Curvature of the spine is a violation of the correct configuration of the spinal column. It can be congenital or acquired, direct or lateral. It is manifested by the presence of visible deformity, pronounced stoop, in severe cases, a hump is detected. The diagnosis is established on the basis of the results of the examination and X-ray data, if necessary, additional studies (MRI, CT and others) are prescribed. Treatment includes physical therapy, massage and wearing corsets. If there are indications, operations are performed.
ICD 10
M41 M40
Meaning
Curvature of the spine is a widespread pathology that occurs mainly in childhood and adolescence. With mild disabilities, the ability to work persists, a significant curvature of the spine causes disability and has a negative impact on the work of internal organs. Orthopedic traumatologists and vertebrologists are engaged in the treatment of this pathological condition.
Causes
Congenital curvature of the spine occurs due to anomalies in the development of the spine, most often – wedge-shaped or additional vertebrae, congenital torticollis. About 80% of scoliotic curvatures are formed for an unknown reason. Other cases of scoliosis develop due to:
- metabolic disorders: rickets;
- infectious diseases: polio, tuberculosis, tick-borne encephalitis, pleurisy;
- neurological pathologies: cerebral palsy, spastic paralysis, syringomyelia;
- injuries and diseases of the musculoskeletal system: acquired or congenital difference in leg length of more than 2-4 cm, limb amputations, joint hypermobility syndrome, Scheuermann disease, incorrect posture;
- tumors.
By origin, there are many types of kyphosis, including:
- genotypic – inherited;
- mobile – formed due to weakness of the back muscles;
- senile – caused by degenerative-dystrophic changes in the spine;
- total – for Bekhterev’s disease;
- compression – resulting from compression fractures of the vertebrae;
- others are rickety, tuberculous, paralytic and with Scheuermann disease.
Cervical lordosis usually develops after vertebral fractures. Taking into account the cause of development, primary and secondary pathological lumbar lordoses are distinguished.
- Primary occurs due to a pathological process in the spine: with tumors, malformations, spondylolisthesis, torsion spasm and contractures of the ilio-lumbar muscle.
- Secondary (compensatory) is formed in the pathology of the lower extremities: congenital dislocation of the hip, ankylosis of the hip joint, contractures of the lower limb, spastic paralysis. The most common is lordosis due to hip dysplasia or congenital hip dislocation.
Pathogenesis
Overload of individual structures of the spine due to changes in the shape or destruction of the vertebrae, degeneration of connective tissue or weakening of the muscular corset leads to a decrease in the cushioning ability of the discs. As a result, there is an excessive load on the joints of the spine, arthrosis develops, instability appears, subluxations of the facet joints form. There are blood supply disorders, muscle tone increases, stiffness of movements is noted, venous stagnation develops.
All of the above enhances degenerative-dystrophic processes in the supporting structures of the spinal column. Initially, the affected part is installed in a vicious position as a result of organic changes or muscle traction. Then fibrosis develops, against which this position becomes fixed. Compensatory curvature of other parts of the spine. Various links of the pathological process aggravate each other, a vicious circle arises.
Classification
There are curvature of the spinal column anteriorly (lordosis), posteriorly (kyphosis) and lateral curvature (scoliosis). Normally, there are no lateral deformities, physiological thoracic kyphosis is no more than 15 °, physiological lumbar lordosis is 150-160 °. If the listed indicators go beyond the specified values, they speak of a pathological curvature of the spine, which is divided by severity:
- With scoliosis: the first degree is 1-10 °, the second is 11-25 °, the third is 26-50 °, the fourth is more than 50 °.
- With kyphosis: the first degree is 31-40 °, the second is 41-50°, the third is 51-70 °, the fourth is more than 71 °.
- With lordosis: less than 145 ° – hyperlordosis, more than 170 ° – hypolordosis.
A combined pathology is also possible – kyphoscoliosis. Any type of curvature with an unidentified etiology is called idiopathic. By localization, kyphosis is usually thoracic, lordosis is lumbar, less often cervical, even less often thoracic, scoliosis:
- thoracic (upper thoracic and thoracic) – pathological bending in the thoracic region;
- thoracolumbal – one pathological bend in the area of the thoracolumbar junction;
- lumbar – curvature in the lumbar region;
- combined – double S-shaped bend at the level of the thoracic and lumbar sections.
