Scoliosis of the cervical spine

The spine takes on a pathological position most often in childhood or adolescence during the period of active development of cartilage and bone tissue, although such a defect can also occur in adults. The term scoliosis itself suggests that the curvature plane is frontal, in contrast to lordosis and kyphosis - bends in the sagittal plane. Cervical scoliosis or, more precisely, cervicothoracic scoliosis is detected as a deviation of the spine from a vertical position to the left or right at the very top of its thoracic region at the level of Th4-Th5 (fourth to fifth thoracic vertebrae), which leads to an asymmetric arrangement of the head and shoulders, as well as deformation chest, skull bones and other complications. Cervical scoliosis is a rare pathology. [1]

Epidemiology

The incidence of scoliosis varies in different countries from 2% to 13.6%. [2],  [3] Statistics show that curvature in the cervical spine is more common in female patients, however, there is evidence that in girls it simply progresses more often. It is believed that the presence of cervical scoliosis in the mother increases the likelihood of the same pathology in her daughter. But the degree of curvature of the spinal column does not depend on the severity of the pathology in relatives, even among monozygotic twins there is no concordance on this basis. In general, scoliosis of all localizations is the most common vertebral pathology. Only one of the four inhabitants of our planet can boast of proper posture.

Causes of the cervical scoliosis

Spinal curvature more often occurs in childhood, sometimes it is noticeable from birth, then they talk about a birth defect, the reasons for which may be hidden in abnormal intrauterine development or be the result of even a minor injury to the upper part of the thoracic spine received during childbirth. The basis of congenital scoliosis is a dysplastic process, signs of spinal curvature are present from birth.

Most of the scoliosis are idiopathic, their origin remains unclear, and they are considered an independent disease. [4] Uneven development can become a hypothetical cause, when the skeleton develops faster than muscles and ligaments that support the correct position of the spinal column (muscle-ligament insufficiency in childhood and adolescence). It is believed that such uneven cell division occurs due to pathological changes caused by metabolic disturbances, underdevelopment of the vertebrae, their irregular shape, displacement of the pineal gland, absent in adults, which is considered the weakest part of the skeleton of a growing organism and can be damaged as a result of even ordinary stretching. [5]

Hormonal insufficiency can occur in puberty when one process (rapid growth of a child) “distills” the others (hormonal restructuring lags behind).

A hereditary familial predisposition increases the likelihood of developing cervical scoliosis, however, apparently, provided that there are still some risk factors. [6] The pathogenesis of this disease is not well understood. It is not yet possible to establish which mutation of which gene or group of genes would be responsible for the development of idiopathic scoliosis. Studies were carried out with different categories of genes that determine the structure of connective tissue and bones, their formation, hereditarily determined metabolic processes in these tissues, the signaling pathway of melatonin, genes that determine the processes of puberty and growth were also studied, however, there is still no clarity in this matter increased.

A relationship has been reported for congenital cervical scoliosis with Klippel-Feil syndrome (KFS), type 1 neurofibromatosis (NF-1). [7], [8]

About a fifth of all scoliosis are acquired, secondary, their development indicates the presence of any pathological process. Neoplasms of the spine and adjacent anatomical structures, cystic formations in the cervical spinal cord - syringomyelia, the causes of which are also unclear for certain, can lead to a lateral deviation of the spine from a vertical position.

The presence of degenerative changes in the spine of various origins (rheumatism, rickets, osteoporosis, osteoarthritis) lead to its curvature at any age.

Acquired static scoliosis can result in a prolonged stay in an uncomfortable position with an unnaturally inclined neck, associated with irrational equipment of the workplace, non-observance of the work and rest regime, simply neglecting the basic recommendations regarding posture - carrying a bag or briefcase in one hand (on one shoulder), low or a very high table for classes, etc.

Neurogenic scoliosis is secondary and may be the result of cerebral palsy, previous meningoencephalitis and other neuroinfections. [9]

Neuromuscular scoliosis is usually associated with various neuromuscular disorders, including conditions affecting the upper and lower motor neurons, as well as myopathies. [10]

Risk factors

Risk factors are spinal injuries, sometimes even minor ones that are forgotten; excessive and, most importantly, uneven physical activity or their complete absence; the presence of diseases of the spine and spinal cord; improper metabolism; cardiac surgery, extensive burns, pleural empyema, overweight.

