Kyphoscoliosis is a combined deformity of the spine, which is a combination of scoliosis (lateral bending) and kyphosis (stooping, excessive bending in the anteroposterior direction). It can be congenital or acquired, manifested by visible deformity and back pain. Due to a secondary change in the shape of the chest and a violation of the functions of the organs located in it, shortness of breath and cardiac disorders are possible. The diagnosis is made on the basis of external signs, radiography, MRI and CT data. Treatment of kyphoscoliosis is usually conservative, with pronounced curvature, surgery may be necessary.
Kyphoscoliosis is a simultaneous curvature of the spine in the lateral and anteroposterior directions. It is a fairly widespread pathology, in most cases it occurs in adolescence. Boys suffer four times more often than girls. In mild cases, kyphoscoliosis can cause increased fatigue and back pain. Pronounced pathology has a negative impact on the condition of the entire body, can cause neurological disorders, impair the functioning of the lungs, heart and digestive system.
The cause of the development of congenital curvature is usually anomalies in the development of the vertebrae. In 20-30% of cases, the deformity is combined with malformations of the genitourinary system. At the same time, pathology is more often detected not immediately, but at the age of 6 months and older (when the child begins to walk or stand). At the same time, cases have been recorded when grade 3 kyphoscoliosis was detected immediately at the birth of a baby.
Among the factors that can lead to the formation of acquired kyphoscoliosis are congenital connective tissue insufficiency, rickets, some diseases of the spine (osteochondropathy, tumors, Scheuermann disease, etc.). In addition, the cause of the development of kyphoscoliosis are disorders of muscle tone and muscle function due to myopathy, myodystrophy and paralysis (for example, with polio or cerebral palsy), rheumatism (due to damage to the cartilaginous tissue of the spine by antibodies), mismatch in the rate of development of bone and muscle tissue during active growth, etc. Most often, the symptoms of acquired kyphoscoliosis appear in 13-15 years.
Predisposing factors that increase the likelihood of developing kyphoscoliosis are excessive load on the spine due to overweight or heavy physical work, as well as a “sedentary” sedentary lifestyle and incorrect body position when working at a computer, sitting at a desk, etc.
Normally, the human spine has several bends in the anteroposterior direction: one bend backward (thoracic kyphosis) and two bends forward (lumbar and cervical lordosis). These bends play a compensatory role under vertical loads on the spinal column. If the spine bends back more than normal (at an angle of more than 45 degrees), they talk about pathological kyphosis. Usually, pathological kyphosis develops in the same place as physiological kyphosis – in the thoracic region. The human spine does not normally have lateral bends, therefore, with any degree of lateral curvature, scoliosis is diagnosed. As a rule, at the initial stage of the formation of kyphoscoliosis, kyphosis is formed, and subsequently scoliosis joins it.
Depending on the severity of the deformation , 4 degrees of kyphoscoliosis are distinguished:
- 1 degree – the angle of curvature of the spine in the anteroposterior direction is 45-55 degrees. There is a slight lateral displacement and twisting (rotation) of the vertebrae.
- 2nd degree is the angle of curvature of the vertebral column in the anteroposterior direction of 55-65 degrees. There is a noticeable twisting and lateral displacement.
- 3rd degree is the angle of curvature of the spine in the anteroposterior direction of 65-75 degrees. A vertebral hump is formed, there is a visible deformation of the chest.
- 4 degree – the angle of curvature of the vertebral column in the anteroposterior direction is more than 75 degrees. As in the previous case, the curvature is accompanied by the formation of a vertebral hump and deformation of the chest.
Taking into account the direction of lateral curvature in orthopedics and traumatology, left-sided and right-sided kyphoscoliosis are distinguished.
Congenital pathology, as a rule, becomes noticeable after reaching 6-12 months. A barely noticeable hump forms on the child’s back, while, unlike “pure” scoliosis, kyphoscoliosis reveals the standing of not a muscle roller, but the spinous processes of several vertebrae. In the early stages, the curvature of the vertebral column is noticeable only when moving to an upright position and disappears in the supine position. Subsequently, kyphoscoliosis becomes persistent, independent of the position of the body. In approximately 50% of cases, kyphoscoliosis is accompanied by progressive neurological insufficiency. At a younger age, sensitivity disorders are detected, and adolescents with congenital kyphoscoliosis may develop rapidly progressive paresis.
Early manifestations of adolescent kyphoscoliosis are changes in posture, increased stooping and back pain. Often, the child begins to complain of pain or discomfort in the back even before the parents notice a violation of posture. It is also possible to have mild shortness of breath, which occurs due to the restriction of chest excursions. Neurological disorders in adolescent kyphoscoliosis are detected less frequently and, as a rule, occur only with severe deformities. The rate of progression can vary significantly depending on the cause of the development of kyphoscoliosis, as well as the timeliness and adequacy of treatment.
