The diagnosis of scoliosis in a child always causes a depressing feeling in parents. Some of them themselves have negative experience on this path, others are afraid of this word firsthand. This is exactly the disease that parents talk a lot about at school, share their experience and knowledge with grandparents in the family, which constantly flashes on the pages of various newspapers and brochures, on television and, finally, on various Internet resources. It would seem that this is not a forgotten problem in society, but it is not at all easy to find answers to many questions. IN best case scenario On a number of issues, there is completely contradictory information, and in the worst case, there is simply no available information. Intrusive invitations from many clinics to “surge immediately” only scare away and cause distrust of everyone and everything. All this became the reason for creating a small but accessible lecture at the everyday level, capable of convincingly highlighting a number of problems associated with pathological deformation of the spine in children and adolescents. Here we present practical advice for the treatment of the disease. So, let's start with the basic concepts.

Basic concepts of pathological deformation of the spine

First of all, it should be noted that when they professionally talk about spinal curvature, they mean the projection of the spinal trajectory onto one of two planes: frontal or lateral (sagittal). This is due to the fact that for the vast majority of cases, documentary registration of deformation and its magnitude is carried out using x-rays. In this case, the projection of the spine onto the plane is recorded on the film.

The frontal plane is parallel to the chest, shoulders and eyes of a person, and the sagittal plane is a plane perpendicular to the frontal and, therefore, running in the direction from the back to the chest of a person. The sagittal plane running along the spine can conditionally divide the torso into two symmetrical halves - left and right. Many terms are associated specifically with the left and right halves of the body.

Normally, the line of the spine in the frontal plane should be straight - Fig. 1a, and in the sagittal plane the line of the spine should have the so-called. physiological bends - Fig. 1c.

This is a convexity of the line of the spine in the thoracic region (kyphosis) and a concavity of the line in the lumbar region (lordosis). Deviation from the norms is a pathology, which is characterized by degree, depending on the severity of the violations. Pathological curvature of the spine in the frontal plane, i.e. lateral curvature of the spine - Fig. 1b is called scoliosis, and deviation from the natural curvature of the spine in the sagittal is called pathological kyphosis or lordosis, according to the zone of manifestation - Fig. 1d, 1e. Assessment of the magnitude of kyphosis, lordosis and scoliosis is often expressed by the angle encompassing the arc of curvature, Fig. 2.

When diagnosing scoliosis, the doctor is guided by a number of factors and examinations, as well as when assessing the severity of the disease. One of the main factors is the angle of deformation. And although the method of such assessment causes a lot of criticism and controversy, a deformation of 10-15 degrees announces a violation of posture, and a deformation of 40-50 degrees emphasizes the extreme seriousness of the situation.

You can often hear the question from parents: “What did we do wrong and what did we do wrong that created such a problem for our child?” Answer: nothing and nothing. Only an orthopedic specialist can deliberately create a permanent deformation of the spine, which, of course, essentially does not happen. There are many natural reasons for the occurrence and development of this disease, some of which are well known, while others are so deep that today they remain undisclosed by a whole army of various kinds of specialists dealing with this problem. In particular, the most representative type of scoliosis is idiopathic, literally translated as a disease of “unknown etiology.” True, when they talk about unknown causes of a disease, they mean deep processes that initiate the occurrence and development of deformity.

There are a number of scientific directions that deal with this problem, for example, genetic, biochemical, biophysical, etc. From the point of view of the mechanogenesis of scoliosis, it can be argued that the cause of the appearance and development of scoliotic deformity is the asymmetry of growth of the skeleton and the musculo-ligamentous apparatus. For example, this may be the growth of one leg or collarbone faster than the other, developmental disorders (dysplasia) of the chest, pelvic bones, etc. Finally, there may be disharmony in the growth of individual segments and adjacent ligamentous-muscular structures in some narrow zone of the spine, etc. Disharmony in the growth of the entire composition of the skeleton, muscles, ligaments, etc. leads to curved growth of the spine in different height zones of the spine and in different directions. Most often, the causes of asymmetric growth manifest themselves in a complex manner, and predicting the dynamics of deformation development is an extremely difficult task. .

We can only say with certainty that the earlier the appearance of scoliotic deformity is noticed, the greater the likelihood of its development in the so-called. rough forms, i.e. the greater the curvature will be by the time the child stops growing and, accordingly, the deformation stops growing.

What are the risks of spinal deformity? Unfortunately, this phrase brings fear to most parents who do not even try to analyze the details of the situation. But, after all, spinal deformity generalizes the range of conditions, ranging from banal curvatures caused by a temporary change in the position of the body - static, quite easily corrected conservatively, to persistent, so-called. structural changes in the elements of the spine, sometimes requiring surgical treatment of the disease. In addition to the magnitude and nature of the deformation, the type of deformation in terms of the characteristics of the disease is also important - the type of scoliosis. So it is almost impossible to answer the question posed in accordance with the regulations of these pages, but it is possible to limit ourselves to discussing the most widespread type of scoliosis - idiopathic, and further conversation can be made useful and relevant for the vast majority of our readers.

Returning to the question, you also need to decide on the concept of the degree of scoliosis, as already mentioned above. Mention was also made of a method for assessing deformation using the arc coverage angle, constructed in a certain way, for example, using the Cobb method. The deformation measured in this way with an angle in the range of 0-10 degrees. is usually classified as 1st degree, 11 - 25 degrees. - to the 2nd degree, 26-50 degrees. - to the 3rd degree, but above 50 degrees. - to the 4th degree of scoliosis. Unfortunately, this classification (Chaklin classifier) ​​and evaluation method suffer from very serious errors. When prescribing treatment, the doctor uses such techniques as a detailed analysis of an x-ray of the spine, examines clinical picture, is conducting additional research current state body, etc. Without a comprehensive detailed examination of the patient’s condition, the measured value of the arc angle, expressed in Cobb degrees, is of little significance. You should very carefully interpret the magnitude of spinal deformation according to this parameter - do not be afraid of large values ​​and do not be deluded by small ones.

Unfortunately, you can often hear, both in conversations between patients and sometimes between a doctor and a patient, that the Cobb angle is used as the dominant factor. This is a very serious mistake and therefore we consider it necessary to pay special attention to this issue.

Let's consider just one expressive example of the absurdity of the angular parameter, Fig. 3.

Shown here is an initial arc of 24 degrees. according to Cobb, which corresponds to the transition zone of degrees II and III of scoliosis according to the classifier of the degree of scoliosis V.D. Chaklina. Let's assume that this is a deformation of a growing child, and the child's growth is like special case, occurs with constant curvature. Most often, as the child grows, the curvature of the arch increases. In the above case, the arch of the spine grows without increasing curvature, i.e. at a constant arc radius, going from states A-A V state B-B. This is possible, for example, in conditions of effective brace therapy.

According to the Cobb method for assessing the severity of the arc, the B-B arc has 39 degrees, which is significantly larger than the A-A arc. At the same time, without analyzing the actual curvature of the arch, the doctor will tell you that the deformity has progressed to 15 degrees. and perhaps warn you to consider spinal surgery. We have repeatedly encountered this situation.

We repeat that there was no real deterioration in the child’s condition - the curvature (deformation) of the arch, which depends only on the radius of the arch, did not increase. .

The error noted above in assessing the real state of the grown arc is only part of the group of errors contained in the Cobb method. A detailed analysis on this issue can be found through our website noted below. Despite the proven absurdity of the angular parameter and the effectiveness of the curvature parameter, the transition from one method of assessing deformation to another cannot be instantaneous, so the Cobb angle, conclusions and assignments based on from these ideas. You need to constantly be prepared for this. In our brace therapy practice, we use special techniques and tools for examining x-rays and assessing the curvature of the arch, which allows us to determine the severity of the disease much more accurately and objectively. More information about brace therapy can be found on the laboratory website http://ol-brace.ru. At the same time, for a general audience or in official documents, we have to conform to generally accepted ideas.

Let's consider the picture of the natural development of scoliotic deformation ε, presented by the graphs in Fig. 3.

Graph “A” represents the type of rapid (malignant) development of scoliosis. These are the so-called infantile scoliosis. As a rule, in this case, pronounced postural disorders are observed in a child already at 3-5 years of age. Unfortunately, often these disorders are left without proper attention at an early age, but by the age of 12-13 the need for surgical treatment becomes obvious - the “OL” zone in Fig. 3A.

Graph “B” represents a moderately progressive type of deformity development. Most often, postural disorders are detected visually at the age of 9-10 years. By the end of the child’s growth, a cosmetic defect is noticeable and the deformation of the spine reaches values ​​at which in most cases it is possible to manage with conservative treatment methods and only in some cases can the question of surgical treatment be raised - the “CT” zone in Fig. 3.

Finally, graph “C” represents the sluggish current type of development. Signs of this type are the rather late visual detection of the deformity in the child and the weak expression of the totality of signs of scoliosis towards the end of growth.

But this case is the most common and most convenient for various types of speculation. Here you can demonstrate “treatment successes” using: all kinds of exotic names of massages, and all kinds of posture correctors and unreasoned corsets, and “miraculous” roller tables and much more. The main thing is not to cause much harm, and a good result, as they say, “will not take long to arrive,” since it is predetermined by the minimal development of the deformity.

Mechanical correction of spinal deformity

The treatment of scoliosis almost always means correction of spinal deformity in one way or another. There is no direct drug treatment scoliosis, just as it is impossible to correct structural scoliotic deformation with massage, physical therapy and swimming. All this is useful only for strengthening the muscular system and, perhaps, making life easier with the deformity. There are only two ways to seriously combat pathological deformation: effective corset therapy and surgery.

The first is held at early stages development of the disease and has limited capabilities. The principle of correction is the rheological restructuring of the entire musculoskeletal mechanism under continuous dosed force. Surgical treatment is used as a last resort for relief in the most severe cases.

Finally, we come to perhaps the most important and popular question among parents: “How can a corset help and why does information about the effectiveness of corset treatment vary so much in different sources of information?” .

The potential for arch correction using corset therapy depends on several factors: first of all, what type of development of deformity do we have to overcome? As mentioned above, approximately the type of development can be assessed by the moment (age) of detection of the deformity in the child. Of course, the sluggish current type of deformity development will require the least qualifications, the effectiveness of the corset and the effectiveness of corset therapy techniques, as well as the investment of time to achieve positive success. On the contrary, a rapidly progressing type of development (malignant) will require the maximum of everything that can be found in the arsenal of means to combat the disease. .

Important has a correction start factor relative to the moment the deformation is detected. The sooner you start corset therapy, the greater the chance of slowing down the development of the disease. After all, the more active - the more powerful the process of development of deformation, the greater the power required to inhibit this process. But the problem is that, contrasting the nature of the development of deformity with correction with a corset, we have a number of limitations. These are: the strength of soft tissues, which are subject to great pressure from the corrective elements of the corset, and the permissible deformability of the ribs, through which forces are transmitted to the spine, and much more. .

As an example, in Fig. Figure 3b shows a diagram of the inhibition potential for the development of type “A” deformity depending on the moment of initiation of brace therapy. As can be seen in the graphs, the chance to avoid surgical treatment (the area with vertical hatching in Fig. 3a) remains, perhaps, only if correction begins immediately upon detection of the deformity itself - at point 1. Delaying the start of brace therapy for 3-4 years leaves virtually no chance cope with deformation in a conservative way. Here, the potential of corset therapy is significantly lower and consists only in minimizing the growth of deformity in a growing organism. This, however, appears to be useful for improving the results of possible subsequent surgical interventions. .

For C-type deformity development, brace therapy is not a decisive procedure. As mentioned above, in principle one can do without “heavy artillery.” At the same time, with the help of a corset it is much easier and more effective to minimize characteristic cosmetic defects.

There is no doubt that a prerequisite for effective correction of deformity is the constructive wisdom of the corset and the effectiveness of the techniques. If the first is available for viewing to everyone, although it is to a certain extent the art of an orthotist, then the methodological part of corset therapy in its intricacies, as a rule, remains a secret of the authors and is not published. Issues of managing the formation of the arch(s) of the spine, in order to minimize the severity of the disease, are resolved by the joint work of the orthotist and the accompanying orthopedist. To a large extent, this area of ​​work is the prerogative of biomechanics.

