Scoliosis is a common pathology of the spine, in which there is varying degrees of severity of its curvature in the lateral plane, which is called a scoliotic arch. Most often, it begins to form in children in early or teenage years, thereby creating the preconditions for the development of a number of complications. Fortunately, the children's spine is quite plastic, which allows, if signs of scoliosis are detected in a timely manner, to take action and correct the situation until complete recovery.
Almost 30% of spinal diseases in children are due to scoliosis.
Causes
Scoliosis in children mainly begins to develop between the ages of 5 and 14 years, and especially at the ages of 4-6 years and 10-14 years, since it is at this time that the child’s active growth is observed. Since the spine remains quite plastic, improper distribution of the load on it, as well as a number of other factors, provokes the deviation of individual vertebrae from the main axis in one direction or another, thereby forming a scoliotic arch. This can occur in only one part of the spine, for example, in the lumbosacral region, or in several simultaneously.
There is also a congenital form of the disease. In such cases, deformation of the spinal column is caused by developmental disorders and the presence of fusions of the ribs, vertebrae with each other, the presence of additional vertebrae, etc. But this is much less common than acquired scoliosis.
In the absence of congenital deformities, the causes of scoliosis in children may include:
- Poor posture when sitting at a desk, working at a computer, or walking;
- uneven distribution of the load on the spine (wearing a backpack on one shoulder, heavy bags, packages);
- premature start to heavy sports;
- weakness of the muscle corset due to a sedentary lifestyle;
- spinal injuries, including compression fractures, severe bruises, fractures of the pelvic bones, much less often the lower extremities;
- unbalanced nutrition that does not ensure the supply of the proper amount of vitamins and minerals to the growing child’s body;
- diseases of the spine, including rickets, cerebral palsy, etc.
Scoliosis is more often diagnosed in girls, although medicine cannot yet provide convincing explanations why boys suffer from it less often.
Prerequisites for the development of the disease are:
- excess weight;
- neurological pathologies (neurofibromatosis, spastic paralysis, poliomyelitis, syringomyelia);
- nonfusion of vertebral arches;
- sacralization or lumbalization.
But in reality, it is not always possible to establish exactly what exactly caused the development of scoliosis.
What are the most common causes of thoracic scoliosis?
- Hereditary factors.
- Congenital deformities of the musculoskeletal structures of the chest.
- Connective tissue diseases - Marfan disease, mucopolysaccharidosis, etc.
- Osteoporosis for various reasons.
- Deformations of the lower extremities and pelvis as a result of injuries or congenital pathologies.
- Tumor processes in and around the spine.
- Pathological changes in the bone tissue of the spinal column as a result of certain diseases - for example, tuberculosis.
- Inflammatory processes of the spinal cord, tumors.
- Intercostal neuralgia.
- Myositis.
- Diseases of the kidneys, liver, intestines, gall bladder and other internal organs, which are manifested by prolonged and very severe pain on the right or left side.
It must be borne in mind that sometimes the cause of scoliosis remains unclear , despite a thorough comprehensive diagnostic examination of the patient.
In such cases, doctors talk about idiopathic scoliosis , and its indirect cause may be poor nutrition, lifestyle and movement disorders, bad habits, and hidden chronic diseases.
Kinds
It is already clear that scoliosis in children can be congenital or acquired. For a more detailed description of the pathology, a more precise classification of the forms of the disease is used based on the period of its occurrence:
- infantile (baby) – found in children under 3 years of age;
- juvenile – develops at 3-10 years;
- teenage - occurs during puberty, i.e. at 10-17 years.
All these forms of the disease respond well to treatment, which cannot be said about adult scoliosis. Therefore, it is very important to diagnose the pathology in time and direct the maximum amount of effort to eliminate it before it is too late.
With adult scoliosis, diagnosed in people over 17 years of age, especially advanced scoliosis, it is almost impossible to achieve absolute recovery even with the help of surgical intervention.
