Grade 2 scoliosis in adults and children

Complex but moderate (within 11-25°) curvature of the spinal column along the frontal and sagittal planes, which is accompanied by twisting of the vertebrae, is called scoliosis. Scoliosis of the 2nd degree is diagnosed quite often, since this stage, unlike the first, already manifests itself with noticeable external signs. [ 1 ]

The disorder has many prerequisites for its occurrence. However, in most cases, the true cause of the pathology cannot be found.

Epidemiology

The first information about scoliosis as a disease of the spinal column was presented by Hippocrates - moreover, the ancient Greek healer even tried to build a treatment for this disorder by external influence on it. By the way, Hippocrates noted that scoliosis can be inherited through the female line. [ 2 ], [ 3 ]

According to current statistics, girls are indeed more likely to get sick: approximately 6:1 compared to boys.

Not long ago, scientists confirmed that girls whose mothers suffer from scoliosis have a 20-fold higher risk of developing this pathology than other children. At the same time, hereditary scoliosis is more aggressive. However, this issue is still being studied.

The first manifestations of scoliosis curvature of the spine most often coincide with periods of active growth of the musculoskeletal system. This is approximately the period of 6-7 years and adolescence.

Statistics show that about 6% of the world's population suffers from scoliosis of varying degrees. However, only in 14% of cases do doctors manage to determine the cause of the pathology: most often, this cause is trauma, rickets, congenital bone anomalies, different lengths of the lower limbs, etc.

Of the hundreds of patients with initial manifestations of scoliosis, further progression of the disease is observed in approximately 1/3 of cases. [ 4 ], [ 5 ]

Causes 2nd degree scoliosis

Scoliosis of the 2nd degree is always a consequence of the progression of the initial, first degree of curvature. The only exceptions to the rule are congenital defects that are formed as a result of a violation of the formation and growth of vertebral discs and ligamentous apparatus in the prenatal period, as well as deformations caused by certain childhood diseases - in particular, cerebral palsy, rickets, poliomyelitis.

In general, doctors identify the following reasons for the occurrence of this disorder:

• Among the congenital causes are developmental defects of the spinal column (complete and additional wedge-shaped vertebrae), fusion of the vertebral bodies and transverse processes, costal synostosis, etc.;
• Among neuromuscular causes are deficiency and weakening of the ligamentous-muscular mechanism of the spinal column, decreased muscle tone in patients with syringomyelia, myopathy, cerebral palsy, multiple sclerosis, etc.;
• Among the syndrome-related causes are connective tissue dysplasia, Marfan syndrome, Ehlers-Danlos syndrome;
• secondary causes include fractures, surgical interventions, cicatricial contractures, etc. [ 6 ]

Risk factors

The appearance and progression of scoliosis disorder can occur due to a combination of the following factors:

• dysplastic disorders affecting the spinal cord, vertebrae, discs, which entails disruption of the normal growth of the spinal column;
• disorders of hormonal balance and metabolic processes, which in general creates an unfavorable background in the body;
• dynamic and static disorders – in particular, excessive and asymmetrical load on the spinal column, especially during the stage of skeletal growth. [ 7 ]

Direct risk factors include weakened back muscles, physical inactivity, insufficient or inadequate nutrition, “asymmetrical” professional or sports activities, regular incorrect body position (during work, study), and wearing a backpack on one shoulder.

