Scoliosis and childbearing: therapeutic measures for the expectant mother

It's no secret that during pregnancy the load on the female body increases tenfold! If the expectant mother has diseases of the musculoskeletal system, then there is a high probability of exacerbation of all complaints. There are situations when a woman finds out about the presence of scoliosis already during pregnancy, or at the planning stage when undergoing a full examination. In this article I would like to highlight such important points as: why is scoliosis so dangerous during pregnancy, what consequences can there be for the health of mother and child in the future.

What is scoliosis?

Scoliosis is a disease characterized by curvature of the spine. In the presence of severe displacements of the vertebrae, symptoms such as different shoulder heights, asymmetry of the torso, deformation of the ribs due to rotation of the thoracic vertebrae are noted. But our body always strives for compensation, so there is a rotation of neighboring areas in the opposite direction. The presence of scoliosis cannot always be noticed during a quick examination.

Very often, patients do not attach much importance to this problem, but the consequences can be very serious, ranging from changes in appearance to the woman’s disability.

How many degrees of scoliosis

Depending on the angle of curvature, the pathology is classified into 4 degrees:

• 1st degree - 1–10°;
• 2nd degree - 11–25˚;
• 3rd degree - 26–40°;
• 4th degree - more than 40°.

To determine the angle of inclination of the spine, X-rays are taken in 3 projections: standing, lying on a horizontal and inclined surface. Grades represent stages of deformation, each characterized by typical signs and symptoms.

For reference! Scoliosis can be considered a disease of women, since it affects girls about 5 times more often than boys.

Causes of scoliosis

The causes of scoliosis in all groups of the population (not only pregnant women) include the following:

• idiopathic scoliosis is the most common; the exact reasons for its development are unknown, but there is an assumption that a mutation in the gene is responsible for its formation;
• congenital deformation of the vertebrae and other vertebral structures;
• as a manifestation of any neurological disease;
• as a consequence of a birth injury to the spine;
• as a consequence of poor posture (connective tissue dysplasia).

TREATMENT FOR SCOLIOSIS AVAILABLE IN BRANCHES:

Treatment of scoliosis in the Primorsky region

Address: St. Petersburg , Primorsky district, st. Repisheva, 13

Treatment of scoliosis in the Petrograd region

Address: St. Petersburg , Petrogradsky district, st. Lenina, 5

Treatment of scoliosis in Vsevolozhsk

Address: Vsevolozhsk , Oktyabrsky Prospekt, 96 A

Stages of scoliosis

There are 4 stages of scoliosis: Stage 1 – curvature of no more than 100, visually invisible, diagnosed during an X-ray examination. Not life threatening.

Stage 2 – the curvature reaches 250, changes are visually visible in the form of: different shoulder levels, asymmetry of the shoulder blades, different waist triangles. This degree can easily be treated in the form of massage, physical therapy, and wearing a corset.

Stage 3 – there is a clear progression of the disease, the angle of curvature of the spine reaches up to 500. Changes in the form of protruding ribs (formation of a rib hump) and torsion of the spine are visually visible. Correction of this stage is possible only with the help of complex surgery.

Stage 4 – curvature of more than 500. No conservative treatment methods will have an effect in this situation, only complex surgical procedures.

Nothing is impossible

But scoliosis is not a death sentence and is not a contraindication for pregnancy . Even in severe cases, with the help of surgery, you can eliminate not only appearance problems, but also arrange your personal life.

This is confirmed by the numbers, behind which there are hundreds of happy women and rosy-cheeked women.

Over the past 20 years, 283 women with grade 4 scoliosis (the angle of spinal deformity was 50-80 degrees) have been operated on in Belarus. Of these, 228 got married. 156 women became mothers 3 years after the operation, while 82 had natural births. 12 women who underwent spinal surgery gave birth to two children. After surgical treatment of scoliosis, 1 woman became a mother of many children, giving birth to three children.

What is the danger of scoliosis for pregnant women?

In the presence of the first and second degrees of scoliosis, there is no disruption in the functioning of the internal organs, but do not forget about the possibility of progression of this pathology during pregnancy, because the ligamentous apparatus becomes softer and the degree of curvature may increase. There are situations when in the early stages of pregnancy a woman had the first degree of scoliosis, and by the end of pregnancy she had reached the third. In the presence of spinal deformity, the pelvis is involved in the pathological process. There is a displacement of the pelvic bones, which leads to overstretching of the pelvic floor ligaments, which can impede the passage of the fetus during childbirth and, as a result, lead to birth injuries in the child.

