Spinal diseases (osteochondrosis, scoliosis) and their treatment

Scoliosis is an abnormal curvature of the spine. When viewed from the front, scoliosis causes the spine to deviate to the side, and each vertebra involved also twists. This twisting is called rotoscoliosis. This may cause one shoulder to appear higher than the other or one side of the chest or lower back to become more prominent (hunchbacked). If there is both a lateral curvature and an increase in the outer curvature of the upper back, the condition is called kyphoscolysis. This deformity occurs in children with neuromuscular diseases. Curvature with a right-sided prominence is called dextroscoliosis, and with a left-sided one - levoscoliosis. Typically, children with idiopathic scoliosis (of unknown cause) have two lateral curves in opposite directions, but they may not be the same size or severity. Treatment of scoliosis depends on the cause of the deformity and the severity of the geometry violation and can be either conservative or surgical.

Types of Scoliosis

There are several types of scoliosis, classified by age of onset and/or cause. These include the following:

• Congenital scoliosis is detected at birth and is caused by improper intrauterine formation of the vertebrae. Part of a vertebra may be missing or there may be a wedge deformity and/or abnormal bony bridges between two or more vertebrae.
• Infantile scoliosis occurs in patients younger than 3 years of age. This type of scoliosis is more common in boys and may disappear spontaneously without treatment. Typically, this type of scoliosis has less of a rotational component than other types.
• Juvenile scoliosis occurs in children aged 3-10 years. This type of scoliosis is more common in girls than boys and is the most at risk of progression of all types, especially girls.
• Idiopathic scoliosis is the most common type of scoliosis. This type of deformity is observed in children aged 11 to 16 years. This type is also more common in girls, and they are at higher risk of progression of the curvature. The term idiopathic refers to any health condition that occurs spontaneously, without a known cause.
• Neuromuscular scoliosis is caused by a number of pathological conditions that affect the nervous or muscular systems. These conditions may include: cerebral palsy, muscular dystrophy, metabolic diseases, and connective tissue disorders such as Marfan syndrome. The age of onset of scoliosis varies and depends on the pathological processes of the underlying disease.
• Acquired scoliosis in adults is caused by degenerative changes and this type of scoliosis occurs in patients over 18 years of age.

Main contraindications

Certain diseases require initial treatment. They are not an absolute contraindication, but even in this condition the procedure cannot be performed. The chiropractor should take this into account and refer to more specialized specialists.

Attention!!! The main age-related contraindication to manual treatment of the spinal column is age under 3 years.

Such prohibitions include:

1. Infectious diseases. Poliomyelitis and tuberculosis have a particular negative impact on the spinal column. However, even ordinary flu accompanied by an increase in body temperature can become a temporary contraindication to therapy.
2. Traumatic back injuries. Often, in childhood and adulthood, due to certain blows or falls, curvature of the spine is observed. Such consequences usually require surgical intervention.
3. Neoplasm of soft and hard tissues. Tumors in the back area can be either benign or malignant. Massage and other types of mechanical influence in this case are absolutely contraindicated.
4. Childhood. Such therapy is prohibited for children under the age of 5-7 years. This is due to the fact that the musculoskeletal system is subject to severe deformation during this period. Frail cartilage tissue can change in a negative direction, without the possibility of recovery in the future.
5. Pathologies of the cardiovascular system. A mandatory ban is imposed in the presence of severe hypertension, atherosclerosis, or a history of stroke or heart attack.
6. Intervertebral hernia. This problem is a certain neoplasm. Even a careless movement can lead to complications, including the formation of disability. Manual therapy in this case will be a very dangerous method of treatment. A herniated disc is usually repaired surgically.
7. 4th degree of scoliosis. This is an already advanced form of the disease. The spine has a serious angle of curvature, which cannot be corrected only by applying pressure with one hand. However, this is only a relative contraindication.
8. Osteophytes on vertebral segments. Such a formation is a growth on bone tissue as a result of various injuries and damage to the spine. If manual manipulation is carried out, the growths can increase and negatively affect the nerve trunks.
9. Osteoporosis. This pathology is usually observed after 40 years of life. Of course, the disease is expressed differently in everyone. As a result of the damage, the bones become brittle, and even a slight application of force can contribute to the occurrence of a fracture.
10. Spinal cord compression. It usually manifests itself as disruption of the brain and changes in the sensitivity of the limbs. With mechanical impact on the area of ​​the spinal column, compression of the brain may increase. As a result, clinical symptoms and the course of the underlying disease worsen.