Pathological kyphosis and lordosis can be congenital or acquired. Taking into account the time of manifestation, the following variants of scoliosis are distinguished:
- infantile – occurs at 1-2 years of life;
- juvenile – develops at the age of 4-6 years;
- adolescent – occurs at the age of 10-14 years.
Depending on the shape of the curvature of the spine, there are C-shaped scolioses (one arc of curvature), S-shaped (two arcs), Z-shaped (three arcs).
Symptoms
Scoliosis
As a rule, the disease occurs in childhood and progresses especially actively during periods of rapid growth. In the initial stages, it is asymptomatic, it is detected by one or more characteristic external signs: the shoulder blades are located asymmetrically, one shoulder and one nipple are higher than the other, the navel is not localized along the median line, when leaning forward, the deviation of the vertebral column to the side is visible. Subsequently, a pain syndrome appears, the curvature is aggravated, a deformation of the chest is formed.
Pathological kyphosis
Pathological kyphosis manifests itself in the form of a stoop, a round back, in severe cases – a hump. Due to the excessive curvature of the spine, the chest narrows, the diaphragm falls down, the upper part of the trunk leans forward, the shoulders drop. The prolonged existence of kyphosis can cause the destruction of intervertebral discs, wedge-shaped deformation of the vertebrae, dysfunction of the muscles of the back and abdominal press.
Pathological lordosis
Like other types of curvature, this deformation affects the position of the trunk and internal organs. There is flattening of the chest and protrusion of the abdomen. The head and shoulders are pushed forward. Due to the redistribution of the load in pathological lordosis, the spine, muscles and ligaments of the back experience an increased load, which is manifested by pain, increased fatigue and impaired mobility.
Complications
With curvature of the spine in the thoracic region, frequent respiratory diseases, shortness of breath and rapid fatigue may occur due to secondary deformation of the chest, impaired heart and lung functions. In severe cases, a kyphoscoliotic heart is formed, respiratory and heart failure develops.
In addition, with pronounced curvature of the spine, the formation of intervertebral hernias, instability of intervertebral discs, deforming arthrosis of the joints of the spine, inflammation of the ilio-lumbar muscle, disorders of the gastrointestinal tract, kidneys is possible. Severe deformities negatively affect the appearance of patients, which affects their psychological state. The ability to work is impaired, disability is possible.
Diagnostics
The diagnosis is established by an adult or pediatric orthopedist or a vertebrologist. Pronounced deformities are visible at any position of the body, a slight curvature of the spinal column is detected when the patient leans forward. The doctor evaluates the symmetry of the spine itself and other structures (hips, shoulder blades and ribs), conducts special measurements. Visualization procedures are used to clarify the nature and severity of the deformation:
- Spine x-ray. It is the gold standard of primary diagnostics, it is carried out both in standard and in special stowings. The images are analyzed according to the appropriate technique, taking into account not only the angle of lateral curvature, but also the degree of torsion (rotation) and rotation (twisting) of the vertebrae.
- Other methods. During periods of active growth, when rapid progression of scoliosis is possible, low-irradiation images are taken, non-radiation techniques are used: ultrasound or contact sensor examination, light-optical measurement and Bunnel scoliometry. This approach allows you to reduce the total radiation dose.
Significant curvature causes secondary deformities of the chest, leads to a decrease in the volume of the abdominal cavity, a violation of the location and deterioration of the function of internal organs, therefore, patients with severe curvature of the spine regularly undergo the necessary examinations, consultations with a pulmonologist, gastroenterologist and cardiologist. All patients are prescribed spirometry. According to the indications, an ECG, MRI of the spine and other studies are performed.
Treatment
Treatment of scoliosis
Treatment of lateral curvature of the spine can be conservative and operative. Conservative therapy programs include specially designed exercise therapy complexes, breathing exercises (by Meal or similar programs), corsets, recliners, physiotherapy procedures and massage.
- Therapeutic gymnastics. When the angle of deformation is up to 15 degrees, specialized gymnastics is prescribed. Exercises are selected individually, in the initial period they should be performed under the supervision of an instructor in order to master the correct technique. The goal of gymnastics is to strengthen the back muscles, create a good muscular corset.
