Scoliosis 2 degrees in adults and children

Complex, but moderate (within 11-25 °) curvature of the spinal column along the frontal and sagittal planes, which is accompanied by twisting of the vertebrae, is called scoliosis. Scoliosis of the 2nd degree is diagnosed quite often, since this stage, unlike the first, already manifests itself in noticeable external signs. [1]

There are many prerequisites for a violation. However, in most cases, the true cause of the pathology cannot be found.

Epidemiology

The first information about scoliosis as a disease of the spinal column was presented by Hippocrates - moreover, the ancient Greek healer even tried to build a treatment for this disorder by external influence on it. By the way, Hippocrates noted that scoliosis can be inherited through the female line. [2], [3]

According to the current statistics, it is true that girls are more likely to get sick: compared to boys, about 6: 1.

Not so long ago, scientists confirmed that girls whose mothers suffer from scoliosis have a 20 times higher risk of developing such a pathology than other children. At the same time, hereditary scoliosis is more aggressive. Nevertheless, this issue is still under study.

The first manifestations of scoliotic curvature of the spine most often coincide with periods of active growth of the musculoskeletal system. This is roughly a period of 6-7 years and adolescence.

Statistics indicate that about 6% of the total population of the planet suffers from scoliosis to one degree or another. Moreover, only in 14% of cases, doctors manage to determine the cause of the pathology: most often, such a cause is trauma, rickets, congenital bone anomalies, different lengths of the lower extremities, etc.

Out of hundreds of patients with initial manifestations of scoliosis, further progression of the disease is noted in about 1/3 of cases. [4], [5]

Causes of the scoliosis grade 2

Scoliosis of the 2nd degree is always a consequence of the progression of the initial, first degree of curvature. The only exceptions to the rule are congenital defects, which are formed as a result of a violation of the formation and growth of vertebral discs and the ligamentous apparatus even in the prenatal period, as well as deformities caused by certain diseases of childhood - in particular, cerebral palsy, rickets, poliomyelitis.

In general, doctors identify the following reasons for the appearance of this disorder:

• among congenital causes - defects in the development of the spinal column (complete and additional wedge-shaped vertebrae), fusion of the vertebral bodies and transverse processes, costal synostosis, etc.;
• among neuromuscular causes - deficiency and weakening of the ligamentous-muscular mechanism of the spinal column, decreased muscle tone in patients with syringomyelia, myopathy, cerebral palsy, multiple sclerosis, etc.;
• among the syndrome-caused causes - connective tissue dysplasia, Marfan syndrome, Ellers-Danlos syndrome;
• secondary causes include fractures, surgical interventions, cicatricial contractures, etc. [6]

Risk factors

The appearance and progression of a scoliotic disorder can occur due to a combination of the following factors:

• dysplastic disorders affecting the spinal cord, vertebrae, discs, which entails a violation of the normal growth of the spinal column;
• disorders of hormonal balance and metabolic processes, which in general creates an unfavorable background in the body;
• dynamic and static disorders - in particular, excessive and asymmetric load on the spinal column, especially at the stage of skeletal growth. [7]

Immediate risk factors include weakened back muscles, hypodynamia, inadequate or inadequate nutrition, "asymmetrical" professional or sports activities, regular incorrect body position (during work, study), wearing a backpack on one shoulder.

If during the diagnosis the doctor fails to establish the cause of the disorder, then the diagnosis is made of idiopathic scoliosis. [8]

Pathogenesis

The main theories of the appearance of scoliotic curvature are structural changes in the spine, disorders of the spinal muscles and collagen fibers, pathology of the endocrine system and the vestibular apparatus. The possibility of a genetic predisposition is also being considered. [9]

In the development of idiopathic scoliosis, the main theories are genetic, endocrinological and neuromuscular. However, the mechanism of the occurrence of a violation due to these reasons has not been fully studied. [10]

In the thoracic segment of the spinal column, in the process of curvature formation, the vertebral body is displaced to the side to the convexity of the curved arch. As a result, the anterior part of the thoracic vertebrae turns to the convexity of the arch, lengthening of the arch root, and expansion of the vertebral foramen are noted. The vertebrae are deformed in a wedge-shaped manner. A similar deformation is observed in the intervertebral discs, which narrow on the concave side and undergo dystrophic changes. [11]

During the development of scoliosis, the spinal column changes its shape and position: there is a posterior deviation of the transverse processes and their decrease. The articular processes near the concavity zone become more horizontal, the articular facets (facet joints) expand. New joints are formed on the adjacent parts of the arches. There is a deviation of the spinous processes of the thoracic vertebrae towards the bulge, and the half-arch of the bulge is shortened in comparison with the concave part.

