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Scoliosis of the spine 3 degrees in adults and children

 
, medical expert
Last reviewed: 04.09.2021
 
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Curvature of the spine in the frontal plane with an angle of deviation from the axis in the range of 26 to 50 degrees is diagnosed as grade 3 scoliosis. If the curvature does not exceed 30-35 degrees, it is considered moderate, but the greater the deviation angle, the more obvious the clinical picture and the more severe the patient's condition. [1]

Epidemiology

Statistically, scoliosis affects 2-3% of the population; in 80% of cases it is idiopathic scoliosis, which is diagnosed at the age of 10-18 years. [2]

Grade 3 scoliosis in adults accounts for no more than 0.2-0.3% of cases of spinal curvature in patients over 25 years old. [3], [4]

Causes of the scoliosis grade 3

The main causes of scoliosis, including grade 3, are detailed in the publication -  Scoliosis: What Causes and How to Recognize? [5]

The same article lists the risk factors for the development of this pathology, including the genetic characteristics of bone growth in the process of skeletal formation and  postural disorders in children  (especially in the frontal plane).

Scoliosis can be a consequence of intrauterine malformations of the musculoskeletal system (skeletal anomalies) and one of the symptoms of a number of congenital syndromes and  some diseases accompanied by spinal deformity . [6]

About what can cause grade 3 scoliosis in children, read more in the materials:

In many cases, it is not possible to identify the exact cause of the spinal deformity, and then idiopathic scoliosis of grade 3 is determined (although there are several versions of possible etiological factors). [7]

And  dysplastic scoliosis of  3 degrees in children is referred to as hereditary systemic diseases of the skeleton with disorders of the formation of vertebral joints in the prenatal period: spondylodysplasia, plate spondyloidia, wedge-shaped vertebrae (with insufficient height of the anterior part of the vertebral body) or lateral hemivertebra (the presence of half of the vertebral joint - the hemivertebra - from- for underdevelopment of one of the two centers of articular cartilage formation). [8]

In addition, it must be remembered that scoliosis is a progressive disease, and although grade 3 scoliosis is diagnosed much more often in adolescents, severe curvature can also occur in adults. And if it is not the progression of previously undiagnosed idiopathic scoliosis, then in many cases scoliotic deformity after 40 years is caused by  degenerative-dystrophic diseases of the spine  or neuromuscular diseases, and in older age - by the  displacement of the lumbar vertebrae . [9]

Pathogenesis

The most pronounced component of the three-dimensional deformity of the spine in scoliosis is the lateral bending of the spine in the frontal plane with torsion (rotation) of the vertebrae. The pathogenesis of such a deformity, and in many cases the reasons for its occurrence, are not completely clear. [10]

However, researchers associate the mechanism of development of scoliosis with pathological structural changes in the vertebrae and intervertebral discs connecting them, which lead to an increase in the inclination of the vertebral joints; with the peculiarities of the growth of the spinal column in childhood (in which the height of the vertebral bodies increases unevenly); with weakness or fibrous changes in the paravertebral muscles, causing displacement of individual vertebrae, etc. [11]

Symptoms of the scoliosis grade 3

At the stage of curvature of the spine corresponding to grade 3, the first signs are an increase in the angle by which the spine is deflected from the axis (the Cobb angle, determined on an x-ray), up to 26 degrees or more - up to 50 degrees.

At the same time, there is a significant asymmetry of the shoulder blades, shoulder girdles and shoulder joints; deformation of the chest with a restriction of its expansion; a violation of the biomechanics of the spine leading to back pain. The center of gravity of the trunk shifts, and it takes an inclined position - towards the curvature arc, and the skewing of the pelvis leads to the development of the so-called  short leg syndrome  - from the contralateral side. [12]

With thoracic scoliosis of 3 degrees - due to the twisting of the vertebrae and the asymmetry of the legs of their arcs - the ribs protrude with the formation of a rib hump in the future.

More information:

Forms

By localization of curvatures, such types of scoliosis are determined as:

  • cervicothoracic scoliosis - curvature at the level of the cervical spine CIII-CVII) and partially thoracic (TI-TV);
  • scoliosis of the thoracic spine  (thoracic or thoracic scoliosis) - with curvature at the level of the vertebral joints of the thoracic segment (TI-TXII), which is considered the most common;
  • lumbar or lumbar scoliosis of grade 3 (frontal deformity of the spine at the level of the lumbar vertebrae LI-LIV);
  • thoracolumbar or thoracolumbar scoliosis of grade 3.

And according to the form of deformity, C-shaped and S-shaped scoliosis of the 3rd degree are distinguished. With a C-shaped curvature of the spinal column is unilateral, and this is either left-sided scoliosis of grade 3, or right-sided. [13]

With  S-shaped scoliosis  (thoracic, thoracolumbar or lumbar), the curvature has the form of two oppositely directed arcs.

