Scoliosis - a stable lateral curvature of the spine. This pathology is accompanied by twisting the vertical vertebral bodies (SARS) and their deformation. The disease begins to develop in childhood and adolescence. Therefore, adults need to begin treatment of the spine at an early age.
Overview
When scoliosis interferes with the normal function of the spine, and many internal organs, muscles of the abdomen and back, there is a shift of the pelvis. In connection with the influence of curvature of the spine almost the entire body, this condition is more properly called "scoliosis".
In this disease most often appears curvature of the thoracic and / or lumbar department.
According to statistics, scoliosis responsible for about a quarter of children orthopedic diseases.
It is necessary to distinguish between the true scoliosis ( "scoliosis") and scoliotic posture.
Scoliotic posture usually develops due to such reasons:
- Improper body position long in one position. This can be caused by incorrectly selected furniture to practice, habit constantly tilting your head in the wrong posture in the chair, and so on. D.
- Excessive exercise, or, conversely, lack of exercise.
- Poor nutrition.
- Improperly organized place to sleep: too soft bed, pillow, etc...
Curvature of the spine with scoliosis posture is unstable in nature and is not accompanied by deformation or change the position of the vertebrae. This is clearly seen on radiographs and during functional tests: in the supine position or when bending forward spine acquires physiological appearance. Such a state with timely treatment usually disappears.
Causes
Distinguish congenital and acquired scoliosis.
Congenital scoliosis occurs when abnormalities of the spine, which arose in utero. These include:
- Congenital vertebral deformity.
- Fusion of two or more vertebrae.
- Malformations of the arches and the processes of the vertebrae.
- Synostosis of ribs.
- Hypoplasia of the various parts of the spine (scoliosis dysplastic), etc.
Congenital scoliosis is usually diagnosed immediately after the birth or during the first years of life.
Acquired scoliosis is influenced by external factors. They are conditionally divided into several groups:
- neurogenic. In this case, scoliosis formed after diseases of the nervous and muscular systems: polio, Cerebral palsy, myopathy, syringomyelia, and some others. In these diseases there is a defeat of the spinal cord structures with the subsequent formation of pathological transformations in the muscle fibers of the back and abdomen. metabolic disorders also develop in the spine. All this, as well as the incorrect static load on the skeleton of the growing child can sometimes lead to quite serious bone deformations.
- rachitic scoliosis. at rickets Scoliosis is formed as a result of degenerative bone lesions and pathological changes of the neuromuscular and ligaments.
- static. Curvature of the spine appears motivated by deforming the lower limb pathologies. The most common - is a congenital dislocation hip.
- idiopathic. Despite the fact that the disease has been known since ancient times, about 80% of cases, a clear reason for its occurrence is not possible to identify.
In most cases diagnosed is acquired idiopathic scoliosis. It is formed by children between the ages of six to fifteen years in the period of intensive growth. Curvature of the spine in girls occurs in almost 7 times more often than boys.
Classification
Several distinct classifications of scoliosis.
According to the time of occurrence is congenital and acquired scoliosis. Depending on the cause of the curvature of scoliosis is divided into dysplastic, static, rachitic etc.
By the number of curving arcs - one, two, or three, respectively isolated C-, S- or Z- shaped scoliosis. deformation direction of the arc is to the right or to the left.
Localization of the pathological process scoliosis is:
- thoracic;
- thoracolumbar;
- lumbar.
Radiological classification distinguishes four types of scoliosis of the spine angle deviation from the normal axis. Based on this classification, there are four degrees of clinical course of disease.
symptoms
The main symptoms of scoliosis are:
- The curvature of the spine in the frontal stem (lateral) plane.
- Asymmetric standing shoulders, shoulder blades, elbows.
- Misalignment of the pelvis axis.
- Gait disturbance.
- Soreness in the back, chest, loins.
- Fast fatiguability.
- Frequent and intense headaches.
- Various strains of the chest bones.
- Disruption of the normal functioning of the heart, respiratory and digestive systems.
In the early stages of the disease can be seen only a change in curvature of the spine and trunk unexpressed asymmetry of the shoulder girdle and the shoulder blades. In the course of the disease there are more symptoms. In severe cases there are serious violations of the function of virtually all internal organs and pronounced bone deformities of the chest, pelvis and spine.
Diagnostics
For primary diagnosis scoliosis patient survey carried out in three binding positions: vertical, horizontal and sitting. During the inspection diagnosed:
- the same length of the lower extremities;
- symmetry standing shoulder girdles and shoulder blades, and waist triangles - the free space between the arm and waistline with lowered upper limbs;
- Modifications of the joints;
- axis position of the pelvis and trunk;
- the mobility of the spine of the barrel;
- the nature of muscle tone.
When viewed as perform various functional tests. For example, stretching up behind his head while sitting or leaning forward with his hands down. If there is no obvious structural lesions of the spine visible distortion of its axis in this case is corrected.
