Scoliosis is a vertebral pathology caused by severe deformity of the column, which is characterized by lateral vertebral curvature, accompanied by the rotation of individual vertebrae relative to each other.
Pathology most often makes itself felt already in childhood, and with the growth of the child, scoliosis becomes more and more pronounced. Very often, such a spinal deformity is confused with a common violation of posture. But for impaired posture, only lateral curvature is characteristic, while scoliosis is necessarily accompanied by rotations of the vertebrae relative to each other along the axis.
There are many classifications of scoliosis:
- By deflection angle:
- Angle up to 10 degrees – I degree of deformation;
- Angle 11-25 degrees – II degree of deformation;
- Angle 26-50 degrees – III degree;
- Angle more than 50 degrees – IV degree;
- Due to the occurrence:
- Idiopathic scoliosis – when the true cause of the deformity cannot be identified;
- Acquired forms of scoliosis – usually occur in children due to improper posture during school years or against the background of a mismatch in the development of the skeleton and muscle mass;
- Age – occurs in adults due to bone processes such as osteoarthritis, osteochondrosis, osteoporosis, osteomyelitis, spondylitis, etc.;
- Congenital forms of scoliosis – occur as a result of a certain kind of genetic anomalies or due to violations in the process of intrauterine development;
Scoliosis of the spine and their features
As already mentioned, depending on the angle of deformation, scoliosis is divided into several degrees.
Depending on the direction of the arc, the curvature is right-sided and left-sided. The left-sided form of scoliosis occurs much more often, but it is more benign than scoliosis directed to the right, which is associated with pronounced hemodynamic and respiratory disorders characteristic of the right-sided form of deformity.
At first, the curvature takes the shape of the letter C, but over time, with a compensatory goal (so that the center of gravity is balanced), along with the first arc, the second is formed, as a result of which an S-shaped deformation is formed.
In rare cases, grade 1 S-shaped scoliosis is formed without a previous C-shaped curvature; the causes of such scoliosis are congenital vertebral defects.
If we talk about lumbar scoliosis of the 1st degree, then such a spinal deformity develops mainly due to clubfoot or flat feet, when the foot is placed incorrectly. In addition, such curvatures can occur with hip articular pathologies, when patients are forced to use a cane while walking for a long time.
At the initial stage of the development of the process of scoliotic deformity from the side, it is almost imperceptible, i.e., it is visually impossible to fix any changes. Although a specialist is quite capable of detecting some manifestations that indicate the development of pathological spinal curvature:
- The presence of a slight stoop;
- Some asymmetry of the shoulders relative to each other;
- X-ray examination shows an angle of inclination of less than 10 degrees.
Home treatment is based on massage procedures, therapeutic and gymnastic exercises, posture control and the mandatory use of orthopedic bedding.
The second degree of scoliotic deformity of the spine, due to a brighter clinical picture, is diagnosed much more often than the pathology of the previous stage.
Experts determine the presence of spinal curvature by the following manifestations:
- The curvature angle is about 11-25 degrees;
- The asymmetrical arrangement of the gluteal folds and shoulder blades is visible to the naked eye;
- Torsion changes take place.
S-shaped thoracolumbar scoliosis of the 2nd degree is accompanied by deformation of the chest, which by the end of the 2nd stage affects the functionality of the internal organs. The heart and lungs suffer, the ribs begin to take a bulging shape, gradually forming a rib hump.
Such changes are accompanied by multiple violations such as:
- Breathing difficulties;
- Pain on inhalation and exhalation;
- Tachycardic symptoms.
At the second stage of scoliotic deformity, home therapy, in addition to stopping the pathological process, is also aimed at eliminating the already formed disorders. At this stage, the use of orthopedic bedding, exercise therapy, massage and physiotherapy is also shown. To maintain posture, it is recommended to wear a corset that will help stop further progression of the deformity.
From the point of view of the choice of therapeutic tactics and in terms of stabilization, the 3rd degree of scoliosis is considered the most difficult.
By the beginning of the third stage, the rib hump is already firmly formed. Typical respiratory and cardiac disorders become pronounced and are accompanied by pain symptoms. X-rays show an angle of curvature of up to 50 degrees. It is at this stage that the question of the patient’s disability may arise.