The success of manual therapy is most noticeable in grade 1 scoliosis. After 2-4 sessions, all segments take their original position. The pain reaction and limitation of movements are significantly reduced. With scoliosis of 2 degrees, noticeable changes occur after 10 sessions. This is a full course of impact. More severe spinal lesions are a contraindication to manual treatment.

Causes of scoliosis

In most cases, the cause of scoliosis is unknown (and such scoliosis is considered idiopathic).

Non-idiopathic types are usually divided into two groups:

• Non-structural (functional): This type of scoliosis is a temporary condition where the spine is intact. Curvature occurs as a result of another problem (one leg is shorter than the other, muscle spasms due to soft tissue damage, a ruptured disc, or abdominal problems such as appendicitis).
• Structural: In this scoliosis, the spine is altered. This may be due to abnormally formed vertebrae or neuromuscular diseases.

About 30% of children with idiopathic scoliosis have a family history of this deformity, but the exact hereditary (genetic) association is currently unknown.

Risk factors for scoliosis and progression of spinal deformity

Risk factors for idiopathic scoliosis and its progression (increasing curvature) include the following:

• Female
• Family history of scoliosis
• Bone age is significantly less than chronological age
• Progression of curvature despite fixation
• Presence of scoliosis before puberty due to the longer period of time before bone growth is completed.
• Typically, the greatest risk of developing scoliosis occurs two years after the onset of puberty during the rapid growth of adolescents.
• In girls, this is usually within two years of the first menstrual period, usually starting around age 12. Typically, boys begin puberty at age 13.

Etiology and clinical forms of scoliosis 3rd degree

Spinal scoliosis grade 3 is considered idiopathic in 80% of cases. That is, its cause is not reliably determined. In world practice, it is customary to distinguish between time intervals in the course of the disease:

• Idiopathic (infantile) scoliosis is observed between the 1st and 2nd years of the child;
• Idiopathic (juvenile) scoliosis appears at the age of 4-6 years
• Adolescent idiopathic scoliosis develops between the ages of 10 and 14 years and is usually associated with rapid growth of the spinal column due to hormonal changes.

Depending on the location of the deformity in the spine, the following forms are distinguished:

• Thoracic – thoracic spine;
• Lumbar - in the lumbar spine;
• Thoracolumbar - one curvature in the thoracic and the second in the lumbar regions;
• Combined - there are several curvatures that deform the spine into an “S” shape.

It is noteworthy that the diagnosis of “grade 3 scoliosis” can only be established after evaluating x-rays of the spine in accordance with the Cobb method. The method involves drawing two lines that are parallel to the vertebral end plates of the vertebral bodies. At the point of their intersection, the angle is measured.

Symptoms of scoliosis

These signs and symptoms can be found in idiopathic scoliosis:

• The head may be located outside the center of the axis of the spine and pelvis.
• One hip or shoulder may be higher than the other.
• The child may walk swaying.
• Opposite sides of the body may be different.
• Your child may experience back pain or fatigue during activities that require excessive movement of the torso (chest and abdomen).
• One side of the chest or lower back may appear more prominent (hunchbacked).
• The chest may appear flattened on one side, or in girls, one breast may appear smaller than the other.
• The child may develop an uneven waist.

Physical deformities may not be obvious because adolescents are self-conscious about their development and parents cannot see the child's back until he/she is wearing a swimsuit or similar costume.

