Backbone curvature – violation of the correct configuration of a spine column. Can be direct or side. Normal the backbone has small bends in the perednezadny direction. If the size of these bends is beyond normal indicators, speak about a pathological lordoz or a kifoza. Side curvatures at a backbone normal are absent if such curvature is, the diagnosis scoliosis is exposed to the patient. The congenital curvature of a backbone arises owing to malformations, acquired can be formed at poliomyelitis, paralyzes, rickets, some other diseases and the wrong bearing. The diagnosis is established on the basis of results of survey and data of a X-ray analysis, if necessary additional researches are appointed (MPT, KT and others). Treatment includes LFK, massage, physical therapy and carrying corsets. In hard cases operations are performed.
Backbone curvature – the widespread pathology arising mainly at children's and youthful age. Allocate a pathological curvature of a spine column of a kpereda (), kzad () and a side curvature (scoliosis). Also combined pathology – is possible. At unsharply expressed violations working capacity remains, the considerable curvature of a backbone becomes the reason of disability and exerts negative impact on work of internals. Orthopedists, traumatologists and vertebrolog are engaged in treatment of curvatures of a backbone.
The congenital curvature of a backbone arises owing to anomalies of development of a skeleton, the most widespread of which are wedge-shaped vertebras, an underdevelopment of vertebras, a congenital wryneck and additional vertebras. The acquired curvature of a backbone can develop owing to rickets, poliomyelitis, pleurisy, the acquired or congenital difference in length of legs more than 2-4 cm, a cerebral palsy, tuberculosis, tick-borne encephalitis, spastic paralysis, a siringomiyeliya, injuries, amputations, exchange violations, a syndrome of hyper mobility of joints, tumors, Sheyermana-Mau's disease, some other diseases and the wrong bearing. About 80% of skoliotichesky curvatures arise for the unknown reason.
Normal the human backbone has no side curvatures. In the presence even the minimum side bend the diagnosis scoliosis is exposed. As a rule, the disease arises in the childhood and especially actively progresses during the rapid growth periods. Taking into account time of a demonstration allocate infantile scoliosis (arises on 1-2 year of life), juvenile scoliosis (develops at the age of 4-6 years), teenage scoliosis (arises at the age of 10-14 years). Depending on a form of a curvature of a backbone distinguish With-shaped scolioses (one arch of a curvature), S-shaped (two arches), Z-shaped (three arches).
Taking into account a corner of a side curvature of a backbone allocate 4 degrees of scoliosis: 1 degree – a corner of 1-10 degrees, the 2nd degree – a corner of 11-25 degrees, the 3rd degree – a corner of 26-50 degrees, the 4th degree – a corner more than 50 degrees. Taking into account localization of a curvature of a backbone distinguish thoracic scoliosis (a pathological bend in chest department), lyumbalny scoliosis (a curvature in lumbar department), torakolyumbalny scoliosis (one pathological bend in the field of grudopoyasnichny transition) and the combined scoliosis (a double S-shaped bend).
The expressed deformations are visible at any position of a body, the insignificant curvature of a backbone comes to light at the patient's inclination forward. At the same time the doctor estimates symmetry of the backbone and other structures: hips, shovels and edges. For more exact definition of an angle of deformation the backbone X-ray analysis is carried out. Pictures are analyzed by a special technique, at the same time not only the corner of a side curvature, but also degree of a torsiya (turn) and rotation (twisting) of vertebras is considered.
During the periods of active growth when perhaps bystry progressing of scoliosis, pictures with low radiation are carried out, not beam techniques are applied: a research an ultrasonic or contact sensor, svetooptichesky measurement and a skoliometriya across Bunnel. Such approach allows to lower the general dose of radiation. The considerable curvature causes secondary deformations of a thorax, leads to reduction of volume of an abdominal cavity, violation of an arrangement and deterioration in function of internals therefore patients with the expressed scoliosis have to undergo regularly necessary inspections and consultations of the pulmonologist, gastroenterologist and cardiologist. All patient appoint spirometry. According to indications carry out the ECG, MRT of a backbone and other researches.
Treatment of side curvatures of a backbone can be conservative and quick. Programs of conservative therapy include specially developed LFK complexes, respiratory gymnastics (on Meal or similar programs), corsets, reklinator, physiotherapeutic procedures and massage. At the angle of deformation to 15 degrees the specialized gymnastics is appointed. Exercises are selected individually, in an initial stage they should be carried out under control of the instructor to master the correct equipment. The gymnastics purpose – strengthening of muscles of a back, creation of a good muscular corset.
At coal of a curvature of a backbone of 15-25 degrees of occupation of LFK are supplemented with carrying corsets. At the same time at coal to 20 degrees the corset should be used at night, and at coal more than 20 degrees – the most part of day and night (not less than 16 hours a day). Corrective corsets of Milwaukee, Sheno and their analogs are applied. The term of carrying makes of 6 months and more. In process of growth of the child and reduction of deformation corsets replace. Corrective devices allow to eliminate not only a side and perednezadny curvature, but also rotation of a backbone. To adult patients recommend to use the supporting corsets and reklinator.
