Scoliosis – a resistant curvature of a backbone sideways concerning the axis (in the frontal plane). All departments of a backbone therefore the curvature in the perednezadny direction (strengthening of physiological bends) and twisting of a backbone joins a side curvature in the subsequent are involved in this process. In process of progressing of scoliosis there is a secondary deformation of a thorax and a basin which is followed by dysfunction of heart, easy and pelvic bodies. The curvature is formed at children's and teenage age. Scoliosis can develop owing to injuries, various diseases and congenital anomalies. In 80% of cases the cause of scoliosis remains unspecified. Treatment can be both conservative, and quick. The forecast depends on the reason and degree of scoliosis, and also existence and expressiveness of secondary deformations and a condition of internals.
Scoliosis is the difficult permanent deformation of a backbone which is followed first of all a curvature in the side plane with the subsequent twisting of vertebras and strengthening of physiological bends of a backbone. When progressing scoliosis deformation of a thorax and bones of a basin with the accompanying malfunction of bodies of a chest cavity and pelvic bodies develops.
The most dangerous periods concerning development and progressing of scoliosis are stages of intensive growth: from 4 to 6 years of years and from 10 to 14 years. At the same time it is necessary to be especially attentive to health of the child at a stage of puberty which at boys happens in 11-14 years, and at girls in 10-13 years. The risk of aggravation of skoliotichesky deformation increases when by the beginning of these periods the child already has radiological a confirmed first degree of scoliosis (to 10 degrees).
Scoliosis should not be confused to usual violation of a bearing. Violation of a bearing can be corrected by means of usual physical exercises, training in the correct landing at a table and other similar actions. Scoliosis demands special complex systematic treatment during the entire period of growth of the patient.
Classification of scolioses
There are several classifications of scoliosis.
It is possible to allocate two big groups: structural scoliosis and nonstructural scoliosis. Unlike structural, at nonstructural the usual side curvature of a backbone which is not followed by permanent pathological rotation of vertebras is observed.
Taking into account the development reasons nonstructural scolioses share on:
- Osanochny scolioses – the bearings which arose owing to violation disappearing at inclinations of a kpereda and carrying out a X-ray analysis in lying situation.
- Reflex scolioses – caused by the compelled patient's pose at a pain syndrome.
- Compensatory scolioses – arisen owing to shortening of the lower extremity.
- Hysterical scolioses – have the psychological nature, meet extremely seldom.
Structural scolioses are also divided into several groups taking into account an etiologichesky factor:
- Traumatic scolioses – caused by injuries of the musculoskeletal device.
- Cicatricial scolioses – arisen owing to rough cicatricial deformations of soft fabrics.
- Miopatichesky scolioses – caused by diseases of muscular system, for example, a myopathy or the progressing muscular dystrophy.
- Neurogenetic scolioses – arising at a neurofibromatosis, a siringomiyeliya, poliomyelitis etc.
- Metabolic scolioses – caused by violations of exchange and shortage of certain substances in an organism, can develop, for example, at rickets.
- Osteopathic scolioses – the development of a backbone which arose owing to congenital anomaly.
- Idiopathic scolioses – the reason of development cannot be revealed. Such diagnosis is exposed after an exception of other causes of scoliosis.
Taking into account emergence time idiopathic scolioses are subdivided on:
- Infantile scolioses – the lives which developed in 1-2 years.
- Juvenile scolioses – the lives which arose between 4-6 years.
- Teenage (adolestsentny) scolioses – the lives which appeared between 10 and 14 years.
In a curvature form all scolioses are divided into three groups: With-shaped (one side bend), S-shaped (two side bends) and Z-shaped (three side bends). The last option meets extremely seldom.
Taking into account the location of a curvature of a backbone allocate:
- Cervicothoracic scolioses (with curvature top at the level of III-IV chest vertebras).
- Chest scolioses (with curvature top at the level of VIII-IX chest vertebras).
- Grudo-poyasnichnye scolioses (with curvature top at the level of XI-XII chest vertebras).
- Lumbar scolioses (with curvature top at the level of I-II lumbar vertebras).
- Lumbar and sacral scolioses (with curvature top at the level V lumbar and the I-II sacral vertebras).