Symptoms of the cervical scoliosis

The severity of symptoms depends on the degree of curvature of the spine. The first signs of the disease are almost invisible visually and do not cause uncomfortable sensations in the patient, except perhaps rapid fatigue. The coexistence of chronic neck and back pain, discomfort, stiffness and numbness are common symptoms of cervical scoliosis. [11], [12] 

Stages

Scoliosis of the first degree of the cervical spine is a deviation of it laterally from the vertical axis by an angle of not more than ten degrees. If such a defect in breast scoliosis is already more noticeable, then in a short cervical area it is most often detected by chance, for example, on x-rays. In the embryonic stage, cervical scoliosis cannot be treated, although the patient is recommended a preventive complex of therapeutic exercises and a periodic examination in order to prevent the progress of the disease.

Scoliosis of the cervical spine of the II degree suggests an angle of deviation from the vertical from 11 to 25 °. Such a tilt of the neck is already visible visually - the head is slightly retracted to the left or to the right, although it is not tilted or turned around like with a crank. It is sometimes noticed that the patient’s ears are at different heights. Usually, the general symptoms in this stage of the disease are not expressed, although sometimes, in addition to muscle weakness, the patient may periodically feel aching neck pain or dizziness. As a rule, the appearance of discomfort of this kind is associated with increased physical and positional stress, as well as with partial compression of the vertebral artery in a certain position. At this stage, scoliosis must already be treated, and the effectiveness of treatment during this period is the highest.

Scoliosis of the cervical spine of the III degree is diagnosed when the cervical vertebrae deviate from the vertical axis by an angle from 26 to 40 °, IV - more than 40 °. Such degrees are difficult to conservatively treat, complicated by turning around the axis passing through the center of the body of the center of the vertebra (torsion), and physiological displacements (rotations).

In patients with the third and fourth degrees of scoliosis, the deviation of the head to the side is noticeable visually, it is clearly visible that not only the ears are located at different heights, but also the shoulders. In addition, the patient complains of pain in the neck, the inability to perform the usual physiological movements of the head - turn, tilt. The patient's complaints of headache, weakness, noise or ringing in the ears, impaired coordination, paresthesia indicate a violation of the blood supply to the brain due to partial compression of the vertebral artery.

It may be present with a complex of craniofacial cervical scoliosis with facial asymmetry, vertical orbital dystopia in combination with torticollis. [13]

Forms

Types of scoliosis are distinguished by the shape of the curvature of the spine, highlighting the number of places of deviation from the vertical axis:

• c-shaped or simple scoliosis - curvature is observed in one place and in one direction;
• s-shaped or complex - in two places in different directions;
• z-shaped or total - in three or more, when the vertebrae of adjacent parts of the spinal column are involved in the curvature process.

According to the localization of the lesion, cervicothoracic scoliosis with a peak of curvature at the level of Th4-Th5 is distinguished; thoracic - Th8-Th9; lumbar-thoracic - Th10-Th11; lumbar - L1-L2. Combined or complex - thoracic and lumbar vertebrae are more often involved.

Left-sided cervical scoliosis is diagnosed when the apex of the curvature arch goes to the left side. More often idiopathic and develops in adolescent girls, although it can be acquired in adulthood. It is less common than right-sided and s-shaped. A consequence of congenital anomalies, basically, is also not.

Right-sided cervical scoliosis, respectively, involves a curvature of the spine to the right and develops in most cases with malformations, and often has the character of an acquired pathology.

There are also such species as fixed scoliosis, which persists at any position of the body, and unfixed when the curvature disappears in a sitting or lying position.

Complications and consequences

On the aesthetic side, noticeable cervicothoracic scoliosis is a significant cosmetic defect that worsens a person’s mental status, self-esteem, and reduces the quality of life. In addition, such a pathology negatively affects the state of health.

Complicated flat curvature of the spine by increasing the angle of inclination, torsion, rotation of the vertebrae, new bends. Cervical scoliosis, which developed in childhood and adolescence, can lead to defects in the formation of skull bones. Partial compression of the vertebral artery leads to impaired cerebral circulation. A frequent companion of scoliosis of the cervicothoracic spine is paresthesia of the upper extremities, intercostal neuralgia. In patients with scoliosis, cervical osteochondrosis is more common.

Simple c-shaped scoliosis gradually transforms into a complex s-shaped. The spine bends lower in the opposite direction to compensate for the first bend. Scoliosis can be complicated by bending the spine forward (lordosis) or backward (kyphosis). Deformation of the ribs and blades may occur.

