Spinal deformities (scoliosis, kyphosis, kyphoscoliosis)

Classification of the severity of scoliosis (angles of spinal curvature, in degrees)

In orthopedics, there are many methods for measuring the angle of curvature of the spine, and, accordingly, classifications of severity with different degree values ​​in the angles of measuring the curvature of the spinal column. In Russia, the method proposed by V.D. is more common. Chaklin, as well as the method of J. Cobb.

At the Vlasov Medical Center they determine the severity of scoliosis (angles of curvature of the spine, in degrees) and use the classification of the severity of scoliosis according to J. Cobb. Since this measurement method (Cobb Angle) is the standard method in international practice for measuring the degree of curvature angle.

Kinds

Spinal scoliosis (degrees express the stage of pathology) has a large number of classification types and varieties:

According to localization, right-sided and left-sided scoliosis are distinguished.

Curvature can occur in any part of the spinal column, so scoliosis also occurs:

• cervical;
• cervicothoracic;
• chest;
• thoracolumbar;
• lumbar;
• lumbosacral.

Causes of Scoliosis and its varieties

There are many reasons for the development of scoliosis; it is very difficult to determine them. Scoliosis is divided into two main groups: congenital and acquired.

Acquired scoliosis:

• 1. Habitual: due to poor posture (they most often appear when the child goes to school, which is why they are called “school problems”). Incorrect sitting at the desk, the desk itself is not selected, heavy briefcases, carrying bags on one shoulder, holding the child by one hand, not always being moved from one row to another in the classroom, etc. etc.
• 2. Paralytic: A consequence of infantile paralysis, with unilateral muscle damage, and with some other diseases in neurology
• 3. Rheumatic: Complicated by spondyloarthritis, muscle contracture
• 4. Rachitic: Due to deformation of the musculoskeletal system due to deficiency of vitamin D 3 in the child’s body
• 5. Dysplastic: When the structure of the connective tissue is disrupted, that is, with connective tissue dysplasia. Dysplasia (from the Greek dys - disorder and plaseo - form) is a consequence of an abnormal development of tissue, cell or organ during embryogenesis and the postnatal period. As a result of this disorder, scoliosis is acquired.
• 6.Idiopathic: In these scoliosis, the origin is not identified, it is one of the common types of scoliosis.

Congenital scoliosis:

1. Congenital scoliosis: the cause is abnormal development of the vertebrae, that is, the formation of an irregular shape, asymmetrical congenital synostosis of the ribs, unpaired rib, etc., this leads to deformation of the spine.

Complications

Manifestation of complications in the thoracic region:

• pinched nerve fibers;
• impaired blood circulation in the tissues of the spine;
• change in the position of internal organs;
• change in the shape of the chest itself;
• active development of a secondary form of organ pathology;
• metabolic disease.

In the lumbar region:

• frequent urination;
• muscle weakness in the abdomen;
• increased constipation;
• congestive processes in the internal organs of the small pelvis;
• constant swelling of the legs.

Medical practice confirms that scoliosis in the thoracic region has many more dangerous complications that impair the functionality of organs.

Treatment of scoliosis

Conservative treatment is carried out at the Vlasov Medical Center. The treatment of scoliosis itself is very labor-intensive, and making any predictions is quite difficult. In most cases, the effectiveness of treatment largely depends on the selection of individual techniques, dosages of exercise, drug treatment and the patient himself. What treatment will be determined immediately after examining the patient. An approximate treatment regimen consists of:

