Thoracolumbar scoliosis

People with scoliosis are given away by their posture. A slight curvature may not be noticed, but sometimes it becomes too obvious. In addition to damaging a person’s appearance, the pathology is detrimental to health, as it affects the position and function of organs and systems. Scoliosis that affects the 10th to 12th vertebrae (the space between the thoracic and lumbar regions) is called thoracolumbar. [ 1 ]

Epidemiology

According to statistics, thoracolumbar scoliosis is most often found in school-age children and predominantly in girls (more than 85% of all cases). [ 2 ], [ 3 ]

Causes thoracolumbar scoliosis

Most often, the disease is detected at the age of 6-15 years - a period of intensive growth. In most cases (according to experts, up to 80%), the causes of its occurrence are unknown (idiopathic scoliosis). The rest occur due to:

• congenital deformities;
• pathologies of the neuromuscular system;
• metabolic disorders of bones;
• connective tissue diseases.

Risk factors

The development of scoliosis can be promoted by such risk factors as injuries, amputations of limbs, removal of malignant tumors, heart surgery in childhood, and different leg lengths. A significant role in the occurrence of deformation is attributed to "hanging" in one static pose (at a desk, computer).

Pathogenesis

It is impossible to determine the pathogenesis of idiopathic scoliosis, since the processes that determine its occurrence are unknown. In any case, the curvature begins with the destruction of the intervertebral discs and the displacement of the nucleus pulposus towards its absence. This entails an imbalance in the muscles of the muscular corset and, in turn, leads to torsion of the vertebrae (their rotation around the vertical axis of the spine), increasing the load on the underlying vertebrae. [ 4 ], [ 5 ]

Symptoms thoracolumbar scoliosis

The manifestations of scoliosis depend on many factors: the degree of development, causes, characteristics of the course, age, intensity of physical activity. In childhood, the first signs are most often unclear and the pathology is detected as a result of a medical examination of schoolchildren.

Although after the body stops growing, the progression of scoliosis stops, the symptoms are manifested by pain in the lower back and rapid fatigue. [ 6 ]

Stages

Thoracolumbar scoliosis is classified by the degree of deviation based on radiographs. The angle is measured between two lines, one of which passes through the center of the non-curved vertebra, and the other - the most protruding one. Several stages of curvature are distinguished:

• thoracolumbar scoliosis grade 1 - 1º-10º;
• thoracolumbar scoliosis grade 2 - 11º-25º;
• thoracolumbar scoliosis grade 3 - 26º-50º;
• thoracolumbar scoliosis grade 4 - more than 50º.

Forms

Thoracolumbar scoliosis is divided into different signs. Thus, depending on the origin, they are:

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

The most common of them are idiopathic. Most scientists associate their etiology with genetic predisposition. Research is still being conducted to identify both the genes responsible for transmitting the disease and other factors not related to genetics.

The most severe form of scoliosis is dysplastic, as it tends to progress steadily. It is based on congenital anomalies of the spine. Without treatment, a person may develop a rib hump, a pelvic tilt, a pinched spinal cord, which causes loss of sensitivity, and sometimes even paralysis of the legs, and pain syndrome may appear.

By the nature of the spinal deformity, several types are distinguished. The C-curve indicates one arc. It can be either left-sided or right-sided. Left-sided thoracolumbar scoliosis is detected less frequently, but it develops more rapidly than right-sided.

S-shaped thoracolumbar scoliosis forms 2 arcs directed in opposite directions. Most often, one of them is primary, and the second is compensatory, formed to maintain the body in an upright position.

Complications and consequences

Consequences and complications of scoliosis appear only starting from its 3-4 degree. Deformation of the chest negatively affects the functions of the lungs, heart, and can also lead to stagnation in the gallbladder, causing exacerbation of pancreatitis.

Diagnostics thoracolumbar scoliosis

Thoracolumbar scoliosis is diagnosed based on external signs and the use of instrumental methods. A visual examination of the patient is carried out in three positions: standing, sitting and lying. The length of the limbs, the position of the pelvis, the level of the shoulders, the location of the shoulder blades, the mobility of the spine, and the presence of asymmetry are determined.

At the first stage of the disease, scoliosis is rarely detected during examination. Subsequent stages are characterized by chest deformation, uneven positioning of the shoulders, abduction of the shoulder blades to the side, and the presence of a hump. [ 7 ]

An X-ray taken in a lying and standing position allows classifying the pathology by location and degree of deformation. Another instrumental method of examination - moire topography - gives a three-dimensional image of the outlines of the back on paper. [ 8 ]

Differential diagnosis

Differential diagnosis of thoracolumbar scoliosis is carried out with its other types.

Treatment thoracolumbar scoliosis

Initial forms of the disease require conservative treatment, which consists of:

• mobilization of the spine (movement of joints and muscles);
• correction of curvatures;
• Strengthening the back and abdominal muscles to keep the spine in the correct position.

For this purpose, special gymnastics, massage are used, and it is also possible to use corrective and fixing corsets. There is also a method of traction on a shield, the duration of which varies from 2 to 4 months. [ 9 ]

Therapeutic physical culture complex (LFK)

The basis of treatment of spinal curvatures is exercise therapy. Exercises and gymnastics for thoracolumbar scoliosis allow you to strengthen the muscular corset, acquire skills of control over posture, and be physically strong.

It is advisable to do the following exercises for thoracolumbar scoliosis (given for the right side, otherwise change the hand):

• in a standing position, stretch the left leg upward while simultaneously pulling the right leg back;
• slowly lower your right arm along your body to your knee, while raising your left arm to your shoulder;
• bends to the right side (right hand up, left hand behind the back);
• standing on all fours, lunge your left knee and arm forward, and move your right leg back as far as possible;
• lying on your stomach, lift your torso off the floor with your left arm extended;
• sitting on a seat slanted to the left, bend to the right, left hand up.

Massage for thoracolumbar scoliosis

Massage can help with the first two degrees of curvature, in more complex cases it is ineffective. It is tasked with improving the blood supply to the tissues around the spine, strengthening the muscles, which will stop the progression of the disease, reduce and even eliminate the curvature. [ 10 ]

Massage techniques are aimed at toning the muscles of the convex side, since they are weakened and stretched, and reducing the increased tone of the concave part.

The massage algorithm is as follows:

• the patient lies on his stomach, head turned to the left side;
• the massage therapist strokes and longitudinally stretches the back muscles;
• the upper part of the trapezius muscle is relaxed (kneaded, rubbed, vibrating movements are made);
• the same techniques are applied to the muscles of the convex side;
• the costal arches are pressed and smoothed;
• the concave side is massaged;
• The patient turns over onto his back to massage the abdominal muscles. [ 11 ]

Surgical treatment

Surgical treatment is carried out if conservative therapy does not bring results and the condition of the spine further deteriorates (the angle of deviation is more than 30º).

Most often, the operation is performed in 2 stages: the curvature in the lumbar region is removed (their fixation occurs with the help of a bone fragment taken from the patient), and then at the thoracic level and the fastening of the bodies of the thoracic vertebrae. [ 12 ]

Prevention

Preventive measures bring results only when applied at an early age. Starting from a young age, children need to be taught to self-control their posture, lead an active lifestyle, and be involved in sports, especially swimming.

Forecast

Measures aimed at preventing and treating thoracolumbar scoliosis in its early stages give a favorable prognosis. The operation does not lead to a complete elimination of the problem, but only reduces the curvature and slows down its further development.