And, at last, taking into account a current allocate the progressing and not progressing scolioses.
Reasons of development of scoliosis
Scoliosis concerns to group of the deformations arising during growth (that is, in the childhood and youth). In the classification given above the set of the reasons of development of scoliosis is listed. However idiopathic scoliosis – that is, scoliosis with the unspecified reason is in the first place on prevalence with a big separation. It makes about 80% of total number of cases. At the same time girls have scoliosis 4-7 times more often than boys.
In the remained 20% of cases scoliosis owing to congenital deformations of a backbone, exchange violations, diseases of connecting fabric, severe injuries and amputations of extremities, and also a considerable difference in length of legs most often comes to light.
Symptoms and clinical diagnosis of scoliosis
Early diagnosis of scoliosis has special value for efficiency of the subsequent treatment, compensation of violations and normal development of the child. At the same time at initial stages scoliosis proceeds asymptomatically therefore it is necessary to pay attention to the following signs:
- One shoulder costs above another.
- When the child costs, having pressed hands to sides, the distance between a hand and a waist differs from two parties.
- Shovels are located asymmetrically – on the concave party the shovel is closer to a backbone, its corner sticks out.
- At an inclination of a kpereda there is noticeable a backbone curvature.
At identification of the listed symptoms of scoliosis it is necessary to address the children's orthopedist that he conducted detailed examination and at confirmation of the diagnosis appointed the corresponding treatment.
The classification of scolioses developed by Chaklin and which is used in the territory of Russia was made taking into account both clinical, and radiological signs therefore it is possible to be guided by it at identification of symptoms of a disease. It includes 4 degrees:
1 degree – a corner to 10 degrees. The following clinical and radiological signs are defined: a sutulovatost, the hung head, an asymmetric waist, different height of nadplechiya. In x-ray pictures – an easy tendency to a torsiya of vertebras.
2 degree – a corner from 11 to 25 degrees. The curvature of a backbone which is not disappearing when changing position of a body comes to light. A half of a basin on the party of a curvature is lowered, the triangle of a waist and contours of a neck of an asimiyetrichna, in chest department on the party of a curvature is available protrusion, in lumbar – the muscular roller. On the roentgenogram – a torsiya of vertebras.
3 degree – a corner from 26 to 50 degrees. In addition to all symptoms of scoliosis characteristic of the 2nd degree, there are noticeable sticking-out forward costal arches and accurately outlined costal hump. Muscles of a stomach are weakened. Muscular contractures and sticking of edges are observed. In x-ray pictures – sharply expressed torsiya of vertebras.
4 degree – a corner more than 50 degrees. Sharp deformation of a backbone, the signs above and above listed are strengthened. A considerable muscle strain in the field of a curvature, a costal hump, sticking of edges in a concavity zone.
Inspection of the patient having scoliosis in the conditions of medical establishment includes detailed survey in a standing position, sitting and lying for identification of the listed above signs.
In a standing position measurement of length of the lower extremities is taken, mobility of talocrural, knee and coxofemoral joints is defined, it is measured , mobility of lumbar department of a backbone and symmetry of triangles of a waist is estimated, the provision of nadplechiya and shovels is defined. Also the thorax, area of a stomach, a basin and a waist is examined. The muscular tone is estimated, muscular rollers, deformation of edges etc. come to light. In the provision of bending existence or lack of asymmetry of a backbone is defined.
In a sitting position measurement of length of a backbone and definition of degree of a lumbar lordoz is taken, side curvatures of a backbone and a deviation of a trunk come to light. Assessment of provision of a basin regardless of position of the lower extremities is made. In a prone position change of a curvature of an arch of a backbone is estimated, muscles of a stomach and internals are investigated.
X-ray analysis and other methods of a research at scoliosis
The main tool method of diagnosis of scoliosis of a backbone is the backbone X-ray analysis. At suspicion on a skoliotichesky curvature it is necessary to conduct a x-ray research at least 1-2 times a year. Primary roentgenogram can be carried out in a standing position. In the subsequent x-ray pictures are carried out in two projections in a prone position with moderate extension – it gives the chance to estimate true deformation.