Genetics of scoliosis

The first information about scoliosis as a pathology of the spine, and attempts to solve this problem using methods of external influences - fixation, traction - were described by Hippocrates. And even then, when we had not even heard of genetics, it was noted that scoliosis has a clear tendency to be inherited through the female line.

“Signs of the disease are noticeable in the daughter, but the causes should be sought in the mother.” (Hippocrates, 5th century BC)

Today, this fact has statistical confirmation: for every 6 girls with scoliosis, there is only 1 boy.

At the end of the last century, after conducting numerous and large-scale studies, scientists confirmed a fact that was disappointing for women. A girl born from a mother with a spinal deformity has a 20 times higher risk of scoliosis than a child born from a mother without such a pathology. According to Russian scientists, every 3rd woman with scoliosis gives birth to a child with the same pathology, and its course will be more aggressive.

But the end to genetic research has not yet been reached. Why are girls and women more susceptible to scoliosis? Are there specific genes that are responsible for the development of spinal deformities? Scientists have yet to find answers to these and many other questions.

In our country, the prevalence of the female population in this pathology is higher than world statistics: 1:8. These are the data from the Republican Scientific and Practical Center of Traumatology and Orthopedics. The first manifestations (onset) of the disease occur during the period of active growth: from 6 to 16 years. Spinal deformities are observed in 55 thousand children and adolescents in this age group. In approximately 10 thousand, scoliosis has an active manifestation, and accordingly, they receive treatment: conservative or surgical. A progressive form of scoliosis was noted in 5 thousand people. And mostly these are girls (more than 4 thousand), that is, potential future wives and mothers. It is for this reason that the problem of scoliosis is of particular relevance for specialists in the field of obstetrics and gynecology.

The role of osteopathy in the treatment of scoliosis in pregnant women

In the presence of scoliosis, the most effective and painless treatment method will be osteopathic. What is its essence? Osteopathic techniques are aimed at relaxing muscles, relieving their tone, normalizing blood circulation in the spine and pelvic organs, and eliminating tension in the pelvic floor ligaments. The necessary preparation of the birth canal is carried out to ensure the smooth passage of the fetus and reduce injuries to a minimum.

Of course, severe bone deformations cannot be eliminated, so the risk of the child receiving a birth injury still remains. Therefore, after birth, the baby will need to be shown to an osteopath during the first month of life. This is simply necessary to eliminate possible dysfunctions that could harm the child’s health. The mother herself also needs to continue treatment, because... after childbirth, the ligamentous apparatus is softer and can contribute to the progression of scoliosis.

How to understand the degree of scoliosis

To determine the stage of deformation, you should pay attention to the external signs and complaints of the patient himself.

1st degree

The scoliotic curve forms an angle of up to 10°, which has almost no effect on well-being. Back pain occurs only with significant physical exertion and after a long stay in a static position.

External signs:

• when a person stands, one of his shoulders is lower than the other;
• the distance from the spine to each of the shoulder blades varies;
• when tilted, it is clear that the spinal column is deviated from its axis to the left or right in one or more places;
• the posture is preserved, but there is already a slight stoop.

2nd degree

The angle of the scoliotic curve is 11–25°. That is, scoliosis of 12 degrees is already the 2nd stage of deformation.

Symptoms:

• pronounced stoop, especially with an S-shaped curvature;
• the presence of an intercostal hump on one side of the back, noticeable in an inclined position;
• muscle roll at the lumbar level, consisting of spasmed muscles;
• pain in different parts of the back, which is more disturbing and more frequent than with 1 degree of curvature;
• the back gets tired quickly even after minor exertion.

3rd degree

Scoliosis, the angle of curvature of which is 26–40°, has degree 3 and is characterized by:

• pronounced vertebral curve in the shape of the letter C, S or Z;
• strong asymmetry of the whole body and stoop;
• chest deformation;
• significant difference in the height of the shoulders and shoulder blades;
• intense and almost constant back pain;
• dysfunction of the respiratory and cardiac organs, which is manifested by rapid fatigue from physical activity, shortness of breath and frequent colds;
• compression of the spinal cord, leading to sensory disturbances, muscle weakness in the back and/or limbs.

