Scoliosis of the cervical spine

The spine most often takes a pathological position in childhood or adolescence during the period of active development of cartilaginous and bone tissue, although such a defect can also occur in adults. The term scoliosis itself indicates that the plane of curvature 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 the vertical position to the left or right in the uppermost part of its thoracic region at the level of Th4-Th5 (the fourth-fifth thoracic vertebrae), which leads to an asymmetrical position of the head and shoulders, as well as deformation of the 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 of 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 a 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 for this feature. In general, scoliosis of all localizations is the most common vertebral pathology. Only one in four inhabitants of our planet can boast of correct posture.

Causes cervical scoliosis

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

Most scoliosis is idiopathic, its origin remains unclear, and it is considered an independent disease. [ 4 ] A hypothetical cause may be uneven development, when the skeleton develops faster than the muscles and ligaments that support the correct position of the spinal column (muscular-ligamentous insufficiency in childhood and adolescence). It is believed that such unevenness of cell division occurs due to pathological changes caused by metabolic disorders, underdevelopment of the vertebrae, their irregular shape, displacement of the epiphyseal plate, which is 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 a simple stretch. [ 5 ]

During puberty, hormonal insufficiency may occur when one process (the child’s rapid growth) “overtakes” others (hormonal changes lag behind).

A hereditary family predisposition increases the likelihood of developing cervical scoliosis, but apparently under the condition of exposure to other risk factors. [ 6 ] The pathogenesis of this disease has not been sufficiently studied. It has not yet been possible to establish which gene or group of genes are responsible for the development of idiopathic scoliosis. Studies have been conducted with different categories of genes that determine the structure of connective tissue and bones, their formation, hereditarily determined metabolic processes in these tissues, the melatonin signaling pathway, and genes that determine the processes of puberty and growth have also been studied, however, there is still no clarity on this issue.

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

Approximately one fifth of all scolioses are acquired, secondary, their development indicates the presence of some pathological process. Neoplasms of the spine and adjacent anatomical structures, cystic formations in the cervical spinal cord - syringomyelia, the causes of which are also not entirely clear, can lead to a deviation of the spine to the side from the vertical position.

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

Acquired static scoliosis can be caused by prolonged stay in an uncomfortable position with an unnaturally bent neck, associated with irrational equipment of the workplace, failure to comply with the work and rest regime, simply disregarding the basic recommendations regarding posture - carrying a bag or briefcase in one hand (on one shoulder), a low or very high table for studying, etc.

Neurogenic scoliosis is secondary and can be a consequence of cerebral palsy, meningoencephalitis and other neuroinfections. [ 9 ]

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

Risk factors

Risk factors include spinal injuries, sometimes even minor ones that have been forgotten; excessive and, most importantly, uneven physical activity or its complete absence; the presence of diseases of the spine and spinal cord; abnormal metabolism; cardiac surgery, extensive burns, pleural empyema, excess weight.

Symptoms 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 discomfort to the patient, except perhaps rapid fatigue. The coexistence of chronic pain in the neck and back, discomfort, stiffness and numbness are common symptoms of cervical scoliosis. [ 11 ], [ 12 ]

Stages

Scoliosis of the 1st degree of the cervical spine is its deviation to the side from the vertical axis at an angle of no more than ten degrees. If such a defect is already more noticeable in thoracic scoliosis, then in the short cervical section it is most often detected by chance, for example, on an X-ray. In the embryonic stage, cervical scoliosis is not subject to treatment, although the patient is recommended a preventive complex of therapeutic exercises and periodic examination in order to prevent the progression of the disease.

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

Scoliosis of the cervical spine of the III degree is diagnosed with a deviation of the cervical vertebrae from the vertical axis at an angle of 26 to 40°, IV - more than 40°. Such degrees are difficult to treat conservatively, are complicated by rotation 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 degree 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 normal physiological movements of the head - turning, tilting. Complaints of the patient about 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.

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 form of curvature of the spine, highlighting the number of places of deviation from the vertical axis:

• C-shaped or simple scoliosis - the 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 sections of the spinal column are involved in the curvature process.

Depending on the localization of the lesion, there are cervicothoracic scoliosis with the peak of curvature at the level of Th4-Th5; thoracic - Th8-Th9; lumbothoracic - Th10-Th11; lumbar - L1-L2. Combined or complex - most often the vertebrae of the thoracic and lumbar regions are involved.

Left-sided cervical scoliosis is diagnosed when the apex of the curvature arc goes to the left. It is more often idiopathic and develops in teenage girls, although it can be acquired in adulthood. It is less common than right-sided and S-shaped. It is also generally not a consequence of congenital anomalies.

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

There are also such types as fixed scoliosis, which persists in any body position, and non-fixed scoliosis, when the curvature goes away in a sitting or lying position.

Complications and consequences

From an aesthetic point of view, 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 pathology negatively affects health.

