27Mar

Kifoskoliosis of the thoracic spine and its treatment

The kyphoscoliosis of the thoracic spine is a combined deformity of the spinal column, which consists of lateral curvature( scoliosis) and pathological kyphosis( excessive bending of the spine back in the thoracic region).This is a fairly common pathology among children and adolescents. Boys get sick 4 times more often than girls.

Such deformation of the spine leads to impaired posture, increased fatigue, and in severe cases - to a pronounced cosmetic defect and disruption of the internal organs of the thoracic and abdominal cavity.

Reasons for

A healthy human spine has several physiological curves in the anteroposterior direction: cervical, lumbar lordosis( forward), and thoracic kyphosis( back).They are necessary to compensate for vertical loads on the vertebral column. Normally, the angle of the kyphosis in the thoracic region is up to 45 °, and all that is greater is the pathological kyphosis.

There are no lateral bends in the healthy spine, therefore any deviations from the vertical line to the left or right are scoliosis.

Thoracic kyphoscoliosis, as a rule, is formed gradually, with kyphosis first, to which scoliosis subsequently joins.

Depending on the cause of development, two groups of etiological factors of the disease are distinguished:

  • congenital,
  • acquired.

Congenital kyphoscoliosis

This leads to genetic abnormalities and various birth defects of the musculoskeletal system. For example, kyphoscoliosis can form due to the absence of the arched vertebrae arches, the presence of additional vertebrae, genetic defects in the development of cartilage, bone and muscle tissue.

It is important to remember that in 20-30% of cases such congenital curvature of the spine is combined with defects in the development of the urogenital system.

Diagnose, as a rule, not immediately. After all, all people are born with a practically straight backbone, and bends are formed in the first year of life, when the child learns to sit, stand and walk. It is during this period that kyphoscoliosis of an innate character is manifested. Although there are cases when immediately after birth in a child diagnosed this is a curvature of 2-3 degrees.

Acquired kyphoscoliosis

Factors that can lead to the formation of kyphoscoliosis during life include:

  • pathology of connective tissue of a dysplastic nature;
  • rickets;
  • poliomyelitis;
  • tumors of the vertebrae;
  • osteochondropathy of the spine;
  • cerebral palsy;
  • of myopathy and myodystrophy;
  • rheumatism;
  • the disparity between the rapid growth of the skeleton and slow muscle tissue in the adolescent period;
  • irrational working posture;
  • overload of the spine( heavy physical labor, overweight, inactivity).

The acquired kyphoscoliosis begins to appear in 13-14 years.

The child is sitting at the desk incorrectly
Wrong posture of the child at the desk - a serious risk factor for the development of kyphoscoliosis

Species and degrees of kyphoscoliosis

Depending on the direction in which the arc of lateral curvature is open, the left and right kyphoscoliosis is distinguished.

Given the severity of the deformity of the spine, there are 4 degrees of pathology:

  1. 1 degree - the size of the kyphosis is 45-55º, there is minimal lateral curvature and vertebral rotation along the vertical axis.
  2. 2nd degree - angle of kyphosis 55-65º, lateral displacement becomes noticeable, rotation of vertebrae increases.
  3. 3 degree - kyphosis in the range of 65-75º, the vertebral hump becomes noticeable, the curvature to the side is well pronounced.
  4. 4 degree - the angle of the kyphosis is more than 75º, there is a pronounced hump, lateral curvature is expressed in extreme degree, pronounced deformity of the thorax develops, the function of the thoracic and abdominal organs is disrupted.

Symptoms of

Congenital kyphoscoliosis of the thoracic region becomes noticeable at the child's age of 6-12 months. At first, the deformation is noticeable only in the vertical position, in the prone position it disappears. On the back, unlike pure scoliosis, not a muscular cushion is noticeable, but the spinous processes of several vertebrae due to the bending of the spine back.

Kifoskolioz 4-th degree in the child
Congenital kyphoscoliosis of the 4th degree in the child

The disease progresses rapidly, which leads to pronounced cosmetic defects. In addition, the child's physical development is disrupted, signs of disruption of the heart, lungs, and gastrointestinal tract appear.