4th degree

A scoliotic curve angle of more than 40° is already a disability and a significant decrease in the quality of life. In addition to pronounced asymmetry of the torso, distortion of the shape of the spine and sternum, there is a displacement of internal organs with disruption of their functioning. The back hurts very much, and compression of the spinal canal can cause serious complications. Among the latter is the so-called “cauda equina syndrome,” which causes paralysis of the lower limbs.

Who is at high risk of developing scoliosis?

In most cases, the causes of scoliosis remain unclear. An increased risk of developing this disease is observed in children with congenital anomalies of the spinal column (torticollis, cerebral palsy, hip dislocation, etc.), weak muscle tone (hypotonia), overweight, flat feet, and vitamin deficiencies.

Rickets and polio suffered in early childhood can also manifest themselves years later as spinal curvature. Stimulation of motor activity in infancy (planting in pillows, walkers, etc.) also leads to poor posture.

Doctors also note a genetic predisposition to scoliosis. If one parent has this disease, the child's risk of acquiring it increases by 50%.

Early diagnosis – why is it important?

In the case of scoliosis, the topic of early treatment is especially relevant due to the anatomical differences in children. Until about 14 years of age, a child’s spine is quite soft, as it consists of cartilage tissue. On the one hand, this is the cause of postural disorders: the mobility of the spine contributes to its abnormal development. But, on the other hand, this same feature allows you to correct the situation using non-surgical methods.

After 14 years, calcification of the spine begins, that is, the bones become harder, and it is more difficult to fight scoliosis. By adulthood, complete ossification occurs. Correcting scoliosis at this age is problematic; conservative methods become ineffective.

The study is devoted to studying the nature of neurological pathology that occurs in children born to mothers with scoliosis and pelvic deformity. Damage to the central nervous system was detected more often in children born to mothers with scoliosis (75.7%), with a combination of scoliosis and pelvic deformity (68.2%). Among the lesions of the central nervous system, cerebral symptoms of damage to the nervous system were noted (74.2%), symptoms of damage to the spinal cord (19.7%), symptoms of combined damage to the brain and spinal cord (6.1%). Children born to mothers with scoliosis and pelvic deformation require stage-by-stage supervision by a neurologist.

Comparative characteristics of neurological disorders in children born in mothers with scoliosis and deformation of the pelvis

This study investigates the nature of the neurological pathology arising in children born in mothers with scoliosis and deformation of the pelvis. CNS lesions were detected more frequently in children born to mothers with scoliosis (75.7%), with a combination of scoliosis and deformation of the pelvis (68.2%). Among the CNS lesions were observed cerebral nervous system symptoms (74.2%), symptoms of spinal cord - 19.7%, symptoms of combined lesions of the brain and spinal cord - 6.1%. Children born in mothers with scoliosis and deformation of the pelvis are needed to be watched by a neurologist.

In the structure of numerous childhood diseases, pathology of the nervous system occupies a large share. Perinatal lesions of the nervous system combine pathological conditions caused by the influence of various factors on the fetus in the antenatal period, during childbirth and in the first days after birth [4, 6]. The task of preventing deep disability in childhood is the timely diagnosis of possible motor and intellectual disorders in the perinatal period [3].

