Scoliosis is a persistent curvature of the spine sideways relative to its axis (in the frontal plane). All parts of the spine are involved in the process, therefore, the lateral curvature is subsequently joined by a curvature in the antero-posterior direction and twisting of the spine. As scoliosis progresses, secondary deformation of the chest and pelvis occurs, accompanied by a violation of the function of the heart, lungs and pelvic organs. Pathology is diagnosed according to the examination and radiography. Treatment can be both conservative and operative.
Scoliosis is a complex persistent deformation of the spine, accompanied, first of all, by a curvature in the lateral plane, followed by twisting of the vertebrae and increased physiological bends of the spine. With the progression of scoliosis, deformity of the chest and pelvic bones develops with concomitant dysfunction of the organs of the thoracic cavity and pelvic organs.
The most dangerous periods in relation to the development and progression of scoliosis are the stages of intensive growth: from 4 to 6 years of age and from 10 to 14 years. At the same time, one should be especially attentive to the health of the child at the stage of puberty, which occurs in boys at 11-14 years, and in girls at 10-13 years. The risk of aggravation of scoliotic deformity increases in cases when by the beginning of these periods the child already has a radiologically confirmed first degree of scoliosis (up to 10 degrees).
Scoliosis should not be confused with the usual posture disorder. The violation of posture can be corrected with the help of regular physical exercises, training in proper seating at the table and other similar activities. Scoliosis, on the other hand, requires special comprehensive systematic treatment throughout the entire period of the patient’s growth.
What causes scoliosis
Pathology refers to a group of deformities that occur during the period of growth (that is, in childhood and adolescence). Idiopathic scoliosis is in the first place in terms of prevalence by a large margin – that is, scoliosis with an unknown cause. It accounts for about 80% of the total number of cases. At the same time, girls suffer from scoliosis 4-7 times more often than boys. In the remaining 20% of cases, scoliosis is most often detected due to congenital deformities of the spine, metabolic disorders, connective tissue diseases, severe injuries and amputations of limbs, as well as a significant difference in the length of the legs.
At the initial stages, the pathology is asymptomatic, so you should pay attention to the following signs: one shoulder is higher than the other; when the child stands with his hands pressed to his sides, the distance between the arm and the waist differs from both sides; the shoulder blades are located asymmetrically – on the concave side, the shoulder blade is closer to the spine, its angle bulges; when tilted anteriorly the curvature of the spine becomes noticeable.
The classification of scoliosis, developed by Chaklin and used in Russia, was compiled taking into account both clinical and radiological signs, so it can be used to identify the symptoms of the disease. It includes 4 degrees:
- 1 degree – angle up to 10 degrees. The following clinical and radiological signs are determined: stooping, lowered head, asymmetric waist, different height of the upper arms. On X–rays, there is a slight tendency to torsion of the vertebrae.
- 2 degree – an angle from 11 to 25 degrees. The curvature of the spine is revealed, which does not disappear when changing the position of the body. Half of the pelvis on the side of the curvature is lowered, the triangle of the waist and the contours of the neck are asymmetrical, there is a bulge in the thoracic region on the side of the curvature, and a muscle roller in the lumbar region. The X–ray shows the torsion of the vertebrae.
- 3 degree – angle from 26 to 50 degrees. In addition to all the signs of scoliosis characteristic of grade 2, bulging anterior rib arches and a clearly defined rib hump become noticeable. Abdominal muscles are weakened. Muscle contractures and sinking of the ribs are observed. The X–rays show a pronounced torsion of the vertebrae.
- 4 degree – an angle of more than 50 degrees. A sharp deformation of the spine, all of the above signs are enhanced. Significant stretching of the muscles in the area of curvature, rib hump, sinking of the ribs in the concavity zone.
If symptoms of scoliosis are detected, you should contact a pediatric orthopedist so that he conducts a detailed examination and, upon confirmation of the diagnosis, prescribes appropriate treatment. Examination of a patient suffering from scoliosis in the conditions of med. The institution includes a detailed examination in a standing, sitting and lying position to identify the signs listed above.
In the standing position, the length of the lower extremities is measured, the mobility of the ankle, knee and hip joints is determined, kyphosis is measured, the mobility of the lumbar spine and the symmetry of the waist triangles are evaluated, the position of the shoulders and shoulder blades is determined. The chest, abdomen, pelvis and lower back are also examined. Muscle tone is assessed, muscle rolls, deformity of the ribs, etc. are detected. In the flexion position, the presence or absence of asymmetry of the spine is determined.