Finally, the last condition for effective correction is strict discipline of the patient. It has been repeatedly verified that for a successful result it is necessary to wear the corset 22-23 hours a day. This is due to the fact that when the patient is standing, the full potential of the corset is spent mainly on keeping the spine from progressing. And in the supine position of the body - in the absence of a vertical load on the spine, the potential of the corset is aimed exclusively at correcting the deformity. .

Unfortunately, that's enough large percentage adolescent children poorly fulfill these requirements. Parents need to find the right actions, words and time to control the child’s compliance with the requirement to constantly wear a corset. Sometimes it is necessary to control the moral and psychological atmosphere at school, sometimes it is necessary to spend money on clothes that hide the corset on the child as much as possible, and so on.

We have developed a method and a prototype version of a device for monitoring the discipline of brace therapy and hope in the near future to create a financially viable industrial version of a miniature “presence sensor”. It will be installed on the corset in a visually inaccessible manner, and information from the sensor about the time the corset is worn can be read by a computer approximately once every two months. This will make it possible to build a much more accurate model for predicting possible correction of deformity for various cases of pathology and modes of wearing a corset. It seems to us that by knowing in advance the possible results of treatment, which in the form of an “expressive picture” can be demonstrated to the patient on a computer monitor, we will increase the child’s responsibility to himself and make the treatment process meaningful and the results expected.

The effectiveness of the "PATTERN" corset - examples of correction

This section presents typical cases of correction of spinal deformities of varying severity - from advanced second to fourth inclusive, which have been our daily practice for the past eight years. Let's immediately say that:

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We use Cobb angle as a strain assessment parameter solely due to its ubiquity in this topic.

In our practice, as noted above, we use the arc curvature method. Curvature is expressed in units [m-1].

So, Fig. 4 shows typical examples of correction of deformities of various types and severity in several children. Shown, that

Deformations of small and medium magnitude can be corrected almost completely with a very high probability, example, Tanya V., fig. 4.1,

Medium-sized deformities can be effectively contained or reduced during active growth and for about a year immediately after the end of active growth, for example,

Katya V., rice. 4.2, .

In some cases, it is possible to correct a 4th degree deformity, lowering it to the 3rd degree, but only with intensive correction during and after active growth, for example, Natasha V.,

Kyphosis, starting from the upper thoracic region and lower, is corrected with maximum probability, example Oksana R., fig. 4.4.

As can be seen from the examples presented, correction of even the fourth (early) degree of deformity is fundamentally possible. It is possible to speak in more detail about the potential for correction only taking into account the characteristics of a particular case.

In conclusion, it is necessary to note one more circumstance. To date, there is a strong opinion among orthopedists that the possibility and feasibility of corrective brace therapy is limited by the age of active growth - Risser test 3.5-4. We, in turn, have repeatedly encountered a situation where an effective correction took place precisely after the end of active growth. Intensified observations of this effect led us to the following conclusions. .

During the period of active growth and formation of all components of the body, this process is endowed with quite high power. For example, lengthening the lower leg is possible only under the condition that the growing mass must lift the entire mass of the torso standing above. The formation of the geometry of the spine is synchronized with adjacent organs and adjacent masses of the torso. The growth of all organs is interconnected both biologically and physically. In this situation, we are trying to change the course of the spine formation process with a device and process that has serious power limitations, as already mentioned above. In the struggle between the “corset and the nature of the development of the body,” precisely at the stage of active growth of the child, the process of development of the body prescribed by nature often wins, which we observe in the form of progression of the deformity. By the time active growth is completed and, accordingly, the power of this process decreases, the possibilities of correction increase sharply, since the body’s resistance to forceful restructuring of the corresponding musculoskeletal structures sharply decreases. The examples presented prove that conservative correction of even the fourth (early) degree of deformity is fundamentally possible.

A particular example is shown in Fig. 4 for Natasha. B. For her, correction of the deformity turned out to be possible just after the completion of active growth - conditionally, from 15 to 17 years old, it was possible to reduce the deformity from the 4th to the 3rd degree. Now that Natasha is over 18 years old, the curvature of the arch is even lower. At the same time, we are not yet ready to answer the question of under what conditions, to what extent and up to what age correction of scoliotic deformity in youth is possible, since we do not yet have sufficient experience in this direction.

Conclusion

Very often you can hear completely unqualified opinions about the possibilities of brace therapy for the correction of scoliotic deformity. These judgments, as a rule, are made by people, including doctors of various specializations, who have never been deeply interested in the biomechanical aspects of the problem and the conditions for its solution. For example, you can often hear from doctors that a corset contributes to the atrophy of a child’s muscles. We do not undertake to talk about all types of corsets, but in our corset, children not only necessarily do special compensatory breathing exercises, sit at a desk, study in labor lessons, walk along the street, but also run, jump rope, kick a football, etc., although , we categorically prohibit the latter. How is muscle atrophy possible under such conditions?

Parents, having listened to an unqualified opinion, often make appropriate decisions for which their child may have to pay for his whole life. We, for our part, advise parents the following: before making a decision on how and where to treat a child, do not regret spending enough time to understand this issue as deeply as possible. Your time will pay off in spades later!

Head Ortho-technical laboratory of the spine, Ph.D. S.A. Schutz

Orthopedist-vertebrologist, Ph.D. L.G. Kuzmishcheva

Scoliosis, that is, curvature of the spine, often develops in adolescents during a period of intensive bone growth.

The disease is characterized not only by noticeable deformation of the spinal column and changes in posture, but also by a decrease in the volume of the chest and abdominal cavity, which negatively affects the condition of the internal organs.

With the rapid progression of spinal deformity, the use of special orthopedic corsets is indicated, designed to correct the pathology and prevent further development of the disease.

Types of corsets for scoliosis

The presence of scoliosis requires appropriate treatment. A mandatory course of therapy is developed for patients, including anti-scoliosis gymnastics, massage sessions, swimming and the use of corsets.

Lack of treatment not only leads to noticeable visual distortions, but also provokes the development of breathing problems, cardiac problems, decreased immunity and the appearance of many chronic diseases.

Parents of children always need to remember that excellent health in the future, adaptation in society and life expectancy of the child depend on the measures taken after the diagnosis of scoliosis.

Technological innovations in the field of medicine have made it possible to develop several types of spinal corsets, varying in type and use depending on the stage of development of scoliosis.

There are two types of corsets used for scoliosis – supporting and correcting. In turn, they are divided into several subtypes, differing in the material of manufacture, principles of use and indications for use.

Supportive corsets for scoliosis

They cannot correct the developing spinal deformity, but they can partially avoid further progression of the disease. Supportive corsets are indicated at the beginning of the development of scoliosis as a preventive measure and in adulthood for pathologies of the support system.

Reclinators

They are elastic bands worn over the upper half of the chest in a figure eight shape.

The tension of the bands allows you to straighten your stoop, correct your posture, relieve the load on the shoulder girdle and spread your shoulders to the sides.

The use of reclinators is indicated in the early stages of scoliosis, with minor irregularities in posture, and with muscle weakness.

Reclinators are worn on top of T-shirts, undershirts, and are used for up to 4 hours a day when viewing files on the computer, TV shows, doing homework, and reading.

Chest posture corrector

It is a bandage with a corset belt and a semi-rigid part for the thoracic region on the back side.

The corset has additional elastic straps covering the upper torso. The main part, located on the thoracic spine, is made with special stiffening ribs, and the entire structure is sewn from elastic material.

Such devices are used for severe stoop, pathology of the shoulder blades, and early kyphoscoliosis.

Thoracolumbar posture correctors

These are orthopedic devices that combine a corset belt, a reclinator and a semi-rigid part for the back with stiffening ribs.

Thoracolumbar correctors are designed to correct posture and grade 1 and 2 scoliosis in children and adults; they are selected by a doctor according to individual sizes.

Chest and back correctors must be worn and used correctly; they are put on in a standing position and secured with special fasteners on the chest or abdomen.

If you follow the donning technique, your spine should be straight, your chest should be straightened, and your shoulders should be pulled back.

Wearing correctors begins with thirty minutes a day, gradually increasing the time of their use to 4 hours a day.

It is necessary to wear thoracic and thoracolumbar correctors when performing physical work, while doing homework at a desk, or when working on a computer.

The changes that occur in the spine are determined by the doctor and x-rays; if the dynamics are positive, the time for using support devices is reduced to one hour per week.

Principles of the effect of corrective corsets on the spine

The main purpose of corrective devices is to prevent further progression of scoliosis and correct the deformity of the spinal column identified during diagnosis.

Correction of the curvature of the spine in a corset is based on the action of supporting structures that exert back pressure on the area of ​​deformation.

A corrective corset for the spine has a positive effect in two planes at once - lateral and anteroposterior; special clamps support the straightened area of ​​the back in a physiological position.

Chenault corset

Today it is the most popular. The material for constructing the device is a special thermoplastic plastic; the device is made using individual plaster casts.

Inside the body, in the projection of the pressure points, special gaskets made of dense foam rubber are glued, providing pressure on the area where the defect needs to be corrected.

WITH opposite side From the area of ​​deformation, special free zones are provided into which the area of ​​curvature moves forward.

As scoliosis is corrected, the corset is replaced. While wearing a corset, it is recommended to perform special breathing exercises aimed at increasing lung capacity.

Back brace Milwaukee

This design has a saddle for the pelvic area and metal support platforms.

The corset has clamps for the chin and occipital area.

The Milwaukee corset is made based on the degree of scoliosis and depending on height; the design provides for the possibility of adjustment.

Lyon corset (Brace corset)

This is a metal-polymer device consisting of horizontal and vertical posts. The corset is adjustable in height, which allows you to change it no more than once every two years.

Boston corset

A device of this design is used to correct grade 3 scoliosis of the lumbar and sacral region.

It is a frame that reaches the level of the chest, has back and front fasteners, which ensures its complete fit to the body.

The choice of corset is made after diagnosis and based on the doctor’s recommendations. To achieve a normal physiological position of the spine, it is necessary not only to change devices in a timely manner, but also to wear them correctly.

You should also additionally note the cost of the products, which is high, since corsets are made from individual plaster casts. Thus, the average price for Chenault corsets varies between 7,500 - 9,000 rubles.

How to wear and use the Chenot corset to achieve the desired result?

When used correctly, the Chenot corset can correct grade 2–3 scoliosis. When prescribing it, you must follow the doctor’s recommendations, the main ones are the following:

• In the first days, the corset is put on for one to two hours for habituation and psychological adaptation. Subsequently, Chenault's corset is worn constantly; it is removed only to take a shower and to perform physical therapy;
• the corset is worn over a tank top or T-shirt; it is necessary to monitor the condition of the skin in pressure areas;
• when using a corrective structure, it is necessary to avoid lifting weights exceeding 5 kilograms in weight;
• Comparative diagnostics are carried out every three months. X-rays are taken of the spine in the corset, then it is removed and two hours later the X-ray is repeated;
• After three to four months, based on repeated radiography, the device is corrected.

Reviews about the use of Chenault corsets

The Chenot corset is manufactured in Russia by only a few companies, so it is necessary to ask to see the certificate at the time of prosthetics.

To correct the deformation of the spinal column, it is necessary to constantly undergo diagnostics and consult a doctor. While using the corset, you should not refuse anti-scoliosis exercises, swimming and breathing exercises. Only a combination of all methods of conservative treatment can be beneficial.

Review by Tatiana M., (39 years old)

“My daughter started wearing the Chenault corset about 8 months ago. I didn’t get used to it right away, I was embarrassed to wear it to school and on the street, but then gradually everything became normal, and after about a month my daughter began to wear it almost all day.

The main problems are the selection of clothes and skin care - the corset chafes in some places. But all these are minor things compared to the results - the correction of the spine is visible on the X-ray and visually, in the first months there was pain in the hip joint, but now everything has returned to normal.

