Thoracolumbar Scoliosis

People with scoliosis give out posture. A slight curvature may not be noticed, but sometimes it becomes too obvious. In addition to damage to the appearance of a person, pathology is harmful to health, as it affects the position and functions of organs and systems. Scoliosis, covering 10-12 vertebrae (the gap between the thoracic and lumbar regions) is called the thoracolumbar. [1]

Epidemiology

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

Causes of the group spondylosis

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

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

Risk factors

Risk factors such as trauma, amputation of limbs, removal of malignant tumors, heart surgery in childhood, different leg lengths can contribute to the development of scoliosis. A significant role in the occurrence of deformation is assigned to “freezing” in one static pose (at the desk, computer).

Pathogenesis

It is impossible to determine the pathogenesis of idiopathic scoliosis, because 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 pulpous nucleus in the direction of its absence. This entails an imbalance in the muscles of the muscle 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 of the group spondylosis

Manifestations of scoliosis depend on many factors: the degree of development, causes, characteristics of the course, age, intensity of physical activity. In the children's period, the first signs are most often fuzzy and the pathology is detected as a result of a medical examination of schoolchildren.

Although after the cessation of the growth of the body, the progression of scoliosis stops, but the symptoms are manifested by lower back pain, rapid fatigue. [6]

Stages

Thoracolumbar scoliosis is classified according to the degree of deviation based on radiographs. The angle is measured between two lines, one of which passes through the center of an undistorted vertebra, and the other of the most protruded. There are several stages of curvature:

• lumbar scoliosis of the 1st degree - 1º-10º;
• chest lumbar scoliosis of the 2nd degree - 11º-25º;
• thoracolumbar scoliosis of the 3rd degree - 26º-50º;
• chest lumbar scoliosis of the 4th degree - more than 50º.

Forms

Thoracolumbar scoliosis is divided according to various characteristics. So, 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 a genetic predisposition. Studies are still being conducted to identify both the genes responsible for the transmission of the disease and other factors unrelated to genetics.

The most severe form of scoliosis is dysplastic, because it tends to progress steadily. It is based on congenital anomalies of the spine. In the absence of treatment, a rib hump, pelvic distortion can form in the person, the spinal cord is pinched, which causes a loss of sensitivity, and sometimes even paralysis of the legs, pain syndrome manifests itself.

Several types are distinguished by the nature of spinal deformity. C-bend indicates a single arc. It can be either left-handed or right-handed. Left-sided thoracolumbar scoliosis is detected less frequently, but it is more rapidly developing than right-sided.

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

Complications and consequences

The consequences and complications of scoliosis appear only starting with its 3-4 degree. Deformation of the chest negatively affects the functions of the lungs, heart, and can also lead to congestion in the gallbladder, cause exacerbation of pancreatitis.

Diagnostics of the group spondylosis

Thoracolumbar scoliosis is diagnosed on the basis of external signs and the use of instrumental methods. Visual examination of the patient is carried out in three positions: standing, sitting and lying down. 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, the presence of asymmetry are determined.

At the first stage of the disease, scoliosis during examination is rarely detected. The subsequent stages are characterized by chest deformity, uneven shoulders, abduction of the shoulder blades, and the presence of a hump. [7]

An x-ray taken in a lying and standing position allows you to classify the pathology by location, degree of deformation. Another instrumental research method - moire topography gives on paper a three-dimensional image of the outlines of the back. [8]

Differential diagnosis

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

Treatment of the group spondylosis

The initial forms of the disease require conservative treatment, which consists in:

• mobilization of the spine (movement of the joints and muscles);
• distortion correction;
• strengthening the muscles of the back and abdominals to keep the spine in the correct position.

To do this, resort to special gymnastics, massage, it is also possible to use corrective and fixing corsets. There is also a method of traction on the shield, its duration ranges from 2 to 4 months. [9]

Therapeutic exercise complex (LFK)

The basis for the treatment of curvature of the spine is exercise therapy. Exercise and gymnastics with chest lumbar scoliosis can strengthen the muscle corset, acquire posture control skills, and be physically strong.

It is advisable to do the following exercises with thoracolumbar scoliosis (given for the right-handed one, otherwise change the arm):

• in the standing position, pull the left up while simultaneously retracting the right;
• slowly lower the right hand along the body to the knee, while raising the left to the shoulder;
• tilts to the right side (the right hand at the top, the left behind the back);
• standing on all fours to lunge the left knee and arms forward, the right leg as much as possible to take back;
• lying on his stomach to tear the torso off the floor with an outstretched left hand;
• sitting on a beveled seat to the left, do tilts to the right, left hand at the top.

Massage for lumbar scoliosis

Massage can help with the first two degrees of curvature, in more complex cases it is ineffective. It is entrusted with the task of 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, because they are weakened and stretched, and a decrease in the increased tone of the concave part.

The massage algorithm is as follows:

• the patient lies on his stomach, his head is turned to the left side;
• the masseur strokes and stretches the back muscles longitudinally;
• the upper part of the trapezius muscle relaxes (stretching, rubbing, vibrating movements are made);
• the same techniques apply to the muscles of the convex side;
• edge arches are pressed and smoothed;
• the concave side is massaged;
• the patient rolls onto his back to massage the abdominal muscles. [11]

Surgery

Surgical treatment is carried out if conservative therapy fails and a further deterioration of the condition of the spine occurs (the deviation angle is greater than 30º).

Most often, the operation takes place in 2 stages: the curvature in the lumbar region is removed (they are fixed with the help of a taken bone fragment from the patient), and then at the level of the thoracic 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 the youngest, children need to be accustomed to self-control of posture, a mobile lifestyle, to engage in sports, especially swimming.

Forecast

Measures aimed at the prevention and treatment of lumbar scoliosis in its initial 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.