In the sitting position, the length of the spine is measured and the degree of lumbar lordosis is determined, lateral curvature of the spine and deviations of the trunk are revealed. The pelvic position is evaluated regardless of the position of the lower extremities. In the supine position, the change in the curvature of the spine arch is evaluated, abdominal muscles and internal organs are examined.
The main instrumental method of diagnosing spinal scoliosis is spine x-ray. If scoliotic curvature is suspected, X-ray examination should be performed at least 1-2 times a year. The primary radiograph can be performed in a standing position. Subsequently, X–rays are taken in two projections in a prone position with moderate stretching – this makes it possible to assess the true deformation.
When studying radiographs of patients with scoliosis, the angles of curvature are measured using a special technique proposed by Cobb. In order to calculate the angle of curvature, two lines running parallel to the closure plates of the neutral (not involved in the curvature) vertebrae are applied to a straight radiograph, and then the angle formed by these lines is measured.
In addition, the following features are revealed on the X-ray image for scoliosis:
- Basal non-curved vertebrae, which are the basis for the curved part of the spine.
- Culminating vertebrae located at the highest point of the arc of curvature (both primary and secondary, if any).
- Beveled vertebrae that are located at the transition points between the main curvature and the anti-curvature.
- Intermediate vertebrae located between the beveled and culminating vertebrae.
- Neutral vertebrae are undeformed vertebrae that are not involved in the process of lateral curvature.
If necessary, images are taken in special stowings to measure torsion (twisting along the axis of the vertebral body) and rotation (turning the vertebrae relative to each other). The torsion angle is also calculated using one of two special techniques: Nash and Mo or Raimondi.
Non-beam instrumental methods
During periods of rapid growth, spinal examination should be carried out more often, therefore, non–radiation harmless techniques are used to reduce the dose of X-ray irradiation, including three-dimensional examination with an ultrasound or contact sensor, light-optical measurement of the back profile and Bunnell scoliometry.
It is also possible to take pictures with low irradiation (with reduced irradiation time). Small details are not visible in such images, but they can be used to measure the angle of curvature in scoliosis. If necessary, an MRI of the spine can also be performed to identify the cause of scoliosis.
Patients should be observed by an experienced vertebrologist or orthopedist who is well acquainted with this pathology. Possible rapid progression and the effect of curvature on the condition of internal organs requires adequate treatment, as well as, if necessary, referral to other specialists: pulmonologists, cardiologists, etc. Treatment of scoliosis can be both conservative and operative, depending on the cause and severity of the pathology, the presence or absence of progression. In any case, it is important that it be comprehensive, permanent, timely.
With scoliosis caused by the consequences of trauma, shortening of limbs and other similar factors, it is necessary first of all to eliminate the cause. For example, use special insoles or orthopedic shoes to compensate for the difference in the length of the limbs. In neurogenic and myopathic scoliosis, conservative therapy is usually ineffective. Surgical treatment is required.
Conservative treatment of idiopathic scoliosis includes special anti-scoliosis gymnastics and the use of corsets. When the angle of curvature is up to 15 degrees in the absence of rotation, specialized gymnastics is shown. When the angle of curvature is 15-20 degrees with concomitant rotation (in patients with incomplete growth), corset therapy is added to gymnastics. The use of corsets is possible both at night and constantly, depending on the doctor’s recommendations. If the growth is completed, the corset is not needed.
With progressive scoliosis with an angle of more than 20-40 degrees, inpatient treatment in a specialized vertebrological clinic is indicated. If the growth is not completed, it is recommended to constantly wear a derotizing corset (at least 16 hours a day, optimally – 23 hours a day) in combination with intensive gymnastics. After the growth is completed, a corset, as in the previous case, is not required.
At an angle of more than 40-45 degrees, as a rule, surgical treatment is required. Indications for surgery are determined individually and depend on the cause of scoliosis, the age of the patient, his physical and psychological condition, the type and location of the deformity, as well as the effectiveness of conservative treatment methods.
Surgery for scoliosis is the straightening of the spine to a certain angle using metal structures. At the same time, the spine that has undergone surgery is immobilized. Special plates, rods, hooks and screws are used to fix the spine. Bone grafts in the form of inserts are used to expand the vertebrae, give the spine a more correct shape and improve consolidation. Surgery to correct scoliosis can be performed transthoracically, dorsally and by thoracophrenolumbotomy.