The corset has already been changed twice, as the scoliosis has become smaller and different support inserts were required. Both my daughter and I hope that in about six months we will have to wear Chenault’s corset much less, and then it won’t be far from a complete cure.”

Review by Alexandra

“We were able to correct our son’s progressive scoliosis only with the help of the Chenault corset. Before this, there were gymnastics classes and training in a specialized center, but there was no desired result. After using the corset, the spine began to improve and my son is already more optimistic about life.”

The results of using the Chenault corset can be assessed from the above photos of scoliosis before using the corrective device and several months later. Based on these pictures, you can judge for yourself: do such corsets help with scoliosis? After all, the results of radiography from the use of corsets speak more eloquently than any words.

Video describing the use of a corset by a real patient

Watch the video of the conference of manual musculoskeletal medicine, which, using a real example of a patient, describes the process of treating scoliosis in stages using the Chenault corset, and talks about the results of treating the disease with a similar method

What is spinal lordosis: symptoms, treatment, exercises.

If you look at the silhouette of a person from the side, you will notice that his spine is not straight, but forms several bends. If the curvature of the arch is directed backwards, this phenomenon is called kyphosis. The curve of the spine with a convexity forward is lordosis.

• What is lordosis
• Causes
• Types of disease
• Symptoms of lordosis
• Lordosis is smoothed or straightened - what does this mean?
• Lordosis in a child
• Treatment of lordosis
• Treatment of cervical hyperlordosis
• Treatment of lumbar hyperlordosis
• Exercises and gymnastics

There is cervical and lumbar lordosis. U healthy person these curves provide shock absorption to the spine. With a significant increase in the physiological curvature of the spinal column, pathological lordosis occurs in the cervical or lumbar regions.

Hyperlordosis may not be accompanied by pathological symptoms. However, it is dangerous due to its complications from the musculoskeletal system and internal organs.

What is lordosis

Lordosis is a curvature of the spinal column with its convexity facing forward. Normally, it appears in the cervical and lumbar regions during the first year of life, when the child learns to sit and walk. Lordosis in the neck area is most pronounced at the level of the V - VI cervical vertebrae, in the lumbar area - at the level of the III - IV lumbar vertebrae.

Physiological lordosis helps a person:

• absorb shocks when walking;
• support the head;
• walk in an upright position;
• bend over with ease.

With pathological lordosis, all these functions are disrupted.

Causes

Primary lordosis can occur with the following diseases:

• tumor (osteosarcoma) or metastases of a malignant neoplasm in the vertebra, as a result of which defects form in the bone tissue;
• spinal osteomyelitis (chronic purulent infection accompanied by destruction of the vertebrae);
• congenital malformations (spondylolysis);
• spondylolisthesis (displacement of the lumbar vertebrae relative to each other);
• injuries and fractures, including those caused by osteoporosis in older people;
• spinal tuberculosis;
• rickets;
• achondroplasia is a congenital disease characterized by impaired ossification of growth zones;
• osteochondrosis; in this case, hyperextension of the spine is combined with increased muscle tone and serves as a sign of a severe course of the disease.

Factors leading to the appearance of secondary lumbar lordosis:

• congenital hip dislocation;
• contracture (decreased mobility) of the hip joints after osteomyelitis or purulent arthritis;
• Kashin-Beck disease (impaired bone growth due to deficiency of microelements, primarily calcium and phosphorus);
• cerebral palsy;
• polio;
• kyphosis of any origin, for example, with syringomyelia, Scheuermann-Mau disease or senile deformity;
• pregnancy;
• poor posture when sitting for a long time or lifting heavy objects;
• iliopsoas muscle syndrome, complicating diseases of the hip joints and the muscle itself (trauma, myositis).

Increased lumbar lordosis occurs when the body's center of gravity moves backward. Lordosis in pregnant women is temporary and disappears after the birth of the child.

Pathological lordosis of the cervical spine is usually caused by post-traumatic deformation of soft tissues, for example, after a burn.

Predisposing factors to the development of hyperlordosis are poor posture, excess weight with fat deposits large quantity belly fat and growing too fast childhood. Interestingly, many years ago a connection was proven between constantly wearing high-heeled shoes and the incidence of hyperlordosis in women.

Types of disease

Depending on the level of damage, cervical and lumbar pathological lordosis are distinguished. Depending on the time of appearance, it can be congenital or acquired. It rarely occurs in the prenatal period. Often this pathology of the spine is combined with other types of curvature, for example, scoliotic deformity.

Depending on the degree of mobility of the spine, pathological lordosis can be unfixed, partially or completely fixed. With an unfixed form, the patient can straighten his back; with a partially fixed form, he can change the angle of the spine with a conscious effort without achieving full straightening. With fixed lordosis, changing the axis of the spinal column is impossible.

If the cause of the pathology is damage to the spine, lordosis is called primary. It occurs after osteomyelitis, with malignant tumors, fractures. If it occurs as a result of the body’s adaptation to a shift in the center of gravity due to other diseases, these are secondary changes. Secondary hyperlordosis accompanies pathology of the hip joints. It is often combined with scoliosis.

In children and young people, hyperlordosis often goes away after the cause of the disease is eliminated. Spinal curvature in adults, on the contrary, is often fixed.

Hyperlordosis can be an individual feature of the figure. In this case, it is not associated with other diseases and does not cause serious symptoms.

Symptoms of lordosis

With hyperlordosis, the vertebral bodies move forward relative to the axis of the spine and fan out. The spinous processes - bony outgrowths on the back surface of the vertebrae - come closer together. Intervertebral discs become deformed. Incorrect tension and spasm of the neck or back muscles occurs. Nerves and vessels leaving the spinal canal may be pinched. The joints between the processes of the vertebrae and the ligaments running along the spinal column suffer.

These phenomena create conditions for the occurrence of the main symptoms of pathological lordosis:

• violation correct form bodies;
• change in posture;
• pain due to compression of the spinal cord roots;
• difficulty moving.

The younger the patient, the faster he develops secondary chest deformation. At the same time, the functioning of the heart and lungs is disrupted, and shortness of breath appears during physical exertion. With severe pathology, the digestive system and kidneys suffer. Thus, the patient is concerned about the manifestations of reflux esophagitis (heartburn), bloating and constipation due to weakness of the abdominal muscles. Nephroptosis develops - prolapse of the kidney.

With hyperlordosis, the shape of other parts of the spine also changes, which enhances the change in posture. The figure becomes “kinked”, the gluteal region protrudes significantly back, the chest and shoulder blades deviate in the same direction. However, such deformity may not be noticeable in obese patients. External measurement of the angles of the spine in this case is not informative enough. This may lead to diagnostic errors.

Pain in the affected area (most often in the lower back) intensifies after exertion (walking, standing) or being in a position that is uncomfortable for the patient. The patient cannot sleep on his stomach. With cervical hyperlordosis, pain spreads to the neck, shoulders, and upper limbs. Signs of compression of the vertebral arteries may be detected - dizziness, diffuse headache.

During examination, signs of kypholordotic deformity of the back are usually determined: a deflection in the lower back, a protruding thoracic spine and shoulder blades, raised shoulders, a protruding abdomen, and hyperextended legs at the knees. With cervical hyperlordosis, the angle between the upper and lower parts of the neck is more than 45 degrees. Head tilts forward and to the sides are limited.

Fixed lordosis is often a complication of intervertebral hernia. The first symptoms of the disease appear in middle-aged people. Curvature of the spine is accompanied by spasms of the lumbar and gluteal muscles. When you try to straighten your back, sharp pain occurs in the hip joints. There is a violation of sensitivity in the lumbar region and lower extremities, which is associated with concomitant damage to the roots of the brain.

Due to disruption of the normal shape of the spine, improper distribution of the load on the bones, ligaments and back muscles occurs. They are constantly tense, as a result of which their weakness develops. A “vicious circle” arises when the muscular corset ceases to support the spinal column. If you look at the patient from behind, in some cases you can notice the “symptom of the reins” - tension in the long muscles located parallel to the spine at the edges of the lumbar depression.

The gait becomes “duck-like.” The patient bends forward not due to movements in the spine, but due to flexion only in the hip joints.

With a long-term course of pathological lordosis, complications may arise:

• pathological mobility of the vertebrae with their displacement and pinching of the nerve roots (spondylolisthesis);
• multiple pseudospondylolisthesis (decreased stability of intervertebral discs);
• herniated discs;
• inflammation of the iliopsoas muscle (psoitis, lumbar myositis);
• deforming arthrosis of the spinal joints, accompanied by limited mobility and chronic pain.

You should definitely consult a doctor if you experience the following symptoms, which may be caused by the following complications:

• numbness or tingling in the limbs;
• “shooting” pain in the neck or back;
• urinary incontinence;
• muscle weakness;
• loss of coordination and muscle control, inability to bend and walk normally.

Quantitative characterization of spinal curvature is carried out using a simple device that measures the degree of curvature. This manipulation is called “curvimetry” and is performed by an orthopedist during the initial examination of the patient.

To diagnose the disease, radiography of the spine is performed in direct and lateral projections. A photograph may be taken in the position of maximum flexion and extension of the spinal column. This helps to determine mobility, that is, to recognize fixed lordosis. For radiological diagnosis of hyperextension, special measurements and indices are used. They do not always reflect the true severity of the disease, so the interpretation of the x-ray report should be carried out by the clinician examining the patient.

With a long-term course of the disease in the lumbar region, the spinous processes of the vertebrae, pressed against each other, grow together. Signs of osteoarthritis are visible in the intervertebral joints.

In addition to radiography, computed tomography of the spine is used. It allows you to identify the cause of the pathology and clarify the extent of damage to the nerve roots. MRI is less informative because it better recognizes pathology in soft tissues. However, it can be very useful in diagnosing a herniated disc.

Each person can find out whether he has pathological lordosis. To do this, ask an assistant to look at the line of the lower back from the side, and then lean forward, lowering your arms. If the curvature in the lumbar region disappears, this is physiological lordosis. If it persists, you should consult a doctor. Another simple test is to lie on the floor and place your hand under your lower back. If it moves freely, there is probably excess lordosis. The likelihood of this pathology increases if the curvature does not disappear when pulling the knees to the chest.

Lordosis is smoothed or straightened - what does this mean?

Normally, the curvature of the spine in the neck and lower back is formed in the first years of life under the influence of walking.

Physiological lordosis can be smoothed or straightened. The flattening of the bend is called hypolordosis. When examining a person's body from the side, his lumbar deflection is not determined. In most cases, this is a sign of intense contraction of the back muscles due to pain caused by myositis, neuritis, radiculitis or other diseases.

Another reason for smoothing the physiological curves of the spinal column is whiplash injury resulting from a road traffic accident. With a sudden movement, the ligaments that hold the spine are damaged, and a compression fracture of the vertebral bodies also occurs.

Smoothed lordosis is often accompanied by long-term back pain. Posture is disrupted, the body leans forward, and the stomach protrudes. A person cannot fully straighten his knee joints without losing balance.

The main method of combating such deformity is physical therapy aimed at strengthening the abdominal muscles and correcting posture.

Lordosis in a child

The first signs of physiological curves are present in a person immediately after birth. However, in infants they are weakly expressed. Intensive formation of lordosis begins after the child has learned to walk, that is, by the age of 1 year. Anatomical structures are fully formed by the age of 16–18 years, when ossification of growth zones occurs.

Lordosis in children is often more pronounced than when it develops in adulthood. The earlier the pathology occurred, the stronger the deformation. Lordosis in children is accompanied by impaired functioning of the lungs and heart. Deformations and compression of other organs may occur.

Sometimes spinal curvature appears in children for no apparent reason. This is benign juvenile lordosis. This form of pathology occurs with excessive tone of the muscles of the back and hips. With age, manifestations of this condition spontaneously disappear.

Hyperlordosis in a child can be a symptom of injury, in particular hip dislocation. The reasons for this condition are car accidents or falls from a height.

Other causes of lordosis in children are associated with neuromuscular diseases. They are registered quite rarely:

• cerebral paralysis;
• myelomeningocele (bulging of the spinal cord through a defect in the spinal column);
• hereditary muscular dystrophy;
• spinal muscular atrophy;
• arthrogryposis is a congenital limitation of movement in the joints.