Symptoms of moderate to severe scoliosis may include:

• Changes when walking. When the spine curves abnormally to the side, it can cause the hips to move asymmetrically, which will change a person's gait. The extra compensation a person makes to maintain balance and symmetry in the hips and legs can cause the muscles to fatigue sooner. A person may also notice that one hand presses against the hip while walking, but the other does not.
• Reduced range of motion. Spinal rotational deformity can increase rigidity, which reduces the flexibility of the spine.
• Labored breathing. If the spine is severely twisted, the ribcage can twist and reduce the space for the lungs to work.
• Cardiovascular problems. Likewise, when the chest is twisted, the reduced distance for the heart can hamper its ability to pump blood.
• Pain. If the curvature becomes severe enough, the back muscles may become more prone to painful spasms. Local inflammation can develop around tight muscles, which can also lead to pain. It is possible that the intervertebral discs and facet joints will also be susceptible to degeneration due to higher loads.
• Decreased self-esteem. This symptom is usually ignored or minimized by outside observers, but it can be an important consideration for people with a noticeable spinal deformity. This is especially true for teenagers who want to fit in with their friends, and the need to wear a corset or the inability to wear tight clothing affects the psychological state.

Diagnostics at the St. Petersburg Medical Center

If signs of scoliosis appear, you should visit an orthopedist or neurologist. If the pathology is diagnosed, the specialist will prescribe effective treatment. The patient is examined, carefully examined in different positions - standing, sitting, lying down. This allows us to most fully identify the characteristic symptoms of the disease.

In a standing position, the patient is measured for the length of each of the lower limbs, the mobility of the joints is objectively assessed, kyphosis is measured, the degree of mobility of the vertebrae in the lumbar region and the symmetry of the waist triangles are checked, and the location of the shoulder girdles and shoulder blades is checked. In addition, the chest, abdominal muscles, lumbar and pelvic areas are examined. Muscle tone is checked, the appearance of muscle ridges, changes in the normal shape of the costal arches, etc. are detected. In a bent position, the symmetry of the spinal line is checked.

In a sitting position, the length of the spine line is measured for the patient and the degree of lumbar lordosis is determined. In this position, it is easier to identify lateral curvatures of the column and abnormal deviations of the torso. After this, the patient is placed on the couch and the distortion of the vertebral arch is checked, the abdominal muscles are examined, and the abdominal organs are examined by palpation.

Diagnostics

Key Components of Scoliosis Diagnosis

There are three key components to consider when diagnosing idiopathic scoliosis:

• Lateral curvature. The lateral curvature of the spine is measured by the Cobb angle. The greater the Cobb angle, the greater the spinal deformity.
• Axial rotation. In addition to the lateral curvature of the spine, there is pathological rotation along the vertical axis. Rotation of the spine can affect the position of the ribs, as well as the rigidity of the spinal column.
• Skeletal maturity. Often assessed by the Risser sign (the amount of calcification at the edge of the apex of the femur), the degree of skeletal maturation is critical in making decisions about the treatment of scoliosis in children and adolescents.
• Understanding these components of a scoliosis diagnosis can help a doctor evaluate the severity of the curve, the likelihood of progression, and what treatment options may be more effective.

Diagnostic methods

• Medical history
  . The doctor talks with the patient and parents and reviews medical records to look for possible conditions that may cause spinal curvature, such as birth defects, injuries, or other disorders that may be associated with scoliosis.
• Physical examination
  : The doctor examines the patient's back, chest, pelvis, legs, and skin. The doctor checks whether the patient's shoulders are at the same level, whether the head is in the center, and whether opposite sides of the body are at the same level. The doctor also examines the back muscles as the patient bends forward to see if one side of the chest is higher than the other. If there is significant asymmetry (difference between opposite sides of the body), the doctor will refer the patient to an orthopedist.
• Radiography
  . This method is the main objective method for diagnosing scoliosis
• Curvature measurement
  : The doctor measures the angle of the curve on the x-ray image. Curvatures exceeding 20 degrees require treatment. In many cases, curvature less than 20 degrees requires only observation.
• MRI
  . This imaging test is indicated for severe scoliosis and for neurological problems (unusual back pain and signs of damage to the central nervous system (brain and spinal cord), such as problems with bowel and bladder control).

Exercise therapy and gymnastics for scoliosis

Exercise therapy is an important link in the treatment of the disease. With its help, correct posture is formed and the muscles of the body are strengthened.