The following types of scoliosis in children are also distinguished depending on the nature of the curvature:
- C-shaped - the spine is curved to the left or right side with the formation of 1 arch;
- S-shaped – 2 multidirectional scoliotic curves are simultaneously formed in two different parts of the spine, for example, in the lumbosacral and thoracic;
- Z-shaped is the most severe form of scoliosis, in which 3 scoliotic arches are formed at once.
Degrees of scoliosis in children
Scoliosis of any of the above types develops gradually. Based on this, 4 degrees of its development are distinguished. Determining what stage of development the disease is at is very important for developing the most appropriate treatment strategy.
To assess the degree of curvature of the spine, the angle of deformation is measured using special techniques. Initially, it is possible to determine the degree of scoliosis with sufficient accuracy by visual signs, but after this confirmation is required using instrumental methods for diagnosing scoliosis.
Scoliosis 1st degree in children
This degree is diagnosed when the first signs of spinal deformity appear, i.e. it is the initial and mildest stage of the development of scoliosis. In such cases, the angle of curvature of the spinal column does not exceed 10°. However, it is grade 1 coliosis that is most easily treated with conservative methods (without surgery). Therefore, it is important that parents can independently notice the first signs of scoliosis development in a timely manner and consult a doctor at this stage.
In such situations, the violation of body symmetry is almost invisible. But you can suspect spinal curvature by:
- differences in the position of the shoulder blades and shoulders;
- slight distortion of the pelvis;
- slight stoop and approach of the shoulder blades to the spine.
These parameters are assessed when the child is standing straight and calm. At the same time, for grade 1 scoliosis in children, it is not typical to have any pain, increased fatigue or other disorders. But changes in the 1st degree of scoliosis are so insignificant that they can often be diagnosed only with the help of x-rays.
Scoliosis 2 degrees in children
If the spinal deformity was not diagnosed at the initial stage of development, the pathology progresses, and the angle of curvature of the spinal column increases to 11-25°. It is at this stage that the disease is most often diagnosed, since changes are noticeable not only when the child is standing, but also when he is lying down.
If initially scoliosis is C-shaped, then in the second degree the formation of a compensatory arch is already visible, i.e. the spine acquires an S-shaped bend. Since the load on it is distributed unevenly, a rib hump and a muscle ridge are formed at the site of the initial curvature, and visual signs of deformation also intensify:
- the asymmetrical position of the shoulders is noticeable even in clothes;
- stooping gets worse;
- rotation of the vertebrae around their own axis is observed.
It is childhood scoliosis of the 2nd degree that is diagnosed in approximately 80% of cases.
Scoliosis 3 degrees in children
This deformity of the spine is considered serious, since the angle of curvature reaches 26-50°. This is accompanied by severe violations of posture, clear signs of asymmetry of the shoulder blades, shoulders, and pelvis, and these signs are visible both in a standing or lying position, and when the child is sitting.
At the 3rd stage of scoliosis already:
- the chest begins to deform;
- the costal hump increases;
- joints are seriously displaced;
- severe pain occurs;
- ribs sink;
- the muscles of the anterior abdominal wall weaken.
All this creates the preconditions for the displacement of internal organs from their natural positions and, consequently, the occurrence of disturbances of varying degrees of severity in their work.
Scoliosis 4 degrees in children
Grade 4 is the most severe stage of spinal curvature, as a result of which it loses the ability to provide reliable support to the body, because the angle of curvature exceeds 50°. Severe scoliotic curves lead to severe deformations in other bones, stretching of some back muscles and spasms of others.
Grade 4 scoliosis in children leads to severe disturbances in the functioning of internal organs, spinal roots are pinched, which can lead to neurological disorders of varying severity. Also, with such severe spinal deformation, there is a serious risk of spinal cord injuries.
What is scoliosis
The human spine is conventionally divided into 4 sections: cervical, thoracic, lumbar and sacral. Each of them has physiological curves: lordosis (inward bending) in the lumbar and cervical regions, as well as kyphosis (outward protrusion) in the thoracic and sacral regions.