If scoliosis of the first degree does not affect the state of internal organs, then higher degrees of curvature of the spine deform the ribs and change the shape of the chest, as a result of which the functions of the respiratory, cardiovascular and nervous systems are impaired. The altered respiration mechanics affects the degree of oxygenation of arterial blood, pulmonary hypertension appears, and the hemodynamics of the whole organism changes.

Diagnostics of the cervical scoliosis

The specialist can determine the curvature of the spine visually by examining the patient. He has a noticeably asymmetric line of the shoulder girdle - one shoulder above the other, respectively - the ears also, since the head is tilted to one side. In the early stages of the patient, they are examined in an inclined position forward (arms hanging freely). On palpation, soreness in a problem place can be felt. [14]

The angle of deviation of the spine with high accuracy allows you to determine instrumental diagnostics. The method of choice is x-ray. A picture of the spine is taken in several positions - standing, lying on a flat, and if necessary - on an inclined surface. The angle of curvature of the spine in radiographs is determined by the method of J. Cobb, torsion and rotation of the vertebrae are detected using the Nash-Mo or Raymondi method. [15]

Computed tomography is also used, which allows to obtain a three-dimensional image of the problem area and to determine with high accuracy the angle of curvature and the presence of twists and turns of the vertebrae. However, the study is expensive and provides a higher dose of radiation. 

For examination of children and adolescents who need regular monitoring, non-radiation techniques are used - visual inspection or photo-monitoring in dynamics, V. Bunnel scoliometry, ultrasound, computer optical topography.

Magnetic resonance imaging is more suitable for the study of soft rather than bone structures, therefore, it is usually prescribed for suspected secondary scoliosis associated with neoplasms, vascular pathologies, etc.  [16], [17]

Differential diagnosis

Differential diagnosis is carried out to determine the cause of curvature of the spine, since its identification is crucial for the choice of treatment tactics. For this, additional studies are used, for example, laboratory studies with suspected tuberculosis of the spine. Magnetic resonance imaging data with high accuracy can exclude or confirm syringomyelia, the presence of other neoplasms, vertebral hernia, computed tomography - pathological fusion of the vertebrae (synostosis), additional vertebrae. It allows you to accurately recognize cervical osteochondrosis and scoliosis, since both of them can cause neck pain and dizziness. Scheuermann-Mau disease also differentiates.

Treatment of the cervical scoliosis

Spinal curvature appears most often in six-year-old children. The debut at this age is associated with the beginning of school, the child begins to sit a lot, and his load on the spine increases sharply. The second surge in the manifestations of scoliosis is observed in early adolescence (in twelve to thirteen year olds), when rapid physical development occurs. If there was already a small scoliosis, then in puberty, deformation is often observed, torsion and rotation appear. It is believed that scoliosis can be completely cured while it is still epiphyseal - the cartilaginous growth plate has not disappeared, turning into bone tissue. The closure of vertebral growth zones occurs at about 14 years old. It is believed that later you can only slow down the process of spinal deformity, but not completely get rid of the pathology. [18]

A developing organism has a good chance of recovery. The main goal of treating cervical scoliosis in childhood and adolescence is to return the vertebrae to their natural position. Many parents are interested in: how to fix cervical scoliosis in adolescents? For this, it is best to consult a specialist. In the initial stages, the pathology is successfully corrected using a special set of exercises. Therapeutic gymnastics from scoliosis has been invented and tested for a long time, of course, perseverance and perseverance will be required to correct posture. Engaging yourself, at least initially, is not recommended, as there are contraindications to certain types of exercises. Jumps, visas, strength exercises, which can enhance deformation, are not recommended. In addition, you need to find out exactly in which part of the spine there is a pathological bend. The instructor will help you choose the right set of exercises, he will also control and correct the technique of performance - pace, amplitude, body position. [19]

If necessary, wearing an orthopedic corset may be recommended. It must be selected by a specialist so as not to squeeze the chest and give the spine the correct position. Wearing a corset for a long time is not recommended, since it helps to weaken our own muscles, which are inactive in this case. [20], [21]

The main emphasis is on normalizing muscle tone, increasing joint mobility, improving blood circulation in the problem area. As additional methods, massage, reflexology, and manual therapy are used, and physiotherapeutic procedures and drug treatment are prescribed in combination with them. Curvature of the spine in the initial stages lends itself well to correction, with progressive forms the treatment process stretches for several years.