An external examination reveals an increased stoop (round back), in severe cases – a hump. The upper part of the trunk and shoulders of the patient with kyphoscoliosis are tilted forward and down, there is a narrowing of the chest and weakness of the abdominal muscles. To detect scoliosis, the doctor performs an examination in a position with a straightened and bent back. In the presence of scoliotic deformity, a deviation of the spine from the median line is detected. An external examination of the chest determines the expansion of the intercostal spaces on the side opposite to the lateral curvature. With kyphoscoliosis complicated by neurological disorders, a local decrease in sensitivity, a change in tendon reflexes and an asymmetry of muscle strength are revealed.
The discrepancy between the shape of the vertebral column and the physiological needs of the body causes a constant overload of all the structures of the spine and the paravertebral muscles. With kyphoscoliosis, early development of osteochondrosis, the formation of protrusions of discs and intervertebral hernias, the occurrence of myositis and arthrosis of the joints of the spine is possible. Some of the listed pathological processes can cause compression of the spinal cord and its roots and lead to the appearance of neurological symptoms (sensitivity disorders, motor disorders, impaired pelvic organ function).
Due to kyphoscoliosis, the mobility of the chest and diaphragm is limited. This leads to an increase in the load on the respiratory muscles, a decrease in the extensibility of the pulmonary parenchyma and a decrease in the functional residual capacity of the lungs. As a result, the volume of the lungs decreases, gas exchange is disrupted: there is more carbon dioxide and less oxygen in the blood. With pronounced kyphoscoliosis, there is a visible deformation of the chest, which entails even more significant violations of lung and heart function.
With severe kyphoscoliosis, not only the heart and lungs suffer, but also the digestive tract: the location of organs is disturbed, their functioning worsens. The likelihood of cholecystitis and biliary dyskinesia increases. Due to kyphoscoliosis, the load on the lower extremities is redistributed, early coxarthrosis develops.
The diagnosis of kyphoscoliosis is made on the basis of external signs and radiography of the spine. If necessary, along with the two main projections, pictures can be assigned in special positions (lying, standing, stretching the spine). To clarify the diagnosis, the patient may also be referred for an MRI and CT spine. Examination for kyphoscoliosis provides for a mandatory consultation with a neurologist. If there is a suspicion of a violation of the function of the internal organs of a patient with kyphoscoliosis, they are sent for consultations to the appropriate specialists: cardiologist, pulmonologist, gastroenterologist, urologist.
Treatment is carried out by vertebrologists and orthopedists with the participation of neuropathologists and other specialists (depending on the identified concomitant pathology). The main methods of conservative correction of kyphoscoliosis are corseting and therapeutic gymnastics. The set of exercises is selected individually. With the 1st degree of kyphoscoliosis, it is often enough to perform exercises regularly to straighten the spine, with the 2nd degree of physical therapy it is necessary to combine with wearing a corset. Corrective corsets made to order are used. In most cases, in the process of corseting, along with the elimination of slouching, derotation is performed (elimination of rotation of the spine along the axis).
To improve blood circulation, increase muscle plasticity and activate metabolic processes in muscle tissue, patients with kyphoscoliosis are prescribed massage. Swimming and moderate physical activity are useful (taking into account the existing contraindications). Classes with weights and “jumping” sports (long and high jumps, volleyball, basketball) are contraindicated.
Indications for surgical treatment are grade 4 kyphoscoliosis, severe pain syndrome, progressive neurological disorders, deterioration of heart and lung functions. Surgical correction for kyphoscoliosis involves the installation of special metal structures (hooks, screws) in the vertebrae and the alignment of the spinal column using special rods that are attached to these metal structures. At the same time, the fixed part of the spine loses mobility.
Prognosis and prevention
Complete elimination of kyphoscoliosis is possible before the end of the active growth of the child, that is, up to 14-15 years (some experts consider the age of 12-13 years to be critical), while the degree of curvature and the rate of progression of the disease matter. In most cases, it is possible to completely eliminate grade 1 kyphoscoliosis, in a significant part of patients it is possible to achieve spine straightening with grade 2 kyphoscoliosis. With kyphoscoliosis of the 3rd and, especially, 4th degree, the prognosis is less favorable – adequate treatment, as a rule, makes it possible to stop the progression of deformation and in some cases to carry out partial correction. Complete straightening of the spinal column in such cases is extremely unlikely.
In the treatment of kyphoscoliosis, the timeliness of all therapeutic measures is very important. Since effective correction of kyphoscoliosis is possible only while the child continues to grow, it is very important to pay attention to the signs of kyphoscoliosis in time, immediately seek medical help and accurately follow all the doctor’s recommendations, especially with regard to therapeutic gymnastics and wearing a corset. It is these methods that make it possible to eliminate kyphoscoliosis, while other methods of treatment perform only a secondary auxiliary function.
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