- Wearing a corset. With an angle of curvature of the spine of 15-25 degrees, physical therapy classes are supplemented by wearing corsets. At an angle of up to 20 degrees, the corset should be used at night, more than 20 degrees – most of the day and night (at least 16 hours a day). Corrective corsets of Milwaukee, Chenault and their analogues are used. The wearing period is from 6 months or more. As the child grows and the deformation decreases, corsets are replaced. Corrective devices make it possible to eliminate not only lateral and anteroposterior curvature, but also rotation of the spine.
- Massage. Therapeutic massage for scoliosis helps to strengthen the back muscles, normalize lymph and blood circulation. The course of treatment, consisting of 15-20 sessions, is carried out 2-3 times a year.
- Physical therapy. Patients are prescribed hydrotherapy, thermal therapy (paraffin, ozokerite) and electrical stimulation.
Indications for surgery for scoliosis are determined individually and depend on the age of the patient, the type and location of the curvature and some other factors. The generally accepted criteria for the need for surgical treatment are a curvature of 45-70 degrees when measured by Cobb in combination with the ineffectiveness of conservative treatment, persistent pain syndrome, steady progression of scoliosis, impaired lung and heart function. Operations on Chaklin, Tsilka, Dubuss, Harrington and others are used.
The essence of all surgical techniques is the removal and retention of the spine in the correct position with the help of metal structures. At the same time, the fixed part of the spine loses mobility. Surgical interventions are performed from anterior or posterior access. To fix the spine, metal rods are used, which are attached to the vertebrae with screws or hooks. Subsequently, the fusion of the fixed vertebrae into a single block occurs.
Treatment of kyphosis
Therapeutic tactics depend on the cause of spinal curvature, the degree of kyphosis, the patient’s age, his condition, and other factors. With 1-2 degrees of kyphosis, a program of complex conservative therapy is compiled, including physical therapy, massage, respiratory gymnastics, physiotherapy, mud therapy and reflexotherapy.
With 3-4 degrees, impaired function of internal organs, severe pain syndrome, rapid progression of spinal curvature, a significant cosmetic defect and the presence of pronounced neurological disorders, surgical operations are performed. The treatment consists in correcting the bend using special metal structures fixed to the vertebrae with hooks or screws. Sometimes several operations have to be performed to achieve the desired effect.
Treatment of lordosis
The tactics of treatment depends on the cause and degree of curvature of the spine, the patient’s age, his state of health and other factors. If possible, therapeutic measures are carried out aimed at eliminating the cause of deformation. A complex of physical therapy, massage, heat and hydrotherapy is prescribed. Some patients are recommended to wear a bandage.
Forecast
The prognosis is determined by the age of existence and severity of deformation, the presence and severity of complications, the possibility of eliminating provoking factors. In children, in mild cases, with timely adequate conservative treatment, the elimination of deformity or the achievement of a state of compensation is noted. Severe cases of spinal curvature in children and adults require surgical treatment, can cause disability.
Prevention
It is necessary to eliminate risk factors in a timely manner, if there are predisposing factors, conduct regular examinations for early detection of pathology. Mass examinations of students play an essential role. With confirmed curvature of the spine, it is necessary to follow the doctor’s recommendations regarding the regime of physical activity, the use of corsets and recliners.
Literature
- Nursing care study: plain sailing. Correcting curvature of the spine. Vandenburgh VJ. Nurs Times. 1981 Apr 30;77(18):770-5. link
- Influence of method of asymmetric trunk mobilization on shaping of a physiological thoracic kyphosis in children and youth suffering from progressive idiopathic scoliosis. Dobosiewicz K, Durmala J, Jendrzejek H, Czernicki K. Stud Health Technol Inform. 2002;91:348-51. link
- The natural history of congenital scoliosis and kyphosis. Marks DS, Qaimkhani SA. Spine (Phila Pa 1976). 2009 Aug 1;34(17):1751-5. link
- Scoliosis and kyphosis in adolescents: diagnosis and management. Shelton YA. Adolesc Med State Art Rev. 2007 May;18(1):121-39, x. link
- [Surgical treatment of deformities of the spinal column and thorax in scoliosis and kyphosis]. Antonov A, Stanimirović B, Dukić D, Cirić D. Acta Chir Iugosl. 1982;29 Suppl 2:267-73. link