With kyphoscoliosis of grade 3-4, neurologic symptoms( paresis of individual muscle groups, impaired sensation) appear due to compression of the spinal cord and its roots.

We also recommend reading: scoliosis Curvature of the spine in children

Acquired kyphoscoliosis in adolescents appears gradually. In the beginning of the disease, parents notice a violation of posture, the appearance of stoop, a child may complain of periodic low-intensity pain in the back.

The speed of progression is different and depends, first of all, on the cause. When the pathology goes to the second stage, dyspnea may occur due to the limitation of the ore cell excursion.

As a rule, acquired kyphoscoliosis rarely reaches 3-4 degrees, but there are also such cases. It is then that there are symptoms associated with the pathology of internal organs.

Complications and prognosis

The pathological shape of the spine leads to increased stress on its specific segments. This contributes to secondary degenerative changes in the tissues of the spinal column. Early osteochondrosis starts to develop in children, which is often accompanied by the formation of multiple protrusions and hernias of intervertebral discs. Such pathological changes only aggravate the condition and promote the progression of deformation. Also increase the risk of developing neurological complications.

At 3-4 degrees of the disease, the respiratory system, heart and abdominal organs begin to suffer. Reduced the tour of the chest, respectively, respiratory volume of the lungs. This leads to chronic insufficiency of breathing with the corresponding consequences. The heart is contracted, its rhythm is broken, eventually the chronic heart failure develops. The function of the digestive system is also disturbed. Such patients are prone to the development of dyskinesia biliary tract, cholecystitis, reflux disease, etc.

Radiography of the spine
The X-ray shows the case of kyphoscoliosis of the 4th degree before and after the operation. The first picture shows how much the spine is deformed, the pronounced compression of the lung tissue

is evident. A critical period that determines the prognosis of the disease is the end of the active growth of the child - 14-15 years. By this age, conservative correction of kyphoscoliosis is possible, and very successful. You can completely get rid of the diseases of the 1 st and 2 nd stage. Kifoskolioz 3-rd and 4-th degree can not be completely corrected. In this case, only surgery will help.

Diagnostic principles

It is not difficult to establish a diagnosis with severe deformation. For this it is enough to examine the orthopedist and the radiography of the spinal column in 2 projections. It is much more difficult to establish a diagnosis in the initial stage, when there are practically no external signs of deformation.

Help in the diagnosis of MRI and CT of the spine. Mandatory appoint an examination by a neurologist, as well as other professionals, depending on the symptoms present in the internal organs.

Radiography and MRI of the spine
Radiography and MRI are the main methods for diagnosing and determining the degree of kyphoscoliosis

Methods of treatment

Treatment should be started as soon as possible. It can be conservative and surgical.

Conservative therapy consists in the regular performance of exercises of therapeutic gymnastics, which must be selected individually for each child. Kifoskolioz 2-nd degree can be eliminated only with the help of exercise therapy. With pathology of the 2nd and 3rd degree, physical training is combined with wearing an orthopedic corset made individually. Additionally, massage and physiotherapy procedures are prescribed.

In kyphoscoliosis of the 4th degree, surgery is indicated. Also, surgical treatment is used when bending the second or third degree in the case when conservative therapy does not bring the desired result, there is a constant pain syndrome, the pathology progresses quickly, neurological complications appear or the work of internal organs is disrupted. In some cases, the operation can be performed according to cosmetic indications. Making the conclusion, it is worth emphasizing that in the treatment of kyphoscoliosis the main role belongs to the timeliness of therapy, since only before the end of active growth can the posture of the child be corrected and the development of complications can be prevented. It is also important to remember that the main role in the treatment is given to corrective therapeutic gymnastics and the wearing of an orthopedic corset, all other methods play an auxiliary role.

Kifoscoliosis in a child
Contents:
  • Reasons for
  • Species and degrees of kyphoscoliosis
  • Symptoms of
  • Complications and prognosis
  • Principles of diagnosis
  • Treatment methods