One of the reasons for various deviations during pregnancy and childbirth is scoliotic deformation of the spine of a pregnant woman, which may also be a consequence of pelvic deformation. During pregnancy, the spine is exposed to great physical stress, and both mechanical and hormonal factors play a role. The fetus, baby's place and amniotic fluid located in front of the spine increase the mother's body weight by 10-20 kg. As a result, the pregnant woman is forced to lean back somewhat to maintain balance, and hyperlordosis occurs. The articular ligaments in the lumbosacral spine are also subject to hormonal influences. Certain aspects of the problem are highlighted in some works related to the outcome of childbirth in women with a severe degree of pelvic narrowing [1], with the course of pregnancy, childbirth and the postpartum period in women with spinal pathology and scoliosis [2]. Studies of the course of pregnancy, childbirth and the postpartum period in women with spinal pathology indicate excessive strain on the body's adaptive and compensatory capabilities, which was confirmed by cardiointervalography (CIG) in pregnant women. As a result, the predominant influence of the sympathetic part of the autonomic nervous system was revealed, which leads to a complicated course of pregnancy and childbirth. Pregnant women with spinal diseases are more often diagnosed with chronic intrauterine fetal hypoxia (44.8%), as well as signs of impending miscarriage in the first trimester (35.2%). Asphyxia of newborns in mothers with vertebral pathology is observed 2.5 times more often compared to the control group. Anomalies of labor in the form of incoordination complicate the course of labor in a large percentage (75.2%). The high frequency of chronic placental insufficiency in pregnant women causes a higher proportion of abdominal delivery (24.7% versus 8% in the control group) [2]. In addition, the presence of scoliotic deformity of the thoracic spine of II, III severity in a pregnant woman with a counter-curvature arc in the lumbar region or scoliosis of the thoracolumbar and lumbar localization is a high risk factor for disruption of uteroplacental blood flow in the third trimester of gestation. More often, a decrease in blood flow velocity is observed in the uterine artery, located on the concave side of the scoliotic curve of the lumbar spine [5]. However, none of the studies examined the relationship between the degree and etiology of scoliosis in the mother and the neurological status of the newborn, as well as the comparative characteristics of the neurological damage detected in children caused by scoliosis and deformation of the mother’s pelvis.

Materials and methods. The main study group consisted of children born to mothers with scoliotic spinal deformity. Since lateral curvature of the spine does not always occur in isolation, and in some cases its cause is an irregularly shaped pelvis, often obliquely displaced, for comparison we took groups of children born to mothers with pelvic deformities and mothers with combined pathology - scoliosis and pelvic deformity. The control group consisted of infants born to women who did not have any of the above pathologies.

A total of 224 children were examined: 176 children born to women with pathologies of the spine and pelvis, 48 ​​children - control group:

Group I (66 people) - children born to women with scoliosis. The average age of women was 22.5±1.9 years.

Group II (88 people) - children born to women with pelvic deformities (transversely narrowed pelvis, simple flat pelvis, flat rachitic pelvis, funnel-shaped pelvis, narrow pelvis, uniformly narrowed pelvis - ORST, obliquely displaced pelvis). The average age of women in this group is 22.6±2.2 years.

Group III (22 people) - children born to women with a combination of scoliosis and pelvic deformity. The average age of women in this group is 23.3±2.1 years.

Group IV (48 people) was the control group, where the mothers had no pathological changes in the spine and pelvis. The average age of women in this group was 22.2±1.7 years.

To confirm the reliability and validity of the identified neurological symptoms, a follow-up study was performed in 168 children of the study groups (from 0 to 12 years). An examination of 109 children was carried out to clarify the level and nature of the damage, using the following methods: clinical neurological, neurophysiological, ultrasound, neuroradiological and neurophysiological (EEG, REG). In addition, if necessary, an ophthalmological examination, MRI examination, consultation with a pediatrician, geneticist, endocrinologist, orthopedist, and surgeon were carried out.

Results of our own research. Based on the identified neurological symptoms, symptoms and syndromes of damage to the central nervous system were identified in the study groups.

The syndrome of diffuse muscular hypotension presented particular difficulties in differentiating the pathology. Among 224 children examined by us on the first day of life, diffuse muscle hypotonia was observed in 106 (47.3%), p <0.01. Of these, 16 children (15.1%) were born by caesarean section to mothers with scoliosis. In this group, pathology of the natal period (35.9%) prevailed over complications of the antenatal period (26.2%). In some children, hypotension was transient. Thus, during a repeated examination in the maternity hospital, we noted normalization of muscle tone in 11 children (10.4%), which is typical for children with drug-induced depression (16 cases - 15.1%). In 20 children (18.9%), we could not determine the cause of diffuse muscle hypotonia. There was also a group of children with myatonic syndrome - this pathology was observed in 6.1% (4 cases), in group II - in 1 (1.2%) child.

Pyramidal insufficiency syndrome prevailed in children of group I in 28.8% (19 cases) and group III - 22.7% (5 cases), p <0.05. An increase in muscle tone to the degree of spastic tetraparesis was observed in group I in 19.7% (13 cases), in group II - in 11.4% (10 cases), in group III - in 31.8% (7 cases). Lower mixed paraparesis was observed only in children of group II - 3.4% (3 cases), p <0.05.