Flat curvature of the spine is complicated by an increase in the angle of inclination, torsions, rotations of the vertebrae, new bends. Cervical scoliosis that developed in childhood and adolescence can lead to defects in the formation of the skull bones. Partial compression of the vertebral artery leads to cerebrovascular accidents. Frequent companions of scoliosis of the cervical-thoracic spine are paresthesia of the upper limbs, intercostal neuralgia. Cervical osteochondrosis is more common in patients with scoliosis.

Simple C-shaped scoliosis gradually transforms into complex S-shaped scoliosis. The spine bends lower in the opposite direction to compensate for the first bend. Scoliosis can be complicated by a forward (lordosis) or backward (kyphosis) curvature of the spine. Deformations of the ribs and shoulder blades may appear.

If scoliosis of the first degree does not affect the condition of the 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 disrupted. The altered mechanics of breathing affect the degree of oxygenation of arterial blood, pulmonary hypertension appears and the hemodynamics of the whole organism changes.

Diagnostics cervical scoliosis

A specialist can visually determine the curvature of the spine by examining the patient. He has a noticeably asymmetrical shoulder girdle line - one shoulder is higher than the other, and accordingly - the ears as well, since the head is tilted to one side. In the early stages, the patient is examined in a forward bending position (arms hanging freely). When palpating, pain may be felt in the problem area. [ 14 ]

Instrumental diagnostics allows to determine the angle of the spine with high accuracy. The method of choice is X-ray. The image of the spine is taken in several positions - standing, lying on a flat surface, and if necessary - on an inclined surface. The angle of curvature of the spine on X-rays is determined by the method of J. Cobb, torsion and rotation of the vertebrae are detected using the Nash-Mo or Raimondi method. [ 15 ]

Computer tomography is also used, which allows obtaining a three-dimensional image of the problem area and determining the angle of curvature and the presence of twists and turns of the vertebrae with high accuracy. However, the study is expensive and gives a higher dose of radiation.

For examination of children and adolescents who require regular monitoring, non-radiological methods are used – visual examination or dynamic photo monitoring, scoliometry according to V. Bunnel, ultrasound, computer optical topography.

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

Differential diagnosis

Differential diagnostics is performed to determine the cause of spinal curvature, since its detection is decisive for choosing treatment tactics. Additional studies are used for this, for example, laboratory studies if spinal tuberculosis is suspected. Magnetic resonance imaging data can accurately exclude or confirm syringomyelia, the presence of other neoplasms, vertebral hernia, and computed tomography data can exclude or confirm pathological fusion of vertebrae (synostosis), additional vertebrae. It allows for accurate recognition of cervical osteochondrosis and scoliosis, since both can cause neck pain and dizziness. Scheuermann-Mau disease is also differentiated.

Treatment cervical scoliosis

Spinal curvature most often appears in children aged six to seven. The debut at this age is associated with the start of school, the child begins to sit a lot, and the load on the spine increases sharply. The second surge in scoliosis manifestations is observed in early adolescence (at twelve to thirteen years old), when rapid physical development occurs. If there was already a slight scoliosis, then during puberty an increase in deformation is often observed, torsions and rotations appear. It is believed that scoliosis can be completely cured while the epiphyseal - cartilaginous growth plate has not yet disappeared, turning into bone tissue. The closure of the growth zones of the vertebrae occurs at about 14 years. It is believed that later it is only possible to slow down the process of spinal deformation, but not get rid of the pathology completely. [ 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 correct cervical scoliosis in adolescents? For this, it is best to contact specialists. In the initial stages, the pathology is successfully corrected with the help of a special set of exercises. Therapeutic gymnastics for scoliosis has long been invented and tested, of course, perseverance and persistence will be required to correct posture. It is not recommended to exercise on your own, at least at first, since some types of exercises have contraindications. Jumping, hanging, strength exercises that can increase the deformation are not recommended. In addition, you need to find out exactly in which part of the spine the pathological bend is observed. An instructor will help you choose the right set of exercises, he will also monitor and correct the technique of execution - tempo, amplitude, body position. [ 19 ]

If necessary, wearing an orthopedic corset may be recommended. It should be selected by a specialist so that it does not compress the chest and gives the spine the correct position. Wearing a corset for a long time is not recommended, since it contributes to the weakening of one's 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. Massage, reflexology, manual therapy are used as additional methods, and physiotherapy procedures and medication are prescribed in combination with them. Spinal curvature in the initial stages is easily corrected, while in progressive forms the treatment process stretches out over several years.

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

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

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

In addition to medical treatment, both adults and children are advised to review and change their lifestyle - become more active, monitor their posture, improve their work and sleeping place, lose weight and optimize their diet - focus on plant-based and dairy foods, eliminate alcohol, limit pickles, smoked foods, and confectionery.

Physiotherapy treatment

This type of treatment involves the impact of natural factors on the body. In the treatment of spinal curvature, movement or therapeutic gymnastics are mainly used. It is contraindicated only for patients with very severe pain syndrome, severe respiratory and/or cardiovascular insufficiency. [ 24 ]

Exercise therapy for cervical scoliosis is recommended at any stage of the disease, in the postoperative period, and also as a preventive measure to prevent the progression of the disease. Exercises for cervical scoliosis are designed to strengthen the back muscles and form a natural corset to support the spine in the most correct position. Without this, the only way to get rid of spinal curvature is through surgery. All other methods - massages, magnetic therapy, electro- and light therapy, 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, the paravertebral muscles of the lower sections should not be forgotten either. They should be in good shape. The author of one of the complexes, M. Norbekov, claims that flexibility and stability of the spine can be restored at any age.