If during the diagnosis the doctor is unable to establish the cause of the disorder, then a diagnosis of idiopathic scoliosis is made. [ 8 ]

Pathogenesis

The main theories for the appearance of scoliosis curvature are considered to be structural changes in the spine, disorders of the spinal muscles and collagen fibers, pathologies of the endocrine system and the vestibular apparatus. The possibility of genetic predisposition is also considered. [ 9 ]

In the context of the development of idiopathic scoliosis, the main theories are considered to be genetic, endocrinological and neuromuscular. However, the mechanism of occurrence of the disorder due to the above reasons has not been fully studied. [ 10 ]

In the thoracic segment of the spinal column, during the process of curvature formation, the vertebral body shifts toward the convexity of the curved arc. As a result, the anterior part of the thoracic vertebrae turns toward the convexity of the arc, an elongation of the root of the arch is noted, and the vertebral opening widens. The vertebrae are deformed according to the wedge-shaped type. A similar deformation is also observed in the intervertebral discs, which narrow on the concave side and undergo degenerative changes. [ 11 ]

During the development of scoliosis, the spinal column changes its shape and position: a posterior deviation of the transverse processes and their reduction are noted. The articular processes at the concavity zone become more horizontal, and the articular facets (facet joints) expand. New joints are formed on the adjacent parts of the arches. A deviation of the spinous processes of the thoracic vertebrae towards the convexity is noted, and the semi-arch of the convexity is shortened in comparison with the concave part.

The mechanism of the ligaments changes pathologically. The anterior longitudinal ligament shifts toward the convexity with subsequent fraying and thinning, and the part of the anterior longitudinal ligament at the concavity becomes compacted. These processes ensure the stability of the curvature that has formed.

The spinal canal becomes uneven: narrowing in the concavity zone and widening in the convexity zone. The protective covering of the spinal cord, together with the inner part, is pressed into the anterolateral surface of the concavity.

The ribs and chest change pathologically in different planes. There is overlapping of the ribs, widening of the intercostal spaces, costal deformation, and formation of a hump. With excessive convergence of the ribs, the likelihood of fibrous adhesions and the development of degenerative processes in the intercostal muscles increases. [ 12 ]

Symptoms 2nd degree scoliosis

Often, even with a relatively small curvature, a person experiences back pain that radiates to the legs, arms, other parts of the body, and even internal organs. The cause of such pain is the pinching of nerves by supporting structures or altered vertebral discs. This entails a deterioration in the passage of bioelectric signals along nerve fibers from the spinal cord to certain organs. [ 13 ]

Curvature of the spine may manifest itself in the following signs:

• violation of body symmetry;
• gait disturbance;
• severe back fatigue (the back quickly becomes tired when there is no support, such as the back of a chair, or when walking or standing for a long time);
• regular pain in the head, back, lower back, between the shoulder blades;
• shortness of breath, periodic problems with the heart and/or digestive system;
• slouch.

If we are talking about children, then parents can pay attention to the following early signs:

• unnatural protrusion of the shoulder blades;
• constant tilt of the head to the side;
• asymmetrical positioning of the shoulders or hips, their visually incorrect positioning (higher or lower in relation to each other);
• curvature of the belt line;
• tilting the body to the side when walking.

If you notice any of the above symptoms, you should definitely seek help from an orthopedist.

What does grade 2 scoliosis look like?

If you look closely at the back area of a person with grade 2 scoliosis curvature, you can note the following features:

• the shoulder blades are located asymmetrically;
• the position of the shoulder blades is different (the shoulder blade protrudes on one side);
• curved line of spinous processes;
• slightly skewed body.

As the deformation develops, the scapula on the convex side of the curved arc becomes higher than the scapula on the concave side. The formation of the so-called costal hump is noted, which seems to "push" one scapula outward.

The distortion of the torso entails a change in the balance of the body: there is an axial tilt towards the apex of the curvature.

If the patient is asked to lean forward, the deformity will become more obvious.

Pain with scoliosis 2 degrees

With cervical curvature, pain manifests itself in the shoulder, interscapular space. Regular headaches and dizziness are also characteristic. Increased pain syndrome is observed when bending forward or when holding the head in one position for a long time.

With thoracic deformity, pain may appear in the chest, in the middle of the back, and in the shoulder blades.

With lumbar scoliosis, debilitating pain in the lumbar region is most often observed.

