Juvenile idiopathic scoliosis: what is the essence of the disease?

Scoliosis is considered the most common among spinal diseases in childhood and adolescence. Depending on the causes of occurrence, the pathology is divided into several types, but there is a type of scoliosis, the origin of which has not been identified. It is called idiopathic and accounts for almost 80% of all cases of the disease. How does idiopathic scoliosis manifest at a young age, how dangerous is it to health, and what is its treatment?

Idiopathic scoliosis at a young age

Features of the disease

Most often, the development of idiopathic scoliosis occurs during periods of active growth of the body - from 5 to 7 years and approximately 10-14 years. Moreover, this pathology is observed much more often in girls than in boys. Depending on the age at which the disease is diagnosed, scoliosis is divided into three types:

• infantile – occurs in children under 3 years of age, often heals on its own;
• pediatric – the age of patients varies between 3-10 years. This variety is less common than others and, as a rule, is a consequence of untreated infantile scoliosis;
• juvenile, or teenage – diagnosed at the age of 10-14 years and is considered the most common type of idiopathic scoliosis.

Most often, idiopathic scoliosis is diagnosed in girls 10-14 years old.

The thoracolumbar region is usually affected, although in some cases the curvature may affect other parts of the spine. The disease occurs without any obvious cause, and during the examination of children, not the slightest disturbance in the internal organs and systems is detected, that is, most patients are completely healthy.

In its manifestations, idiopathic scoliosis does not differ from other forms of this disease. A typical symptom is a gradual deviation of the spine from its axis to the left or right side, with the formation of a secondary compensatory arch. Subsequently, torsion of the vertebrae occurs, the deformation increases, and a rib hump is formed. But, compared to other types of scoliosis, the idiopathic form develops more intensively and is almost always characterized by rapid progression and severe course of the disease.

Idiopathic scoliosis develops faster than other forms and is more severe

Although the cause of development has not yet been identified, the factors that provoke the occurrence of idiopathic scoliosis are well known. These include:

• sitting for a long time in one position - at a desk at school, at home at the computer;
• diseases in which the child must remain in bed for a long time, which leads to weakening of the muscle corset;
• poor nutrition, which affects metabolic processes in bone and cartilage tissue;
• excessive stress on the spine, for example, carrying a heavy briefcase.

A heavy school bag can cause problems with the spine, which is not yet strong enough and is not ready for constant stress.

If one or more of these factors is present, the risk of scoliosis increases significantly.

Orthopedic briefcases

Bibliography:

1. Dr. Miguel B. Royo Salvador (1996), Siringomielia , escoliosis y malformación de Arnold-Chiari idiopáticas, etiología común (PDF). REV NEUROL (Barc); 24 (132): 937-959.
2. Dr. Miguel B. Royo Salvador (1996), Platibasia , impresión basilar, retroceso odontoideo y kinking del tronco cerebral, etiología común con la siringomielia , escoliosis y malformación de Arnold-Chiari idiopáticas (PDF). REV NEUROL (Barc); 24 (134): 1241-1250
3. Dr. Miguel B. Royo Salvador (1997), Nuevo tratamiento quirúrgico para la siringomielia , la escoliosis , la malformación de Arnold-Chiari , el kinking del tronco cerebral, el retroceso odontoideo, la impresión basilar y la platibasia idiopáticas (PDF). REV NEUROL; 25 (140): 523-530
4. M. B. Royo-Salvador, J. Solé-Llenas, J. M. Doménech, and R. González-Adrio, (2005) “Results of the section of the filum terminale in 20 patients with syringomyelia , scoliosis and Chiari malformation .” (PDF). Acta Neurochir (Wien) 147:515–523.
5. M. B. Royo-Salvador (1992), “Aportación a la etiología de la siringomielia ,” Tesis doctoral (PDF). Universidad Autónoma de Barcelona.
6. M. B. Royo-Salvador (2014), “Filum System® Bibliography” (PDF).
7. M. B. Royo-Salvador (2014), “Filum System® Guía Breve.”

Characteristic manifestations

For a long time, idiopathic scoliosis develops asymptomatically. The child does not feel discomfort or pain, his mobility remains normal, and a slight curvature can only be noticed by accident. But when the pathology passes from the first degree to the second, that is, the angle of curvature increases to 11-30 degrees, external changes are already clearly visible.

When the angle of curvature exceeds 10 degrees, external signs of scoliosis are clearly visible

Typical signs of idiopathic scoliosis:

• in a standing position, there is a distortion of the pelvis and shoulders;
• the shoulder blades are located asymmetrically, one protrudes more than the other;
• When the body is tilted, a noticeable bulge is formed on one side of the back, and the vertebrae appear unevenly.

Characteristic manifestations of scoliosis are pronounced asymmetry of the shoulder blades, shoulders, pelvic distortion

In the future, if treatment is not started, the deformation will intensify and affect the internal organs: with severe curvature, the lungs, stomach, and liver are displaced and compressed, which causes a disruption in the functioning of these organs. In the spine itself, nerve fibers and blood vessels are pinched, wear of the intervertebral discs accelerates, and inflammatory processes occur. At this stage, the child suffers from back pain, dizziness, headaches, and mobility is significantly limited.

