This is a condition in which there is a bending of the ridge to the side, and from birth, a defect occurs in 1 out of 10,000 newly born, and much less often than the acquired type of disease. Congenital scoliosis in the ICD-10 is listed under the code M41.
Causes
There is no hereditary predisposition, and the causes of congenital scoliosis in infants are disturbances in the formation of the spinal column at the fetal stage. In total, there are three main types of anomalies that begin to develop in the womb:
- A mild form in which there is a slight deformation of the structure of one vertebra or a small group (2-3). Most often this occurs in the chest area.
- The average form of congenital scoliosis of the thoracic spine. In this case, part of the vertebrae loses mobility, as a result of which large fixed sections of several bone formations are formed. In this case, inactive areas begin to move sideways.
- In severe form, the vertebrae and discs begin to grow together. This is the most dangerous type, as it can lead to displacement and deformation of internal organs. Defects of all three types develop in the first weeks of pregnancy.
The main reasons are factors such as the use of drugs contraindicated during pregnancy, alcohol consumption, smoking and other forms of intoxication, as well as radiation exposure. In addition to external harmful effects, vitamin D deficiency also plays a role. It is impossible to completely cure congenital scoliosis in children.
Symptoms
For congenital scoliosis of the spine, pronounced pain is not characteristic. Symptoms of it at an early age can be detected by parents and pediatricians with careful examinations. The main, visible upon examination, signs of congenital scoliosis include such pathological changes:
- shoulders are uneven (not at the same level);
- with an external assessment of the position of the body, certain curvatures can be detected;
- asymmetry is observed in the location of the hips, moreover, on the one hand in the thigh area there may be a bulge;
- at the waist line there is a visual skew.
Other signs
If nerve endings are affected in scoliosis, partial numbness in the extremities, impaired coordination of movement can be diagnosed. As medical practice shows, birth trauma can entail just right congenital scoliosis. The following symptoms are typical for this type of spinal deformity:
- the asymmetry described above in the position of the shoulder blades, shoulders;
- respiratory dysfunction (chest deformity with right-sided scoliosis affects the respiratory system);
- fixation of intense pain in the lumbar region.
Physical diagnosis
The usual way to detect scoliosis is considered to be an inclined forward test. At the same time, the doctor examines the spinal column and reveals the difference in the shape of the ribs on each side. The deformation of the ridge is more noticeable in this position.
Next, the doctor checks the level of the hips, shoulders and head position in relation to each other. The movements of the ridge in all directions are also checked.
To determine pathologies with the spinal cord and nerve roots, the doctor performs a test of muscle strength and tendon reflexes. It is used for congenital or acquired scoliosis.
Instrumental diagnostics
A direct test with an inclination forward makes it possible to detect curvature, but it does not allow to establish congenital deformities of the vertebrae. For this reason, radial diagnostic methods are carried out.
The easiest and most acceptable way to diagnose. He is able to demonstrate the existence of vertebral destruction, as well as to assess the level of curvature of the ridge. Radiography is carried out in two projections: anteroposterior and lateral.
If the doctor is diagnosed with congenital scoliosis, he will be referred to an orthopedist for further diagnosis.
It makes it possible to notice not only the bone tissue of the vertebrae, but also the soft tissues - the spinal cord and nerve roots. The advantage of CT is that it provides a layered accurate image of the ridge. In addition, the doctor can prescribe multidimensional computed tomography for the most detailed assessment of the patient's condition.
It is carried out to reveal the possible concomitant deviations, for example, of the kidneys or bladder.
- Magnetic resonance imaging (MRI).
It is believed that MRI makes it possible to more accurately assess the state of soft tissues, for this reason it is used to assess abnormalities in the spinal cord. This method is not associated with x-ray radiation, its principle is based on a strong magnetic field, for this reason it is contraindicated in patients with implanted devices (pacemakers, cochlear implants, artificial joints, etc.).
Treatment
The treatment of congenital scoliosis depends on its stage. If the disease is not pronounced, you can solve the problem with conservative treatment, in other cases, you can not do without surgery.
First stage
At the first stage, when the deviation does not exceed 10 degrees, to achieve positive dynamics, experts prescribe treatment, the complex of which includes:
- physiotherapy;
- physiotherapeutic procedures;
- playing sports;
- massage.
Second stage
At this stage of development of scoliosis, the radius of curvature does not exceed 25 degrees. With the help of medical procedures and exercises to correct the situation is no longer possible. As the main method of treatment, a special supportive corset is used.
Third stage
It is even more difficult to treat, since the deviation can reach 50 degrees. In this case, in addition to the usual supporting corset, a special correction device with the effect of traction can be additionally used. In addition, the doctor prescribes physiotherapeutic procedures. Therapeutic gymnastics should be carried out only under the supervision of a specialist, all exercises are performed carefully, without sudden movements.
Fourth stage
In the fourth stage of the disease, when the curvature exceeds 50 degrees, all of the above treatment methods will not give a positive result. The situation can only be corrected surgically.
Recently, most experts agree that the first stage of congenital scoliosis is the norm and it is not worth panicking. You just need to monitor the development of the disease and prevent its progression.
Surgical treatment is prescribed if conservative methods have not yielded results, the corset and gypsum have not been able to correct the situation, or the patient's health is in real danger.
Surgical treatment can be carried out in the following ways:
- Hemiepiphysiodesis.
- Removing half-vertebrae.
- Growing designs.
- Merge.
In the first case, the operation is performed on one side of the deformation, and its essence is to remove growth areas. Deformation, as a rule, is concave on one side and convex on the other. Using special implants, the latter is corrected by the surgeon, and the concave part can continue to grow, which will lead to self-correction.
To correct the situation, you can delete the semi-vertebrae. The surgeon eliminates the anomaly, after which the patient will need some time for the lower and higher vertebrae to grow together.
The postoperative period involves the wearing of a special corset. Only a specialist determines the duration of recovery. Although the operation is effective, the likelihood of complications, such as bleeding and neuralgic disorders, is quite high.
Often during surgery, use the method of establishing special growing structures. Their main advantage is that they gradually lengthen, and this does not prevent the child from growing and developing.
All manipulations are carried out from the rear access. During the operation, rods are used that are attached to the spine using special screws. About once every 6-8 months, the structure lengthens. Most often, the child must additionally wear a corset. Modern technology has significantly improved treatment. Now you do not need to carry out operations often by inserting a new rod. The design itself lengthens as the patient grows.
The merger is aimed at stopping the growth of the spine in a certain area. For the operation to succeed, the surgeon must remove only the back of the vertebra, installing a bone graft in its place, which eventually fuses with the "relatives", forming a single structure.
As the child grows and grows, the spine will no longer change shape, which means that deformation will no longer progress. It should be borne in mind that the operation is also associated with certain risks. After surgery, the bone block can behave unpredictably. Such a process leads to curvature of the spine in another department.
Surgical intervention most often positively affects the patient's further condition. If no complications have arisen, the patient can get out of bed 2-3 weeks after the operation. In the normal course of the postoperative period, the patient is in the hospital for a week, after which he can continue to recover at home.
Usually the restriction on physical activity is 1 year. During this period, you need to move carefully, do not lift weights. The lower the load on the spine, the faster recovery will take place. At first, the patient wears a corset. For 1-2 years, you need to constantly be monitored by a doctor, undergo an x-ray examination.