Scoliosis is called spinal deformity, in which its lateral curvature and simultaneous rotation of the vertebral bodies develops. As a rule, this disease is diagnosed in childhood. With the growth of a child, scoliosis can progress. Pathological changes in this case become more pronounced.
Quite often, this disease is confused with a violation of posture, when there is a curvature of the spine, but the vertebral bodies do not change their position. To make this diagnosis, such violations are mandatory.
It should be noted that scoliosis of the cervicothoracic spine may develop , as well as curvature in the chest, lower back and sacrum.
Etiology
In 80% of cases, the causes of the disease remain unknown, therefore, they speak of idiopathic scoliosis. If etiological factors that lead to congenital curvature are indicated, the following should be mentioned:
• fusion of the vertebrae;
• fusion of ribs (in this case, scoliosis of the thoracic spine develops);
• the presence of underdeveloped vertebrae, improper development of their processes and arches (such pathological changes lead to the fact that the vertebral column develops asymmetrically).
Causes and types of acquired scoliosis
As a result of the action of factors that affect the body from the outside, spinal curvature develops, which is diagnosed after birth.
The following types of congenital scoliosis can be distinguished:
1. Neurogenic - occurs with lesions of the nervous system. It develops after poliomyelitis, dystrophic lesions of the spinal cord, with cerebral palsy or myopathy. These diseases cause paralysis of the motor nerves. This leads to impaired muscle functions that maintain the correct position of the body.
2. Rickety - observed with a lack of vitamin D, characterized by muscle hypotension, bone deformation, osteoporosis.
3. Static - is associated with the deformation of the legs, when the pelvis is placed in space incorrectly, which leads to deformations of the entire spine.
4. Idiopathic - as a rule, it is diagnosed in children after 10 years.
Scoliosis of the thoracic spine: severity
Normally, the spine has physiological bends, as a result of which it resembles the letter S. With scoliosis, curvatures of the spine of different sizes occur. The larger the angle of displacement from the main axis, the more difficult this pathology can be corrected.
In most cases, right-sided scoliosis of the thoracic spine is diagnosed. Depending on the angle of curvature, such severity levels are distinguished:
• light - the angle of curvature reaches not more than 10 °;
• moderate severity - this indicator is 10–25 °;
• heavy - curvature can reach 50 °;
• very severe - characterized by deformation of the ribs and a curvature angle of more than 50 °.
It should be noted that at the beginning of the disease you can notice only one bend of the spine to the side, but subsequently another one is formed, which is localized below the first, but goes in the opposite direction. Left-sided scoliosis of the thoracic spine has no fundamental differences (the difference is only in the direction of the scoliotic arch).
Manifestations of the cervico-thoracic curvature of the spine
Such scoliosis is also called upper chest. This form of the disease is characterized by the fact that the primary curvature arc is short and steep, and the secondary is rather gentle and long.
It should be noted that such scoliosis is rare, but has a characteristic clinical picture, which is associated with the involvement of not only the cervical vertebrae, but also the bones of the facial skull in the pathological process.
On examination, the doctor may notice a sharp torticollis, asymmetric placement of the eyes or oblique localization of the nose. In addition, deformities of the upper chest and shoulder girdle are diagnosed. The patient’s neck looks shortened, the edge of her trapezius muscle sharply protrudes, which is difficult to correct, especially when the therapy is started late.
With severe deformation of the chest and thoracic vertebrae, they speak of thoracic scoliosis. It is important to identify this pathology by the time the formation of the spine is completed (by the age of 20-21 years). Otherwise, the treatment may be hopeless.
Clinic of thoracic scoliosis
This disease can be detected by evaluating the data that are obtained during examination of the patient. So, if there is scoliosis of the thoracic spine, you can visually notice a curved line of the spinal column, asymmetric shoulder placement, raised shoulder blades, and also protruding abdomen due to impaired posture.
In addition to visual symptoms, thoracic scoliosis is characterized by certain complaints from the patient. As a rule, people with such a curvature of the spine notice discomfort in the chest and pain in the area between the shoulder blades, which can be explained by the pinching of the nerve processes. In severe cases, patients have respiratory, cardiac abnormalities.
With further progression, both left-sided and right-sided scoliosis of the thoracic spine leads to anatomical disorders in the structure of not only the chest, but also the abdominal cavity, which is accompanied by pathological changes in the digestive system.
Diagnostics
Scoliosis of the thoracic spine, the symptoms of which may be mild, requires the attention of doctors, because the treatment of such disorders of the skeleton is more effective when seeking early medical help.