The following exercises are suggested for the cervical region (move smoothly, breathe through the nose, watch your posture):

• bow your head and slide your chin down, trying to touch your chest, imitating the movement of a bird cleaning its feathers;
• we throw our head back, trying to touch the back of our head to our back, in this position we pull it into our shoulders, straighten up, then bend forward smoothly, 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, keep your back straight);
• turn your head around an axis passing through the nose and the back of your head, to the right and left in three positions: with your head level, tilted forward and backward;
• from the starting position: the head is positioned straight, the gaze is in front of you, we look away, and then the head as far to the right as possible, then to the left (like an owl), trying to look as far back as possible;
• slowly and smoothly roll your head over your shoulders in one direction, trying to touch your chest with your chin, your ear with the corresponding shoulder, and the back of your head with your back; then do the same in the opposite direction.

As already mentioned, it is not advisable to do independent exercises, except for prevention or at the very initial stage. In case of severe scoliosis, it is necessary to select a set of exercises and master them together with an instructor, so as not to harm or worsen the condition.

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

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

Electrical stimulation of muscles is carried out in courses of 10 to 25 procedures; electrophoresis is used as a preventative measure against bone loss (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 flow of light waves of a certain length, the altered cells are destroyed, stimulating the reproduction of new and healthy cells, thus restoring normal spinal tissue. 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 progression.

Swimming, balneotherapy and mud therapy are also used.

Ayurvedic methods

Weakness of the inner core – this is how Ayurvedic medicine interprets the 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 between children and parents.

However, it is possible to help the matter. For scoliosis of the I-II degree in the upper back (cervical-thoracic region), the exercise of sliding your hands along the wall will be effective. To do this, go to a flat wall and lean your head, back and buttocks on it. Raise your arms to shoulder level, bend them upward at the elbows at a right angle, lean them against the wall (the back of your hands touches the wall). Bend your knees slightly. Smoothly raise your arms upward, sliding them along the wall. Fix yourself in the upper position, then return them back. Repeat the exercise 10 to 12 times.

In addition, Ayurveda recommends proper nutrition and sleeping on a pillow no thicker than your arm, some medicinal compounds, a special Tibetan massage. Here, too, you cannot do without consulting a specialist.

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

These asanas are performed in various variations, their description is available on the Internet. For beginners, you need to choose the most comfortable and gentle options for performing. Monitor your posture and breathing. It is better to start practicing therapeutic yoga 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 may cause disability. The choice of orthotic device is based on the type and level of curve and the expected tolerance of the patient. [ 27 ]

Official medicine often recommends wearing corsets and bandages to correct posture. Correctly selected, they fix the body in the desired position. They are produced for adults and children, and are soft and hard. There are Cheneau corsets, the so-called active ones, which not only fix, but also affect the arcs of curvature. In some cases, therapeutic exercises are done in a corset. However, corsets contribute to the atrophy of the muscles that should work and support the spine, so a corset alone will not do, you will have to make an effort. Experts recommend wearing posture correctors for no more than four hours a day. [ 28 ], [ 29 ]

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

Surgical treatment

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

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

Indications for surgery are rapid progression of the disease, a spinal angle of more than 50° in an adult patient and more than 45° in a child, pain that cannot be relieved with medication, danger to vital organs, threat of paralysis and sudden death (angle of 60° or more). [ 30 ]

The structures that fix the spine can be mobile, they are installed for children taking into account their further growth, and fixed - for adults. There are several methods of performing surgical correction of the spine. After the operation, in most cases, the patient wears a corset for a month. Almost always, therapeutic exercise is prescribed during the recovery period. Physical activity for patients who have undergone surgical correction of the spine is limited for life.

Prevention

To prevent curvature of the spine, it is necessary to use orthopedic bedding, wear underwear and shoes of the appropriate size, corresponding to the requirements for it. If flat feet have developed, it is necessary to use orthopedic insoles that compensate for the incorrect position of the foot. [ 31 ]

In everyday life, avoid carrying bags and briefcases (other heavy objects) in one hand. Backpacks and satchels are preferable.

The workplace should be comfortable, well-lit, and appropriate for the height, so that there is no need to bend low or raise your arms and stretch your neck. The feet should also rest on the floor or a footrest. The knee and hip joints should bend 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: adults - every 45 minutes, children - 20.

Active recreation, moderate sports, yoga, swimming, gymnastic exercises to strengthen the back muscles, in particular, sliding your hands along the wall, are useful.

Forecast

Cervical scoliosis of I-II degree is easily corrected with the help of special gymnastics to strengthen the back muscles. In more complex cases, long-term complex treatment or surgery may be required.