Cervicothoracic deformity manifests itself through intense pain in the muscles and head. The pain intensifies with physical activity, as well as with deep inhalation and coughing impulses.

Hump with scoliosis 2 degrees

Scoliosis of the 2nd degree is poorly defined externally, therefore the hump at this stage of the pathology is present only in the form of a costal curvature. The stoop is barely noticeable, the deformation becomes visible only when the body is tilted forward.

The problem may cause mild discomfort, muscle tension may be felt, and pain may occur in the absence of physical activity.

The appearance of a costal hump is more typical for grades 3-4 of curvature affecting the upper thoracic, thoracic or thoracolumbar spine, although upon visual examination one may notice a stronger protrusion of the scapula on one side.

Scoliosis of the 2nd degree in a child

In childhood, scoliosis begins to develop between the ages of five and 14. The most dangerous periods are considered to be 5-6 years and 10-14 years, since it is at these stages that the child's spine is actively growing.

Since the spinal column is characterized by a fairly pronounced plasticity, with improper distribution of the load on it, or under the influence of other factors, individual rows of vertebrae can deviate from the base axis to the left or right, forming an arc of scoliosis. This phenomenon is typical for the lumbosacral spine, but can also appear simultaneously in different sections.

In addition, a congenital form of the pathology is typical for children. In such a situation, the problem is explained by the improper development of the baby's musculoskeletal system, defects in the form of costal or vertebral adhesions, the presence of additional vertebrae, etc. It should be noted that the congenital form is much less common than the acquired one.

Scoliosis 2 degrees and pregnancy

Among all the pathologies of the spinal column in pregnant women, scoliosis is in second place, after osteochondrosis. At the same time, this disorder significantly complicates the life of a woman in such a responsible period of gestation. Even in a healthy state, the spine of pregnant women undergoes heavy loads, especially in the lumbar region, which in the third trimester manifests itself in quite severe pain. In women suffering from scoliosis of the 2nd degree, pain syndrome can be detected earlier and manifest itself even more strongly.

In addition, pregnancy often causes a failure of the compensatory changes that were achieved during the treatment of the problem. It is also possible that complications may develop due to post-deforming disruption of the internal organs and nervous system. Women with scoliosis curvatures are more likely to have premature births, spontaneous miscarriages, developmental defects in the baby, and the degree of curvature may worsen during the period of gestation.

However, many expectant mothers successfully carry and give birth to healthy children. The main condition: regular medical supervision, proper pregnancy management, weight control, and the use of special bandages.

Stages

To determine the stage of scoliosis disorder, criteria such as the primacy and degree of curvature, its stability, the presence of structural vertebral changes (rotational, torsional, deformational), and the localization of compensatory curvatures above and below the main defect are used. [ 14 ]

According to the altered static spinal function, the following are distinguished:

• compensated (balanced) curvature, in which the vertical axis, passing from the apex of the spinous process of the C7 vertebra, runs through the intergluteal line;
• uncompensated (unbalanced) curvature, in which the vertical axis extending from the apex of the spinous process of the C7 vertebra is diverted to the side and does not pass through the intergluteal line.

According to the radiological classification, scoliosis disorder can have the following stages: [ 15 ], [ 16 ], [ 17 ]

1. The scoliosis angle is 1-10°. The spine has a slight curvature along the frontal plane, asymmetry of the shoulder blades and shoulder girdles (thoracic and cervicothoracic scoliosis) or waist (lumbar scoliosis), muscle asymmetry at the level of the arc of deformation.
2. The scoliosis angle is 11-25°. The curvature is pronounced and does not "hide" when the spine is unloaded. There is a small compensation arc and a slightly pronounced costal hump.
3. The scoliosis angle is 26-50°. The curvature is significant in the frontal plane. There is a compensatory arc, the chest is deformed, the costal hump is pronounced. There is a deviation of the trunk to the side from the basic scoliosis arc. Unloading the spine gives minor correction.
4. The angle exceeds 50°. Kyphoscoliosis is stable, sharply intense. There are disorders of the respiratory and cardiac organs. [ 18 ]

Forms

Depending on the etiology of the development of the pathology, scoliosis can be:

• myopathic;
• neurogenic;
• dysplastic;
• cicatricial;
• traumatic;
• idiopathic.