In the early stages of the disease, fluoroscopy in two projections allows not only to confirm the presence of scoliosis, but also to determine the most optimal treatment methods. It should be remembered that with curvature of the spine, concomitant serious diseases can occur. Improper body weight distribution in scoliosis leads to degenerative changes in the vertebrae, dorsopathy of the spine, as well as osteochondrosis and intervertebral hernias.
Scoliosis can be diagnosed with the naked eye. On examination, a different height of the shoulders is noticeable, as well as a curved line of the vertebrae, which becomes even more noticeable if the patient leans forward.
If you are interested in what scoliosis of the thoracic spine looks like, a photo of this pathology is presented below.
Scoliosis treatment
The success of therapy depends on timely diagnosis. The faster this pathology is detected, the greater the chance of obtaining positive results.
It should be noted that for each patient an individual plan of therapeutic measures is drawn up. At the same time, the stage of the disease and the features of its course are taken into account. As a rule, when scoliosis of the thoracic spine is diagnosed, treatment is carried out in three stages:
• a direct effect on the parts of the spinal column in which lateral curvature was found;
• procedures aimed at correcting scoliosis;
• fixing the correct position of the spine obtained after therapy.
It should be noted that the last stage is the most difficult. Patients do not give him proper attention, so scoliosis develops repeatedly. That is why it is important to follow all the doctor’s prescriptions, develop back muscles and carry out posture correction. Therapy should be comprehensive and include conservative methods of treatment, and, if necessary, surgical intervention.
Physiotherapy
One of the main conservative therapeutic methods is exercise therapy. Especially effective is a specially designed set of exercises, which in childhood has not only a rehabilitative, but also a therapeutic effect. Its main goal is to reduce the load on the spine, eliminate muscle imbalance, strengthen the ligamentous apparatus and the formation of proper posture.
As a rule, it is recommended to perform exercises that strengthen the group of muscles supporting the spinal column, and also have a corrective effect on its curvature, improve the
function of external respiration and have a general strengthening effect on the body.
Most often, the following types of exercises are recommended:
• lie on your back, bending your knees, raise your pelvis, bending in the thoracic region;
• a positive effect is given by hanging on the crossbar, in which you should slowly turn the body to the sides;
• lie on your stomach and raise your torso so that the thoracic spine bends;
• so that the curvature does not progress, you need to put a stick at shoulder level, wrap it in your arms and walk with it like this every day for 2 hours;
• exercise “bicycle” also has a positive effect on curvature of the spine.
When there is scoliosis of the thoracic spine, exercises must be performed at a slow pace. After classes, it is useful to rest for 20 minutes, lying on your side.
In addition to exercise therapy, patients are also recommended to wear special corsets and go in for swimming.
Massage
It must be said right away that in cases where the patient suffers from scoliosis for a rather long time, and there are pronounced pathological changes in the spine, massage will not give a positive result.
As a rule, it is prescribed for 1 or 2 degrees of curvature. A massage is carried out in a clinic or hospital. A set of exercises is selected individually depending on the form and severity of the disease, appointing it every 6 months.
When scoliosis of the thoracic spine is detected, massage is carried out taking into account the direction of deformation. Since the muscles on one side of the scoliotic arch are in constant tone, the massage therapist uses techniques that promote relaxation. On the other side, muscle fibers are stretched and weakened, so we need a massage technique that would bring them into tone and strengthen.
It should be noted that self-massage with scoliosis is contraindicated, since improper tactics of it can provoke an increase in deformation and worsen the patient's condition.
Surgical treatment of scoliosis
Despite the high level of modern medicine, severe forms of scoliosis are difficult to correct. The most effective treatment is the use of metal implants.
Surgery is carried out by two methods:
1. Anterior mobilization of the spine (or multilevel discectomy with simultaneous correction of deformity). Such surgery is performed under general anesthesia. The most optimal results after the operation are a decrease in the angle of the scoliotic arc from 30 to 54 °.
2. Halpelvictraction combined with correction of deformities. This surgery is even more effective and helps to reduce the angle of bending of the spine to 22 °.
When scoliosis of the thoracic spine is diagnosed, surgical treatment always reduces the rib hump. This is due to the fact that after the operation, the intercostal space expands, and the deformation decreases.
Surgical treatment of scoliosis among children is considered the most difficult, since their spine is constantly growing, and the use of metal structures can lead to crankshaft syndrome. That is why, in the treatment of scoliosis in childhood, special dynamic designs are used that can be increased as the patient grows.