The mechanism of the ligaments changes pathologically. There is a displacement of the anterior longitudinal ligament towards the convexity, followed by its dissociation and thinning, the compaction of a part of the anterior longitudinal ligament at the concavity. These processes ensure the stability of the formed curvature.

The canal of the spine becomes uneven: narrowing in the concavity zone and expansion in the convex zone. The protective covering of the spinal cord, together with the inner part, is pressed into the anterolateral surface of the concavity.

The ribs and chest are pathologically changed in different planes. There is a superposition of ribs on top of each other, widening of intercostal spaces, rib deformity, and hump formation. With excessive convergence of the ribs, the likelihood of fibrous adhesions, the development of degenerative processes in the intercostal muscles increases. [12]

Symptoms of the scoliosis grade 2

Often, even with a relatively small curvature, a person experiences back pain, radiating to the legs, arms, other parts of the body, and even internal organs. The cause of such pain is pinching of the nerves by supporting structures, or altered vertebral discs. This entails a deterioration in the passage of bioelectric signals along the nerve fibers from the spinal cord to certain organs. [13]

Curvature of the spinal column can be manifested by the following symptoms:

• violation of body symmetry;
• violation of gait;
• severe back fatigue (the back gets tired quickly in the absence of support - for example, a back on a chair, as well as when walking or standing for a long time);
• regular pain in the head, back, lower back, between the shoulder blades;
• shortness of breath, recurrent problems with the heart and / or digestive system;
• slouch.

When it comes to children, then parents can pay attention to these first signs:

• unnatural protrusion of the shoulder blades;
• constant head tilt to one side;
• asymmetrical landing of the shoulders or hips, their visual incorrect location (higher or lower in relation to each other);
• curvature of the belt line;
• tilt of the body to the side when walking.

If you find any of the above signs, you should definitely seek help from an orthopedist.

What does scoliosis of the 2nd degree look like?

If you look closely at the back area of a person with grade 2 scoliotic curvature, you can note the following features:

• shoulder girdle is located asymmetrically;
• the position of the shoulder blades is different (protrusion of the shoulder blade on one side);
• curved line of spinous processes;
• somewhat skewed body.

During the development of deformity, the scapula on the convex side of the curved arc becomes higher than the scapula on the concave side. The formation of the so-called rib hump is noted, which, as it were, "pushes" one scapula outward.

The tilt of the trunk entails a change in the balance of the body: there is an axial tilt towards the apex of the curvature.

If you ask the patient to lean forward, the deformity will become more evident.

Pain in scoliosis grade 2

With cervical curvature, pain manifests itself in the shoulder, interscapular space. Regular headaches and dizziness are also characteristic. An increase in pain syndrome is observed when bending forward, or with prolonged holding of the head in one position.

With chest deformity, pain may appear in the chest, in the middle of the back, and in the shoulder blades.

With lumbar scoliosis, debilitating pain in the lumbar region is most often noted.

Cervicothoracic deformity reveals itself as intense pain in the muscles and head. Soreness increases against the background of physical activity, as well as with a deep breath, cough shocks.

Hump with scoliosis grade 2

Scoliosis of the 2nd degree is outwardly little defined, therefore the hump at this stage of the pathology is present only in the form of costal curvature. The stoop is hardly noticeable, the deformation becomes visible only when the body is tilted anteriorly.

The problem can cause slight discomfort, muscle tension is felt, pain may appear in the absence of physical activity.

The appearance of the rib hump is more typical for 3-4 degrees of curvature affecting the upper thoracic, thoracic or thoracolumbar spine, although on visual inspection you can notice a stronger protrusion of the scapula on one side.

Scoliosis of 2 degrees in a child

In childhood, scoliosis begins to develop between about five and 14 years of age. Especially dangerous periods are considered 5-6 years and 10-14 years, since it is at these time stages that the child's spine is actively growing.

Since the spinal column is characterized by a rather pronounced plasticity, with an incorrect distribution of the load on it, or under the influence of other factors, individual rows of vertebrae can deviate from the base axis to the left or right, forming an arc of scoliosis. A similar phenomenon is typical for the lumbosacral vertebral region, but it can also appear simultaneously in different departments.

In addition, children are characterized by a congenital form of pathology. In such a situation, the problem is explained by the improper development of the baby's musculoskeletal system, defects in the form of rib or vertebral adhesions, the presence of additional vertebrae, etc. It should be noted that the congenital form is much less common than acquired.