Treatment of lordosis

In mild cases, hyperlordosis does not require special medical intervention. This refers to unfixed lordosis, which disappears when the torso bends forward. For such patients, only physiotherapy.

This disease is treated by a vertebrologist or orthopedist. You should consult a doctor if there is a fixed deformity that does not disappear when bending over. Therapy is also necessary for long-term back or neck pain.

To eliminate pathological curvature of the spine, it is necessary to treat the disease that caused it. When the normal position of the center of gravity is restored, pathological lordosis most often disappears.

Thermal procedures (baths, paraffin, ozokerite), therapeutic massage and special gymnastics are carried out. Special positioning and spinal traction may be required.

It is necessary to unload the spine. The preferred sleeping position is on your back or side with your knees bent. It is necessary to normalize weight.

For pain, painkillers and medications are prescribed to relax the muscles. Prevention of vitamin D deficiency in children is important.

One of the methods of conservative orthopedic treatment is the use of corsets and bandages that support the spine in the correct position. It is better to entrust the choice of a corset to a specialist. If the deformation is mild, you can purchase such a product yourself. In this case, you should pay attention to elastic models.

For more serious deformities, rigid corsets with metal inserts or elastic plastic elements are selected. This product is invisible under clothing, provides air exchange and removes moisture. The use of support devices helps to get rid of back pain, improve posture and form “muscle memory”, which will help maintain the results achieved in the future.

There are devices with which the human body is attracted to the chair. Devices have been developed to restore the functioning of motor centers in the brain, which are used in the treatment of cerebral palsy (Gravistat).

In severe cases, spinal surgery may be performed. It is indicated mainly for primary lordosis. The surgical method is used for progressive deformation of the spine, accompanied by disruption of the lungs, heart or other organs. Another indication for such intervention is chronic pain, which significantly worsens the patient’s quality of life.

Metal staples are used to restore the normal axis of the spine. In this case, artificial immobility of the spine is formed - arthrodesis. This technique is used in adults. For children, special designs can be used to change the degree of bending as they grow. For example, the Ilizarov apparatus is used to eliminate spinal deformities.

Surgical correction of hyperlordosis is an effective but complex intervention. It is carried out in leading orthopedic institutions in Russia and other countries. To clarify all questions regarding the operation, you need to contact an orthopedist-traumatologist.

An indirect method of correcting lordosis is surgery to eliminate hip dislocations, the consequences of spinal fractures and other root causes of deformity.

Treatment of cervical hyperlordosis

To get rid of cervical hyperlordosis and its symptoms, the following methods are used:

1. Limiting the load on the cervical spine. Avoid work that requires you to tilt your head back (for example, whitewashing a ceiling). When working at a computer for a long time, you need to take regular breaks, do light exercises and self-massage.
2. Self-massage of the back of the neck: stroking and rubbing in the direction from bottom to top and back, grasping the shoulder girdle.
3. Therapeutic exercises to strengthen the neck muscles and improve blood circulation in the brain and upper limbs.
4. Dry heat: heating pad, paraffin compresses; they can be used in the absence of intense pain.
5. Physiotherapy with devices for home use (Almag and others).
6. Regular courses therapeutic massage cervical-collar area (10 sessions 2 times a year).
7. If pain intensifies, use non-steroidal anti-inflammatory drugs in the form of tablets, injection solutions, as well as ointments and patches (diclofenac, meloxicam)
8. If signs of vertebral artery syndrome appear (nausea, headache, dizziness), the doctor will prescribe medications that improve cerebral circulation (Ceraxon).
9. Treatment of pain syndrome includes muscle relaxants (mydocalm) and B vitamins (milgamma, combilipen).
10. When pain subsides, therapeutic mud is useful.

Treatment of lumbar hyperlordosis

Hyperlordosis of the lower back requires the use of the following treatment methods:

1. Limiting work in a standing position and regular gymnastics.
2. Courses of therapeutic massage of the back and lumbar region twice a year for 10 - 15 sessions.
3. The use of thermal procedures, for example, paraffin compresses.
4. Physiotherapy: electrophoresis with novocaine, electrical stimulation, ultrasound therapy.
5. Balneotherapy: hydromassage, underwater traction, aqua aerobics, therapeutic baths with pine extract or turpentine.
6. Nonsteroidal anti-inflammatory drugs orally, intramuscularly, locally; muscle relaxants, B vitamins.
7. Spa treatment, swimming.
8. Use of special restraint devices (corset, bandage, tapes).

Exercises and gymnastics

The goals of therapeutic exercises for hyperlordosis:

• posture correction;
• increased mobility of the spine;
• strengthening the muscles of the neck and back;
• improving heart and lung function;
• normalization of the patient’s general well-being and emotional state, improving his quality of life.

• circular rotations back and forth with arms bent at the elbows;
• bending the neck to the sides;
• exercise “cat” - alternate arching and deflection in the lower back while standing on all fours;
• exercise “bridge” - raising the pelvis from a supine position;
• squats while simultaneously bending the body forward;
• any exercises while sitting on a large gymnastic ball (rolling, jumping, warming up the shoulder girdle, bending, turning to the sides).

Therapeutic exercises for hyperlordosis should be carried out effortlessly. It shouldn't cause any discomfort. All exercises are repeated 8–10 times, done at a slow pace, stretching the spasming muscles. If pain worsens, exercise should be avoided.

1. Raise and lower your shoulders while sitting or standing.
2. Circular movements of the shoulders back and forth.
3. Smoothly tilt the head forward and back, avoiding excessive tilting.
4. Tilts of the head to the shoulders.
5. Turns the head to the sides.
6. Clasp your hands crosswise behind your back, spread your shoulders;
7. Draw imaginary numbers from 0 to 9 with your head, avoiding excessive hyperextension of the neck.

Gymnastics for lumbar hyperlordosis:

1. In a standing position:

• bending the torso forward, pulling the body towards the hips;
• tilt to each foot in turn;
• squats with outstretched arms moving backward (imitation of skiing);
• walking with high knees; you can additionally press the thigh to the body;
• stand with your back to the wall, try to straighten your spine, stay in this position for a while;
• standing against the wall, slowly tilt your head, then bend at the thoracic region and lower back, without bending the body at the hip and knee joints; After this, smoothly straighten up.

1. In a lying position:

• relax your back muscles and press your lower back to the floor, fix this position;
• pull your legs to your knees, roll on your back; you can try to raise your pelvis and stretch your legs above your head;
• put your forearms on your chest, sit down without helping yourself with your hands; lean forward, trying to reach your feet with your fingers, return to the starting position and relax your back muscles;
• holding your hands behind your head, raise and lower your straightened legs; if you have difficulty, lift each leg in turn.

1. While sitting on a low bench, imitate the movements of a rower: bending forward with arms extended.
2. At the Swedish wall:

• stand facing the stairs, grab the bar at chest level, perform a squat with your back stretched, bringing your knees to your stomach;
• stand with your back to the stairs, grab the bar above your head, bend your knees and hips, pull them to your chest and hang;
• from the same position, raise your legs straightened at the knees;
• from the same position, perform a “bicycle”; if there are difficulties, raise your bent legs alternately, but be sure to hang on the crossbar;
• From the previous position, make alternating swings with straight legs.

It is better to learn such exercises under the guidance of a physical therapy instructor. In the future, these exercises should be performed at home once a day, preferably after a light massage of the corresponding muscles.

Spinal lordosis is a curvature of the spinal column in the sagittal plane, that is, noticeable when viewed from the side. The resulting arc is convexly facing forward. Lordosis is a physiological condition necessary for upright walking. The causes of excessive lordosis may be damage to the vertebrae themselves or diseases of the hip joints, surrounding nerves and muscles.

The leading manifestations of hyperlordosis are back deformation, gait disturbance, and chronic pain. Treatment includes elimination of the underlying disease and a variety of physiotherapeutic methods. Massage and exercise are aimed at straightening the spine, strengthening the muscles of the neck or back and improving blood circulation in surrounding tissues. In severe cases, surgical treatment is indicated.

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Just a Guest
Scoliosis was discovered around the age of seven. Chest S-shaped. Boarding School 76, the first two classes...only good memories remained...then, under the signature of my parents (since there was no point in being in this institution), they took me home, where I attended a regular school and studied for the rest of the years. There were no acquaintances or friends with scoliosis in my circle, so I dealt with psychological problems on my own. I swam, not as successfully as Mommy, but 4 times a week I gained a kilometer a day. I went to Kasyan a couple of times.... Sometimes I ran in the evenings, did gymnastics, skied. I was lazy like most of us... no moral teaching or requests from my parents could force me to do gymnastics conscientiously... after all, from 18 to 19 is the time for walks... all my friends are in the yard... shouting, playing... In general, by the age of 18 they assigned grade 2-3. Over time, scoliosis progressed (including the appearance of a hump on the right side above). As of June 2006, full 3rd degree. 38 degrees. Now I go to a chiropractor (I’m not advocating for this method of treatment, but I think it’s inappropriate to remain silent).

As for Kasyan, I went to see him twice when I was 13-14 years old (7 sessions each). He received us at night, 80-100 people in batches of 5 while he did it for one, the others undressed for no more than a minute for each.....the upper legs are on the floor, part of the torso is on the bed..he slaps the spine from bottom to top..then you stand...he under your arms and shakes you... that's it! next!

In general, a conveyor belt! 2 times is not enough... my father refused to sponsor him, he said, since I don’t do gymnastics, there is no point in throwing money around (he’s right about something)... but one girl there seemed to feel better, but then we didn’t correspond, so that I don’t know the further results. Treatment of scoliosis is a long process, but everyone went there differently? some once every three months, some 2 times every four. We came from all over the union.
In general, I don’t regret that I stopped running there.....they say there were injuries...he didn’t calculate the force of the impact....

quote: mommy :
For example, by the 8th grade I had a 3rd grade in swimming, I don’t know in skiing, but I was a champion in cross-country skiing in my class. I was the one who swam so skillfully and quickly, and I could even dive the entire pool 25 meters. I didn't play sports professionally. Those sports “successes” that I wrote about were in a boarding school for scoliosis. I swam really well and managed to swim up to category 3 at boarding training - 3 times a week for 45 minutes - even though the coaches tried to limit my enthusiasm in every possible way.

Many people will now tell you that you missed the time when the main progression took place, and when it was best to fight it. However, like us, like so many other people. Unfortunately, in our state (society), there are no people who would diagnose scoliosis in the early stages and help fight it on time, and not after. But ordinary parents are all the same, they hope for the best while rapid progress is made, and then begin to grieve about the lost time.

At 23 degrees, we were told that the worst had already happened, that we had missed the girl. As a result, the impression was that since it had already happened, nothing more would happen. Now we have 60 degrees and I would not say a kind word about those who scolded us for missing out on 23 degrees, without offering real ways to fight. It’s better to wear a corset in vain than to regret later that you didn’t do it.

http://skoleoz.borda.ru/?1-2-0-00000098-000-0-0
ledi-dozhdja
It all started as usual, at the age of 12, grade 1-2, then exercise therapy, swimming pool, massage. In the 8th grade, all this worsened sharply, and at the BelNII, based on the photographs, they set it to 53 degrees. Then a Cheneau-type corset - exercise therapy - massage - swimming pool. In the corset, a correction of up to 24 degrees was achieved (3 years old). No pictures were taken without a corset back then.

The period of removing the corset began (it was June 2007, I graduated from the 1st year), and I received a kidney injury (I tripped, but I didn’t fall, and I didn’t hit myself, but just tripped). As they later came to the conclusion, the kidney hit the spine (the right kidney, and the main curve in my lumbar is right-sided, yes, I didn’t specify at the beginning, S-shaped scoliosis). The signs were similar to those of acute appendicitis, so they cut it out first (one less problem, now it definitely won’t bother me). I had signs similar to those of acute appendicitis (terrible pain to the point of loss of consciousness just to the right and a little lower). They called an ambulance - they brought me to the hospital - they did the necessary tests (to be honest, I don’t remember about the ultrasound, I wasn’t in the right condition) - then they did an appendectomy (and I won’t say for sure whether they took me for an ultrasound immediately after the operation or not, my parents say - right away) By the way, I got there just on the weekend, the ultrasound specialist was not for the kidneys, and in general it’s better not to go to the hospital on the weekend. There are always some tests and examinations. Then they yelled at me why I couldn’t get up on the third day after such a simple operation.

