Scoliosis, as a common type of spinal curvature abnormality, is one of the common diseases that jeopardize the health of children and adolescents. In recent years, the incidence of scoliosis among children and adolescents has been on a significant rise. A few days ago, People’s Daily, in conjunction with the National Health Commission, invited Ma Jun, director of the School Health Center of the China Center for Disease Control and Prevention (CDC) and professor of the Institute of Child and Adolescent Health at Peking University, Liu Haiying, chief physician of the People’s Hospital of Peking University, and Guo Xin, chief physician of the Beijing Municipal Center for Disease Control and Prevention (BCCDC), to answer the netizen’s concerns about the reasons for the formation of scoliosis among children and adolescents, how to prevent it, and treat it. They called on families, schools, and society as a whole to correctly recognize scoliosis, and to guard the spinal health of children and adolescents through early detection and treatment.
What is scoliosis in children and adolescents?
Liu Haiying explains that by disciplinary definition, if the spine of a child or adolescent deviates from the normal midline, with a Cobb angle of 10 degrees or more on imaging, it is defined as scoliosis. Of course, scoliosis is not a simple coronal plane deformity, but a three-dimensional deformity that may be accompanied by sagittal and vertebral rotation.
“Etiologically, scoliosis is categorized into congenital and acquired scoliosis. Congenital scoliosis is caused by a history of adverse medication use, the presence of psychiatric disorders, or environmental influences that may affect the physiologic makeup of the spine during embryonic development, resulting in spinal deformities. Congenital scoliotic vertebrae also include hemivertebrae, wedge-shaped vertebrae, and butterfly vertebrae deformities. Acquired scoliosis is a scoliosis caused by uneven muscle tone, malnutrition, trauma, or posture. The most common is also unexplained idiopathic scoliosis, which is categorized into infantile, juvenile, and adolescent idiopathic scoliosis according to the age of onset. In recent years the incidence of adolescent idiopathic scoliosis is as high as 60 to 70 percent.” Liu Haiying said.
From the age of onset and prevention point of view, in recent years the concept of “early onset scoliosis”, that is, 0-10 years old age group of scoliosis in children. “Understanding the causes and types of early-onset scoliosis is of great significance to treatment. If the etiology is confused, after surgical correction, although the appearance is straightened and the surgical area is fused into one, the child’s front is still developing and will induce the deformity again.” Liu Haiying noted.
Prolonged sitting inappropriate posture, insufficient exercise resulting in high incidence of scoliosis
Guo Xin pointed out that the results of the survey showed that most of the students in school, primary and secondary school students there are “sitting in the front half of the chair, leaning forward” and other bad sitting posture. In addition to the habits of students, the main reason is that the desk and chair storage space is not enough, students will be placed on the chair, the bag occupies half of the chair surface, so that the student’s body can not rely on the back of the chair, the spine can not form an effective support. Even if the school adjusts the desks and chairs according to the height of the students, the students still cannot ensure a correct sitting posture. The habit of sitting in such a posture increases the incidence of stooping, hunching, and spinal pathology, posing a great danger to students’ health. The monitoring also found that some students keep a large number of books on their classroom desks. Children can only read and write in a small space and cannot fully stretch out and ensure correct sitting posture, which has a great impact on vision and spinal health.
Ma Jun analyzed that, for children and adolescents, common postural scoliosis and idiopathic scoliosis, mainly with a long time to take the improper sitting posture and lack of exercise is more closely related. Students 1/3 of the time is in school learning, desks and chairs height is not suitable for height, classroom lighting, lighting, how bright and dark, these factors will trigger students to bend over, tilting the head, twisting and other bad sitting posture. This bad sitting posture makes the spine long-term uneven force, the two sides of the tension is not balanced, it is easy to lead to scoliosis.
“Long-term incorrect standing, walking, sitting, as well as reading and writing posture, also makes the spine can not get a good rest, easy to cause fatigue of the back muscles are damaged, so that the fixed spine on both sides of the normal curvature of the muscle strength decline, coupled with the puberty of the spinal column of the sudden increase in the speed of the relatively fast, it is easy to cause the curvature of the abnormality. Of course, more importantly, lack of physical exercise, insufficient muscle strength, and malnutrition can also cause abnormal spinal curvature. According to current research, children and adolescents scoliosis in the middle school age detection rate accounted for the highest proportion.” Ma Jun claimed.