The cervical symptom complex manifested itself as symptoms of a “short neck”, torticollis, it was observed more often in 22.7% (15 cases) of newborns of group I and in 31.8% (7 cases) of group III.

Symptoms of brainstem disorders were identified in most cases in newborns of group III - 18.2% (4 cases) in the form of bulbar disorders: regurgitation, choking, decreased palatal and pharyngeal reflexes. Hypertensive-hydrocephalic syndrome was diagnosed among children of all groups, but prevailed in large numbers in group III - 45.5% (10 cases), p <0.05. In addition, changes in other cranial nerves were detected in the first day after birth - in 3.1% (2 cases) of children (group I): damage to the facial nerve of the central type (1 child); damage to the oculomotor nerve (III pair) in 1 child in the form of divergent strabismus. Damage to the cranial nerve in children of group II of the study on the first day after birth - only in 3.4% of children (3 cases): damage to the trigeminal nerve (V pair) 2.3% (2 cases), manifested by asymmetry in the position of the alveolar processes; damage to the oculomotor nerve (III pair) in 1.5% (1 case) in the form of divergent strabismus.

Neuroreflex excitability syndrome was more common among newborns of group III - in 27.3% (6 cases) and manifested itself in the form of spontaneous periodic shudders, increased Moro reflex with a delay in the first phase, small-amplitude tremor, and irritated unmotivated crying. The syndrome of depression of the nervous system was also observed more often in group III - 18.2% (4 cases) and was manifested in all by a decrease in innate reflexes, a weak cry, and sluggish sucking.

The symptom complex of intracranial hypertension reached its greatest severity at 3-4 months, then the symptoms gradually decreased. Tension and bulging of the large fontanelle at the age of 1 month was observed in 16.7% (4 cases) of children in group I, in 5.9% (1 case) in group II, which indicated a possible disturbance of hemocerebrospinal fluid dynamics in them. Hypertension-hydrocephalic syndrome (supported by clinical and neurophysiological examination methods) at the age of 1 month was detected more often in group I in 33.3% (8 cases), in group II - 25.3% (4 cases); at the age of 1 year it was detected in group I in 17.4% (4 cases), in group II - 20.7% (6 cases). At the age of 1 year, 8.7% of children (2 cases) remained with a hydrocephalic head shape and diffuse muscle hypotonia in 17.4% (4 cases) of children in group I, in 10.3% (3 cases) of children in group II, P< 0.05.

Diffuse muscle hypotonia occurred at the age of 1 month in children of group I of the study in 33.3% (8 cases) in group I, in 23.5% (4 cases) in group II, in 40.0% (4 cases) in group III group. By the age of 1 year, the number of children with diffuse muscular hypotonia increased and amounted to: group I - 30.4% (7 cases), group II - 51.7% (15 cases), group III - 50.0% (5 cases), P<0.05. Myatonic syndrome persisted in isolated cases.

An increase in pyramidal tone increased at the age of 1 month and was observed in half of the children - in 50.0% (12 cases) in group I, in 58.8% (10 cases) in group II, in 60% (6 cases) in Group III, P<0.05. By 1 year, the number of children with these changes in the groups decreased only in group I to 43.5%, increased to 44.8% in group II and to 40.0% (4 cases) in group III, P<0.05.

The symptoms of spastic paresis increased at the age of 1 month to 50.0% (12 cases) in group I, to 31.1% (9 cases) in those studied in group II and 62.5% (5 cases) in group III. At the age of 1 year, symptoms of mixed paraparesis first appear in 8.7% (2 cases) of children with lesions of the lower thoracic and lumbar spinal cord. In group II, this pathology persists in 10.3% (3 cases), in group III - 20.0% (2 cases), P <0.05.

Dynamic observation revealed developmental delays in some children. Later, 50% (12 cases) of children from study group I, 11.4% (10 cases) from group II, 22.7% (5 cases) of children from group III began to sit due to impaired trunk straightening reactions after 7–8 months of age. study groups. Motor function disorders were observed in 7.6% (5 cases) of children of group I, 4.5% (4 cases) of children of group II, 9.1% (2 cases) of group III, children began to walk later than 14 months.