Scoliosis is a persistent deformity of the spine in which it bends sideways in relation to the central axis. In this case, the deformation does not affect a separate part of the spinal column, but most often each of them. Scoliosis is characterized by increased natural lordosis and kyphosis. Rotation of the vertebral bodies is also observed, which provokes changes in posture of varying degrees of severity, changes in the line of the shoulders and pelvic bones.
In most cases, the main curvature occurs in the lumbar region. In this case, the rest of the ridge is also subject to compensatory deformation. Scoliosis in any form leads to disruptions in the functioning of almost all body systems, since organs are displaced from their natural positions, which, of course, affects the quality of their functioning.
Most often, scoliosis is detected in children or already in adolescence, i.e., during the periods of the most active growth of the child. Growth spurts peak at ages 4–6 and also at ages 10–14. It is these periods that are considered the most critical, so parents should not neglect preventive medical examinations of children during these time periods that are important for the proper formation of the spine.
Do not confuse poor posture with scoliosis. If in the first case we are talking about a “bad habit”, then in the second we are talking about a disease that requires qualified complex treatment.
Spinal deformity can develop in adulthood and also progress. But more often it is a consequence of the lack of timely intervention at the time of initial formation, i.e. in childhood or adolescence.
Expert Opinion of a Doctor
The earlier a scoliotic curvature is found, the easier it is to correct it with the help of exercise therapy complexes, which are often neglected by parents.
Personal: Udovenko Bogdan Viktorovich
Orthopedist, chiropractor, vertebroneurologist, osteopath
Experience: More than 20 years
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Symptoms
How scoliosis manifests itself in a child directly depends on the location of the scoliotic curve, the severity of the curvature, the causes of the development of the disease and the age of the child. Each patient with the same diagnosis may experience different symptoms. Scoliosis in children is characterized by:
- the appearance of signs of asymmetry, poor posture, stoop;
- drooping of the head, which is already present in grades 1 and 2 of scoliosis;
- periodic occurrence of pain, and initially they are usually localized in the neck, shoulders, lower back (often occurs when the curvature progresses to the 3rd degree, although it may appear earlier);
- breathing problems with episodes of shortness of breath, which can appear even with light exertion;
- increased heart rate;
- increased fatigue;
- impaired coordination of movements;
- absent-mindedness;
- headache;
- sleep disorders;
- deterioration of general condition.
Pain of varying intensity can be present even at the earliest stages of scoliosis development in children.
Often, with scoliosis, spinal roots are pinched, which leads to disturbances in the innervation of internal organs, and subsequently to organic changes. Which ones will suffer depends on the location of the scoliotic curve. In general, the disease can provoke dysfunction of the bronchi, lungs, liver, genital organs, pancreas, etc.
Scoliosis in children is also dangerous due to the emergence of psychological problems, since when an aesthetic defect appears in a child, the attitude of peers towards him changes dramatically. This can result in long-term depression, isolation, a sharp decrease in self-esteem and difficulties in communication.
Lordosis
Lordosis is the opposite of kyphosis in the shape of the curvature, that is, the pathological convexity will be directed forward. Most often, pathology is observed in the lumbar region, less often in the thoracic region. With lordosis, there is a violation of posture, pain, and difficulty maintaining balance. A person begins to get tired faster and cannot perform a number of previously habitual movements. Sometimes diseases of internal organs develop due to their compression.
What is lordosis
There are several types of pathology, divided into categories. For example, from the point of view of the location of lordosis, lumbar and cervical . Pathology may be primary or secondary, physiological or pathological . There is also non-fixed lordosis (the back can be straightened with effort), partially fixed (it is extremely difficult to change the position of the back), fixed (it is impossible to straighten the back).
What is lordosis of the spine?