The main method of diagnosis of scoliosis is still considered X-ray. Moreover, most researchers believe that the more modern methods of investigation such as MRI are less informative than X-rays.
Patients suspected of having scoliosis radiography of spine in at least two positions - vertical and horizontal. The main objectives of the study are to determine the angle of scoliosis as well as the presence of torsion and rotation of the vertebral bodies.
According to X-ray and clinical signs are four current degree of scoliosis:
- first degree - initial. deformation angle not exceeding 10 degrees. When viewed from standing and lying diagnosed decreased muscle tone back and abdomen. Nadplechya asymmetric blade angles are at different levels and at different distances from the spine of the barrel. The bones of the pelvis are arranged horizontally. torso vertebrae yet.
- at second degree deformation angle is in the range of 11 to 25 degrees. The X-ray has revealed torsion of the vertebrae. Visualized pronounced asymmetry of the shoulder girdle. pelvic axis shifts. Revealed muscle compression in the lumbar and thoracic areas, which is due to abnormal muscle tone. When you lean forward diagnosed rib hump.
- third degree. The angle of curvature - from 26 to 49 degrees. Revealed a clear distortion of bony structures of the chest. Going ceasing intercostal spaces with the concave side of the curvature and protrusion - with convex. Abdominal muscles relaxed. Formed inner hump. spinal deformity leads to displacement of the spinal cord that is manifested in various neurological disorders.
- fourth degree - terminal. Scoliosis angle exceeds 50 degrees. There is a pronounced deformation of the whole body. Its axis is rejected towards the main arc of curvature. skeletal growth ceases. There are violations of the interaction of all internal organs. Spinal cord compression develops pathologically altered vertebrae followed by progressive paresis of the lower extremities. Disability occurs the patient.
When pronounced deformation of the spine stem sure to explore the function of internal organs. To this end, a spirometry, electrocardiography, ultrasound and other methods of research.
Treatment
Therapy scoliosis includes both conservative and surgical methods. The choice of a particular type of treatment depends on the degree of curvature of the spine and the patient's age.
In the early stages of scoliosis possible full curvature correction. However, with grade 3-4 the spine will not be able to return to its original position, so the treatment in these cases is aimed at reducing the angle of curvature and to reduce the progression of the disease.
The earlier treatment is started, the greater the likelihood of successful completion. Complete the formation of the spine ends to approximately 20-22 years. Therefore, many effective treatments that have been successfully used in children and adolescents in this age is no longer effective.
The main goals of treatment of scoliosis are:
- Stabilization of the position of the spine.
- Elimination of pathological manifestations.
- Improve metabolism and blood circulation intensity in the spine.
- Normalization of muscle tone.
If conservative treatment methods are used:
- drug therapy. It is more a secondary method. Use of vitamin and mineral supplements, immunostimulants, tools to improve microcirculation and others.
- therapeutic physical training (LFK). Gymnastics instructor developed individually for each patient set of exercises. With the help of physical therapy strengthening the muscle corset back, chest and neck, improves blood circulation in these areas. This creates favorable conditions for the straightening of the spine. Useful for swimming lessons.
- Massage and manual therapy. These methods of influence on the body must be carried out only by specially trained personnel.
- Physiotherapy - electrophoresis, phonophoresis, electrical and others.
- position treatment. This method of treatment is required for all patients with scoliosis. The essence of it is to fix the spinal column in the correct physiological position. With this purpose corsets various configurations.
Surgical treatment is usually applied when expressed vertebral deformations (usually it is the fourth degree of scoliosis) and at the ineffectiveness of the conservative therapy.
During the surgery is usually performed:
- Plastic correction of the individual vertebrae.
- Creating arthrodesis - stationary fixation of the vertebrae in place of curvature. For this purpose various metal structures.
Usually, surgical treatment is not carried out for young children and teenagers, as they have the processes of the spine formation is not over yet.
complications
Scoliosis - is primarily a cosmetic defect, which gives a lot of aesthetic problems to the patient.
In marked curvature of the spine occurs the displacement of internal organsWhich is manifested in a sharp infringement of their work. These patients often have bronchitis, Pneumonia, heart failure, chronic cholecystitis and pancreatitis etc.
prevention
Preventive measures for the prevention of scoliosis should begin in early childhood. They include:
- Maintaining an active lifestyle. Necessary at an early age to vaccinate your child a love of sports, do gymnastics, play outdoor games.
- Balanced diet.
- Properly organized workplace. for baby furniture should match his height and age.
- Timely adjustments to habits that lead to a violation of posture (long head tilt, the wrong seat and so on. D.).
- Sleep best on orthopedic mattress with a small and hard pillow.
- During the training sessions at home and school periodically take breaks to warm up.
In most cases, these activities help to prevent the development of disease.
Forecast
If early detection of curvature in the initial stages of its timely treatment effectively. Can usually be achieved in these cases and full correction of scoliosis.
When expressed deformation of the spine of the barrel with the development of disorders of the internal organs, especially over the age of 25 years, the prognosis for recovery is most often adverse.
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