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Idiopathic Scoliosis

 

It all starts one morning…

Miss Vertebra awakes very anxious. She has only realised that she has scoliosis.
She seeks to get information.

It is really not simple, all is so new for her! Fortunately Doctor Ortho is there to explain and answer her questions…

What is scoliosis?

It is a painless deviation of the spine. It can occur at any age. The physician confirms the diagnosis by examining you then by taking X-rays of the spine.

You can have one or more curves on the level of the spine, which normally is right.

The side of curve is defined by its convexity which corresponds to the top of the deformation thus a dextro-convex scoliosis is a scoliosis deformed towards the right.

Your physician will show you that on the X-rays. He will also show you how the angle of the scoliosis is calculated, which enables him, with other criteria, to determine the best treatment for you.

It will be necessary to keep all the X-rays and to bring them each time in consultation so that the physician can see the changes and your progress.

This deformation is accompanied by a rib hump.
The hump is a hump in the back, due to the rotation of the vertebrae and the deformation of the ribs. It is sometimes difficult to see in upright position and it is better seen when one is bent forward.

The origin of this condition is not known, this is why it is qualified "idiopathic". On the other hand, it is not due to a nasty attitude, nor with the carrying of the school bag.
On the other hand, it is known that it can effect between 3 and 4,5% of children and that it affects girls more than boys. Often  other people in the family have a scoliosis.

But why make a treatment if scoliosis is painless?

The scoliosis is likely to worsen until the end of growth and especially during puberty. It thus should be treated as soon as possible when it is progressive.

If you do not follow your treatment correctly, curve and rib hump will increase and involve a disharmonious hump, and you will be perhaps constrained (pain, aesthetics) in the life of the every day.

Perhaps this scoliosis will have a day to be operated.

The treatment by brace will not correct totally the deformation, nor cure your spine; but it will aim to prevent the scoliosis from worsening and will slow down its evolution.
 
How that will it occur?

According to the case, you can have:

a removable brace from the start, made after a moulding (Milwaukee or another brace…)

or you could need a reducing plaster cast made on a frame which makes the best correction of your scoliosis. It is the best method when a more extreme approach is required (at the time of a more important, more progressive, or stiffer scoliosis). The duration of this plaster cast, its renewal (one, two or three times) also depends on these other factors. This time is necessary to stiffen your spine in the corrected position.


Then, one carries out a moulding of your spine (a plaster cast which is immediately removed and makes it possible to manufacture your custom brace).

You will need a fitting, and with the delivery, test your brace with the orthotist who will explain you how to put it and carry out the last adjustments. X-rays are made with the orthotic device (another name of the brace).

The first technical control is envisaged one week after to check that all occurs well at the same time as the doctor visit. Of course if a problem occurs, return as quickly as possible. The physician will see you every six months. Always ask the questions which you want if there is anything that you do not understand.
In general, X-rays are required at the time of the consultations every six months. They must be made before the consultation and are carried out without the brace (it should have been removed six hours before the X-ray).

If the correction is insufficient or if there exists an aggravation, one checks the adaptation of the brace, one modifies it, one modifies its protocol of wearing (one increases the time of wearing). Sometimes it is necessary
• to remake a correct plaster cast,
• to change the brace when the precedent is considered to be ineffective or badly tolerated.

The physician prescribes you sessions of physical therapy to learn how to complete the correct exercises to be practiced with and without brace.

When should I remove it?


It is the physician who decides with you, but it is always important to wait until -at least- you have finished growing. The weaning of the brace is progressive and increases two hours per day every fifteen days while passing from a protocol of 23:00 to a protocol of 20:00, until 16:00 with a control in consultation with three and six months.

How to put on my brace?


You can put your brace upright, the spine against a wall opposite a mirror or lying on your back, and you can do it all alone.
It is important to tighten the brace sufficiently so that it is effective, moreover it hurts if it moves and if it is badly fixed.
In addition, the orthotist may put reference marks of tightening at the time of the first check, then you cannot be mistaken. These reference marks are checked with you during the successive surveillances.

Why I must wear it for so long?


The brace is should be worn permanently from the onset, and it is necessary to respect the protocol of wear prescribed by your physician. Often it should be carried 23 hours out of 24, and sometimes 16 hours of the 24. It is only in this way that the treatment will be effective. The protocol is proposed according to the type of curve or scoliosis and according to its progression risk.
The vertebrae are more delicate, they become deformed while growing and the brace is the stake which allows the spine to rectify itself, and is less likely to collapse.
The brace is also worn in the night because you grow during the night, therefore it is effective at this time; it is difficult at the beginning, but you will quickly get used to this and at the end of the treatment there is even difficult to sleep without brace!

