-4:1. In children aged 3-6 years, the ratio of female to male is about 1:1; while in the age group of 6-10 years, the ratio of female to male is about 8:1, which is basically the same as that of adolescent idiopathic scoliosis. The types of juvenile idiopathic scoliosis are mostly right thoracic curvature and double main curves, with right thoracic curvature accounting for 2/3 of adolescent idiopathic scoliosis, double main curves accounting for about 20%, and thoracolumbar curvature accounting for 15%. Left thoracic curvature is not common in adolescents. If this kind of curvature occurs, it often indicates the presence of intraspinal lesions, and a comprehensive neurological examination should be conducted.

　　3. Adolescent idiopathic scoliosis

　　Idiopathic scoliosis is relatively common, with an incidence rate of about 2% to 4% in the 10 to 16-year-old age group of adolescents; most of the curvature degrees are small; in patients with scoliosis around the age of 20, the male-to-female ratio is basically equal; and in the population with a scoliosis greater than 20°, the female to male ratio is more than 5:1, and the condition of female scoliosis patients is more severe. This fact suggests that female scoliosis may be more prone to progression, and they may need more treatment than boys.

　　The vast majority of adolescent idiopathic scoliosis (adolescent idiopathic scoliosis, AIS) patients can live normally. In certain situations, the progression of AIS curvature often accompanied by decreased pulmonary function and back pain, if the thoracic curvature is greater than 100°, the forced vital capacity (FVC) usually decreases to 70% to 80% of the expected value, and the decrease in pulmonary function is usually secondary to restrictive lung diseases. If severe scoliosis damages pulmonary function, the patient may die early from pulmonary heart disease. Some scholars have estimated that the mortality rate of severe scoliosis patients is twice that of the general population, the risk of death in smokers is increased, the incidence of intermittent back pain in patients with moderate scoliosis (40° to 50°) is roughly the same as that of the general population, and the incidence rate is high in patients with severe lumbar scoliosis, and even higher when the apical vertebra is significantly shifted.

　　Mild scoliosis in patients with idiopathic scoliosis can be corrected through posture training, proper sitting posture, and guidance on deep breathing exercises or participation in swimming exercises to train the chest muscles to correct the deformity. Students can use the horizontal bar during class breaks for pull-up exercises, and at home, they can often use their hands to hang from doors and window frames for suspension traction. At the same time, they need to visit specialized hospitals for close observation and follow-up.

　　Routine preoperative examinations for idiopathic scoliosis include blood routine, urine routine, creatinine, blood urea nitrogen, blood glucose, and X-ray examination, which is an indispensable routine examination for scoliosis. Generally, it can distinguish the classification, type, curvature, vertebral rotation, compensatory degree, and flexibility of the scoliosis, often including standing full-length anteroposterior and lateral radiographs, supine anteroposterior radiographs, left and right flexion radiographs, and traction radiographs. CT and MRI examinations are very helpful for patients with spinal cord lesions, such as spinal cord splitting and syringomyelia, to understand the plane and scope of the bony spine, which is very important for surgical correction, resection of the bony spine, and prevention of paraplegia. However, they are expensive and should not be performed as routine examinations.

　　Patients with idiopathic scoliosis should have a diverse diet, consume more fruits, vegetables, mixed cereals, and easily digestible and soft foods rich in fiber and vitamins. It is advisable to avoid or eat less刺激性, spicy, fried and roasted foods, and to avoid greasy, cold, and hot foods.

　　Although with the development of the third-generation scoliosis correction system, segmental internal fixation systems such as CD, USS, TSRH, etc., have been successively launched, the scoliosis itself has not changed, and the treatment goal of scoliosis remains unchanged.

　　The treatment principles for idiopathic scoliosis are observation, brace treatment, and surgical treatment. Those with Cobb angle less than 25° should be observed closely. If there is a progression of more than 5° per year and the Cobb angle is greater than 25°, brace treatment should be performed; for those with Cobb angle between 25° and 40°, brace treatment should be performed. If there is a progression of more than 5° per year and the Cobb angle is greater than 40°, surgical treatment is recommended. For those with Cobb angle between 40° and 50°, due to the curvature of the scoliosis being greater than 40°, the probability of progression is relatively high, so if the patient has not matured in development, surgical treatment should be recommended. For patients who have matured in development, if the curvature of the scoliosis is greater than 50° and there is significant progression detected during follow-up, surgical treatment should also be performed. Surgical treatment is adopted for those with Cobb angle greater than 50°.

　　Non-surgical treatment includes physical therapy, physical therapy, surface electrical stimulation, plaster and braces, but the most important and reliable method is brace treatment. Surgical treatment is divided into two aspects: orthopedic surgery and bone graft fusion. Orthopedic methods have developed rapidly, but are basically divided into two categories: anterior and posterior orthopedic surgery. It is necessary to use two or more surgeries in combination when necessary. The choice of surgical approach and the range of orthopedic fusion are determined according to the specific condition.