But when hemoglobin and lower pressure dropped to zero, we realized that something was wrong and decided to cut it open and take a look. They did a transfusion. During the ultrasound, the urologist found free fluid in the cavity (I won’t say more precisely; but at one ultrasound I clearly remember (I don’t know what kind of specialist there was, he said that there was some kind of carrion in there! - that’s exactly how he put it - I’ve been around for a long time after such words, I was in shock, and I was terribly afraid of the ultrasound). After the transfusion, I felt better - I was already walking more or less (and my kidney didn’t hurt, after all, they injected me with painkillers after appendictonia). to do - then they decided that they still needed to do it, and if something was discovered during the operation, it would be expanded (the sequence of all examinations and the like, in general I vaguely remember all these 4-5 days)

Then I woke up in intensive care - the first 2 questions that I asked were clearly remembered: where am I, and what happened to me. They said: in the intensive care unit, there was a kidney injury (as they formulated later, a traumatic rupture of the lower pole of the right kidney, a retroperitoneal hemotoma), the kidney itself did not have to be sutured, but to clean everything inside - yes. And of course, such injuries do not occur on their own - and doctors are obliged to report such cases to the police (which is what was actually done). And then, every doctor who came into the intensive care unit considered it his duty to reproach me for HIDING the kidney injury! So that WHO BEATED me would confess! And in that spirit. And no one really beat me! I didn’t know about the injury either (after all, the signs really were like those of acute appendicitis; and would I really hide such an injury? Why? To die of pride? Absurd.)

Then I remembered what could have caused such an injury (I didn’t hit or fall anywhere), I stumbled only once (something sharply jerked in my side, as they say, it jumped, I can’t describe those sensations now, but it passed quite quickly, it only hurt at night, but if you don’t move, everything is ok, and when I want to sleep, nothing will stop me) . The evening and night passed normally, but when in the morning there was a sharp pain and I began to lose consciousness, then they called an ambulance.

Then they guessed who could do what! For a long time they did not believe that I had not been beaten, and everyone considered it necessary to accuse me of lying! Like this doesn’t happen! And then I needed to register for an academic certificate and the re-certification was just happening, and they would only humiliate the person and make fun of him. Even now, I think many will say that this does not happen. Plus, in the early postoperative period, the formation of a urinary fistula in the area of ​​the subcutaneous wound was noted. Given the presence of a fistula, stenting of the right kidney was performed. After insertion of the stent, the fistula closed on its own, and the wound healed by secondary intention. It took about a month to get rid of the stent, although installation and removal is a terrible procedure. In conclusion, I can say that appendicitis will certainly not bother me now.

The brace, of course, was completely canceled, no pictures were taken immediately after the operations, a follow-up was scheduled for March of this year (the injury occurred at the end of August 2007, yes, I had to go to the academy). Of course, sitting and waiting is not an option, so we went to Moscow to the Dikul center (however, I only worked out on simulators there for 6 classes, trial ones, and without a full load, they said it was too early, they needed a couple more months, they gave me a disk with exercises to take home) . As soon as possible, I immediately rushed into the pool. Even in the center of Dikul they discovered flat feet (I wasn’t really surprised, but they made insoles) and even my legs became straighter.

The corset then, of course, the manager. urology, who operated on me together with the head. surgery, looked (at first we also thought, maybe the corset had something to do with it?) But no, he said that it had nothing to do with it

There were far-reaching plans. At this point we had to go to the research institute for control and then we planned to go to the Dikul center to study. But the results of the pictures shocked me: still the same original 53 degrees. Now here's the operation. First Tesakov D.K. I set it for 2009, but the urologists allowed it earlier, so it was decided to postpone it to the fall of 2008. It dropped to 53 despite the fact that I only worked on my back, there were no terrible loads like 6-7 hours of sitting at the university, and I strengthened my muscles as best I could.

Olga/Paha
That summer I was hospitalized for the first time in my life with cystitis. So, during the ultrasound of my kidneys, they also pestered me with the question of who hit me on the right kidney. I almost fell off the table, I looked so bad that later we didn’t return to this issue. The right kidney is greatly enlarged and has traces of tissue bruises. My scoliosis is thoracolumbar S-shaped and right-sided. I've never worn a corset. This means scoliosis causes complications not only on the heart and lungs. Everything is sad.

Larissa
So I, having discovered this forum and read a lot of things in it that were new and useful to me, decided, on the advice of one of the respected forum members, to tell our story. Why ours? We’re just talking about my daughter, she’s 17 and has 4th degree scoliosis. Today it is 76 degrees. Surgery is necessary. We live in France and, no matter how strange it may seem, we under no circumstances want to have surgery here. Back in 2001, when our daughter was a little over 10 years old, we noticed that something was wrong with her back. The right shoulder blade began to bulge.

We immediately went to the hospital at our place of residence. It must be said (but we know about this only now) many people have the wrong idea about French medicine and doctors, but since this is a separate and very extensive topic for conversation, I will not go deeper into it and will say briefly - horror.

A very good orthopedic specialist accepted us, and we waited in line for an appointment for 16 days, and diagnosed us with grade 2-1 scoliosis. conclusion - corset. Definitely. No other methods. This, as it turned out after two years, was a fatal mistake. Since, along with wearing a corset, and we needed a different one, and not the one they made for us, we should also use other methods of conservative treatment that were then still possible and justified. But nothing! The result is that scoliosis was not only stopped, but it also progressed instantly and within a year the existing 19 (19 in total!) gained 22 degrees.

Her daughter refused to wear a corset and nothing could convince her otherwise. In addition, we were in shock; non-healing ulcers and wounds began to form on our bodies, some terrible, just huge bruises. When two years ago we turned to another luminary orthopedist, he examined the girl and looked at the pictures and said: “well... your daughter is out of luck... It’s no longer possible to help her. You are young parents, you will give birth to another child... When I later told my husband about this, he said that if he had been there, he would have punched the scoundrel in the face.

Well, now, this year we learned about Krasnoyarsk, then about other clinics in Russia and Ukraine and decided that we would go there. My daughter wants to go to Krasnoyarsk, she believes that they will help her there.

The first pictures were taken immediately after being “shackled” in a corset, and the next ones were taken 7 months later, and only because the daughter was howling naturally and ulcers appeared. We went for an unscheduled visit and the orthopedist examined her and sent her for pictures. Jade didn’t measure anything, so he looked at both of them and said - continue wearing them. You can't even take it off at night! And then, after a little over two months, things had already reached the point of a nervous breakdown, neurosis and all that, refusal of everything, including school, food (!!!), we decided to go to the doctor again. He’s angry, saying why did they come, I told you to come back six months later, and then when he saw his daughter’s condition he calmed down a little and said, you need to make another corset, this one is not entirely successful. I almost fainted, I said, how come you haven’t seen this before! In general, they made the second one, this is the one in the pictures under the “jeans,” but it also didn’t turn out to be quite right, and besides, it suddenly unfastened with a bang, and my daughter couldn’t button it back up without outside help.

perte
Me in 2002-2003. had surgery in Kurgan. After the operations I was almost straight, but I ruined everything myself. This makes it even more painful, I had a chance, but I missed it. You can’t do the surgery again, and you can’t get anything back... But I know that everything will be fine, that I can handle it! Of course, it’s hard to live in our world with such a disease, in a world where beauty and a disgusting figure are so glorified, but there’s nothing you can do, you have to adapt.

I was in the Ilizarov center for 7 months (5 of them in the hospital). There were 5 operations in total. 1-removal of 5 ribs (not completely, but only sections of 7-10 cm), 2-device (16 pins), 3- adding another base (to be honest, I don’t remember how many more were added :)), 4-cavity (fixation of the lower part of the spine with titanium implants), 5- second cavity ( top part spine), and after removing the device (but this is without anesthesia). There are 7 implants in total, 3 in the lumbar region, and 4 in the thoracic region. So, as you can see, the glands still remain. I also have part of the pin left, because one broke while wearing the device. These are small plates that are inserted into the vertebrae. The spinal discs are pulled out, and titanium plates are inserted into them. You can lie on your stomach and sides. In general, you get so used to the device that later you don’t even want to part with it

Previously, there were bone implants, and if everything moved out, it was possible to operate again. But now this is simply impossible, because titanium plates are like Penza. Bone tissue grows in these holes, and there is no longer any possibility of removing the implants.

In general, it’s not scary and not difficult. Even interesting and fun. Afterwards you have to wear a corset for 6 months, and then come to the control, and they will tell you whether you can take off the corset or not. You also cannot sit these months, and in the future you need to put a gradual load on the spine. At first, movements are limited, but full recovery is given 5 years. I can now move almost without restrictions.

How did I ruin everything? It’s very simple... The doctors strictly forbade me to study full-time at the university, but I didn’t listen, and still entered. Moreover, if before this I hardly sat at all, now I sit 4 times a day. And this without a corset, because I was afraid that someone would find out. During the first semester, everything dropped to almost the same level (it was 65 degrees, after the operations it was 9, and now it is 45).

It was 45 degrees 1.5 years ago, and now it’s already 60. Although, when I had surgery, the main thing for me was to stop the curvature, because it was progressing quickly. And I did it, it won’t go further than what was there, the implants won’t let me in.

It’s just that that moment fell at a difficult age, I thought that I knew everything better than anyone, and I could handle everything myself. For me, the main thing was to keep up with the group, but I didn’t even think about health. I even stopped doing exercise therapy at such a difficult time for my back. And only now I understand what a fool I was, but it’s too late... After all, there will be no second chance...

Holes from the device, in their place there were pins. I'll try to post a photo with the device.

Sweta
My daughter has grade 3 scoliosis, s-shaped, she is 11 and a half years old. Above - 45, below - 37 - this was in May. We do massages every 1.5 months, swimming pool 3 times a week, daily exercises, had 10 sessions with a chiropractor in May, wears insoles, 1 cm under the left heel. Yes, I forgot to say, thoracic on the right, lumbar on the left. In July we took another photo. They told us it was possible in 3 months, both pictures were taken standing, but the second time she was with insoles, top-50, bottom-32. The doctor said that this was not a deterioration, that it might not be straight or because of the insoles.

In April 2007, I noticed that my daughter was sitting somehow unevenly. She examined her back, visually one shoulder blade was slightly higher than the other, she took it to local clinic, the doctor diagnosed scoliosis of the 1st degree, prescribed massages, exercise therapy, we went through everything, we were told to come again in September. We went to the sea in the summer, and in general my back was open, I didn’t see any deterioration. In July, my daughter started menstruating. Over the summer she grew a lot, by 7 cm.

At the end of September, I accidentally went into her bathroom (the girl was an adult and wouldn’t let me in anymore) and saw that her back had gotten worse. I didn’t want to go to the clinic anymore, so I went to the regional children’s hospital. They took a picture, visually the doctor said stage 2, again massages, exercise therapy and said that a sanatorium is needed.

We went to the sanatorium in December. I didn't see any improvement, it only got worse. When bending over, a hump already appeared. In April 2008, I myself started looking for information, rather than hearing that everything will pass and scoliosis is not scary.

I took my daughter to a private clinic, took a picture, and made them calculate both this and the previous one. In October 2007 - 37 on top, 37 on bottom, in April 2008 - 45 on top, also 37 below. I took her to different doctors and professors. Everything is the same, there is no cure, it will get worse - surgery. Naturally, this doesn’t suit me.

I’ve read a lot of literature, why don’t our doctors explain in case of grade 1, don’t calculate, make a diagnosis by eye? I fought with my daughter for a long time, well, she doesn’t want to do exercises for an hour a day, she thinks that everything is fine with her, she says, nothing hurts me, you’ve already tortured me (swimming pool, chiropractor, massages every other month, a specialist picked up the exercises , and she’s also doing vocals and performances - there’s not enough time for everything). On the one hand, I’m glad that psychologically she feels this way, but on the other hand, I understand what will happen next, but I don’t want to intimidate her.

