Kifoskolioz – the combined deformation of a backbone representing a scoliosis combination (a side bend) and a kifoz (stoop, an excess bend in the perednezadny direction). Can be congenital or acquired. Depending on the direction of a side bend allocate left-and right-hand . Congenital deformations of vertebras, a myopathy, an osteochondropathy, paresis and paralyzes, rickets, rheumatism, disproportionate growth of a muscular and bone tissue, the wrong bearing, some other diseases and pathological states can become the reason of development of a kifoskolioz. Kifoskolioz is shown by visible deformation and back pains. Because of secondary change of a shape of a thorax and violation of functions of the bodies located in it short wind and violations of warm activity is possible. The diagnosis is exposed on the basis of the external signs given to a X-ray analysis, MPT and KT. Treatment of a kifoskolioz usually conservative, at the expressed curvature can arise need for operation.
Kifoskolioz – a simultaneous curvature of a backbone in the side and perednezadny direction. Is rather widespread pathology, in most cases arises at teenage age. Boys suffer four times more often than girls. In mild cases can become the reason of increased fatigue and back pains. The expressed pathology exerts negative impact on a condition of all organism, can cause neurologic violations, worsen functioning of lungs, heart and gastrointestinal tract.
Normal the human backbone has several bends in the perednezadny direction: one bend back (chest ) and two bends forward (lumbar and cervical ). These bends play a compensatory role at vertical loads of a spine column. If the backbone is bent back more, than normal (at an angle more than 45 degrees), speak about a pathological kifoz. Usually pathological develops in the same place where also physiological – in chest department. The human backbone normal has no side bends therefore at any degree of a side curvature expose the diagnosis scoliosis. As a rule, at the initial stage of formation of a kifoskolioz it is formed , and in the subsequent scoliosis joins it.
Usually anomalies of development of vertebras are the reason of development of a congenital kifoskolioz. In 20-30% of cases deformation is combined with malformations of urinogenital system. At the same time pathology is found more often not at once, and at the age of 6 months and is more senior (when the child starts walking or to stand). At the same time, cases when 3 degrees came to light at once at the birth of the kid are recorded.
Among factors which can lead to formation of the acquired kifoskolioz – congenital insufficiency of connecting fabric, rickets, some diseases of a backbone (an osteochondropathy, tumors, Sheyermana-Mau's disease etc.). Besides, violations of a muscular tone and function of muscles owing to a myopathy, a miodistrofiya and paralyzes (for example, at poliomyelitis or a cerebral palsy), rheumatism (owing to defeat of cartilaginous tissue of a backbone antibodies), discrepancy of speed of development of bone and muscular tissue during active growth etc. become the reason of development of a kifoskolioz. Most often symptoms of the acquired kifoskolioz appear in 13-15 years.
The contributing factors increasing probability of development of a kifoskolioz are the excessive load of a backbone caused by the excess weight or hard physical activity and also a "sedentary" inactive way of life and the wrong position of a body during the work at the computer, sitting behind a school desk etc.
Depending on expressiveness of deformation allocate 4 degrees of a kifoskolioz:
- 1 degree of a kifoskolioz – a backbone curvature corner in the perednezadny direction of 45-55 degrees. Insignificant side shift and twisting (rotation) of vertebras is noted.
- 2 degree of a kifoskolioz – a corner of a curvature of a spine column in the perednezadny direction of 55-65 degrees. Noticeable twisting and side shift comes to light.
- 3 degree of a kifoskolioz – a backbone curvature corner in the perednezadny direction of 65-75 degrees. The vertebral hump is formed, visible deformation of a thorax is noted.
- 4 degree of a kifoskolioz – a corner of a curvature of a spine column in the perednezadny direction more than 75 degrees. As well as in the previous case the curvature is followed by formation of a vertebral hump and deformation of a thorax.
Taking into account the direction of a side curvature in orthopedics and traumatology allocate left-side and right-hand .
Congenital , as a rule, becomes noticeable on reaching 6-12 months. On a back of the child it is formed hardly noticeable , at the same time, unlike "pure" scoliosis, at a kifoskolioza the vystoyaniye not of the muscular roller, but awned shoots of several vertebras comes to light. At early stages the curvature of a spine column is noticeable only upon transition to vertical position and disappears in a prone position. In the subsequent kifoskolioz becomes resistant, not depending on position of a body. Approximately in 50% of cases is followed by the progressing neurologic insufficiency. At younger age sensitivity violations come to light, at teenagers with a congenital kifoskolioz development of quickly progressing paresis is possible.
Early manifestations of a teenage kifoskolioz are change of a bearing, strengthening of stoop and back pain. Quite often the child begins to complain of pain or unpleasant feelings in a back still before parents notice violation of a bearing. Also unsharply expressed short wind arising owing to restriction of excursions of a thorax is possible. Neurologic violations at a teenage kifoskolioz come to light less often and, as a rule, arise only at heavy deformations. Speed of progressing can differ considerably depending on the reason of development of a kifoskolioz, and also timeliness and adequacy of treatment.