In childhood and adolescence, efforts are aimed at monitoring the state and timely correction of the growth process, for example, hormonal status, functions of the spinal cord, central and autonomic nervous system. Drug therapy may be prescribed. Basically, vitamin-mineral complexes and fortifying agents are used. With severe pain, analgesics are prescribed, hormone therapy is sometimes necessary.

Physiotherapy is applied to the vertebral growth zones, as well as to the paravertebral muscles. Physiotherapy exercises and massage, wearing corsets, breathing exercises and swimming, alternative methods (acupuncture, Tibetan medicine, treatment with leeches) - this whole complex helps to improve posture and in uncomplicated cases allows you to completely get rid of curvature of the spine. Based on the available literature, it is too difficult to come to a clear conclusion regarding the effects of acupuncture on scoliosis. [22], [23]

Treatment of cervical scoliosis in adults, in principle, does not differ from pediatric methods. Only the effect occurs a little later, and often comes down to stabilization of the state, rather than a complete recovery.

In addition to therapeutic measures, both adults and children are encouraged to review and change their lifestyle - to become more active, monitor their posture, improve work and sleeping places, lose weight and optimize the diet - focus on plant and milk foods, eliminate alcohol, limit pickles, smoked meats, confectionery.

Physiotherapeutic treatment

This type of treatment involves exposure to the body's natural factors. In the treatment of spinal curvature, movement or therapeutic exercises are mainly used. It is contraindicated only in patients with very severe pain syndrome, severe respiratory and / or cardiovascular failure. [24]

Exercise therapy for cervical scoliosis is recommended at any stage of the disease, in the postoperative period, and also as a preventive measure that impedes the progress of the disease. Exercises for scoliosis of the cervical spine are designed to strengthen the muscles of the back and form a natural corset to maintain the spine in the most correct position. Without this, spinal curvature can only be removed surgically. All other methods - massages, magnetotherapy, electro and phototherapy, corsets, alternative medicine are additional, although very useful.

Exercises for cervical scoliosis are aimed primarily at strengthening the muscles of the problem area. [25] However, paravertebral muscles of the lower sections should also not be forgotten. They should be in good shape. The author of one of the complexes, M. Norbekov, claims that you can restore flexibility and stability to the spine at any age. 

The following exercises are offered for the cervical region (movements are smooth, breathe through the nose, monitor posture):

• bowing your head, slide your chin down, trying to touch your chest, simulating the movement of a bird that cleans feathers;
• we lean our head back, trying to touch the back of the head, in this position we pull it into our shoulders, we straighten, then we gently bend forward, touch our chest and in this position again try to pull it into our shoulders;
• tilt your head to each shoulder in turn, ideally, trying to touch them with your ear (do not raise your shoulders, straight back);
• turn the head around the axis passing through the nose and back of the head, to the right and left in three positions: the head is straight, tilted forward and backward;
• from the starting position: the head is straight, the gaze is in front of us, we look away, and behind it the head is as far as possible to the right, then to the left (like an owl), trying to look back as far as possible;
• slowly and smoothly roll the head over the shoulders in one direction, trying to touch the chest with the chin, the ear - the corresponding shoulder, the back of the head; then in the opposite way.

As already mentioned, it is not advisable to conduct independent studies, except for prevention or in the very initial stage. With severe scoliosis, it is necessary to select a set of exercises and master them together with the instructor, so as not to harm or aggravate the condition.

Additional physical methods for scoliosis are magnetotherapy, electrical procedures, ultrasound therapy, heat and light therapy. They are combined with physical therapy, massage, reflexology and drug treatment.

Magnetic radiation is used both to affect the spine and the muscles that support it. It tones the muscles, activates blood circulation, stimulates recovery processes in the vertebrae, has an analgesic and anti-inflammatory effect.

Electrostimulation of muscles is carried out in courses of 10 to 25 procedures, electrophoresis is used as a prevention of rarefaction of bone structures (osteoporosis). [26]

Photodynamic therapy is also used - treatment with light waves of a certain length. The method is based on the fact that photosensitizers accumulate in pathologically altered cells. Under a local stream of light waves of a certain length, the altered cells are destroyed, stimulating the reproduction of new and healthy cells, thus restoring normal spinal tissues. The source of such waves is most often a laser.

Thermal procedures (applications, hot wraps) are used to stimulate blood and lymph flow in the absence of scoliosis progress.

