Scoliosis : Causes, Symptoms , Treatment
Diseases Of The Spine / / April 22, 2016
Scoliosis - is an abnormal curvature of the spine.The normal spine has the natural curves that make the lower back bent inward.Scoliosis usually causes deformity of the spine and rib cage.Spine in scoliosis curved from one side to another to varying degrees, some of the vertebrae may rotate slightly, making uneven the shoulders or hips.
Curvature of the spine can be developed as follows:
- C-shaped scoliosis. The simplest kind of scoliosis.It is characterized by the presence of one arc of curvature.C-shaped scoliosis is the most common.It reveals easily enough: the patient is asked to bend, while on his back visible arc of curvature of the letter C;
- S-shaped scoliosis.This form of scoliosis characterized by two arcs of curvature, causing the spine takes the S-shaped.One is the main arc, scoliosis.The second arc - compensatory.It occurs in the overlying spine in order to align the position of the body in space.For example, if developing bending of the lumbar spine to the right side, then even
- Z-shaped scoliosis. If the spine forms a right bend 3, a scoliosis is called the Z-shaped.The third arc is weaker than the other two.This is the most rare and severe form of the disease, which can be identified only by radiography.
Apart form the spine deformation can be bent to the right or to the left.In connection with this are the right-hand and left scoliosis.An S-shaped scoliosis arc deformation pointing in different directions.With Z-shaped scoliosis of the upper and lower arc in the same direction and located between them - in the opposite direction.
Scoliosis can occur in adults, but is more likely to be diagnosed for the first time - in children aged 10-15 years.About 10% of adolescents have some degree of scoliosis, but only less than 1% of them develop scoliosis, which requires treatment.
Among the adult population may also be a scoliosis that is not associated with disabilities.Scoliosis may be associated with spinal problems.
other spinal abnormalities that may occur alone or in conjunction with scoliosis include: hyperkyphosis (or kyphotic posture - the thoracic spine deformity with convexity backward, backward) - abnormal exaggeration to reverse rounding of the upper spine, and hyperlordosis (overvalued aheadbending the lower part of the spine, which is also called a "swayback"; lordosis - curvature of the spine, a bulge facing forward).
Scoliosis usually develops in the area between the upper thoracic and lower back (waist).It also can occur only in the upper or lower back.The doctor tries to determine the scoliosis with the following characteristics: the shape of the curve (curvature), its location, the direction, magnitude and causes, if possible.
severity of scoliosis is determined by the degree of curvature of the spine and torso rotation angle (APR), which is usually measured in degrees.The curves of less than 20 degrees are considered to be soft, and they account for 80% of cases of scoliosis.Curves progressing more than 20 degrees, in need of medical assistance.However, generally, in such cases, a periodic monitoring.
Brief anatomical information about the spine
- Spine. The spine is a column with small bones (vertebrae) that support the entire upper body.The vertebrae are grouped into three sections:
- 7-necks vertebrae (C), that support the neck;
- 12 thoracic or thoracic (T) of the vertebrae, which are connected to the chest;
- 5 lumbar (L) vertebrae lowest and largest bones of the spine.Most of the body weight falls on the lumbar vertebrae.
number indicates the location of the vertebra within its area.For example, the C4 - the fourth vertebra down in the cervical region, T8 - the eighth thoracic vertebra.
- Sacrum. below the lumbar region is the sacrum - the bone structure in the form of a shield, which connects to the pelvis at the sacroiliac joints.At the end of the sacrum - 4 tiny vertebrae, known as the tailbone.All the vertebrae form the spinal column.The upper body vertebral column usually iskivlena outward (kyphosis), while the lower back - is curved inward (lordosis).
- discs. vertebrae in the spine are separated by small cushions of cartilage, known as "the intervertebral discs."Inside each disc - a jelly-like substance, the nucleus pulposus surrounded by tough fibrous ring.Drive on 80% consists of water.This structure makes the wheels resilient and strong.They do not have an independent blood supply, and the power for support nearby blood vessels.
- spinous processes. Each vertebra in the spine has a number of bone formation, known as "the spinous processes."Spinous and transverse processes serve small levers to the back muscles, allowing your spine to be flexible.