Medical massage at scoliosis promotes strengthening of muscles of a back, normalization lympho-and blood circulations. The course of treatment consisting of 15-20 sessions is carried out by 2-3 times a year. Besides, to patients appoint balneotherapy, heattreatment (paraffin, ozokerite) and electrostimulation.
Indications to scoliosis operation are defined individually and depend on age of the patient, a look and localization of a curvature and some other factors. At the same time the standard criteria of need of surgical treatment are a curvature of 45-70 degrees at measurement across Kobbu in combination with inefficiency of conservative treatment, a persistent pain syndrome, steady progressing of scoliosis, dysfunction of lungs and heart. Operations on Chaklin, Tsilke, Dyubusse, Harrington and others are applied.
The essence of all surgical techniques consists a conclusion and deduction of a backbone in the correct situation by means of metal designs. At the same time the fixed department of a backbone loses mobility. Surgical interventions are carried out from forward or back access. For fixing of a backbone use metal cores which fasten to vertebras screws or hooks. In the subsequent there comes the union of the fixed vertebras in the uniform block.
Pathological – strengthening of a chest bend of a backbone (the corner of a curvature exceeds 15 degrees). It is shown in the form of stoop, a round back, in hard cases – a hump. Because of an excessive curvature of a backbone the thorax is narrowed, the diaphragm falls from top to bottom, the top part of a trunk bends forward, shoulders fall. Long existence of a kifoz can become a cause of destruction of intervertebral disks, wedge-shaped deformation of vertebras, dysfunction of muscles of a back and an abdominal tension. At the expressed pathology violations of work of heart and lungs are possible.
Distinguish a set of types of a kifoz, including congenital (owing to anomalies of development of a backbone), genotipicheskiya (descended), mobile (arising because of weakness of muscles of a back), senile (caused by degenerate and dystrophic changes of a backbone), total (at Bekhterev's disease), compression (arising owing to compression fractures of vertebras), the rachitic, tubercular, paralytic and formed at a disease Sheyermana-Mau. Taking into account the size of deformation distinguish 4 degrees of a pathological kifoz: 1 degree – a corner of a curvature of 31-40 degrees, the 2nd degree – 41-50 degrees, the 3rd degree – 51-70 degrees, the 4th degree – more than 71 degree.
The diagnosis is established taking into account external signs and data of a X-ray analysis. If necessary it is in addition appointed backbone MPT and KT. In the presence of neurologic violations consultation of the neurologist is shown, at suspicion on dysfunction of lungs and heart – consultation of the pulmonologist and cardiologist. Medical tactics depends on the reason of a curvature of a backbone, degree of a kifoz, age of the patient, his state and other factors. At 1-2 degree of a kifoz the program of complex conservative therapy including LFK, massage, respiratory gymnastics, physiotreatment, mud cure and reflexotherapy is formed.
At 3-4 degree, dysfunction of internals, the expressed pain syndrome, bystry progressing of a curvature of a backbone, major cosmetic defect and existence of the expressed neurologic violations surgeries are performed. Surgical treatment consists in correction of a bend with use of the special metalwork fixed on vertebras by hooks or screws. In certain cases for achievement of desirable effect it is necessary to carry out several backbone operations.
Pathological – strengthening (is more rare – easing) a bend of a backbone of a kpereda. It is usually formed at the same levels, as physiological (in lumbar and cervical departments), less often formed in chest department. Depending on the reason of development allocate primary and secondary pathological lordoz. Primary arises owing to pathological process in a backbone: at tumors, malformations, spondilolisteza, the torsion spasm and contractures of a podvzdoshno-lumbar muscle. Secondary (compensatory) is formed at pathology of the lower extremities: congenital dislocation of a hip, anchylosis of a coxofemoral joint, contractures of the lower extremity. The most widespread – owing to a dysplasia of a coxofemoral joint or congenital dislocation of a hip.
As well as other types of curvatures, this deformation influences position of a trunk and internals. Flattening of a thorax and protrusion of a stomach is noted. The head and shoulders are put forward kpered. Because of redistribution of loading at a pathological lordoz the backbone, muscles and ligaments of a back experience the raised strain that is shown by pains, increased fatigue and violation of mobility. At the expressed curvature of a backbone formation of intervertebral hernias, instability of intervertebral disks, the deforming arthrosis of joints of a backbone, an inflammation of a podvzdoshno-lumbar muscle, violation of work of digestive tract, kidneys, lungs and heart is possible.
The diagnosis is exposed taking into account data of survey and a X-ray analysis. If necessary KT, MPT and other researches are carried out, consultations of the gastroenterologist, the cardiologist, the pulmonologist, the urologist or the nephrologist are appointed. Tactics of treatment depends on the reason and degree of a curvature of a backbone, age of the patient, state of his health and other factors. The medical events directed to elimination of the reason of deformation are whenever possible held. The LFK complex, massage and physical therapy is appointed. Recommend to some patients carrying a bandage.