Kifoz is a curvature of a backbone in the front-back (saggitalny) plane. Can be both physiological (normal), and pathological. Pathological usually develops in chest department though in literature curvature cases in lumbar and cervical department are described. Hereditary predisposition, injuries, various diseases and violation of a bearing owing to weakness of muscles of a back or constant wrong situation in operating time or studies can be the cause of a kifoz. Pathological quite often is followed by back pains. At a considerable curvature perhaps sdavleny nervous backs and a spinal cord with the corresponding symptomatology (weakness in legs, sensitivity violations, pelvic frustration). In especially hard cases violation of action of the heart and lungs can be observed. Treatment of a kifoz, generally conservative. In certain situations operation is shown.
Kifoz is called both the pathological, and physiological curvature of a backbone in the front-back direction. Physiological is defined at all people in chest department of a backbone. Speak about pathology when the bend angle makes 45 and more degrees. Kifoz can be observed as separately, and in a combination to scoliosis (a backbone curvature in the side plane). Fractures of vertebras are the most frequent reason of development of a pathological kifoz.
Depending on character of a curvature can be angular or the arc-shaped. Angular usually arises at backbone tuberculosis, is followed by formation of a hump, shortening of a trunk and protrusion of a breast forward. At the arc-shaped kifoz smooth With-shaped deformation of all chest department of a backbone is observed.
Reasons and classification
Kifoz can arise owing to violations of pre-natal development, adverse heredity, injuries and backbone operations, weakness of muscles of a back at insufficient physical activities etc. At elderly people (especially – women) often develops owing to pathological compression fractures of chest vertebras. Osteoporosis – reduction of density of bones becomes the reason of such changes.
Taking into account the cause in orthopedics and traumatology allocate the following kinds of a pathological kifoz:
- functional (stoop);
- dorzalny youthful (develops at Sheyermana-Mau's disease);
- congenital ;
- paralytic ;
- post-traumatic ;
- degenerate .
Besides, can develop at some infectious and noninfectious diseases: spondilita, ankiloziruyushchy spondilit (Bekhterev's disease) and backbone tumors. It becomes very rare the cause of a pathological kifoz the radiation therapy which is carried out for treatment of malignant new growths at children's age.
Taking into account a corner of a curvature allocate normal, strengthened (with the increased corner) and straightened (with the reduced corner) .
Strengthened , in turn, it is subdivided into three degrees:
- 1 degree at which the bend angle makes 35 or less degrees.
- 2 degree at which the corner of a curvature fluctuates from 31 to 60 degrees.
- 3 degree at which the bend angle makes 60 and more degrees.
The excessive curvature of chest department exerts adverse impact both on anatomical structures of the backbone, and on nearby bodies. The volume of a thorax and capacity of lungs at the maximum breath decrease. Insufficient intake of oxygen in blood causes violations from the blood circulatory system and other systems.
The diaphragm presses stronger on an abdominal cavity because of what normal work of the bodies located there is broken, in particular – locks develop. Intervertebral disks suffer because of redistribution of loading, there is osteochondrosis. At the expressed kifoz perhaps sdavleny a spinal cord and nervous backs, followed by loss or easing of sensitivity, muscular weakness and violations from pelvic bodies.
Functional – manifestation of the wrong bearing. Arises owing to poor development of muscles of a back or not physiologic situation during study or work. In some cases such it is caused by psychological factors (usually at teenagers who hesitate of the growth). The organism seeks to compensate an excess bend of chest department of a backbone of a kzada therefore at such kifoz often develops accompanying lumbar (an excess bend of lumbar department of a kpereda).
Unlike other types of a kifoz, at this pathology the excess curvature disappears in attempt to straighten a back or laying on a firm flat surface. On roentgenograms of any anomalies does not come to light. Treatment of a functional kifoz conservative. The patient is trained to keep the correct situation during sitting, standing and walking. For strengthening of muscles of a back specially developed sets of exercises (LFK) are appointed. Carrying corsets is not shown.
The reasons of development of this form of a kifoz (Sheyermana-Mau's disease) are up to the end not studied, however is precisely established that a part in its development is played by hereditary predisposition. It is supposed what in this case arises or owing to an avaskulyarny necrosis (necrosis) of switching plates (layers of a hyaline cartilage between a vertebra and an intervertebral disk), or because of the excess growth of a bone tissue in bodies of vertebras. There is also an assumption that develops because of multiple microfractures of vertebras owing to osteoporosis.
Bodies of three or more chest vertebras at Sheyermana-Mau's disease are deformed, become wedge-shaped (on side roentgenograms they look almost triangular). Because of change of a shape of vertebras amplifies. The bend in chest department of a backbone reaches 45-75 degrees.
At early stages patients, as a rule, do not show any complaints. In process of progressing of a kifoz and strengthening of a curvature of a backbone there are pains in the struck department. Because of the accompanying deformation of a thorax the act of breath is at a loss over time. There can be violations of warm activity. The neurologic symptomatology usually is absent.
The diagnosis of a dorzalny youthful kifoz is exposed on the basis of the anamnesis, clinical and radiological survey. In certain cases carry in addition out an elektroneyromiografiya and MRT of a backbone.