And if I grow?


The brace is changed if you grew much and because the brace is not suitable any more. For example: you could increase from 7 cms and 5 kilograms. In fact, the need for changing the brace depends on the type of brace, of height and weight but also on the modifications of the shapes of the thorax and the pelvis.
Must I carry my brace to the school?
Yes if you have a protocol of port of 23:00 on 24. It is in sitting position that the vertebrae become deformed more.

Will my friends make fun of me?


“I have the look of a robot, the device makes me stiff, the contact is tough, I have the impression to carry a carapace, it is unaesthetic, it’s visible, I am not like the others.
But the brace protects me, I have the impression to be strong, I am held better, it is necessary courage for me to face the others, I make efforts.”

If the others know, if you explain to them, they will not make fun of you, do not be afraid to speak about it and you will see. Other people can help you, other young people perhaps have the same problem. Your friends, the professors, the parents can render service to you to arrive there.

Are there particular maintenances?


To wear the brace requires a undershirt. It will be selected out of cotton without lateral seam, or carried upside down to prevent that the seams do not mark the skin. Small sleeves protect the hollow axillary. It will be sufficiently long to exceed of the lower part of the brace. It will be washed with the neutral soap without dye and fragrance (standard household soap) to avoid the allergies, and will be changed the every day.

Maintenances of hygiene will be daily, you perspire more with the brace, especially in summer. Then take a shower or a bath each day, or better twice a day, morning and evening.

There too, you will take a neutral soap without dye and fragrance or a dermatologic product without soap if you have the delicate skin.

Be wary of the heatstrokes: use creams with total protection.

If a part of the skin is irritated or painful speak with your physician, you can all request from him; moreover is your tetanus vaccination up to date?


Must I follow a food regimen?


Yes, quite simply to prevent that your belly does not inflate  too much, which would involve a compression in your brace which is not elastic. One should not eat too much during a meal but to eat more often, 4 meals per day for example, and the fizzy drinks are prohibited.

Certain food materials are to be consumed with moderation:
• Those which always make inflate: all the cabbages (cauliflowers, Brussels sprouts, red cabbage, curly kale, broccolis…), lenses, garbanzos, white beans, flageolets
• Fresh bread
• The starchy foods (rice, pastes, potatoes, semolina)
• Certain fruits like banana, cherries
• Pastries and Viennese pastries especially if you want to keep the line

And remember: no fizzy drinks, but water and always water, at least 2 liters per day, and even more if you make sport.

Do I have to quit the sport?


Especially not!

You can continue the sport or the activities which you had before the brace, and if possible start others of them. The contraindications with the sports practice are exceptional.

If the brace obstructs you, you will remove it for the strict length of time of the sport.

Do not forget that you need muscles to support your spine, now and also when one removes the brace definitively.
More over when you move, calcium is fixed better on your vertebrae which need some to grow and to solidify itself. And never forget to drink, during and after the effort.

Must I make it in addition to physiotherapy?


The sport enables you to move, and physiotherapy to better move. They are two complementary activities. It is also important to make each day the exercises of physiotherapy which you learned.

These exercises are different according to the type of scoliosis which you have, the physiotherapist and your physician check and control these exercises, some are to be made in brace, others without brace.

For the lumbar scoliosis, the shift is very important to make anywhere, as often as possible any time.
For the thoracic scoliosis, without the brace it is necessary to work in kyphosis because it becomes flat in its high part where you have the scoliosis.


And if I must be operate?

 
Sometimes, in spite of a treatment of well followed brace, the scoliosis worsens and a surgical operation can be necessary to the end of growth. The surgical procedure consists in rectifying the deformation of the spine with metal rods, hooks, and a bone grafting which fix the vertebrae. The surgical procedure depends on your age, of your scoliosis. The purpose of it, is to block the spine in corrected position so that the deformation does not worsen any more. The surgery rigidifies the spine. It is the surgeon who decides the method of treatment according to your own situation.

The surgical procedure proceeds under general anesthesia, before you will give a little of your blood so that one can give again it to you during the surgical procedure. After the surgical procedure, the brace is generally not necessary. The hospitalization is not very long. It is proposed if possible during school vacations and you can normally go back to school after surgery. The surgeon that you will see explains what he will do and why; All the questions should be asked to him.

To avoid the surgery, the treatment by brace is very important and this is why this treatment should be observed as well as possible. It also makes it possible to be operate under better conditions when that remains necessary.

And here, it is finished, Miss vertebra does not need more her brace!

She already left for other adventures…