Progressive scoliosis causes persistent pain in the spine

Why is idiopathic scoliosis dangerous? In the initial stage there is no threat to health, but as soon as the disease becomes more severe, the following complications may occur:

Symptoms

The following signs will indicate the development of this pathology:

Back corsets for scoliosis

• visually it seems that the legs are of different lengths (although this is not the case);
• the shoulders are at different heights, that is, not horizontal relative to each other;
• flat feet (by the way, it can provoke various diseases of the musculoskeletal system, including juvenile idiopathic scoliosis);
• leg pain;
• the physiological deflection of the spinal column in the chest area increases significantly;
• the physiological deflection in the lumbosacral area is smoothed;
• feet have different sizes;
• asymmetry of the blades;
• one half of the back in the chest area is more convex.

The last two signs are usually noticed only at an appointment with a specialist. The rest are quite clearly visible to both households and strangers. If idiopathic scoliosis is severe, then it is accompanied by heart failure, partial loss of tactile sensations due to poor nerve conduction, problems with the digestive tract, proliferation of connective tissue in the lungs due to compression exerted on them, and edema.

Diagnosis and treatment of idiopathic scoliosis

Diagnosis is performed using radiography in several projections. Due to the high degree of protection from x-ray radiation that modern equipment is equipped with, the procedure is absolutely safe for children. The image allows you to accurately assess the degree of deformation, the condition of bones and intervertebral discs, and identify possible pathologies of tissues adjacent to the spine.

Diagnosis of idiopathic scoliosis is carried out using radiography

The difficulty of treating idiopathic scoliosis is largely due to the absence of a clear cause of the disease. Very often, conservative methods are ineffective, and the pathology steadily progresses, even with the complete elimination of provoking factors. That is why the prognosis is not always favorable, especially if scoliosis is diagnosed too late.

Conservative techniques

The use of conservative treatment methods is advisable for grades 1 and 2 of curvature. When diagnosing grade 3, the chances of success are significantly reduced, and in some cases it is necessary to resort to surgical intervention. Stage 4 idiopathic scoliosis can only be cured surgically.

Table. Methods of conservative treatment of juvenile scoliosis

Physiotherapeutic devices

Swimming is also very often prescribed as a treatment. Classes in the pool are conducted under the supervision of an instructor who selects exercises taking into account the degree of deformation. Swimming has an excellent therapeutic effect, especially in combination with these techniques.

As part of complex therapy, swimming gives excellent results for scoliosis at a young age.

Drug treatment is also used, but only to eliminate the symptoms of the disease. It is impossible to cure idiopathic scoliosis with medications, like other forms of spinal curvature. With the help of medications, back pain, muscle spasms, swelling and inflammation caused by pinched roots are eliminated. All medications, their dosages and duration of use are selected by the attending physician.

Medicines for scoliosis

Surgery

Corrective corset for the spine

Spinal surgery is quite complex and dangerous, since there is a high risk of damage to the spinal cord. For patients at a young age, the indications for such an operation are quite limited:

• rapid progression of the disease;
• the curvature is greater than 40-45°; development of pulmonary or heart failure due to scoliosis;
• serious neurological complications;
• severe pain that is not relieved by medications.

During the operation, the vertebrae are fixed with special devices, thanks to which the spinal column returns to its normal position. After such treatment, the patient requires long-term rehabilitation.

Instrumental methods

Prevention of scoliosis

Due to the fact that the causes of idiopathic scoliosis are unknown, prevention of the disease does not provide a 100% guarantee, but still allows you to reduce the risk of its occurrence to a minimum. The main condition is constant control of posture, and this primarily concerns parents. From a very young age, a child should be taught to hold his back straight, sit correctly at the table, and devote more time to physical activity. It is very important to select the height of the chairs and table at which the child studies, as well as the mattress and pillow for sleeping.

While sitting, your posture should be correct

Orthopedic chairs

Diet is no less important: for the normal formation of the skeleton, meals high in vitamins (especially group B), as well as calcium, phosphorus and other microminerals are needed. A lack of nutrients during the period of active growth will subsequently negatively affect the condition of bone and cartilage tissue.

Causes

– According to generally accepted theories:

Scoliosis occurs due to imbalance of the back muscle mass, ligament abnormalities, incorrect posture/posture, reaction of the spine to gravity or muscle tension, inborn error of metabolism, neurological disorders, etc.

– According to the Filum System® sanitary method:

Idiopathic scoliosis results from an avoidance or compensation mechanism in the spine in response to spinal cord tension. This tension occurs due to the tension of the terminal filament, which is difficult to see in the photographs. For the same reason, other idiopathic disorders of the spine occur: hyperkyphosis, hyperlordosis, straightening of cervical and lumbar lordosis, straightening of thoracic kyphosis, rotation of the vertebrae (rotoscoliosis), inversion of the natural curves of the spine.

Rehabilitation period

After surgical treatment, the patient returns to normal life. You can get up and walk the next day after surgery. The rehabilitation period is shortened to 6 months in adolescents, since their spinal column quickly recovers. In adults, it lasts about a year and requires regular gymnastics and exercise therapy. Most people who have surgery to correct scoliotic deformity quickly adapt to their new lifestyle. Minor restrictions in flexibility do not interfere with their daily activities and do not cause any discomfort.