Now I want to take her to a sanatorium, maybe we’ll think about a corset. Yes, she has not been growing for the last 2 months, she is now exactly 11 and a half, height is 155 cm.

avia
I was diagnosed with scoliosis when I was 10 years old in a pioneer camp, and they immediately diagnosed me as grade 3 - I don’t know what kind of doctor he was... But in fact, it was grade 1-2. At the age of 13, with grade 2, I was in a clinic in Omsk. There, conservative treatment brought the spine to almost ideal condition (as far as possible). But then scoliosis began to progress little by little.

Today I am 27 years old and I have S-shaped scoliosis (thoracic - 60 degrees, lumbar - 53). I have been swimming and playing sports all my life. And despite the fact that I have long been accustomed to back pain, personal life There are no problems, but it’s impossible to come to terms with the fact that nothing can be fixed. In 2004, I went to Kurgan to the Ilizarov clinic - they treat scoliosis with the Elizarov apparatus. But they refused to give it to me because of my age. They justified it by the fact that at my age (I was 24 years old at the time), after the device is removed, the spine gradually returns to its previous state. That is, during wear (about a year) everything straightens, and then back again. In general, I advise young girls to consider this method (up to 17 years old it gives good results).

I recently learned about LSZ. And hope appeared again. On next week I’ll go to Moscow for a consultation.

But I, like many here, are afraid of complications. Still, over 27 years, the internal organs have become “accustomed” to being positioned incorrectly. And how they adapt is unknown.

Surgery to correct scoliosis is the only method that allows you to eliminate cosmetic defects of the back and relieve a person from pain due to lateral displacement of the spinal column of the 4th degree.

Other degrees of pathology are initially treated by doctors with conservative methods. Surgery is started only when the therapy used is ineffective. Scoliosis surgery is performed in emergency cases when there is a threat to a person’s life.

Principles and features of surgical treatment of spinal curvature

Surgical treatment of scoliosis is a last resort, since manipulation is associated with the risk of complications. Indications for surgical intervention for lateral displacement of the spine:

• Ineffectiveness of conservative measures in the treatment of pain. For this reason, about 85 percent of surgical interventions are performed for frontal (lateral) curvature of the spinal axis;
• Increased curvature of the spine. If the deformity increases to 40 degrees, doctors prescribe surgery. When the curvature is less than 60 degrees, a disruption in the functionality of the pulmonary and cardiac systems occurs;
• Some patients undergo surgery if they have a disfiguring cosmetic defect of the back with a lateral deformation of the spinal axis.

The surgeon performing the operation faces several important tasks simultaneously:

1. Eliminate distortion as much as possible;
2. Prevent or correct spinal cord compression;
3. Protect nerve fibers from further damage;
4. Prevent subsequent development of curvature.

In most cases, surgery is performed when the growth of the spinal column is close to the final stage (age 16-19 years). In adults, surgical treatment of scoliosis is carried out to eliminate compression syndrome. In the presence of concomitant diseases, it is difficult to guarantee complete restoration of the physiological axis of the spinal column.

Emergency intervention is performed regardless of age, when pathological changes are life-threatening. This situation occurs when there is severe compression of the spinal cord due to a prolapsed intervertebral disc.

Surgical treatment of the disease is a complex one. When performing it, the accuracy of each manipulation is necessary, since an error can lead to disability due to nerve damage.

It should be noted that after the intervention the spine straightens, which is an unnatural state, since during the development of the disease the body has become accustomed to a different position of the spinal column. Against this background, there is a temporary disruption of the blood supply and innervation in the internal organs. To eliminate them, conservative therapy is carried out over several months for the symptoms that arise.

The main types of operations for spinal curvature:

• Stabilization and correction of the spinal axis;
• Correction of vertebral defects;
• Limiting the asymmetry of the muscular system;
• Elimination of cosmetic defects.

With lateral curvature of the spinal column of 3 or 4 degrees, surgeons have to perform several types of operations simultaneously.

How do you prepare for surgical treatment?

In 60% of cases, surgical interventions are performed urgently, so preliminary preparation the patient has no time left. However, the operation is quite complex and it is advisable that the patient is well prepared for it not only physically, but also mentally. Scoliosis surgery takes less than an hour and is therefore performed under general anesthesia to avoid discomfort for the person being operated on.

Intervention is the key to new life, and for rehabilitation after it a person will need strength.

The doctor examines the patient's body before surgery. It is mandatory to take x-rays of the spine in various positions (sitting, standing, from the side). They will help determine the type of surgical treatment and develop patient management tactics.

patient before and after surgical treatment of scoliosis

What awaits a person after surgery?

Scoliosis of 3 or 4 degrees makes a person’s life significantly more difficult. After surgical treatment, the patient returns to normal life.

How is the rehabilitation going:

• In the first 3 or 4 days, a person should observe strict bed rest. Minor movements on the bed are allowed. You will be able to get up and walk in a week;
• After 8 days, an X-ray of the spinal column is performed for control. Physical therapy classes are held around this time;
• Foot massage can be performed 6-10 days after surgery;
• If the patient has undergone surgery for grade 3 or 4 scoliosis, it is likely that support corsets will be prescribed until the muscular system begins to function correctly;
• The next control X-rays or computed tomography are performed after 3 months.

The rehabilitation period is reduced to 6 months in adolescents, since their spinal column quickly recovers. In adults, it lasts about a year and requires regular exercise and, in most cases, wearing orthopedic corsets.

Types of spine surgery for scoliosis

Surgical interventions on the spine are performed using high technology. Most of the manipulations performed are performed using neurosurgical methods with minimal tissue trauma.

Correction of spinal deformities is carried out by installing metal structures. They fix the spinal segments in the correct position and prevent their mobility.

Types of metal pins:

Movable structures are installed in young people whose spinal column tends to grow. Because of this, metal systems used in the surgical treatment of curvature in young people are stretched in height.

Fixed types have a lower cost and are installed for scoliosis in adults.

Methods for installing metal pins for scoliosis:

1. Harrington's method. Began to be used in the last century. A special plate made of a rod and hooks is used to fix the spine. The rod is located on the side of the curvature, the hooks are movable and allow you to optimally establish the position of the spinal axis. On the side of the convexity there is a second rod designed to limit the displacement.

The operation to install a Harrington pin takes about 3 hours. This method does not completely eliminate grade 4 scoliosis, since it can only shift the spinal axis to the side by 60 degrees;

1. The Cotrel-Dubousset method was developed in France. It differs from the Harrington method in that it does not require wearing an orthopedic corset for a long time during the rehabilitation stage due to the specific features of the metal structure. It consists of flexible rods and hooks that are attached to the vertebrae;

1. The Luke method involves installing a special structure in the area of ​​curvature, consisting of a central cylinder and wire. The design is quite stable and does not require wearing a corset after surgery;

1. The Zielke method is used not only to correct spinal deformities, but also to eliminate compression syndrome (pinched nerves). It involves the use of several paired elements (screws and rods) that reliably fix the vertebrae. After installing the pin, prolonged wearing of the corset is required.

What methods are used in domestic hospitals?

Domestic medical institutions use metal structures from Fishchenko, Kazmin, Gavrilov, Rodnyansky-Gupalov, and Chaklin.

A special feature of the Kazmin distractor is that the device simultaneously fixes the lumbar spine and the ilium. The device turns out to be practical for grade 3 scoliosis, when there is a shift in the angle of the pelvis.

The Rodnyansky-Gupalov endocorrector can consist of one or two plates. The device is used for dysplastic scoliosis, when abnormalities in the structure of the vertebrae are observed, leading to a lateral curvature of the spinal column of up to 50 degrees. This situation often occurs with Scheuermann-Mau disease (dorsal juvenile kyphosis).

In European countries, surgical treatment of scoliosis is carried out everywhere. Due to the careful development of instrumentation and the low invasiveness of the techniques, patients with spinal curvatures can quickly return to normal life through surgery.

True, these interventions are not cheap. For example, correction of scoliosis using the Cotrel-Dubousset method in America costs about 250 thousand dollars. It is also performed by domestic surgeons at lower prices. However, due to the insufficient equipment of our clinics, complications after the procedure are observed more often.

Despite significant international developments in the field of scoliosis surgery, in domestic clinics doctors give preference to conservative methods of treating the pathology. Surgery is performed in emergency cases or when the medications used are not effective.

Basic steps and methods of treating scoliosis in adults

Scoliosis is a common disease in any age group. The only difference is that correcting spinal curvature in childhood and adolescence is much easier. When it comes to how to treat scoliosis in adults, things get complicated. This happens because while the body is growing, its skeleton and spine are just developing and have not yet acquired their final shape. Therefore, in such conditions it is much easier to influence the process.

But in adults, the spine and skeleton are already formed; changes in the structure or position of the vertebrae are no longer caused by development, but by destructive processes. Scoliosis can be residual, untreated at a young age. Or it may already be acquired under the influence of external factors.

Medicine identifies the following reasons for the development of such pathology::

• diseases of the spine: from protrusions to tumors;
• untreated childhood scoliosis;
• osteoporosis;
• softening of bone tissue;
• spinal injury;
• consequences or complications after spinal surgery.

Treatment of scoliosis in adults depends on the cause that caused its development. Before starting treatment, the specialist determines for himself the main tasks in treatment and the main methods of eliminating the original source. It is difficult to influence an already formed skeleton; you need to have a lot of patience.

Supporting, main stages in treatment:

1. improving blood circulation;
2. eliminating the cause that provokes changes in the intervertebral space;
3. relief of degenerative changes in joints;
4. strengthening the entire muscular system;
5. eliminating the cause that interferes with the mobility of the vertebrae;
6. improvement and strengthening of the skeletal system;
7. elimination and prevention of secondary symptoms.

The main steps in eliminating scoliosis in an adult

As the curvature progresses, strong pressure occurs on the intervertebral discs. The space between them changes, the mobility of the vertebrae is disrupted, and as a result, the entire spine is affected. Therefore, it is necessary to pay attention initially to the condition of the disks. Without this, cure will be unlikely.

A good assistant and main “therapist” here is massage and the involvement of a competent chiropractor. The specialist must know all the intricacies of how to treat the disease in adults. But the attending physician must first authorize manual therapy. This effect is aimed at improving blood flow and restoring proper muscle tone.

Drug treatment is supplemented by:

1. taking muscle relaxants, most often Mydocalm;
2. injections of reparative drugs;
3. taking vitamins: D, Ca and P.

The second step is to strengthen the muscle corset and correct pathologies in gait. The specialist selects exercises or performs gymnastics with the patient on his own. The main task of gymnastics is to strengthen the muscles, strengthen the restored ability to maintain proper tone and contraction. As a result of exercise therapy, the muscles must learn to keep the position of the entire spine in correct position. Extremely difficult moment, more psychologically, since patients cannot endure back discomfort for a long time. For them, curvature has already become a comfortable state, and attempts to change this introduce discomfort and imbalance.

For effective treatment scoliosis requires wearing orthopedic devices. Usually this is a corset or a soft corrector, depending on the degree of curvature. Corrective corsets must be worn by the patient throughout the day. It is also prescribed to change the bed and replace it with an orthopedic mattress.

The third step is to stabilize the muscle condition and eliminate radicular syndromes. With any disease associated with the spine, muscle spasms occur due to pinched nerve endings. The nerve endings in the spine are like small antennae-roots; if even one is pinched, the person will feel severe pain. But if muscle spasm can be affected by manual techniques, then radicular syndrome will also require treatment.

Reflexology and acupuncture are prescribed here. These techniques will relieve spasms and release nerve endings. Among the medications, Mydocalm is taken with the addition of sedatives. Sedative treatment is necessary for the reason that during the period of pain, a zone of special excitation has formed in the brain. This scheme does not work in one case: if pinched roots are caused by mobility of the vertebral bodies.