Scoliosis grade 2 and pregnancy

Among all pathologies of the spinal column in pregnant women, scoliosis is in second place, after osteochondrosis. At the same time, this violation significantly complicates the life of a woman in such a crucial period of gestation. Even in a healthy state, the spine in pregnant women undergoes severe stress, especially in the lumbar region, which in the third trimester is manifested by rather pronounced pain. In women suffering from grade 2 scoliosis, pain syndrome can be detected earlier and manifest even more strongly.

Apart from this, pregnancy often causes the failure of the compensatory changes that have been made during the treatment of the problem. The development of complications caused by post-deforming disruption of the work of internal organs and the nervous system is also possible. Women with scoliotic curvatures are more likely to experience premature birth, spontaneous miscarriage, developmental defects in the baby, and the degree of curvature during gestation may worsen.

Nevertheless, many expectant mothers successfully carry and give birth to healthy children. The main condition: regular supervision by a doctor, proper management of pregnancy, control of body weight, the use of special bandages.

Stages

To determine the stage of scoliosis, criteria such as the primary and degree of curvature, its stability, the presence of structural vertebral changes (rotational, torsion, deformation), localization of compensatory curvatures above and below the main defect are used. [14]

According to the altered static vertebral function, the following are distinguished:

• compensated (balanced) curvature, in which the vertical axis extending from the apex of the spinous process of the C7 vertebra runs through the intergluteal line;
• uncompensated (unbalanced) curvature, in which the vertical axis extending from the apex of the spinous process of the C7 vertebra is set aside and does not run through the intergluteal line.

Under radiologic classification skolioznoe disorder can have the steps of:  [15],  [16], [17]

1. The scoliotic angle is 1-10 °. The spine has a slight curvature along the frontal plane, asymmetry of the shoulder blades and shoulder girdles (thoracic and cervicothoracic scoliosis) or waist (lumbar scoliosis), muscle asymmetry in the level of the deformity arch.
2. The scoliotic angle is 11-25 °. The curvature is pronounced, does not "hide" when unloading the spine. There is a small arc of compensation and a less pronounced rib hump.
3. The scoliotic angle is 26-50 °. The curvature is significant along the frontal plane. There is a compensatory arch, the chest is deformed, the rib hump is pronounced. There is a deviation of the body away from the base scoliotic arch. Unloading the spine gives a minor correction.
4. The angle is greater than 50 °. Kyphoscoliosis is stable, sharply intense. Respiratory and heart disorders are present. [18]

Forms

Depending on the etiology of the development of pathology, scoliosis is:

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

Grade 2 idiopathic scoliosis is a disorder whose causes remain unclear.

Dysplastic scoliosis of the 2nd degree is caused by impaired metabolism and blood supply to the tissues of the vertebrae and discs. [19]

According to the shape of the deformation, they are distinguished:

1. C-shaped scoliosis with one curved arch;
2. S-shaped scoliosis of the 2nd degree, with two curvature arcs;
3. Ʃ-shaped scoliosis with three curvature arcs.

According to the location of the deformation, there are:

• left-sided scoliosis of 2 degrees (with a predominant curvature of the arc to the left side - occurs more often and has a more favorable prognosis);
• right-sided scoliosis of 2 degrees (with a curvature of the arc to the right side);
• cervicothoracic scoliosis with deformity apex at the Th3-Th4 level;
• thoracic scoliosis of the 2nd degree with deformity apex at the Th8-Th9 level;
• thoracolumbar scoliosis of the 2nd degree with deformity apex at the level of Th11-Th12;
• lumbar scoliosis of the 2nd degree with deformity apex at the L1-L2 level;
• lumbosacral with deformity apex at the L5-S1 level.

According to the altered degree of curvature, depending on the load on the spinal column, there are:

• fixed scoliosis of the 2nd degree, it is also stable;
• non-fixed scoliosis of the 2nd degree (unstable).

Depending on the clinical characteristics:

• non-progressive scoliosis (without increasing the deformity angle);
• progressive scoliosis of the 2nd degree, which is subdivided into slow and rapidly progressive (up to 9 ° and more than 10 ° in 12 months).