Complications and consequences

In cervical and cervicothoracic scoliosis of grade 3, the consequences and complications can be in the form of narrowing of the lumen of the artery in the cervical spine, leading to the development  of vertebral artery syndrome  - with severe headaches and tinnitus, numbness in the occipital region and ataxia (impaired coordination movements).

With scoliosis of the thoracic spine of grade 3 and severe S-shaped curvature of the spine in patients - in addition to chronic pain in the back and thoracic ribs - there are cardiological and pulmonary problems: displacement of the heart (with the risk of heart failure) and a decrease in total lung capacity with pulmonary hypertension and shortness of breath... And if with S-shaped scoliosis intramedullary compression of the spinal cord occurs, there may be paralysis of both legs. [14]

Among the consequences of grade 3 dysplastic scoliosis are chest deformity, muscular dystonia, and urinary incontinence.

Children under five years of age with severe congenital scoliosis have an increased risk of developing  cor pulmonale , and in the absence of treatment, death.

Diagnostics of the scoliosis grade 3

In order to prevent the progression of scoliosis to grade 3, deformity should be detected when the curvature angle is 10 degrees or slightly more. [15]

Diagnostics includes determining the state of the spinal column, taking into account the  visual criteria of statics and dynamics of the musculoskeletal system  and using various  methods of examining the spine .

X-ray in three planes,  spondylometry , MRI or  computed tomography of the spine  [16]are the main methods by which instrumental diagnostics of scoliosis is carried out. [17], [18]

Differential diagnosis

Differential diagnosis is carried out with pathological kyphosis and lordosis.

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Treatment of the scoliosis grade 3

Traditional treatment at a Cobb angle of 26-50 degrees consists of corrective therapy: to correct the abnormal curvature as much as possible and stop the progression of the curvature, a redressing orthosis or a replacement corset is used for grade 3 scoliosis. [19]

There are various types of corsets for corrective fixation of the spinal column and its stabilization, but one of the most effective over the past 40 years has been the Chenot corset for grade 3 scoliosis in children and adults. The corset is made individually, taking into account the anatomical features of each patient, using an X-ray image with the corresponding measurements of the trunk or its 3D scanning. The orthosis corrects the scoliotic arch in three planes at once, which makes it easier to breathe and avoid muscle atrophy.

Treatment of scoliosis of the  3rd degree is complex, and it combines: Exercise therapy - special exercises for scoliosis of the 3rd degree; with S-shaped scoliosis - gymnastics according to Katharina Schroth (with asymmetric exercises); yoga and therapeutic massage (which helps to normalize the tone of the muscles of the back and lower back); physiotherapy treatment (with the use of electromyostimulation). Manual therapy can be used to improve the extensibility of muscle tissue and increase the range of motion of the joints of the spine. [20]

Experts recommend swimming for grade 3 scoliosis, which has a positive effect on the entire musculoskeletal system. What exercises in the pool are best done, orthopedists will tell you, see the publication -  Exercises for the back in the pool [21]

Surgical treatment used for scoliosis in many cases makes it possible to correct the deformity of the spinal column by increasing the stability of the vertebral joints. In children, scoliosis with a curvature angle of 45 degrees or more requires surgical intervention. What kind of surgery is necessary for grade 3 scoliosis depends on the type of curvature, and it can be spinal fusion with metal implants, epiphysis spondylodesis, corrective vertebrotomy, etc.  [22]More information in the materials:

What can not be done with grade 3 scoliosis?

Experts' answers to questions frequently asked by patients or parents of children with a given degree of spinal deformity.

  • How long can you sit or stand in one position?

No more than 20-25 minutes, after which the position of the body must be changed.

  • Can I carry something in one hand or a bag on the shoulder?

Better not to.

  • How to sleep with grade 3 scoliosis?

You need to sleep on a semi-rigid mattress, ideally on an orthopedic one.

  • Can high heels be worn?

The heel height should be 3-4 cm maximum.

  • Is childbirth possible with grade 3 scoliosis?

If a woman with this disease becomes pregnant and was able to maintain the pregnancy until the required time, then the delivery is carried out by cesarean section.

  • What sport is prohibited for grade 3 scoliosis?

Football, all contact and power sports, athletics, artistic gymnastics, acrobatics for scoliosis of the 3rd degree are excluded.

  • Are they drafted into the army with scoliosis?

Even with grade 2 scoliosis, conscripts are considered unfit for military service, and grade 3 scoliosis and the army are simply incompatible.

  • Scoliosis grade 3 and disability

With a given degree of scoliotic deformity, disability is given.

Prevention

To date, the key in preventing the development of scoliotic deformity of the spine is correct posture in children and adolescents, and in case of its violation, posture correction and physical exercises recommended by vertebrologists are necessary .

Read more -  Prevention of posture disorders in school-age children .

Forecast

Since grade 3 scoliosis is a progressive pathology, the prognosis for all patients cannot be the same. [23]It is very important to stop the increase in the angle of curvature of the spinal column by all methods available for medicine.

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