Treatment is usually conservative. Massage, physiotherapeutic procedures, LFK and manual therapy, sometimes – carrying a corset is appointed. The indication to surgery is the big corner of a curvature (more than 75 degrees), a resistant pain syndrome, and also violations of breath and blood circulation.
Congenital is a consequence of violation of an embryonal development. Arises at emergence of anomalies at a stage of formation of vertebras therefore babochkovidny or wedge-shaped vertebras, back semi-vertebras, microvertebras, etc. can be formed. Less often violations of segmentation (division) into separate vertebras meet.
It is possible as "pure" at which the backbone is bent only in the front-back direction, and , followed by a curvature in the front-back and side directions. The top of a kifotichesky curvature can settle down at any level – from a backbone, cervicothoracic to lumbar department. Kifoz at this disease often has the progressing character.
Quite often (approximately in 13% of cases) the combination of a kifoz as with other anomalies of the vertebral channel (dermoidny cysts, fibrous banners, thermal sine, abnormal spinal backs etc.), and with violations of development of various bodies and systems is observed (urinary, warm and pulmonary, and also extremities, a belly and chest wall). Usually the curvature of a backbone is followed by neurologic violations.
As additional methods of a research the X-ray analysis (survey and aim pictures in various projections), is used by KT, MPT. The X-ray contrast research of the vertebral channel can be appointed. Neurologic examination is surely conducted.
Conservative treatment of a congenital kifoz is ineffective. Surgery at children's age for elimination of a pathological kifoz, stabilization of a backbone and prevention of its further deformation is recommended.
Paralytic it is caused by the diseases which are followed by paresis and paralyzes of muscles of a back (a cerebral palsy, poliomyelitis, etc.). At a cerebral palsy strengthening of a chest kifoz and increase in its extent is noted (the bend extends to the top part of lumbar department). Kifoz can be combined with scoliosis. It is characteristic gradual deformation progressing. Treatment is usually conservative, complex, long.
The diagnosis is exposed on the basis of the anamnesis, a clinical and radiological trial. According to testimonies of patients direct to KT and MPT. To patients appoint massage, LFK, physiotreatment, manual therapy. Operation is shown at the expressed pain syndrome and malfunction of the bodies located in a thorax.
Fractures of chest and lumbar vertebras – the most frequent reason of development of kifotichesky deformation (about 40% of all kifoz). The risk of emergence of a kifoz depends on weight of a trauma, violations from bone and muscular system (osteoporosis, weakness of muscles of a back) and observance of medical recommendations during treatment. The basis for diagnosis is the corresponding anamnesis, clinical and radiological signs of a post-traumatic kifoz.
In certain cases it is combined with neurologic violations. Treatment is mainly surgical. In the presence of contraindications to operation (advanced age, serious associated diseases etc.) conservative therapy is carried out, carrying a corset is appointed.
Degenerate results from degenerate violations (osteoporosis, osteochondrosis). It is more often observed at women of advanced and senile age. It is quite often combined with the previous injuries (pathological compression fractures of bodies of vertebras). Kifoz promotes aggravation of degenerate changes of a backbone and has the progressing character. Treatment is mainly conservative.
Diagnosis begins with detailed poll and survey of the patient. The doctor (treatment of kifoz orthopedists are engaged) studies history of development of a disease, specifies features of a pain syndrome, pays attention to absence or existence of neurologic violations. Survey includes a palpation of a back and neck, determination of force of muscles and skin sensitivity. The expert investigates tendinous reflexes and carries out special tests for assessment of the neurologic status, carries out an auskultation of heart and lungs.
Obligatory stage of inspection is the backbone X-ray analysis which can include both survey straight lines and side pictures, and aim roentgenograms in non-standard projections and at specially chosen position of the patient (for example, in the conditions of extension of a backbone).
For detection of pathology from soft fabrics MRT can be appointed. For assessment of pathological changes from bone structures of the patient can direct to a computer tomography.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Treatment of kifoz is more often conservative, includes LFK for strengthening of a muscular corset of a back, massage and physiotherapy. Manual therapy is shown to some patients. Carrying corsets is appointed mainly for reduction of a pain syndrome. However constant use of corsets in most cases is not recommended as in itself they do not correct a bearing and, besides, can become the reason of weakening of muscles of a back with the subsequent aggravation of a kifoz.
The indication to surgical intervention is:
- Resistant pain syndrome which does not manage to be eliminated with conservative methods.
- Bystry progressing of a kifoz, especially – followed by neurologic violations, and also dysfunction of lungs and hearts.
- The cosmetic defect significantly reducing quality of life of the patient and interfering performance of professional duties.
The operation purpose – whenever possible to correct a bend angle of a backbone and to stop deformation progressing, and also to eliminate a compression of nervous trunks and to protect them from damages to the future. Surgeries on a backbone belong to the category of difficult, large-scale interventions and are carried out under the general anesthesia only after full inspection of the patient. Sometimes achievement of desirable result requires several operations.
For fixing of a backbone various designs made of inert metals are used (the titan, a nikelid of the titan). They do not cause reaction of rejection and can be in an organism without consequences for many years.