Osteoporotic changes and secondary symptoms

With age and under the influence of external factors, people may develop a disease such as osteoporosis. The disease is complex; when it occurs, bone tissue becomes fragile due to the fact that it cannot accumulate calcium. Treatment of such a disease in an adult requires a careful approach. The patient is prescribed hormonal therapy with the mandatory inclusion of calcium.

For osteoporosis, the following therapies are combined:

1. desensitizing, in which antihistamines are prescribed in order to improve and accelerate the supply of necessary substances;
2. applications of Dimexide or novocaine on the spine itself;
3. hormones: Prednisolone, Hydrocortisone to increase calcium synthesis and relieve the inflammatory process.

Most often, it is against the background of osteoporosis that secondary disorders occur. Internal organs may be involved in the process. The consequences of this can be different, it is extremely difficult to treat. In most cases, relieving secondary symptoms takes much longer than treating scoliosis itself.
Often, conventional therapy does not give the desired result; in such cases, the only option is to resort to a surgical solution to the problem.

Surgery for scoliosis

The decision to surgically treat scoliosis is made based on the angle of deviation from the norm. If the angle is up to 50 degrees, then experts are in no hurry to intervene radically. It’s interesting that medicine has such a cautious attitude only towards the spine. Surgeons will try to find other methods until the last minute, just to avoid open surgery. This is due to the fact that the spine is the only one that almost always gives complications and consequences after surgical interventions. And it is impossible to predict the reaction. Some surgeons call situations where the operation was successful and there were no consequences “God anointed the patient.” From this small detail one can already judge how complex and responsible any spinal surgery is.

If the angle tends to 80-90 degrees, then such a curvature can block the functions of the lungs, bronchi and heart. To treat scoliosis, doctors often use a corset-implant design: a rod with clamps that actively move along the axis. During surgery, these clamps are attached to the vertebrae themselves. This deprives the spine of normal mobility, but makes it possible to stop the deformation of the skeleton.

There are two types of possible operations: ventral method and dorsal method. In the first method, an incision is made from the side, then the rib is removed. Removal of the rib is necessary, otherwise there will be no access to all the necessary vertebrae due to the rib cage. Screws are attached and donor bone implants are inserted. Externally, such a corset is invisible and retains partial mobility of the spine. But such an operation is only possible if there is scoliosis in the thoracolumbar spine. This curvature is very rare in adults.

The second type of operation involves the treatment of thoracic curvature. An incision is made across the entire chest, and an axle with parts is inserted that will allow the spine to remain stretched. In some cases, implantation is possible only after removal of the intervertebral disc.
Fusion occurs, on average, in 4-6 months. But it can last longer, it all depends on the characteristics of the operation performed and the individuality of the body. During the rehabilitation period, auxiliary therapy is prescribed, including therapeutic exercises in order to avoid muscle atrophy and teach the body to work in new conditions. In general, such operations are successful as long as there is no bleeding or damage to the spinal cord.

Scoliosis surgery, life after surgery

Doctors prefer to fight scoliosis with conservative methods, but in 10% of cases the treatment does not give the desired results. And when the disease is already seriously advanced, surgery cannot be avoided. Scoliosis of 3-4 degrees reduces the quality of life by an order of magnitude, moreover, rarely do any of these patients cross the forty-year mark. Therefore, surgery often becomes simply a vital necessity.

Who is suitable for surgery to correct scoliosis?

Surgery to eliminate scoliosis is prescribed only in cases where the patient has one or more of the following indications:

• constant severe pain that is not relieved by standard anti-inflammatory drugs;
• paralytic forms of scoliosis;
• noticeable defects in appearance that have developed as a result of illness and greatly complicate life;
• progressive scoliosis of 3-4 degrees (including congenital), in which the angle of curvature increases by more than 15º per year;
• scoliosis, in which the total angle of curvature is more than 50º in an adult and exceeds 45º in a child.

If the deviation of the spinal line from the standard increases to 60º, the operation is performed as an emergency, since this disrupts the functioning of the internal organs and can significantly complicate the patient’s life, or even lead to death.
Surgical treatment of scoliosis also has a number of contraindications. In particular, it is not prescribed in the following cases:

• scoliosis developed as a result of a group of neuromuscular diseases;
• scoliosis of the Klippel-Feil type;
• chronic diseases of the respiratory and circulatory system in the acute stage;
• elderly patients.

Interestingly, being too young is not a contraindication to surgery. As a rule, surgery is most effective when skeletal growth is almost complete. But in case of urgent need, operations are performed even on six-year-old children - with the exception of interventions for cosmetic purposes. At the same time, doctors take into account that the spine will still grow and use appropriate designs and techniques.

With grade 4 scoliosis, it is not always possible to achieve significant improvements: patients often have problems with the heart, which is still pressed by the spine, but respiratory function improves and the progression of the disease stops.

Surgical treatment of scoliosis: types of operations

Spinal deformities are corrected using various metal pins and structures. Adult patients are often fitted with fixed devices that fix the vertebrae in the correct position. Children and adolescents who continue to grow their skeleton are given more expensive movable structures that can grow with their bones.
There are many techniques used to perform operations to eliminate scoliosis. Let's look at the most common of them.

1. Harrington method. The spine is fixed using titanium rods and hooks. The operation lasts about three hours, and after it the patient must wear an orthopedic corset. This technique is not suitable for surgical treatment of grade 4 scoliosis, since it is effective only if the angle of spinal displacement does not exceed 60º.

1. Zielke method. With its help, you can not only correct the deformity, but also eliminate pinched nerves, thereby relieving pain. The vertebrae are fixed on both sides of the spine with rods and screws, after which patients are shown wearing a corset.
2. Luke's method. A structure made of a metal cylinder and wire is installed in the deformed area. In this case, the spine is fixed quite firmly, so a corset is not needed after the operation.
3. Cotrel-Dubousset method. This method also does not require wearing an orthopedic corset after surgery. The vertebrae are fixed using flexible rods and hooks, creating a reliable structure to support the spine in the correct position.
4. Kazmin-Fishchenko method. This development of Soviet scientists is effective in cases of displacement of the pelvic tilt angle with scoliosis of the 3rd degree. The design simultaneously fixes the ilium and spine in the lumbar region in the correct position.
5. Rodnyansky-Gupalov method. When using this technique, the structure for fixing the spine may consist of one or two plates, depending on the specific case. This method is often used in domestic hospitals, including for grade 4 scoliosis. Successful operations allow you to eliminate deformation by 50-70%.

In America and Europe, operations to eliminate spinal deformities are practiced quite often and successfully. Russian clinics, due to a lack of modern equipment, carry out such operations using outdated and traumatic methods, which is why patients periodically experience complications in the form of fractures, damage to the nerves or spinal cord, and paralysis. In weakened people, negative reactions to anesthesia and exacerbations of chronic diseases are possible.

Preparation and progress of the operation

Preparing for a planned operation is a long process and can take 2-3 months. A good doctor will definitely conduct a full examination of the patient: both the general condition of his body and the specifics of the damaged area of ​​the spine. In addition to x-rays in several projections, you will need a variety of tests, ultrasound of internal organs and the heart, cardiogram and others standard studies. When an infection is detected in the body, it is imperative to eliminate its source.

Many methods involve prolonged traction of the skeleton before surgery: in horizontal position or using an orthopedic corset. This allows you to improve blood supply to the spine, activate the work of muscles and ligaments, and also reduce the risk of postoperative complications.
Spinal surgery lasts at least an hour and is performed under general anesthesia. Modern clinics are trying to make it as less traumatic as possible, using neurosurgical methods and high-tech hardware developments. During the operation, the spine is straightened, after which the problem area is fixed using a variety of structures made of plates, pins, hooks and wires. If some parts of the vertebrae cannot be straightened, they are removed and replaced with titanium structures or material taken from the patient's pelvic bone. In the first case, recovery after surgery occurs much faster.

Life after surgery

Spinal surgery is a very serious intervention, so there are many restrictions in the postoperative period. In the first 2 days, the patient is on IVs and takes antibiotics; he is prohibited from moving or even turning his head. On the third day, the patient is transferred to the general ward and allowed to move a little, but he can get up and start walking only after a week and a half.
On day 8, a control x-ray of the spine is performed, after which you can massage your legs and do exercise therapy. At the end of the second week, if there are no complications, the patient is discharged home, 3 weeks after the operation he is allowed to sit down, and he can ride while sitting in a car no earlier than 3 months later. Then it is necessary to appear for a control x-ray and computed tomography.
With scoliosis of 3 and 4 degrees, patients often need to wear orthopedic corsets after surgery, which greatly hinder movement and complicate life. It is especially difficult for children, because in order to give the skeleton the opportunity to grow, doctors install structures for them without rigid fixation, which require the mandatory wearing of a corset. Life in this device is quite difficult, since many actions become impossible without outside help. Therefore, during the rehabilitation period, it is very important that someone is constantly with the person who has undergone surgery.
For complete recovery, adults need about a year, while children and adolescents need 6 months. At the same time, life after surgery is impossible without dosed physical activity and physical therapy. To avoid unwanted displacements of the spine, you must adhere to the following restrictions.

• You cannot lift weights, turn or bend sharply, or hang on the crossbar.
• It is not recommended to participate in outdoor sports games.
• You should not sit or be in a half-bent position for a long time.
• It is necessary to engage in physical exercise, in particular, to strengthen the back muscles, only according to a program developed by a physical therapy specialist.

After about a year, the life of a patient suffering from scoliosis returns to normal: he can study, work, travel and not experience much discomfort. Of course, the structures built into the spine limit its flexibility, but they practically do not interfere with self-care, household and work activities. In general, life after a successful operation improves by an order of magnitude, and for many patients it even changes dramatically for the better.

Magazine headings

Treatment methods for scoliosis are based on three main principles: mobilization of the spine, correction of deformity, and maintenance of correction. The technique is selected depending on the type of scoliosis, the degree of spinal deformity, and concomitant neurological pathologies. The most balanced method of treatment is the combined one.

Is it possible to cure scoliosis without surgery?

Conservative treatment of this disease has the main goal of achieving a sustainable weakening of the disease.

To approach the stage of stable remission, it is necessary to achieve a certain state:

• The very spine.
• The surrounding muscles, blood vessels, soft tissues.

Traditional conservative correction of the defect consists of:

• Therapeutic physical education.
• Massage sessions.
• Manual therapy.
• Treatment of patients in sanatoriums.

Conservative treatment of the disease in question is based on the following principles:

• Release of the damaged area of ​​the spine from both static and dynamic loads.
• Strengthening the posture of rational posture at the reflex level.
• Stimulation of spinal muscle activity.
• Individual selection of a set of physical therapeutic exercises.
• Guiding the patient through a complex of rehabilitation measures.
• Impact on the internal organs involved in spinal deformation in order to prevent possible aggravation of the disease scoliosis on their part.

When performing physical therapy, it is important to use exercises for different groups of back muscles, while eliminating axial load on the spine!

Today, in order to cure scoliosis effectively, therapeutic exercises are successfully complemented by exercise classes.

Unfortunately, a typical mistake in assignment is often made. If an orthopedist discovers scoliosis and prescribes therapeutic exercises for children, such children are often simply exempted from school physical culture. At the same time, is scoliosis treatable in a child, and is it possible to cure scoliosis by completely removing all physical activity?

It is very important to have the right approach to physical activity for children with the initial phase of spinal curvature!

They should be exempted only from certain activities:

• From sports where a child can get a direct spinal injury. These include boxing, sambo, judo, apparatus gymnastics, and wrestling.
• From sports that involve asymmetric muscle tension. This happens when practicing fencing or tennis.
• From persistent vertical loads on the spine. Such loads inevitably arise during horseback riding, weightlifting, and cycling.

The following activities are very useful at the initial stage, as methods of effective treatment of pathology:

• Yoga.
• Dancing.
• Swimming.
• Game sports.
• Eastern martial arts.

Engaging in these types of physical activity promotes:

• Formation of correct posture.
• Development of muscle mass of harmonious shape.
• Flexible and plastic motor activity.