Idiopathic scoliosis of the 2nd degree is a disorder, the causes of which remain unclear.

Dysplastic scoliosis of the 2nd degree is caused by a violation of the metabolism and blood supply of the tissues of the vertebrae and discs. [ 19 ]

According to the form of deformation, the following are distinguished:

1. C-shaped scoliosis, which has one curved arc;
2. S-shaped scoliosis of the 2nd degree, with two arcs of curvature;
3. Ʃ-shaped scoliosis, which has three arcs of curvature.

According to the location of the deformation, the following are distinguished:

• left-sided scoliosis of the 2nd degree (with predominant curvature of the arc to the left side – occurs more often and has a more favorable prognosis);
• right-sided scoliosis grade 2 (with curvature of the arc to the right side);
• cervicothoracic scoliosis with the peak of deformation at the level of Th3-Th4;
• thoracic scoliosis grade 2 with the peak of the deformity at the level of Th8-Th9;
• thoracolumbar scoliosis grade 2 with the peak of the deformity at the level of Th11-Th12;
• lumbar scoliosis of the 2nd degree with the peak of the deformity at the level of L1-L2;
• lumbosacral with the apex of the deformity at the level of L5-S1.

According to the changed degree of curvature depending on the load on the spinal column, the following are distinguished:

• fixed scoliosis of the 2nd degree, also known as stable;
• non-fixed scoliosis grade 2 (unstable).

Depending on clinical features:

• non-progressive scoliosis (without increasing angle of deformity);
• progressive scoliosis of the 2nd degree, which is divided into slowly and rapidly progressing (up to 9° and more than 10° in 12 months).

Complications and consequences

If the curvature of the spinal column progresses, over time it can lead to secondary deformation of the pelvis and chest, impaired pulmonary function, pathologies of the heart and abdominal organs, and the development of degenerative-dystrophic changes.

Growing deformation can lead to the following adverse consequences:

• Anatomical and functional changes in the internal organs, deterioration of respiratory function, the appearance of pulmonary insufficiency, which entails a chronic hypoxic state. [ 20 ], [ 21 ]
• The development of right ventricular failure, which is caused by increased pressure in the pulmonary circulation, and the development of the “scoliotic heart” syndrome. [ 22 ], [ 23 ] The syndrome is characterized by respiratory failure, chest pain, impaired consciousness, increased fatigue, tachycardia, spinal pain, paresthesia, night sweats, swelling of the legs and blue lips, and coldness of the hands and feet.
• Change in the localization of the kidneys and liver by the type of prolapse, disorder of these organs and intestines. Possible violation of the urodynamic state, development of inflammatory processes in the genitourinary sphere.
• Dystrophic processes affecting intervertebral discs and synovial joints, accompanied by pain syndrome similar to osteochondrosis with radicular syndrome.
• Severe spinal disorders, spasms, flaccid paresis and paralysis caused by circulatory disorders, lymph flow, and the development of cerebrospinal fluid congestion.

These factors can generally lead to general exhaustion of the body and disability due to severe functional and organic disorders.

What is the danger of grade 2 scoliosis?

Not in all cases does the second degree curvature worsen and progress. But if it does happen, there is a risk of chest deformation, formation of incorrect arrangement of internal organs of the abdominal and thoracic cavity, development of functional disorders on the part of several body systems at once: urinary, respiratory, digestive, cardiovascular systems.

In addition, the scoliosis defect itself is a noticeable cosmetic defect. This, in turn, can cause depression and neurosis: a person becomes withdrawn, uncommunicative, socialization suffers, problems with studies and professional activity appear.