- the spinal canal. Each vertebra and spinous processes surround and protect the central arched opening.This smooth arches go down the spine and form the spinal canal, which covers the spinal cord and the nerves of the central trunk, which connect the brain with the rest of the body.
- Determination of the scoliosis curve shape . Scoliosis is often classified according to the shape of the curve, or as structural or non-structural.
- Determination of scoliosis on its location. Location structural curve determined by the location of the apical vertebra.This bone is at the highest point (top) in the dorsal hump.This particular bell is also very difficult to rotate during the disease.
- Determination of scoliosis according to his directions . curve direction is determined by the structural scoliosis convex (rounded) side of the curve to the right or left turns.For example, a doctor will diagnose a patient having a right thoracic scoliosis, if the apical vertebrae (located on the top, facing upwards) in the thoracic spine (upper back), and the curve turns to the right.
- Determination of scoliosis on its value. value of the curve is determined by taking measurements of length and angle of the curve on the x-ray image.
- Structural scoliosis. vertebrae rotation and twisting of the spine bent in different directions.When twisting, the chest with one hand pushed outward, so that the space between the ribs expands and vanes act by producing a deformation of the chest, or a hump.The other half of the chest is twisted inward, squeezing the ribs.
- nonstructural scoliosis. nonstructural scoliosis is a simple lateral deviation of the spine, without structural anatomic changes of the vertebrae and the spine as a whole, in particular, there is no fixed rotation of the spine, which is characteristic for structural scoliosis.
Causes of scoliosis
- physical disabilities. Physical abnormalities can cause an imbalance in the bones and muscles, leading to scoliosis.Research shows that an imbalance in the muscles surrounding the spine can lead to a change in posture in children during their growth.
- coordination problems. Some experts point to the coordination of inherited defects that some children can cause development of scoliosis of the spine.
may be other biological factors.
Causes of scoliosis in adults
Adult scoliosis has two main reasons:
- the development and progression of scoliosis children;
- degenerative scoliosis.This condition, which usually occurs after 50 years.Under this condition, the lower part of the spine tend to suffer from degeneration of disks.Osteoporosis is a serious problem for many older people, is not a risk factor for the start of the new scoliosis, but it can be a factor, reinforcing the already existing scoliosis.However, in most cases it is not known why the scoliosis occurs in adults.
conditions affecting the spine and surrounding muscles
Scoliosis can result from a variety of conditions that affect the bones and muscles associated with the spine.They include:
- tumors, trauma, or other changes in the spine.These pathologies of the spine can play a major role in the occurrence of cases of scoliosis;
- stress, fractures and hormonal disorders that affect the growth of bones in young people and professional athletes;
- Turner's syndrome - a genetic disease in women, affecting the physical and reproductive development;
- other diseases that can cause scoliosis - Marfan syndrome, Aicardi syndrome, Friedreich's ataxia, Albers-Schonberg disease, rheumatoid arthritis, Cushing's syndrome and osteogenesis imperfecta;
- spina bifida is a congenital disorder in which the backbone and spinal canal do not close after birth.In severe cases it can lead to spinal cord injury.
Risk Factors scoliosis
- Risk factors for idiopathic scoliosis. idiopathic scoliosis, the most common form of scoliosis, occurs more often in human growth period in adolescence (mostly in children 3 to 10 years).Soft curvature (up to 20 degrees), there is approximately the same for girls and boys, but the curve progression occur in girls 10 times more often.And other factors must be present to scoliosis arose.The risk factor that affects women, is caused by the onset of menses, which can prolong the period of bone growth, thereby increasing the likelihood of developing scoliosis.
- Risk factors for the progression of the curvature. Once diagnosed with scoliosis, it is very difficult to predict who is at highest risk for progression of the curve.At about 2-4% of all adolescents develops curvature of 10 degrees or more, but only about 0.3-0.5% of adolescents curves have more than 20 degrees, which requires medical treatment.
- Medical risk factors. People with certain medical conditions that affect the joints and muscles, are at higher risk of scoliosis.These diseases: rheumatoid arthritis, muscular dystrophy, polio, cerebral palsy.Children who undergo organ transplants (kidney, liver and heart) are also at increased risk.