Scoliosis is very harmful, parents can through the “four horizontal and one vertical” early detection
“Scoliosis is particularly harmful to children and adolescents, in addition to the spinal appearance and function will certainly have an impact, will also cause damage to the nervous system, the spinal cord compression caused by the inability to walk. It can also cause abnormal heart and lung function, which in turn affects life expectancy. Finally, it may also cause psychological and mental problems to the affected children.” Liu Haiying claimed.
Liu Haiying reminded that scoliosis should still be detected and diagnosed early.
In this regard, Ma Jun said, early scoliosis is not easy to be found, especially in the state of the child wearing clothes, many children in the bath or wearing less clothes before being found by parents. Of course, there are some areas where students can be screened during their annual physicals. Often, if scoliosis occurs, there may be, for example, two uneven necklines in clothes, or one shoulder is high and the other is short, or there is a bulge in the back, or there is a wrinkle on one side of the skin after undressing, or even the pelvic hips are taller than the hips, or even the legs are longer than the hips.
Liu Haiying suggested that, in addition to the child’s own observation of the shape of the shoulders, for parents, through the “four horizontal and one vertical” method of checking the child. Look at the child’s back is not symmetrical, look at the two shoulders is not high, the two shoulder blades under the angle is not high, the two waist nest is not symmetrical, and the pelvis on both sides of the iliac crest height is not the same.
“In addition to this observation, a very important check is the “forward bending test” – heels together, legs straight, trunk 90 degrees forward bending, hands together, upper limbs perpendicular to the ground. If there is spinal deformity, there will be two sides of the height asymmetry, in medicine called “razorback deformity”. Parents can often let the child to do this action to detect themselves.” Liu Haiying said.
“In addition, if scoliosis is found, further judgment can be made with measuring tape, cloud diagrams, etc., and ultimately the diagnosis is confirmed by X-ray examination, which is the gold standard. Comprehensive medical judgment, close observation and follow-up, and subsequent systematic treatment are also required.” Liu Haiying said.
9 common misconceptions about scoliosis in children and adolescents
In recent years, for scoliosis disease, the party and the government attaches great importance to and increase screening efforts, but the community, including many parents have a lot of misconceptions about adolescent scoliosis, Liu Haiying summarized as 9 aspects:
First, there are a lot of life posture stand wrong, both sides of the paraspinal muscle development asymmetry, can not look at the muscle asymmetry is said to be scoliosis.
Second, the degree of curvature and muscle tension, posture, habits, etc. are related, when the Cobb angle more than 10 ° is defined as scoliosis. You can’t just say scoliosis when you look at the X-ray curvature, you have to make a comprehensive judgment.
Parents think that the prevalence of scoliosis is relatively low, but in fact, the overall prevalence of scoliosis is much higher than we all know.
Fourth, scoliosis is not just a sideways curvature, in fact, it is a three-dimensional deformity, from the sagittal position, that is, the lateral view of the deformity, or vertebral body rotation. Now through the 3D printing, CT three-dimensional reconstruction model can be more intuitive, serious as twisted twist-like.
Fifth, scoliosis is not just an orthopedic disease, in some cases, it is also combined with spinal cord cavitation, neurofibromatosis, Marfan syndrome and other endocrine metabolic diseases.
Sixth, the occurrence of scoliosis does not mean that do not exercise. In fact, relatively mild scoliosis, especially adolescents, are encouraged to exercise, especially swimming, such as the overall muscle balance of the exercise is very beneficial.
Seven, there are parents think that when the child grows up will be good, in fact, between 0-10 years old and puberty is the fastest growing time, but also the fastest growing scoliosis, especially for girls, if this stage does not carry out effective intervention, prevention, will miss a good opportunity, and in the end, if there is a serious deformity, the risk of surgery will be higher.
Surgery is also more risky and can have a particularly large impact on the child.
Eight, the pursuit of straightening the better is not right, under the premise of safety, corrected to an acceptable degree can be, corrected straight but may stimulate the nerves, the child ended up paralyzed.
Nine, there are those who believe that surgery once and for all, in fact, for some serious patients have to do preoperative traction. The key is that adolescents are still developing, and the relationship between development and correction needs to be fully considered in treatment.