• Autogravitational traction of the spine.
• Hanging on the board at a certain angle with your head down, this unloads the spine.
• Massage, which includes a combination of several types: reflex-segmental, work with trigger points, PIRM (post isometric muscle relaxation) of one group, and toning of the other group.
• Multichannel myostimulation, it allows you to correct the back and work with antagonist muscles at the same time. This procedure, due to the special placement of electrodes, tones those muscles that are relaxed, and relaxes those that are in good shape.
• Physiotherapy (calcium electrophoresis, laser therapy, magnetic quantum therapy)
• Corset. Selection, correctness and duration of wearing, exercise therapy after its removal.
• Physiotherapy. Selection and training of individual exercises. Exercise therapy is a very important point in the treatment of scoliosis, it directly depends on the patient, on his desire to exercise
• Drug treatment of patients with connective tissue dysplasia (CTD). (Nechaeva G.I., Viktorova I.A., Gromova O.A., Vershinina M.V., Yakovlev V.M., Torshin I.Yu. et al. Connective tissue dysplasia in children and adolescents. Innovative hospital- saving technologies for diagnostics and treatment in pediatrics. M., 2010. A vitamin-mineral complex and monoforms of vitamin (vitamins D, C, etc.) and/or mineral preparations (monoforms of magnesium, zinc, copper, manganese, boron, etc.) are used. Particularly noteworthy is the role of vitamins C, E, B6 and D. Among microelements, magnesium, copper and manganese are especially important for maintaining the physiological metabolism of connective tissue. For the structure of connective tissue, the role of magnesium is extremely important, which is one of the main bioelements that ensure physiological metabolism connective tissue [3]. When correcting deep magnesium deficiency, pharmacotherapy is often required. Studies of bioaccumulation when using various magnesium preparations have given grounds to assert that the bioavailability of organic magnesium salts is almost an order of magnitude higher than inorganic ones [16]. At the same time, organic magnesium salts are not only much better absorbed, but also easier to tolerate by patients. Inorganic magnesium salts more often cause dyspeptic complications, such as diarrhea, vomiting, and abdominal cramps [17]. Treatment is more effective if both magnesium and a magnesium fixative (vitamins B6, B1, Glycine) are administered simultaneously. Among the drugs used to correct magnesium deficiency, the drug Magne B6 has approval for use in pediatrics. The form of Magne B6 in the form of an oral solution is approved for use in children from the first year of life (body weight more than 10 kg) in a dose of 1–4 ampoules per day. Magne B6 and Magne B6 Forte tablets are approved for children over 6 years of age (body weight over 20 kg) at a dose of 4-6 tablets per day.)

Treatment methods are determined by the degree of scoliosis

Fourth degree

This is the most severe degree of curvature. The back, chest, and pelvis are subject to deformation, and a rib hump is formed in front and behind. The photographs show pathological changes in the vertebrae and vertebral joints along the entire length of the compensatory arch. Calcification of the ligamentous apparatus is also observed. The lungs, heart, stomach and liver are compressed and stop functioning normally.

Scoliosis of the fourth degree is the most severe form with the greatest deformation of the torso

How does this degree of scoliosis manifest:

• the body is very skewed, the stomach is sunken, one leg is noticeably shorter than the other;
• due to pinched roots and blood vessels, severe back pain is observed, radiating to the sternum, pelvic region, and limbs;
• arms and legs often go numb, a person cannot remain in an upright position for a long time;
• constant headache, dizziness;
• severe shortness of breath, sudden changes in blood pressure;
• violation of digestive functions;
• congestive processes in the kidneys;
• frequent colds and infectious diseases caused by decreased immunity.

Severe headache is one of the common symptoms of stage 4 scoliosis

A favorable prognosis when using conservative methods is possible for children 10-12 years old: in most cases, it is possible to reduce the angle of curvature to 2 degrees, eliminate pain, and fully restore motor functions. In adults, conservative treatment gives a positive result in rare cases, but we are talking only about pain relief and the elimination of concomitant diseases. To get rid of the curvature, surgery is necessary.

Prevention

Scoliosis of the spine (degrees increase in degrees if treatment recommendations are not followed) can be prevented by observing the following rules:

• you need to monitor your posture and the posture of your child when walking, standing and sitting;

• sleep on a flat surface (preferably on a hard or orthopedic mattress);
• monitor your weight and prevent obesity;
• eliminate physical inactivity, move more and engage in physical activity (riding a bicycle, swimming, playing outdoor games);
• evenly distribute the load on your back when playing sports, do not carry weights on your shoulders and back;
• when working sedentarily, it is recommended to choose a comfortable chair with a back and adjust its height so that the table is approximately at the level of the solar plexus; also, when working sedentarily, it is advisable to get up every hour and do a small exercise of 2-3 back stretching exercises;
• eat a balanced diet (the diet should contain a variety of foods rich in vitamins of all groups and minerals);
• practice yoga, as it helps to improve the health of the spine;
• strengthen the back and abdominal muscles (as they support the spine);
• if you have flat feet, wear special arch supports or orthopedic insoles (to evenly distribute the load on the spinal column);
• prevent the progression of degenerative-dystrophic diseases of the spine and other elements of the musculoskeletal system, follow all doctor’s recommendations during treatment.

Prevention of scoliosis in children includes the above recommendations, as well as the correct selection of a backpack for school (with two straps and an orthopedic back for an even load), sports or dancing, and an equipped workplace, depending on the age and height of the child.

Also, you should not sit an infant before 7-8 months and until the child begins to make independent attempts to sit up.