The main manifestations of S-shaped scoliosis of grade 3 include:
- Great difference in the height of the shoulder blades and shoulders;
- The aforementioned rib hump;
- Skewed torso, especially the pelvis, stoop;
- Obvious deformity of the thoracic spine.
Patients with a similar degree of scoliosis are often worried about shortness of breath, back pain, and excessive fatigue. Sometimes the deformation leads to compression of the nerves or blood vessels, which subsequently causes a violation of sensitivity in certain areas of the body.
Most often, doctors recommend adult patients to deal with the third degree of deformity with surgical methods, since a conservative approach can only stop further deformity, but is not able to correct existing violations.
Of course, the decision about surgery is purely individual. If there are no serious violations in the work of internal organs, then the disease can be fought conservatively.
Not the last meaning in the matter of the operation is given to the type and localization of the curvature.
If there is a thoracic right-sided deformity, then it is characterized by rapid development, therefore, surgical treatment will be required. If scoliosis differs in lumbar localization, then it is characterized by a very slow progression, so the disease may not bother the patient until old age.
The last fourth degree of scoliotic deformity of the spine is characterized by obvious pathological disorders in the musculoskeletal system. The body is characterized by sharp asymmetry. The patient has pronounced damage not only to the vertebrae, but also to the chest.
The following symptomatic manifestations are observed:
- Pain syndrome of a permanent nature;
- The deformation angle is more than 50 degrees;
- There is a rapid increase in functional disorders of internal organs.
The main direction in therapy is an operation, which consists in installing metal elements into the body of the spinal column, which hold the body in the correct position from the position of anatomy.
Such mounts can be static (fixed) or dynamic (movable) in nature. The consequence of this degree of deformity is the patient’s disability, so he is shown a disability group.
How to determine the stage of the disease?
The degree of scoliosis is determined depending on the magnitude of the deformity angle and in accordance with the symptoms accompanying such curvatures:
- So, for 1 degree, different shoulder heights, different distances between the vertebra and the shoulder blades are characteristic, and when tilting, the curvature of the spine is clearly visible, the deformity angle is not more than 10 °.
- The second degree of scoliotic deformity is characterized by a noticeable stoop of the patient, periodic pain in the back, a roller appears on the lower back, and a protrusion on the chest. The deflection of the bend from the norm is up to 25 °.
- In the third degree, the whole body is skewed, the deformation angle is up to 50 °, the ribs are falling in one half of the body, and their protrusion is on the other.
- For the fourth degree, the deformation exceeds 50 °, the whole body is terribly bent, and serious organic disturbances take place.
It is for these symptomatic manifestations that the scoliosis degree is determined.
Can it be cured?
The second degree of scoliosis is quite amenable to conservative treatment , regardless of the age of the patients. Whereas in the third degree, conservative treatment ensures recovery only for children, since their spine is still growing and amenable to conservative correction. And for adult patients with grade 3 deformity, only surgery can most often help.
Do they take into the army with the second stage?
According to the law, persons with fixed grade 2 scoliosis are exempted from military service, provided that there is a violation of vertebral functions. In the absence of those, only persons with grade 2 scoliosis with a deformity angle of more than 17 ° will be exempted from military service.
In other words, if you have a fixed grade 2 scoliosis, there is no impairment of vertebral functions, and the degree of inclination is about 11-17 °, then you are subject to conscription.
Which doctor should you contact?
Experts recommend starting the treatment of any disease with a therapist who can correctly assess the clinical situation and prescribe the necessary diagnostic tests, as well as determine which specialist you need to contact. As a rule, a patient with scoliosis is referred to an orthopedist and neurologist.
If scoliosis is accompanied by back pain and other neurological disorders, then the patient is referred to a neurologist. The orthopedist deals directly with the treatment of spinal scoliosis and the correction of bone and articular deformities. Often, a therapeutic and gymnastic instructor or a chiropractor takes part in the treatment process. If surgical treatment is indicated, then surgeons are also involved in the process. But you should still start with a local therapist.