Whether rapidly progressing scoliosis can be corrected with conservative methods, the doctor decides on the basis of regularly performed examinations. In certain cases, surgical intervention is indicated.

Absolute indications for surgical treatment of scoliosis

Surgical treatment of spinal curvature is prescribed for patients with the disease of grade 3 or 4.

The absolute indications for surgery are:

1. Signs indicating spinal cord damage. They are accompanied by symptoms in the form of persistent severe pain that is not amenable to conservative treatment, as well as neurological disorders.
2. The stage of scoliosis when the angle of curvature of the spine is more than 50 degrees. This angle of deformation is also potentially dangerous due to possible pinching of the spinal cord.
3. The presence of actively progressive scoliosis in patients with a spinal deformity angle of over 40-45 degrees. At this angle of curvature and continued rapid growth The patient's body is at risk of damage to internal organs, primarily the lungs and heart.

The most favorable period for surgery for the pathology in question is the time before the end of spinal growth!

World surgical practice uses the following methods to treat spinal curvatures:

• Installation of static metal structures on the spine.
• Surgery with installation of dynamic implants.

Static structures are stable, not changing over time. They are installed on the posterior parts of the spine. This method is excellent for treating adults with scoliosis.

This operation achieves:

• Stopping further development of scoliotic disease.
• The scoliotic arch is firmly and reliably fixed.

Dynamic implants are used to treat spinal curvature in children. The optimal method of surgical intervention in children is the installation of dynamic metal structures on the posterior parts of the spine.

A dynamic implant installed on the spine “grows” with the child! Thanks to this, the normal growth of the spine is not disrupted!

Thus, the operation performed:

• Does not interfere with the development of the child's spine.
• It is a corrective factor for existing scoliosis.

Treatment of scoliosis with orthopedic methods - corsets for the treatment of the spine

The process of orthosis sets the goal of rehabilitation of patients with scoliotic disease with the help of certain technical means - orthoses, or corsets.

Orthoses create:

• Fixation.
• Unloading.
• Correction.
• Activation of functions.

Depending on the patient’s condition, corsets are used for:

• Corrections of a deformed spine.
• Compensation for weak ligaments and muscles.
• Stable fixation of a curved spinal column.

It is recommended to wear a compensating corset for the spine for the pathology in question in case of a disease of the 1st degree. Such corsets should be elastic, soft designs. They are worn during the day for no more than 4 hours at a time. They should also be used for static physical activity. Due to the compensatory function of the corset, muscle tone is balanced.

For scoliosis of 1 and 2 degrees of severity with a high probability of progressive deformation, elastic and, at the same time, elastic corsets are recommended. Their function is not to support the spine.

The use of orthoses allows you to achieve:

• Stabilization of the spine in its physiological position under static loads.
• Limitations in range of motion.
• Removing part of the load from the vertebral bodies.
• Maximum compensation for underdeveloped muscles that are responsible for maintaining the spine.

The duration of wearing the corset in this case should be at least six hours a day. If static loads are present, a back brace should also be worn.

If, with stage III scoliosis, it is impossible for the patient to undergo surgery, orthosis becomes the main therapeutic factor!

For 3rd degree curvature of the spine, treatment such as a corset with support on the pelvis is prescribed. With its help, a correction of the correct direction is created. During the period of spinal growth, patients are recommended to wear such immobilizing corsets for almost the whole day, including during sleep.

When a person stops growing, the corset can be worn for six to twelve hours during the day.

For this diagnosis, treatment is most often prescribed in combination, depending on the nature and severity of the disease.

Idiopathic scoliosis

Idiopathic scoliosis is a lateral curvature of the spine, exact reason which cannot be determined. Pathology develops against the background of absolute health of the musculoskeletal system in the absence of any congenital anomalies. This group includes all scoliosis that has an unclear origin. Moreover, this is about 80% of cases of all such spinal curvatures. Its peculiarity is that it develops in children and adolescents.

general characteristics

Idiopathic scoliosis is a separate group of spinal deformities that appear in children during bone growth. Despite the development of medicine, doctors cannot determine why this happens.

But the following spinal pathologies were combined into a separate group based on the presence of common signs:

• such curvature of the spine develops in children and adolescents and without timely treatment constantly progresses;
• Idiopathic scoliosis most often occurs in girls during adolescence;
• usually the development of the process stops during puberty;
• most often the pathology is localized in the thoracic or lumbar region;
• the higher the arc of curvature, the worse the prognosis of the disease, since internal organs may be involved in the deformation process;
• most often, curvature in the lateral plane is accompanied by twisting of the vertebrae - torsion;
• the larger the arc of curvature, the faster it progresses;
• in many cases, such scoliosis is a combination of two curves or even the occurrence of kyphoscoliosis.

How it develops

With this pathology, a primary arc of curvature first appears for no apparent reason. Several vertebrae deviate from their axis. Most often this occurs in the thoracic or lumbar spine. To compensate for the deformation and balance the center of gravity, the body forms another curvature in the other direction above or below the primary arc. In this case, 2, 3 or even 4 arcs of curvature may occur. The spine takes on an S or Z shape.

Such deformation most often develops slowly and imperceptibly. But it is believed that until the growth of the skeleton has stopped, scoliosis will progress. The younger the patient’s age and the larger the initial arc of curvature, the faster this process occurs and the greater the possibility of developing complications.

Why is it developing?

Sometimes doctors can accurately determine the cause of spinal curvature. This is if it develops after suffering from rickets, injuries, or severe nervous diseases. Sometimes scoliosis accompanies congenital anomalies of skeletal development. But most cases of curvature have an unclear etiology. And since they have much in common in symptoms and developmental features, such scoliosis was combined into one group - idiopathic.

Patients with this spinal curvature do not have any congenital skeletal abnormalities, nor do they have neuromuscular or other disorders. Idiopathic scoliosis develops during bone growth - at 5-7 or 10-14 years. And in many cases, the pathology is not even associated with carrying heavy bags or sitting at the computer for long periods of time. But many doctors consider the presence of spinal deformities in parents to be a determining factor in the development of curvature.

Varieties

Idiopathic scoliosis is distinguished by the degree of curvature and the time of its appearance. Regardless of where the deformity appeared, in medicine there are 4 degrees:

• at the initial stage, the angle of curvature reaches 10 degrees, with only a slight stoop noticeable;
• when the arc is from 10 to 25 degrees, they speak of the second degree of scoliosis, in which there is already asymmetry in the location of the shoulder blades and different heights of the shoulders;
• the third degree is more serious, when the angle reaches 50 degrees, complications from internal organs develop, and spinal deformation is noticeable;
• the fourth is the most serious form of scoliosis, when the angle of curvature is more than 50 degrees.

In addition, there are several types of scoliosis based on the form of deformation. The simplest is one curve in the shape of the letter C. If a secondary curve develops, the spine takes on an S- or Z-shape. The more arcs of curvature, the more difficult it is to correct the deformity and the more complications develop. Most often, with this form of scoliosis, the arcs of curvature are located in the thoracic and lumbar regions. In this case, the vertebrae also rotate around their axis.

It is interesting that when it appears in childhood, the arch in the thoracic region is usually convexly directed to the left, and in the lumbar region - to the right. And in adolescents, the direction of curvature occurs in the opposite direction.

Depending on when the pathology is detected, infantile idiopathic scoliosis, juvenile and adolescent scoliosis are distinguished. The infantile form is the least common and is believed to be associated with congenital anomalies of skeletal development. It is usually discovered before the age of 3 years. Since the bones are still soft at this time, most often the deformity is corrected quickly.

If scoliosis is detected at the age of 4-10 years, it is said to have a juvenile form. At this age, active bone growth occurs, so the disease progresses quickly. Even with timely initiation of treatment, it is necessary to apply a set of measures. This is not only special gymnastics and massage. It is also necessary to use manual therapy, fixation of the spine with a corset and other methods.

But the most common is adolescent or juvenile idiopathic scoliosis. It develops in adolescents after 10 years of age. Moreover, it occurs most often in girls. This is the time of puberty and the strengthening of individual differences in the body. Therefore, it is impossible to predict how the pathology will develop. For some, the deformity progresses very slowly and does not affect the functioning of the body in any way, while for others the curvature actively increases.

Localization

Depending on the location of the primary curve of curvature, several types of scoliosis are distinguished. Its most common form is thoracic. Most often it occurs in children 5-7 years old or in teenage boys. The curvature is observed at the level of 7-10 thoracic vertebrae. The arc is mainly directed to the right, sometimes compensatory arcs develop above or below the deformity. With this form of scoliosis, twisting of the vertebrae is often observed. As it progresses, it can cause severe problems with the heart and lungs. In the area of ​​the thoracolumbar vertebrae, pathology is slightly less common and is also quite severe. This deformity usually has two arcs of curvature.

The lumbar form of scoliosis with the apex of the arch in the region of the 1st-2nd lumbar vertebrae is usually mild and rarely causes complications. This type of deformation is easiest to correct. But curvature in the cervicothoracic region, usually at the level of 3-4 vertebrae, can have serious consequences. The deformation affects not only the torso, but also the face. And displacement of the vertebrae can lead to pinching of nerve endings or vessels responsible for blood supply to the brain. But this form of scoliosis is quite rare; most often it has a congenital form.

Diagnostics

The appearance of idiopathic scoliosis in the initial stages is very difficult to notice. Visible symptoms usually appear as the pathology progresses. In this case, you can see the asymmetry of the child’s shoulders, incorrect posture, one of his shoulder blades may protrude, and a rib hump may form. At the same time, other symptoms also appear: back pain, fatigue, feeling tired after standing for a long time, intercostal neuralgia. With a severe degree of curvature, disorders of the internal organs are also possible: cardiac or respiratory failure, increased blood pressure, enlarged liver, congestive gastritis.

In order not to miss the development of pathology, it is very important to regularly examine the child with a doctor. Examination of the child's spine is carried out in a forward bending position, so it is easier to notice the curvature at the initial stage. Parents need to be more attentive to the child’s posture and constantly examine his spine. After all, the curvature can progress very quickly, and with idiopathic scoliosis it is very important that treatment is started as early as possible.

Treatment

The danger of idiopathic scoliosis is that the curvature occurs at first painlessly and without visible external symptoms. But since it is constantly progressing, sometimes parents turn to a doctor when the child’s scoliosis is already in an advanced stage. In this case, only surgery can help. Therefore, it is very important to start treatment of pathology on time. At the initial stages of deformation, it is possible to stop its progression and prevent complications. All treatment methods help the body develop its own compensation mechanisms and strengthen the muscle corset.

To treat idiopathic scoliosis, a comprehensive application of measures is necessary. This includes therapeutic exercises, breathing exercises, massage, manual therapy, physiotherapeutic procedures, wearing special corsets. Constant monitoring of the child’s posture is very important to prevent progression of the process. A balanced diet, an active lifestyle, and the right choice of sleep accessories will all help slow down the progression of the deformity. Playing sports, especially swimming, is good for your child. It is undesirable to run a lot and lift weights.

Scoliosis is easiest to correct in children under 3 years of age. Infant bone tissue is still very soft and pliable, so if parents behave correctly, the curvature can go away on its own. This often happens in children under 1 year of age. But with a more serious degree of deformation, fixation of the child’s spine with a plaster corset is sometimes used. In older children and adolescents, grade 1 or 2 scoliosis must be corrected. If treatment is started on time, the progression of the pathology can be stopped. Grades 3 and 4 scoliosis usually develop due to congenital pathologies and are very rare. This stage of deformation can only be corrected surgically.

Surgical treatment of scoliosis is rarely prescribed. Usually it is needed when the degree of deformation reaches 45 degrees and is still progressing. Surgery is also prescribed when scoliosis causes severe pain, disruption of the respiratory system or heart, or in the presence of neurological complications.

Idiopathic scoliosis, which occurs in childhood or adolescence, rarely progresses after the end of skeletal formation. Especially if the angle of curvature was less than 30 degrees. Typically, such a deformation does not prevent a person from leading a normal life in the future. But for this you need to pay attention to the curvature of the spine in time and take appropriate measures. This will help avoid rapid progression and development of complications.