Disease to Kalva (a vertebra body osteochondropathy, a platispondiliya) — seldom found disease of a backbone which cornerstone the aseptic (noninfectious) necrosis of a body of one or two vertebras which are in a spine column is. The disease to Kalva proceeds with the increasing pain syndrome in the vertebra affected with necrotic process. Protrusion of an awned shoot of the affected vertebra, its morbidity at a palpation is characteristic, tension of paravertebralny muscles and restriction of mobility of a backbone in this area. The disease to Kalva is diagnosed according to a X-ray analysis, backbone KT or MCKT. The basis of treatment of a disease to Kalva is made by a conservative technique, at its inefficiency expeditious treatment is carried out.
Disease to Kalva
The disease to Kalva carries the name in memory about for the first time described it in 1925 scientific. Along with Köhler's disease, Shlyatter's disease and Timann's disease the disease to Kalva concerns to group of the diseases called in orthopedics and traumatology osteokhondropatiya. The disease to Kalva is observed among children and teenagers aged from 2 up to 17 years, but is the most frequent at boys during from 4 to 7 years. In the greatest number of cases the disease to Kalva proceeds with damage of the chest vertebra which is in the highest point of a chest kifoz and bearing the biggest loading. Much less often the aseptic necrosis of a vertebra in lumbar department meets. In some cases the disease to Kalva is followed by a necrosis of two vertebras, as a rule, nearby or through one healthy vertebra at once.
Reasons and pathogenesis
So far in medicine there is no fair idea of the reasons causing a disease to Kalva. Among factors most of which possibly are its cornerstone call hereditary predisposition as a result of which in a vertebra, "weak" from the birth, as a result of physical activities pathological changes begin to happen. A number of authors considers that the disease to Kalva develops as a result of local violation of blood supply of a bone tissue of the separate taken vertebra.
The necrotic processes characterizing a disease to Kalva happening in a vertebra body lead to violation of its strong bone structure. As a result under the influence of pressure from adjacent vertebras it is flattened, and the intervertebral disks adjoining it are thickened. These changes are clearly visible on roentgenograms of the struck department of a backbone. Over time in we nekrotiziruyushchtsya a vertebra there is a deep reorganization and process of restoration of bone structure begins. The disease to Kalva lasts several years. At the patients who transferred it it is observed the residual phenomena in the form of insignificant decrease in height of a vertebra and its easy wedge-shaped deformation. At mature age they have a development of osteochondrosis in intervertebral disks, adjacent to the changed vertebra, earlier.
The disease to Kalva usually has the hardly noticeable beginning which in some cases can be followed by rise in temperature from 37,2 to 38 °C. The main complaint of the patients having a disease to Kalva is back pain. The pain syndrome can have periodic character. Often it is followed by irradiation of pain in the lower extremities. As a rule, pain decreases and even completely disappears in a prone position and increases the intensity at physical activity. Localization of pain corresponds to area of an arrangement of the affected vertebra. Strengthening of pain at physical activity leads to the fact that the children having a disease to Kalva avoid games and walks, become inactive and prefer to lie.
At survey in the affected vertebra small pugovchaty protrusion of its awned shoot attracts attention. Palpation and percussion in the area a vertebra lead to strengthening of a pain syndrome. The palpation of muscles in this area reveals their excess tension. Mobility of a spine column in the struck area is limited. First it is connected with the expressed morbidity at the movements, and secondly is caused by the muscular tension limiting the free movements. It should be noted that accurate correlation between expressiveness of symptomatology and extent of destruction of a vertebra at a disease to Kalva is not observed.
In certain cases the disease to Kalva to become for the traumatologist, a vertebrolog or the orthopedist the casual find found on the roentgenogram of a backbone. In diagnostic sense the X-ray analysis of a backbone is most informative if it is carried out in a side projection. For more detailed studying of the changes happening in a vertebra and for the purpose of differential diagnosis of a disease to Kalva the patient is in addition examined by means of backbone MCKT or KT.
At the beginning of a disease in pictures the thickening of switching plates and osteoporosis of the central department of a body of the changed vertebra comes to light. Further progressing of an aseptic necrosis leads to reduction of height of the affected vertebra on average up to ¼ its heights in a healthy state. At the same time increase in thickness of intervertebral disks, from above and from below adjoining to to a vertebra is noted. The body of the changed vertebra is squeezed in forward department more that looks on the roentgenogram as small wedge-shaped deformation. Its width is increased so that the body of a vertebra supports limits of healthy vertebras, close to it. Radiological the crenation of contours of a body of the flattened vertebra is observed. Big intensity of the image of a body of this vertebra demonstrates development in it necrotic processes.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Conservative treatment of the patients having a disease to Kalva is standard. It consists in the all-strengthening actions, the unloading mode for a backbone (constant horizontal position of the patient), performing massage, physical therapy (magnetotherapy, reflexotherapy) and physiotherapy exercises. Carry out a vertebra reklination by means of a plaster bed. Control of results of treatment is made by each half a year by a radiological research. After restoration of a vertebra up to 2/3 of its heights to the patient allow to accept vertical position, but at the same time it has to be in a rekliniruyushchy corset. Conservative treatment of the patients having a disease to Kalva can take from 2 to 5 years.
In cases when the disease to Kalva progresses, despite the held conservative events, surgical treatment is shown. Its purpose is the stop of the progressing deformation of a vertebra by fixing of a backbone. However it is necessary to consider that the carried-out surgical treatment is not able to correct completely available deformation of a vertebra and for 100% to restore its function. Kalva can treat a disease by means of several surgical techniques: mezhtelovy spondilodez, fixing by plates or brackets, etc. In 3-4 weeks after the carried-out surgical intervention to the patient allow to be gradually in vertical position with obligatory carrying a corset.