Throughout the entire observation period, damage to the central nervous system (CNS) predominated in study groups I and III, P <0.05 (Table 1).

Table 1.

Damage to the central nervous system among children of the study groups during the neonatal period, at the age of 1 month, 1 year (in%)

In children aged 10-12 years, general cerebral symptoms begin to appear in the form of headaches, dizziness, fatigue - in 23.2% of cases. They occurred more often in the main study groups: group I - 33.6%, group II - 29.2%, group III - 25.0%.

In the same age group, scoliosis was diagnosed in the examined children - 12 cases (17.4%), more common in study groups II and III (25.0% and 25.0%), P <0.05 when compared with the control group - 5.3%. In group I, scoliosis was detected in 11.2% of children.

In total, during the study from 1 month to 12 years, 137 (61.2%) children received medication and physical treatment. Treatment was carried out in greater numbers at the age from 1 month to 1 year - 76.2% (64 cases) and at the age from 1 to 5 years - 68.1% (47 cases). Children who did not appear for examination by a neurologist at the age of 1 month (56 cases - 25%), but had neurological symptoms in the maternity hospital, began treatment only at the age of 6 months - 25% (56 cases). Of these, 37.5% (21 cases) of children had neurological symptoms by the age of 1.5-2 years, expressed in uncompensated hydrocephalus, manifestations of pyramidal insufficiency, and delayed physical development.

In general, during dynamic observation of the study groups, regression of neurological symptoms was noted. The number of cases with positive dynamics of neurological disease has increased: at the age of 1 month, the number of children without neurological symptoms was 20% in group I of the study, 37% in group II, 30% in group III; in the long-term period - 34, 42 and 38%, respectively, P<0.05.

The results obtained allow us to classify women suffering from scoliosis and pelvic deformation as being at high risk of complications in the development of neurological symptoms in the children they give birth to.

To prevent the development of abnormalities during pregnancy and childbirth in women with scoliosis and pelvic deformation, the development of pathology of the fetus and newborn from these mothers, it is necessary to identify scoliosis at the prenatal stage and monitor it from the period of registration for pregnancy in the consultation of the maternity hospital. It is necessary to conduct dynamic examinations by an obstetrician-gynecologist together with dynamic examinations by a neurologist and orthopedist throughout pregnancy.

Our observations show that the main condition for achieving a positive effect, expressed in reducing the degree of damage to the central nervous system and improving the functional state of children, is a timely visit to a neurologist at the first signs of neurological disorders, even in the maternity hospital, and a differentiated approach to therapy, which allows for rapid relieving neurological disease and reducing the risk of complications.

Conclusions. Damage to the central nervous system was detected more often in children born to mothers with scoliosis (75.7%), with a combination of scoliosis and pelvic deformity (68.2%). Among the lesions of the central nervous system, children had cerebral symptoms of damage to the nervous system (74.2%), symptoms of damage to the spinal cord - (19.7%), symptoms of combined damage to the brain and spinal cord (6.1%), predominant in children born from women with I-II degree of scoliosis (48.1±4.1%), born naturally (43.2±3.1%).

Children born to mothers with scoliosis and pelvic deformation require stage-by-stage supervision by a neurologist. To prevent the development of neurological pathology, it is advisable to have dynamic observation by a neurologist from the first days of life, continuity and comprehensive use of preventive, therapeutic and rehabilitation measures on an outpatient basis and at the hospital level, rehabilitation centers.

O.V. Knyazeva, V.I. Marulina

Kazan State Medical Academy

Knyazeva Olesya Vasilievna – Candidate of Medical Sciences, senior laboratory assistant at the Department of Child Neurology

Literature:

1. Belov E.V. Specificity of diagnosis, course of pregnancy, childbirth and birth outcome in young women with a transversely narrowed pelvis / E.V. Belov, V.I. Bychkov // System analysis and management in biomedical systems. - 2008. - No. 4. - P. 952-958.

2. Brynza N.S. The course of pregnancy, childbirth and the postpartum period in women with spinal pathology: abstract. diss. ...cand. honey. Sciences / N.S. Brynza // Barnaul, 2000. - 24 p.

3. Prusakov V.F. Clinic and correction of behavioral disorders in children with minimal brain dysfunction / V.F. Prusakov, M.V. Belousova, M.A. Utkuzova // Neurological Bulletin. - Vol. 1, 2009. - pp. 99-101.