- profeesionalnyh FACT risk. Scoliosis may be evident in young athletes, with a predominance of 2-24%.The highest rates were observed among dancers, gymnasts and swimmers.Scoliosis may be partly due to the weakening of the joints, the delay in the onset of puberty (which can lead to a weakening of the bones) and to the growing spine stress.Higher risk of scoliosis in young people who are actively involved in sports and provide an uneven load on the spine.Sports give extra-large load on the spine, it is: figure skating, dancing, tennis, skiing, javelin, etc.In most cases, scoliosis occurs in minors.Exercising provides many benefits for young and older people, and may even help patients with the generated scoliosis.
Types of scoliosis
- idiopathic scoliosis. 80% of patients the cause of scoliosis is unknown.Such cases are called idiopathic ( "no known cause") scoliosis.Idiopathic scoliosis can be associated with hereditary factors.
Idiopathic scoliosis can be classified depending on the age of the patient.Age at onset of disease, and may determine an approach to treatment.Classification by age as follows:
- Children: up to 3 years;
- Minors: from 4 to 9 years;
- adolescents 10 years of age.
idiopathic scoliosis may be initially diagnosed in adults in the evaluation of other complaints or disorders, although the curve when it may be small.
- Congenital scoliosis. Congenital scoliosis is caused by a congenital deformity of the spine, which can lead to a lack of or fused vertebrae.Kidney problems, especially for those who have only one kidney, often coincide with congenital scoliosis.The disease usually can appear at any age, but is most often congenital scoliosis seen in children aged 8-13 years, when the spine starts to grow faster, creating an additional burden on unhealthy vertebrae.It is important for the diagnosis and monitoring of such curvature as early as possible as it can progress rapidly.Early surgical treatment to prevent serious complications - to the age of 5 years - can be important for many of these patients.
- Neuromuscular scoliosis . Neuromuscular scoliosis may result from various causes, including:
- traumatic injuries of the spine;
- neurological or muscular disorders;
- cerebral palsy;
- traumatic brain injury;
- mielomeningo (central nervous system defect);
- spinal muscular dystrophy;
- spinal cord injuries;
- myopathy (muscle damage).
These patients often have serious complications, including lung problems and severe pain.
Symptoms of scoliosis
Scoliosis is often asymptomatic.The curvature itself may be too small to be seen even observant parents.Some parents may notice this kind of abnormal postures of their growing child:
- the inclination of the head, not coinciding with the level of the hips;
- speakers and asymmetric blades;
- one hip higher than the other or one shoulder higher than the other;
- deformity of the chest;
- reliance on one side more than the other;
- unequal breast size in girls during development;
- one side of the upper back is higher than the other, and when the child bends his knees together;
- back pain, increased pain after a short walking or standing.
Scoliosis may be suspected when one shoulder is higher than another - it means that scoliosis develops in the spine at the level of the pelvis.Treatment of such scoliosis may include surgery or the insertion of brackets.Treatment is determined by the cause of the scoliosis, the size and location of the curve, and the bones of the patient's stage of growth.
with more severe scoliosis fatigue may occur after prolonged sitting or standing.Scoliosis caused by muscle spasms or growths on the spine, can sometimes cause pain.Almost always weak scoliosis does not cause any symptoms, and the disease is detected at the pediatrician or in screening.
diagnosis of scoliosis
severity of scoliosis and the need for its treatment is usually determined by two factors:
- the degree of curvature of the spine (scoliosis is diagnosed when the curve - 11 degrees or more);
- torso rotation angle in degrees (APR).
These two factors tend to be interconnected.For example, if an individual curvature of the spine at 20 degrees, typically APR be 5 degrees.However, patients typically do not need medical help until the curve reaches 30 degrees, and ATP not be 7 degrees.
- Medical examination.The test "in the slope." Screening tests are most commonly used in schools and offices have pediatricians and primary care physicians.They are called "in the slope."The child leans forward, with his hands must hang, feet to be together, knees - straight.Any imbalance in the chest or other deformations along the back may be a sign of scoliosis.Structural scoliosis curve is more obvious when a child leans.A child with scoliosis expert can observe unbalanced chest - on one side higher than the other, or other deformation..