Complications and consequences

If the curvature of the spinal column progresses, then over time it can lead to secondary deformation of the pelvis and chest, impaired pulmonary function, pathologies from the heart and abdominal organs, the development of degenerative-dystrophic changes. [20]

Increasing deformation can lead to the following adverse consequences:

• Anatomical and functional changes on the part of internal organs, deterioration of respiratory function, the appearance of pulmonary insufficiency, which entails a chronic hypoxic state. [21], [22]
• Formation of insufficiency of the right ventricle, which is caused by an increase in pressure in the pulmonary circulation, the appearance of the "scoliotic heart" syndrome. [23],  [24]For the syndrome characterized by disordered breathing, chest pain, impaired consciousness, fatigue, tachycardia, spinal pain, paresthesia, night sweats, swollen legs and blue lips, sensitivity to cold hands and feet.
• Change in the localization of the kidneys and liver by the type of prolapse, a disorder on the part of these organs and the intestines. Perhaps a violation of the urodynamic state, the development of inflammatory processes in the urogenital area.
• Dystrophic processes affecting the intervertebral discs and synovial joints, accompanied by pain syndrome like osteochondrosis with radicular syndrome.
• Severe spinal disorders, spasms, flaccid paresis and paralysis caused by circulatory disorders, lymph flow, the development of cerebrospinal fluid stagnation.

These factors in general can lead to general depletion of the body, disability due to severe functional and organic disorders.

What is the danger of scoliosis of the 2nd degree?

Not in all cases, the curvature of the second degree is aggravated and progressing. But if this nevertheless happens, then there is a danger of deformation of the chest, the formation of an incorrect location of the internal organs of the abdominal and chest cavity, the development of functional disorders on the part of several body systems at once: urinary, respiratory, digestive, cardiovascular system.

In addition, a scoliosis defect is itself a noticeable cosmetic defect. This, in turn, can cause the appearance of depression, neuroses: a person becomes withdrawn, uncommunicative, socialization suffers, problems with study and professional activity appear.

Diagnostics of the scoliosis grade 2

During the appointment, the doctor first of all listens to complaints from the patient himself. The patient may indicate back pain, discomfort, increased fatigue in the spine. After that, the specialist conducts an examination: the doctor determines the presence of curvature in all planes visually. In this case, the patient needs to undress to the waist, stand up straight, then bend forward and touch the floor with his fingers. Next, the doctor assesses the symmetry of the trunk, checks the quality of reflexes, the strength of the muscles and the breadth of joint movements. [25]

Analyzes are not specific and can be assigned as additional studies. [26]

Instrumental diagnostics is usually represented by the following procedures:

• Scoliometry - helps to determine rotational changes in the vertebrae, calculate the degree of the costal hump, determine the angle of deformity. For research, a special device is used - a scoliometer.
• Radiography - allows you to visualize the area of violation, to consider changes in the vertebrae and intervertebral discs, to monitor the dynamics of treatment.
• Computed tomography or magnetic resonance imaging is appropriate when there is a simultaneous violation of the nerve functions, or at the preparatory preoperative stage.

X-rays usually include two images in a posterior projection: one with a horizontal supine position, the other with an upright position. [27]

X-ray signs of rotational and torsional changes in the vertebrae in the picture in the posterior projection are as follows:

• the spinous process of the vertebra is displaced to the concave part of the scoliotic arch;
• the indicators of the length of the right and left transverse processes differ;
• the position and shape of the legs of the vertebral arch are asymmetric;
• the position of the intervertebral joints is also asymmetric;
• the vertebral body and intervertebral spaces are wedge-shaped.

If the scoliotic angle does not change in the horizontal position, then one speaks of stable scoliosis. If the angle in the prone position changes, then the scoliosis is considered unstable (non-fixed, unstable). [28]

Differential diagnosis

Differential diagnosis is carried out with posture defects such as stoop, round or flat back, pterygoid scapula, lumbar hyperlordosis. The cardinal distinguishing feature is the presence of pathological rotational and torsion vertebrae in scoliosis, and the appearance of a rib hump and a muscular ridge may become a clinical symptom. [29]

For differentiation, the following diagnostic methods are used:

• neuro-orthopedic research;
• X-ray with functional tests;
• ultrasound procedure;
• electrocardiography, echocardiography;
• ultrasound dopplerography;
• electroneuromyography.

Treatment of the scoliosis grade 2

What method of treatment to use in case of curvature of the spine of the 2nd degree? It depends on how much the pathological process is started. At the initial stages of development, with grade 1-2 scoliosis, it is often enough to find and eliminate the cause of the deformity. You can correct the position of the spine with the help of long courses of massage and exercise therapy. Doctors advise pediatric patients to go in for swimming, equestrian sports, as well as sleep on a hard mattress, and control posture. [30]

As additional methods, the following can be recommended:

• physiotherapy;
• manual therapy;
• wearing corsets.

More complex methods - for example, surgical treatment - are usually offered to patients with 3-4 degrees of curvature, and only on condition that the pathology disrupts the work of individual organs and systems, negatively affects the patient's health. The most favorable age for the operation is 10-14 years. The intervention is quite traumatic and is accompanied by a long period of rehabilitation.