Reasons for development
Lordosis can appear in a person at absolutely any age. As a rule, it is provoked by pathologies of the spinal segments, problems with the hip joints, back muscles, buttocks, etc. The disease develops against the background of spondylosis, tumors, muscle spasms, injuries, polio, and pregnancy. Lordosis can be provoked by excess weight and rapid growth.
On a note! Lordoses that develop due to pregnancy disappear after the baby is born.
Lumbar lordosis
Against the background of lordosis, various complications can develop. For example, the formation of intervertebral hernias, psoitis, excessive mobility of spinal segments, arthrosis.
Diagnostics
Most often, signs of scoliosis in children are detected during preventive examinations, since even a very caring and attentive parent is not always able to notice the initial manifestations of deformation of the spinal column in a child. The doctor assesses the position of the spine, shoulder blades and pelvis in the following ways:
- The child is placed face down on the couch and places his arms along his body. The doctor palpates the spine with light pressure, determining the position of the vertebrae.
- The child stands with his back to the specialist and bends over, bending his back in an arc and lowering his arms. The doctor evaluates the position of the shoulder blades and spine in this position of the body. He also pays attention to whether the ribs are protruding on one side or another of the body.
If during a visual examination the doctor suspects that there is a curvature of the spine, he will order an x-ray of the spine in the straight axis. This simple and accessible study is often sufficient to accurately diagnose scoliosis and determine the degree of its development.
Diagnosis of scoliosis of the thoracic spine
Diagnosis of thoracic scoliosis includes several important methods:
- Changes in the patient’s appearance (asymmetry of the shoulder girdles, different heights of the angles of the shoulder blades), visible changes in the spinal column and chest make it possible to initially diagnose scoliosis during examination of the patient .
- The diagnosis of scoliosis of the thoracic spine is confirmed using radiography , which also makes it possible to accurately calculate the angle of pathological curvature (or angles) of the spine. Using an x-ray, the doctor can also see if there are deformities in other bones of the skeleton, such as the chest.
- In the diagnosis of thoracic scoliosis, the computed tomography method - it allows you to determine the amount of torsion of the vertebrae, as well as the pathological position of the chest organs.
Treatment of scoliosis without blade surgery
If a child is diagnosed with scoliosis, treatment begins immediately. But it can be carried out using conservative methods, that is, non-surgically, only for deformities less than 40°. In other cases, and especially with grade 4 scoliosis, surgical treatment of scoliosis is indicated.
So, if the disease is diagnosed in the early stages of development and it is still possible to restore the normal axis of the spine without direct intervention in it, the patient is prescribed complex therapy. Its character directly depends on the degree of scoliosis and the child’s well-being. In general, conservative treatment for scoliosis may include:
- exercise therapy;
- manual therapy;
- massage;
- physiotherapy;
- wearing an orthopedic corset;
- kinesio taping.
With grades 1 and 2 of scoliosis (most often observed in children under 5 years of age), only exercise therapy, massage and manual therapy are often sufficient. But other methods can also be used to increase the effectiveness of treatment. In more complex cases, doctors definitely recommend using all possible methods of aligning the spinal axis. Otherwise, the deformity will progress and sooner or later lead to severe complications, severe pain and an urgent need for surgery.
Scoliosis in adolescence is much more difficult to treat than in an earlier period. This is due to the spine not being as flexible as in younger children. Moreover, adolescents are often diagnosed with 2-3 degree curvature of the spine, which is accompanied by more pronounced changes in its axis and requires decisive action to eliminate the pathology.
Exercise therapy (therapeutic physical education)
Physical therapy plays a large role in correcting spinal deformities. For each patient, a set of exercises is developed individually based on the location, stage, and type of scoliosis. The child’s age and level of physical development are also taken into account.
Exercise therapy is required regularly. The first classes are conducted under the guidance of a specialist, and only later, when both the child and his parents have fully mastered the correct technique for performing each exercise, are they allowed to practice at home independently.
Regular physical therapy exercises help strengthen the muscle corset, which allows you to create reliable support for the spine and reduce the likelihood of its further curvature. Also, properly selected exercises can reduce pain and increase the possible range of movements.