Also used are swimming, balneotherapy and mud therapy.

Ayurveda Methods

Weakness of the inner core - this is how Ayurvedic medicine interprets curvature of the spine. The reasons for this are quite complex and are hidden in the lack of balance of the central nervous system and are associated with the emotional state, and the roots of the problem go back to deep childhood and the relationship of children and parents.

Nevertheless, you can help the cause. With scoliosis of the I-II degree in the upper back (cervicothoracic), an exercise will be effective - sliding hands on the wall. To perform it, we approach a flat wall and rest on it with our head, back and buttocks. Raise your hands to shoulder level, bend up at the elbows at a right angle, lean against the wall (the brushes touch the wall with the back). Bend your knees slightly. Gently raise your hands up, sliding them along the wall. We are fixed in the upper position, then we return back. The exercise is repeated 10 to 12 times.

In addition, Ayurveda recommends proper nutrition and sleep on a pillow, no thicker than your hand, some medicinal formulations, a special Tibetan massage. There is also no need to consult a specialist.

Yoga apologists recommend: to get rid of scoliosis, you need to completely reprogram the muscles of the back. To do this, it is enough to do exercises - yoga asanas. Not much, just two or three, but every day; morning, afternoon and evening. One exercise takes about two minutes. The three basic asanas for correct posture are: ardha navasana or half the pose of the boat (held at first for 10 seconds, gradually increasing the time to a minute); utkatasana or stool pose; salabhasana or locust pose.

These asanas are performed in various versions; their description is on the Internet. For beginners, you need to choose the most convenient and soft options for execution. Monitor your posture and breathing. It is better to start a yoga class with an instructor.

Corset for scoliosis

The main goal of non-surgical treatment is to successfully stop the progression of curves or regular curves that cause or can cause disability. The choice of orthopedic device is based on the type and level of the curve and the patient's expected tolerance. [27]

Official medicine often recommends wearing corsets and bandages to correct posture. Properly selected, they fix the body in the right position. Available for adults and children, are soft and hard. There are Chenot corsets, the so-called active, which carry out not only fixation, but also the effect on the curvature arcs. In some cases, corset do therapeutic exercises. However, corsets contribute to the atrophy of the muscles that must work and support the spine, so corset alone can not do, you will have to make an effort. Experts recommend wearing posture correctors no more than four hours a day. [28], [29]

Corsets are contraindicated for pregnant women, patients with osteoporosis, lung and heart diseases, allergies to the material from which the product is made.

Surgery

In cases of progressive complex scoliosis with the ineffectiveness of conservative methods, the patient may be recommended surgery to fix the spine in the correct position using metal-plastic structures and autografts.

Surgical intervention stops the curvature of the spine and reduces the harmful effects on the work of other organs and systems. The operation does not remove scoliosis, but fixes the correct position of the spine.

The indication for surgery is the rapid progress of the disease, the angle of deviation of the spine is more than 50 ° in an adult patient and more than 45 ° in a child, drug pain that cannot be stopped, danger to vital organs, the threat of paralysis and sudden death (angle 60 ° or more). [30]

The structures fixing the spine are movable, they are placed for children taking into account their further growth, and motionless - for adults. There are several methods for surgical correction of the spine. After surgery, in most cases, the patient wears a corset for a month. Almost always in the recovery period, physiotherapy exercises are prescribed. Physical activity for patients undergoing surgical correction of the spine is limited for life.

Prevention

To prevent curvature of the spine, it is necessary to use orthopedic bedding, wear linen and shoes of a suitable size that meets the requirements for it. If flat feet have developed, orthopedic insoles should be used to compensate for the incorrect position of the foot. [31]

In everyday life, avoid carrying bags and briefcases (other weights) in one hand. Backpacks and satchels are preferred.

The workplace should be comfortable, well-lit, consistent with growth so that there is no need to bend low or raise arms and crank your neck. Feet should also rest on the floor or footrest. The knee and hip joints should be bent at an angle of 90 ° when sitting. If you need to sit for a long time while doing work, you need to take technological breaks to warm up: for adults - every 45 minutes, for children - 20.

Useful recreation, feasible sports, yoga, swimming, gymnastic exercises to strengthen the muscles of the back, in particular, sliding your hands along the wall.

Forecast

Cervical scoliosis of the I-II degree lends itself well to correction with the help of special gymnastics to strengthen the muscles of the back. In more complex cases, prolonged complex treatment or surgery may be required.