Diagnostics 2nd degree scoliosis

During the appointment, the doctor first listens to the complaints of the patient. The patient may indicate back pain, discomfort, increased fatigue in the spine. After this, the specialist conducts an examination: the doctor determines the presence of curvature in all planes visually. In this case, the patient is required to undress to the waist, stand up straight, then bend forward and touch the floor with his fingers. Then the doctor evaluates the symmetry of the torso, checks the quality of reflexes, muscle strength and the breadth of joint movements. [ 24 ]

The tests are not specific and can be prescribed as additional studies. [ 25 ]

Instrumental diagnostics is usually represented by the following procedures:

• Scoliometry – helps to determine rotational changes of the vertebrae, calculate the degree of the rib hump, determine the angle of deformation. A special device – a scoliometer – is used for the study.
• Radiography – allows you to visualize the area of the disorder, examine changes in the vertebrae and intervertebral discs, and monitor the dynamics of treatment.
• Computer or magnetic resonance imaging is appropriate in the case of simultaneous impairment of nerve functions, or at the preparatory preoperative stage.

The X-ray usually includes two images in the back projection: one in a horizontal position lying on your back, the second in a vertical position. [ 26 ]

The radiological signs of rotational and torsional changes in the vertebrae in the posterior projection image are as follows:

• the spinous process of the vertebra is displaced toward the concave part of the scoliotic arc;
• the lengths of the right and left transverse processes differ;
• the position and shape of the pedicles of the vertebral arch are asymmetrical;
• the position of the intervertebral joints is also asymmetrical;
• The body of the vertebra and the intervertebral spaces have a wedge-shaped form.

If the scoliosis angle does not change in the horizontal position, then we speak of stable scoliosis. If the angle changes in the lying position, then the scoliosis is considered unstable (not fixed, unsteady). [ 27 ]

Differential diagnosis

Differential diagnostics are carried out with postural defects such as stoop, round or flat back, winged scapulae, lumbar hyperlordosis. The cardinal distinguishing feature is the presence of pathological rotational and torsional vertebrae in scoliosis, and the clinical symptom may be the appearance of a rib hump and muscular ridge. [ 28 ]

The following diagnostic methods are used for differentiation:

• neuroorthopedic research;
• radiography with functional tests;
• ultrasound examination;
• electrocardiography, echocardiography;
• ultrasound Dopplerography;
• electroneuromyography.

Treatment 2nd degree scoliosis

What treatment method should be used for grade 2 spinal curvature? It depends on how advanced the pathological process is. At the initial stages of development, with grade 1-2 scoliosis, it is often enough to find and eliminate the cause of the deformation. The position of the spine can be corrected with the help of long courses of massage and exercise therapy. Doctors advise pediatric patients to go in for swimming, horse riding, and also to sleep on a hard mattress, and to control their posture. [ 29 ]

The following additional methods may be recommended:

• physiotherapy;
• manual therapy;
• wearing corsets.

More complex methods, such as surgical treatment, are usually offered to patients with 3-4 degrees of curvature, and only if the pathology disrupts the functioning of individual organs and systems and negatively affects the patient's health. The most favorable age for surgery is 10-14 years. The intervention is quite traumatic and is accompanied by a long rehabilitation period.

Read more about the treatment of grade 2 scoliosis in this article.

Prevention

Preventive measures include early diagnostics of curvature by conducting widespread medical examinations of children attending preschool and school institutions. It is important to explain the need for a healthy lifestyle and a rational daily routine. Children should eat well to prevent a deficiency of vitamins and minerals in the body.

It is necessary to ensure sufficient physical activity during the day, with the correct static-dynamic loads on the spine. Avoid staying at the table for too long: it is important to regularly do warm-ups, dynamic breaks in work and study approximately every 20 minutes. Regular walks and active pastime are no less important.