At external survey the increased stoop (a round back), in hard cases – a hump comes to light. The top part of a trunk and the patient's shoulders kifoskoliozy are inclined forward and down, narrowing of a thorax and weakness of muscles of an abdominal tension is noted. For detection of scoliosis the doctor examines in situation with the straightened and bent back. In the presence of skoliotichesky deformation the backbone deviation from the median line is found. At external survey of a thorax expansion of intercostal intervals on the party opposite to a side curvature is defined. At the kifoskolioz complicated by neurologic violations local decrease in sensitivity, change of tendinous reflexes and asymmetry of force of muscles comes to light.
Discrepancy of a shape of a spine column to physiological requirements of an organism becomes the reason of a constant overload of all structures of a backbone and okolopozvonochny muscles. At a kifoskolioza perhaps early development of osteochondrosis, formation of protrusions of disks and intervertebral hernias, emergence of miozit and arthrosis of joints of a backbone. Some of the listed pathological processes can become the reason of a sdavleniye of a spinal cord and its backs and lead to emergence of neurologic symptomatology (violations of sensitivity, motive violations, to malfunction of pelvic bodies).
Because of a kifoskolioz mobility of a thorax and a diaphragm is limited. It leads to increase in load of respiratory muscles, decrease in tensile properties of a pulmonary parenchyma and reduction of functional residual capacity of lungs. As a result the volume of lungs decreases, gas exchange is broken: in blood there is more carbon dioxide less oxygen. At the expressed kifoskolioz there is a visible deformation of a thorax involving even more significant dysfunction of lungs and heart.
At a heavy kifoskolioz not only heart and lungs, but also a digestive tract suffer: the arrangement of bodies is broken, their functioning worsens. The probability of developing of cholecystitis and dyskinesia of biliary tract increases. Because of a kifoskolioz there is a redistribution of load of the lower extremities, early coxarthroses develop.
The diagnosis is exposed on the basis of external signs and data of a X-ray analysis of a backbone. If necessary, along with two main projections, pictures in special provisions (lying, standing can be appointed, at extension of a backbone). For specification of the diagnosis of the patient can also direct to backbone MPT and KT. Inspection at a kifoskolioza provides obligatory consultation of the neurologist. At suspicion on dysfunction of internals of the patient kifoskoliozy direct to consultations to the corresponding experts: to the cardiologist, pulmonologist, gastroenterologist, urologist.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of a kifoskolioz is performed by orthopedists with the assistance of neuropathologists and other experts (depending on the revealed accompanying pathology). The main methods of conservative correction of a kifoskolioz are the korsetirovaniye and remedial gymnastics. The set of exercises is selected individually. At 1 degree of a kifoskolioz for straightening of a backbone quite often rather regularly to carry out exercises, at the 2nd degree of LFK it is necessary to combine with carrying a corset. The corrective corsets made by the individual order are used. In most cases in the course of a korsetirovaniye, along with stoop elimination, the derotation is made (elimination of rotation of a backbone along an axis).
For improvement of blood circulation, increase in plasticity of muscles and activization of exchange processes in muscular tissue kifoskoliozy massage is appointed by the patient. Swimming and moderate physical activities is useful (taking into account the available contraindications). Occupations with burdenings and "hopping" sports (long jumps and height, volleyball, basketball) are contraindicated.
The indication to expeditious treatment are the 4th degree of a kifoskolioz, the expressed pain syndrome, the progressing neurologic violations, deterioration in functions of heart and lungs. Surgical correction at a kifoskolioza provides installation of a special metalwork (hooks, screws) in vertebras and alignment of a spine column with use of special cores which fasten to this metalwork. At the same time the fixed department of a backbone loses mobility.
Full elimination of a kifoskolioz is possible before the end of active growth of the child, that is, up to 14-15 years (some experts consider critical age of 12-13 years), at the same time degree of a curvature and speed of progressing of a disease matters. In most cases it is possible to eliminate completely 1 degrees, it is possible to achieve straightening of a backbone at a kifoskolioza from a considerable part of patients 2 degrees. At a kifoskolioza 3 and, especially, 4 degrees the forecast less favorable – adequate treatment, as a rule, gives the chance to stop progressing of deformation and in some cases to carry out partial correction. Full straightening of a spine column in such cases is extremely improbable.
At treatment of a kifoskolioz timeliness of all held medical events is very important. As effective correction of a kifoskolioz is possible, only when the child continues to grow, very important to pay attention to signs of a kifoskolioz in time, to ask immediately for medical care and to precisely implement all recommendations of the doctor, especially – concerning remedial gymnastics and carrying a corset. These methods allow to eliminate while other ways of treatment perform only minor support function.