Read more about the treatment of grade 2 scoliosis in this article .

Prevention

Preventive measures consist in the early diagnosis of curvature by conducting widespread professional examinations of children attending preschool and school institutions. It is important to explain the need for a healthy lifestyle, adherence to a rational daily regimen. Children should eat well in order to prevent deficiencies in the body of vitamins and minerals.

It is necessary to provide a sufficient motor regime during the day, with the correct static-dynamic loads on the spinal column. Excluding too long stay at the table: it is important to regularly warm up, dynamic breaks in work and study approximately every 20 minutes. Regular walks and active pastime are equally important.

The workplace of a person must be well organized, have sufficient illumination. The sleeping area should also be “correct”: the bed should be semi-rigid, the pillow should be orthopedic, with adequate relief of the cervicothoracic vertebral zone.

We must not forget about the posture, which is the basis for the correct position of the spine. It is necessary to explain to the child how important it is not to slouch and hold his back. It is in childhood that a kind of "muscle memory" of the paravertebral muscles is formed, which contributes to the normal position of the spinal column throughout the day.

Forecast

The prognostic data for the life of a person with grade 2 scoliosis are considered favorable. If we are talking about a severe progressive course of pathology, then over time there may be a question about the appropriation of disability, limitation of working capacity, and narrowing of opportunities in professional choice. Difficulties appear with the adaptation of the patient in society.

The quality of the prognosis largely depends on the course of the scoliotic process. If it does not progress, or progresses slowly, then often the curvature can be corrected by conservative treatment, thereby preventing the development of complications in the work of the respiratory and cardiovascular systems. If the pathology is rapidly progressing and reacts poorly to conservative therapy, then it is possible to use intensive corset therapy or even surgery. [31]

In general, it is generally accepted that grade 2 scoliosis responds well to treatment under certain conditions:

• lack of hereditary predisposition;
• adequate physical development of the patient;
• sufficient motivation to heal.

However, in many cases, the disorder remains with the person for life: not progressing, or slowly progressing throughout life.

Scoliosis grade 2 and the army

Scoliosis of the 2nd degree with spinal deformity in the range of 11-17 ° usually does not become a sufficient excuse for exemption from military service. However, there are a few things to keep in mind. So, if the curvature in the thoracic vertebral region is fixed, minor movement disorders are noted, then a person may be recognized as fit with restrictions for urgent or contract service in the army. The final decision is made by the military medical board.

Full exemption or deferral from service can be granted only in such cases:

• a person suffers from constant disorders of the musculoskeletal system after a few hours of standing on his feet or walking slowly;
• the motor amplitude is markedly impaired and has a chronic character;
• there are movement disorders against the background of the absence of a tendon reflex and a decrease in sensitivity;
• there is a decrease in muscle strength in a certain muscle group, with compensation at the expense of other muscle groups.

Health group for scoliosis grade 2

The conclusion about which health group to classify a child into is made on the basis of the recommendations of several medical specialists at once: a pediatrician, a surgeon, an ophthalmologist, an ENT doctor, a dentist, a neuropathologist.

As a rule, healthy children are included in the first health group. It is allowed that they have minor morphological disorders that do not affect the general state of health and do not require medical correction. In physical training lessons, such children can perform all permissible loads.

The second health group includes children with minor disorders without chronic pathologies. For example, this includes children who are overweight, undersized, often ill, or those who have recently suffered injuries or surgical interventions.

The third health group includes children with chronic pathologies, including gastritis, bronchial asthma, and cardiovascular diseases. The same group can include patients with grade 2 scoliosis: this means that such children cannot jump, run long distances, and load their backs. However, an individual selection of exercises and workouts is shown. In some cases, one or another health group is assigned temporarily, changing as the disorder is corrected or aggravated.

Scoliosis grade 2 and disability

Disability is not assigned to patients, regardless of the degree of scoliosis:

• if professional activity and working conditions do not affect the course of the pathology;
• if there are no signs of respiratory failure above 1 tbsp.;
• if there is no exacerbation of pain and neurological symptoms;
• if the statodynamic disturbance is insignificant.

The patient is recommended to change the occupation if the work is associated with heavy or moderate physical labor, if during the labor process there is a need for a forced body position, frequent bends, vibration, prolonged upright position.

A patient is referred to a commission if:

• there are absolute contraindications to work;
• the risk of complications increases, including respiratory failure of at least grade 2;
• there are regular exacerbations of pain with neurological symptoms.

As a rule, scoliosis of the 2nd degree in the overwhelming majority of cases does not become an indication for assignment of disability, since at this pathological stage, the restrictions on the mobility of the spine are insignificant.