The most effective exercises are:

• We lie on our backs, bend our knees. We lift the bent right leg and bring it to the stomach, then do the same with the left leg.
• We lie on our backs, put our hands behind the back of our heads. We spread and bring our elbows together.
• We lie on our backs, bend our legs at the knees, and place our feet as close to the pelvis as possible. Raise the pelvis, hold in this position for several seconds and return to the starting position.
• We lie on our stomachs, hands at our sides. Inhale, lean on your hands and lift your torso and legs. We return to IP, exhale.
• We lie on our side, on the side where the top of the scoliotic curve is located. We put our hands behind our heads.
• We get on all fours. We raise and extend our left arm forward and at the same time raise and extend our right leg back. We do the same with the right hand and left leg.
• We get on all fours, bend our elbows and do push-ups from the floor.
• We lie on our stomach, put one hand on our chest, the other on the back of our head. We lift the body.
• We lie on our backs, hands at our sides. We raise our hands up, then lower them.

It is strictly not recommended to independently select exercises for daily gymnastics if you have a disease. Only the attending physician can develop an effective and safe set of exercises taking into account the characteristics of your body.

Treatment

Treatment tactics

Depending on the degree of curvature and the degree of progression, the orthopedic surgeon can not only conduct observation, but also prescribe specific treatment.

• If the curvature is less than 25°, no treatment is required and the child can be seen every four to six months for a physical examination and x-rays
• If the curvature is more than 25° but less than 40°, a special brace (scoliosis brace) may be used for treatment. The type and length of the corset depends on the location of the curvature. The corset can cover the area below and above the curvature area.
• Curvature greater than 45° requires consideration of surgical treatment.
• Treatment options depend more on how likely the curve is to get worse rather than the angle of the curvature. A child with a 20° curve who has another 4 years of growth remaining may require treatment, while a child with a 29° curve who has stopped growing may not require active treatment.

Bone age compared to chronological age, as well as monitoring the rate of progression of scoliosis, can help determine treatment options.

The doctor will suggest the most optimal treatment for each patient, depending on the patient's age, how much he can still grow, the degree and structure of the curve, and the type of scoliosis. Your doctor may recommend observation, bracing, or surgery.

Treatment methods

Observation and corseting

About 90% of cases of idiopathic scoliosis are mild and require only observation. Typically, follow-up is carried out by a doctor every 4-6 months until the adolescent reaches full skeletal maturity.

However, a brace may be recommended for the treatment of scoliosis if the following changes in the Cobb angle occur:

• Progression reaches 25 or 30 degrees, while significant skeletal growth remains
• Progress of at least 5 degrees over any 4-6 month period
• If the curvature has become severe or is rapidly progressing, the next step is active treatment.

Cost of treatment for scoliosis in adults

To achieve a beautiful and healthy back, it is necessary to conduct a diagnosis in order to identify the stage of the disease and the appropriate course of treatment.

The sooner you start procedures, the greater your chances of defeating scoliosis.

Book a consultation at our neurology clinic. To do this, you can fill out a special form on the Medical Center website or call. The appointment is conducted by a professor of neurology who has extensive theoretical knowledge and practical experience.

Thus, the price of a course of treatment for curvature of the spinal column (provided that this is not an advanced stage when surgical intervention is necessary) is determined based on the results of consultation and diagnosis.

Corseting parameters

There are two main options for treating scoliosis with braces:

• 24 hours a day. These corsets are designed to be worn 16 to 23 hours a day. The goal is to wear them all the time, with exceptions for swimming, skin care and sports.
• Night fixation. These corsets use hyper-corrective forces and should be worn at least 8 hours a day.

The choice between permanent bracing and overnight bracing may depend on the size and location of the curves, as well as what the patient wants to do. Some studies have found that overnight bracing may be more effective because patients are more likely to wear the brace at night as prescribed, but other studies have found that permanent bracing—if targeted—may work even better.

Initial appointment and examination of the patient

At the initial appointment, the chiropractor prescribes a detailed examination, which is carried out using laboratory and instrumental methods and includes:

• General analysis of urine and blood - to determine inflammation that occurs in an asymptomatic form.
• An electrocardiogram to assess the functioning of the cardiovascular system.
• X-ray or MRI to determine details of the pathology (examination of displaced segments of the spine).

The patient may undergo an X-ray or CT scan, but the results of these diagnostic methods do not provide a complete picture of the condition of the soft tissues and vertebrae.

A comprehensive examination helps to determine the risks for the patient’s physical condition and individually create a health-improving course program (including calculating the number of procedures). The total number of treatment sessions should not exceed 15 procedures within one year, otherwise manual therapy may cause excessive mobility of the vertebrae and joints. This will cause a worsening of the underlying disease (progression of scoliosis).