A person's workplace should be properly organized and have sufficient lighting. The sleeping area should also be "correct": the bed should be semi-rigid, the pillow should be orthopedic, with adequate unloading of the cervical-thoracic spinal zone.

We must not forget about posture, which is the basis for the correct position of the spine. It is necessary to explain to the child how important it is not to slouch and to hold the back. It is in childhood that a kind of "muscle memory" of the paravertebral muscles is formed, which contributes to the normal position of the spinal column throughout the day.

Forecast

The prognostic data for the life of a person with scoliosis of the 2nd degree are considered favorable. If we are talking about a severe progressive course of pathology, then over time the question of assigning a disability, limiting the ability to work, narrowing the possibilities in professional choice may arise. Difficulties with the adaptation of the patient in society arise.

The quality of the prognosis largely depends on the course of the scoliotic process. If it does not progress, or progresses slowly, then the curvature can often be corrected with conservative treatment, thereby preventing the development of complications in the functioning of the respiratory and cardiovascular systems. If the pathology progresses rapidly and does not respond well to conservative therapy, then intensive corset therapy or even surgery may be used. [ 30 ]

In general, it is generally accepted that grade 2 scoliosis responds well to treatment under certain conditions:

• absence of hereditary predisposition;
• adequate physical development of the patient;
• sufficient motivation for healing.

However, in many cases the disorder remains with a person for life: not progressing, or progressing slowly throughout life.

Scoliosis 2 degrees and the army

Scoliosis of the 2nd degree with a spinal deformity within 11-17° usually does not become a sufficient pretext for exemption from military service. However, several points must be taken into account. Thus, if the curvature in the thoracic spine is fixed, minor motor impairments are noted, then the person may be recognized as fit with restrictions for urgent or contract military service. The final decision is made by the military medical commission.

A complete exemption or deferment from service may be granted only in the following cases:

• a person suffers from constant disorders of the musculoskeletal system after just a few hours of standing on their feet or walking slowly;
• the motor amplitude is noticeably impaired and is chronic in nature;
• there are movement disorders against the background of the absence of tendon reflex and decreased sensitivity;
• a decrease in muscle strength is observed in a certain muscle group, with compensation at the expense of other muscle groups.

Health group for scoliosis grade 2

The conclusion about which health group to assign a child to is made based on the recommendations of several medical specialists at once: a pediatrician, surgeon, ophthalmologist, ENT doctor, dentist, neurologist.

As a rule, healthy children are included in the first health group. They may have minor morphological disorders that do not affect their general health and do not require medical correction. Such children can perform all permissible loads during physical training lessons.

The second health group includes children with minor disorders without chronic pathologies. For example, this includes children who are overweight, short, often ill, or who have recently suffered injuries or surgeries.

The third health group includes children with chronic pathologies, including gastritis, bronchial asthma, cardiovascular diseases. This group may also include patients with grade 2 scoliosis: this means that such children cannot jump, run long distances, or strain their backs. However, individual selection of exercises and training is recommended. In some cases, one or another health group is assigned temporarily, changing as the disorder is corrected or worsens.

Scoliosis grade 2 and disability

Disability is not assigned to patients regardless of the degree of scoliosis:

• if professional activity and working conditions do not affect the course of the pathology;
• if there are no signs of respiratory failure above stage 1;
• if there is no exacerbation of pain and neurological symptoms;
• if the static-dynamic disturbance is minor.

The patient is advised to change his/her occupation if the work is associated with heavy or moderate physical labor, if the work process requires a forced body position, frequent bending, vibration, or prolonged vertical position.

The patient is referred to the commission if:

• there are absolute contraindications to work activity;
• the risk of developing complications increases, including respiratory failure of at least grade 2;
• there are regular exacerbations of pain with neurological symptoms.

As a rule, grade 2 scoliosis in the vast majority of cases does not become an indication for assigning disability, since at this pathological stage the limitations of spinal mobility are insignificant.