When studying roentgenograms of patients with scoliosis measurement of corners of a curvature with use of the special technique offered by Kobb is taken. To calculate a curvature corner, apply two lines passing parallel to switching plates neutral on the direct roentgenogram (which are not participating in a curvature) the vertebras, and then measure the corner formed by these lines.
Besides, in a x-ray picture at scoliosis reveal the following features:
- The basal not bent vertebras which are the basis for the bent part of a backbone.
- The culmination vertebras located on the highest point of an arch of a curvature (as the main, and secondary if it is).
- Sloping vertebras which are in places of transition between the main curvature and an anticurvature.
- The intermediate vertebras located between sloping and culmination vertebras.
- Neutral vertebras – not deformed vertebras which are not participating in process of a side curvature.
If necessary carry out pictures in special laying for measurement of a torsiya (twisting along a vertebra body axis) and rotation (a turn of vertebras from each other). The torsion corner also pays off by one of two special techniques: Nash and Mo or Raymondi.
During the rapid growth periods the research of a backbone needs to be conducted more often therefore for decrease in a dose of x-ray radiation not beam harmless techniques are used, including – a three-dimensional research an ultrasonic or contact sensor, svetooptichesky measurement of a profile of a back and a skoliometriya across Bunnell.
Perhaps also performance of pictures with small radiation (with the reduced radiation time). Fine details in such pictures are not looked through, but on them it is possible to take measurement of a corner of a curvature at scoliosis. If necessary for identification of the reason of development of scoliosis backbone MRT can be also carried out.
Treatment of scoliosis
Patients with scoliosis have to be observed at the skilled orthopedic surgeon or a vertebrolog well familiar with this pathology. Possible bystry progressing and impact of a curvature on a condition of internals demands adequate treatment, and also, if necessary – the directions to other experts: to pulmonologists, cardiologists etc. Treatment of scoliosis can be both conservative, and quick, depending on the reason and expressiveness of pathology, existence or lack of progressing. Anyway – it is important that it was complex, constant, timely.
At the scolioses caused by trauma consequences, shortenings of extremities and other similar factors it is necessary to remove the cause first of all. For example – to use special insoles or orthopedic footwear for compensation of a difference in length of extremities. At neurogenetic and miopatichesky scolioses conservative therapy is, as a rule, ineffective. Surgical treatment is required.
Conservative treatment of idiopathic scolioses includes special anti-scoliotic gymnastics and use of corsets. At curvature coal to 15 degrees for lack of rotation the specialized gymnastics is shown. At coal of a curvature of 15-20 degrees with the accompanying rotation (at patients with incomplete growth) add a korsetoterapiya to gymnastics. Use of corsets is possible as soon as at night, and is constant – depending on recommendations of the doctor. If growth came to the end, the corset is not necessary.
At the progressing scoliosis with a corner more than 20-40 degrees hospitalization in the conditions of specialized vertebrologichesky clinic is shown. If growth is not complete, constant carrying a derotiruyushchy corset (not less than 16 hours a day, it is optimum – 23 hours a day) in combination with intensive gymnastics is recommended. After completion of growth the corset, as well as in the previous case, is not required.
At coal more than 40-45 degrees expeditious treatment, as a rule, is required. Indications to operation are defined individually and depend on the reason of development of scoliosis, age of the patient, his physical and psychological state, a look and localization of deformation, and also efficiency of conservative methods of treatment.
Scoliosis operation represents straightening of a backbone to a certain corner with use of metal designs. At the same time the department of a backbone which underwent surgery is immobilized. Special plates, cores, hooks and screws are applied to fixing of a backbone. For expansion of vertebras, giving to a backbone of more correct form and improvement of consolidation bone transplants in the form of inserts are used. Operation on correction of scoliosis can be performed transtorakalno, dorsalno and by a torakofrenolyumbotomiya.
Scoliosis and army
Young men with scoliosis of the I degree (a curvature from 0 to 10 degrees) are subject to conscription. Existence II and subsequent degrees of scoliosis confirmed with the radiologist on the basis of the roentgenograms executed during special medical examination is the basis for release from an appeal.