On the day of your initial appointment with any doctor in our Neurology clinic, you can undergo manual therapy or massage with a 25% discount. This way you can form an objective opinion about the services of our clinic and the quality of work of our specialists. And if after this you decide to pay for the full course of further procedures, you will receive a 10% discount on the course of treatment.

Exercise therapy

Physical exercises are selected taking into account the degree of curvature and are necessary in order to strengthen and balance the back muscles.

In childhood, exercise therapy consists of various types of gymnastics. After reaching 14 years of age, it is possible to engage in physical activity with weights (on exercise machines).

The Schroth technique, created in Germany in 1921, has become quite widespread in various countries around the world in recent years. The physical exercises of this gymnastics focus on the back and torso muscles, as well as breathing techniques that help balance posture and improve lung function. To achieve the desired result, you need to practice this method for a long time. The Schroth technique has proven its effectiveness over decades of use as a treatment method for scoliosis.

Massage and manual therapy: differences and similarities of effects

Both methods are carried out directly by the hands of specialists. During the massage, the doctor provides a reflex effect. Muscle tissue is subjected to various mechanical vibrations: vibration, kneading, stroking, effleurage, rubbing.

Manual therapy is a more complex procedure. All movements used are aimed at returning the spinal segments to their original physiological position. The technique begins directly with warm-up movements. This allows you to relieve tension in the muscle tissue, which reduces the pain of the procedure and ensures the desired treatment result. After warming up, the therapy session involves stretching, twisting movements, as well as kneading deep tissues that are in a stagnant state.

For scoliosis, manual therapy is carried out extremely carefully. The doctor must clearly understand the features of the anatomical structure of the spine and have reinforced practical skills in the technique. Generally, additional specialization in neurology and orthopedics is required for the internist.

Even the most competent massage is unable to eliminate spinal diseases. Manual treatment provides a therapeutic effect for many years to come. This way you can successfully get rid of the conditions that scoliosis causes by affecting your overall well-being:

• periodically a tingling sensation in the area of ​​the heart muscle;
• constant dizziness and severe pain associated with changes in the position of the vertebrae;
• unpleasant sensations from possible displacement of the internal organs of the heart, stomach, lung.

Attention!!! The duration of the massage effect on the back area is 20-40 minutes. The manual procedure involves up to 2 hours of using various therapeutic movements.

Surgery

Traditional conservative treatments for scoliosis include periods of observation, bracing (although this is usually for adolescents) and the use of other treatment methods (physical therapy, manual therapy, massage). But, if the curvature progresses significantly above 40 degrees, then we can talk about surgery.

Many doctors will say that surgery is the only way to treat a scoliotic curve above 45 degrees. But in some cases, non-surgical treatment options for scoliosis can be used.

Surgery can correct the curve by about 50 percent, but this does not necessarily prevent future progression. Rods have been known to bend or even break due to increased spinal deformity. In addition, surgical correction of scoliosis is also a fairly invasive surgery.

Before deciding to undergo scoliosis surgery, it is important to weigh all the information to ensure it is right for the patient.

Forecast

With early screening and detection, the prognosis for children with idiopathic scoliosis is good. Most children with idiopathic scoliosis do not require treatment and only follow-up.

If necessary, fixation (bracing) and exercise therapy are performed, which helps prevent worsening of the curvature and allows the patient to avoid surgery. With proper treatment, whether conservative or surgical, the vast majority of children with scoliosis will go on to lead normal, independent lives, be active in the workforce, participate in non-contact sports, have healthy pregnancies, raise families, and have the same life expectancy as people without scoliosis .

Scoliosis 1st degree - how to treat it in a teenager

If the diagnosis is made in adolescence, then physiotherapists, massage therapists, exercise therapy instructors and chiropractors are included in the treatment process. After the course of correction, its effectiveness is assessed, the indicators of which are:

• elimination of pain and discomfort in the back;
• increasing resistance to physical activity;
• increase in motor amplitude of the spine;
• straightening the curvature and returning balance and symmetry to the body;
• strengthening the muscular frame of the back, abdominals, and chest;
• ability to maintain correct posture.