Manual therapy
Manual therapy plays a huge role in the treatment of scoliosis in children. It is this method that allows you to directly influence the spine, normalizing the position of the vertebrae and releasing the pinched spinal roots. But such manipulations require a high level of qualification from a chiropractor, so you can only trust the child’s health to an experienced specialist.
Additionally, manual therapy makes it possible to eliminate functional blocks and normalize the tone of the back muscles. Also, local effects on soft tissues provoke increased blood circulation and an increase in metabolic rate.
After the first sessions, there is usually a significant improvement in the child’s well-being. The pain gradually goes away, neurological disorders are eliminated, memory and the ability to concentrate improve. But to obtain pronounced results and consolidate them, you need to undergo at least 10 sessions, and subsequently undergo preventive courses.
One of the effective methods of manual treatment of scoliosis in children is the Gritsenko method. It is based on the ability of the human body to recover independently when negative factors are eliminated, which, in combination with the high plasticity of the children’s spine, allows one to achieve maximum results.
Physiotherapy
Physiotherapeutic procedures are aimed at improving blood circulation and activating metabolic processes. They help normalize the contractile functions of the muscles and thereby reduce muscular dystrophy on one side of the back, as well as relieve increased tone from the muscles of the other half of the back.
Wearing an orthopedic corset
Special corrective corsets are prescribed for children with stage 2-3 scoliosis. They have different degrees of rigidity, which is selected depending on the severity of the pathology. Wearing an orthopedic corset can reduce the load on the spine and achieve postural alignment. This eliminates the risk of further progression of the deformity and reduces pain.
Often, orthopedic corsets are prescribed for children over 7-10 years of age.
Kinesio taping
Kinesio taping is a relatively new technique used to treat scoliosis. Its essence consists of gluing elastic bands called tapes to certain areas of the back. They help reduce the load on the necessary back muscles and reduce pain. At the same time, tapes do not hinder movements and are completely invisible under clothing.
Prevention
It is within the power of every parent to prevent spinal curvature in a child. But this requires monitoring the child’s posture from a very early age and paying great attention to the balance of his diet. In general, scoliosis prevention is as follows:
- The child should always keep his back straight when walking and sitting;
- from an early age it is recommended to start swimming, gymnastics, and dancing, since these sports do not put a high load on the spine, but effectively strengthen the back muscles;
- the child needs to buy a moderately hard orthopedic mattress;
- it is important to avoid prolonged sitting at the computer and smartphone (especially important for teenagers);
- if a child cannot independently monitor his posture, you can purchase a special corset that will help him maintain the correct body position when sitting at a desk at school (on the recommendation of a doctor).
Thus, childhood scoliosis is a common, but quite dangerous problem that requires the earliest possible diagnosis and careful attention to oneself. Therefore, it is worth regularly undergoing preventive examinations and independently monitoring the condition of your child’s back. And if, nevertheless, it was not possible to avoid the development of the disease, it is necessary to contact a vertebrologist, orthopedist or neurologist as soon as possible and undergo the prescribed course of treatment. Then, with a high degree of probability, scoliosis will be overcome and the development of severe complications will be prevented.
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Combined curvatures
Pathological changes in spinal curvature in adults can be combined.
- Kypholordotic posture , also called a rounded back, is characterized by an increase in all natural curves. The head and stomach move forward a little, the shoulder blades stick out.
- Kyphotic posture is characterized by a decrease in natural lumbar lordosis and an increase in thoracic kyphosis. The patient begins to bend his knees when moving or standing, the head is tilted forward, the stomach protrudes, and the chest is sunken. The pathology is called round back.
- A plano-concave back is characterized by the presence of strong cervical lordosis, and thoracic kyphosis decreases. The pelvis is shifted back, the shoulder blades stick out, the head is usually lowered down.
- With a flat back, all the curves of the spine are reduced.
Comparison of some pathological changes in spinal curvature