Scoliosis – combines all forms of persistent lateral curvature of the spine , combined with the rotation of the vertebral bodies and torsos . Allocate nestrukturalnye scoliosis (no structural damage to the bones , the vertebrae of the normal form , the deformation is always reversible ), and structural . By structural scoliosis include: idiopathic , juvenile , adolescent and adult scoliosis , congenital , neuropathic , myopathic , etc. Nestrukturalnye scoliosis can occur as postural ( scoliosis posture ) , hysterical , antalgichesky (with considerable pain in the lower back ) , inflammation (eg , appendicitis ), and shortening of the lower limb , contracture of the hip , etc.
In the diagnosis of scoliosis is important to use clinical examination (indicated by curvature of the spine , rib hump , asymmetry triangles waist line and shoulder girdle ) . X-ray examination reveals a deformity of the spine ( direct projection in the standing and lying down) . They can be used and additional studies : computed tomography, magnetic resonance imaging , spirography , contrast myelography , elektromiografiya .
According to the modern classification L.Lenke distinguish these types of scoliosis : Lenke I – chest ; Lenke II – double rib ; Lenke III – combined ; Lenke IV- three major arc of curvature ; Lenke V- thoracolumbar ( lumbar ) bending ; Lenke VI – thoracolumbar ( lumbar ) bending ( primary breast ) .
There are four degrees of severity of scoliosis :
I degree . Clinically observed scoliosis curvature of the spine and paravertebral asymmetry at this level when bent spine rib hump is not defined. Radiologically determined by one of the primary forms of distortion , which does not completely disappear when lying or upright sipping patient. Expressed by the initial manifestation of torsion spine. Primary bending angle is 10 °.
II degree. Clinically defined pronounced curvature and the presence of the rib hump when bent spine. Triangles are asymmetrical waist , shoulder girdle , and marked asymmetry vane position , paravertebral muscle asymmetry in the lumbar spine bending it . The angle of curvature of the primary X-ray expressed in the range of 10 -25 °. It is noted compensatory protivoiskrivlenie spine. Torsion spine clearly expressed. With the traction possible to completely eliminate the compensatory curvature of the spine and significantly eliminate the main curvature of the spine , as well as change the amount of torsion .
III degree. Clinically significant deformation of the sharp asymmetry, tilting the pelvis. Rib hump is determined and in a vertical position, it is not eliminated by lying with traction and above the head . Both primary and secondary , compensatory curvature fixed , and the initial curvature is not completely eliminated in any correction. The angle of curvature of the primary X-ray is defined as 25-40 °. Sum of the angles of compensatory protivoiskrivleny smaller than the main curvature , which is subject to correction by traction achieved by significantly reducing or eliminating the compensatory distortions and significant reduction of the main curve. A marked deformity of the chest , sometimes rib hump front , sternum rejected in the concavity of the spine.
IV degree. Heavy deformation body : obliquity of pelvis , trunk deviation , limitation of movement in the spine, thoracic spine kyphoscoliosis , fixed deformity of the chest , the presence of anterior and posterior rib hump . Observed radiographically pronounced wedge-shaped deformation of the bodies of the thoracic vertebrae , and spondylosis deformans spondylarthrosis in the thoracic and lumbar spine. The slope of the curvature of more than 40 . Sum of the angles of the secondary compensatory curvature equal to the corner of the main curve. All curvature fixed and can not be significantly reduced without wedge resection of the vertebral body at the top of the arc curvature .
Special group consists of scoliosis , complicated neurological disorders with clinical symptoms. When scoliokyphosis disorders in the spinal cord are the result not only of bone compression and destruction of the dura mater , but also circulatory disorders that lead to ischemic degeneration. Some radicular artery stretched as well as roots , they accompany . Surface shell arteries become strained and a strangled . The appearance of spinal disorders in kyphoscoliosis and 15 – 20 years is not the same as the increase in spinal deformity , but rather everything related to arterial ischemia. Participation circulatory disorders can also see a partial reduction or complete disappearance of signs of spinal disease after surgical intervention, which aims to eliminate distortion and reduction of spinal canal compression and tension neurovascular elements. Spinal disorders may be accompanied by partial or complete spinal cord conduction disturbance ( paraparesis , paraplegia ) .
Depending on the severity of scoliosis conducted conservative ( corset, Phys . Procedures) or operational ( transpedicular correction of the deformity , anterior release) treatment. prior to surgery after surgery