4. Sokolovskaya T.A. The contribution of perinatal causes to the formation of disability / T.A. Sokolovskaya // Social aspects of public health. - 2008. No. 4. - P. 4-14.

5. Skryabin E.G. Fetoplacental blood flow in pregnant women suffering from scoliosis / E.G. Scriabin, N.V. Ivanova, N.S. Brynza // Kazan Medical Journal. - T. 84, No. 1. - 2003. - P. 48-50.

6. Barkley RA Global issues related to the impact of untreated attention deficit / hyperactivity disorder from childhood to young adulthood / RA Barkley // Postgrad Med. — 2008. — Sep; 120(3). — P. 48-59.

Diagnosing scoliosis yourself

Timely detection of scoliosis will allow you to avoid aesthetic defects in posture, lameness, flat feet, circulatory disorders, breathing, pinched nerves and other complications in the child in the future. Therefore, we bring to your attention simple self-diagnosis methods. Before the examination, the child must undress down to his underpants.

Method 1: Forward Bend

The child stands straight, without straining, with his arms along his body. You stand behind him so that you can clearly see the child's back. First we ask him to lower his head. There should be no tension. Let's see if there is any curvature in the cervical spine.

Then we ask you to lower your shoulders, the child is relaxed. We evaluate whether there is a curvature in the thoracic region.

Afterwards, the child needs to bend down as low as possible. The back is arched, there should be no discomfort in the knees. We examine the spine, the symmetry of the shoulders, pelvis, and shoulder blades.

Method 2: Hints

There are some clues by which a specialist can notice even the slightest violation of posture. Try using them too.

The child stands straight, arms along the body. Checking from the back:

1. Are the earlobes and the protrusions on the shoulder blades symmetrical?
2. We evaluate whether the distance between the waist triangles and the arms is the same. This can be done using your palm - turn it parallel to the floor and check how many fingers from the waist to the line of the child’s arm enter on one side and how many on the other.
3. We look at the subgluteal folds. Normally, there is one fold under the buttock, on the right and left they are the same. We also evaluate the symmetry of the popliteal folds.
4. We turn the child to face us and evaluate the symmetry of the collarbones, shoulders, nipples, and knees.

Method 3. Tilts and turns

1. To check the cervical spine. We ask the child to turn his head to the right and touch his chin to his shoulder. Then repeat the exercise to the left side. There is a violation if it is easier for a child to do an exercise in one direction than in the other. If you don't see this, ask your son/daughter about the sensations.
2. To check the thoracic and lumbar region. The assessment is carried out in the same way as in the previous case, but tilts must be made to the side. Any even the slightest restriction of movement indicates a violation of posture.

Important: the proposed diagnostic methods will help you identify postural disorders, but these disorders are not always associated with scoliosis. Therefore, do not panic and consult a pediatric orthopedist to check your suspicions.

If you notice that your child’s posture is poor, you discover a curvature of the spine, or your child begins to complain of pain and fatigue in the back, do not despair. In childhood, scoliosis can be corrected. Orthopedic doctors at Best Clinic have extensive experience working with children diagnosed with it. Make an appointment and let's solve the problem together!

Signs of back scoliosis in children

Scoliosis of the thoracic and lumbar regions often develops with the beginning of school life. This is due to two things. Firstly, the load on the back increases - the child sits more. And secondly, during the school years there is a period of increased growth, during which posture disorders most often appear.

Here are the signs that indicate scoliosis of the back in the early stages:

• asymmetry of shoulders, shoulder blades, waist triangles;
• the collarbones are at different levels;
• the child’s knees may be asymmetrical, or one of them may be slightly turned inward;
• there is a disturbance in gait, the soles of shoes wear down unevenly;
• walks stomach forward, buttocks retracted;
• there is restriction of movements to the right or left;
• one arm is longer than the other in a standing position;
• the child sits incorrectly (“lies down” to the side, mainly to the right or left, crosses his legs), when trying to sit him correctly (back straight, legs together), he says that he is so uncomfortable.

What is the child complaining about?

Often these signs are combined with complaints of back and lower back fatigue, tingling or numbness in the fingers and toes, pain in the right or left hypochondrium, shortness of breath (because the chest is deformed).

Cost of scoliosis treatment: