Overview: Spinal deformity is a common spinal disorder with a high incidence in adolescents and children.
Hazards: Spinal deformity affects the normal growth and development of the patient, not only affects the patient’s aesthetics, serious cases can lead to a decline in cardiopulmonary function, limb mobility or even paralysis, and cause serious harm to the patient’s mental health, resulting in both physical and psychological disability.
Performance: Generally, back deformity is the main symptom, manifested as hunchback, asymmetric posture, unequal shoulders, short stature, etc. Severe spinal deformity leads to decreased activity endurance, shortness of breath, palpitations and other signs of impaired cardiopulmonary function due to decreased thoracic volume. Some patients may present with low back pain.
Diagnosis.
I. Scoliosis
1. Ask about any family history, the time of discovery, degree and development of scoliosis, any history of trauma, infection, tumor and metabolic diseases, and the time of first menstruation in female patients.
2.Measure the height, check the degree of scoliosis, and pay attention to the development of the whole body, especially the shape of the thorax and cardiopulmonary function, and the presence of knife-back-like deformity.
3.X-ray examination to determine the presence of hemivertebral deformity, except for acquired lesions, and to measure the angle of scoliosis according to the Cobb method. The degree of spinal development should also be estimated. If necessary, de-rotation radiographs should be performed.
4. If necessary, myelography or MRI should be performed to rule out other causes of secondary lateral kyphosis.
5. Cardiopulmonary function tests should be performed for severe deformities.
Second, kyphosis
1. Ask about family history, history of trauma, infection, tumor and metabolic disease, morning stiffness of the lower back, dyspnea and hip pain, and the time, degree and development of the kyphosis.
2. Check the degree of kyphosis, limitation of spinal movement and cardiopulmonary function. Bilateral hip joints with or without pressure pain and activity restriction.
3.Laboratory examination mainly includes: erythrocyte sedimentation rate, anti-streptococcal hemolysin O, rheumatoid factor, and serum HLA-B27 examination.
4.X-ray examination should include spine and pelvis films to observe the angle of deformity and whether the hip joint is involved.
Treatment plan
(A) Treatment of scoliosis (specific treatment plan should take into account the cause of the onset of the spinal deformity, the age of the patient and the impact of the deformity on the patient, etc.)
1, light cases (Cobb angle <20 °) to correct the study and work posture, supplemented by physical therapy.
2.Cobb angle between 20° and 40° is mainly based on non-surgical treatment, including brace orthosis, plaster undershirt fixation and body therapy.
3, Cobb angle of more than 50 ° to the main surgical correction, can be used as appropriate lesion segment spinal fusion and instrumentation surgery. In the case of hemivertebral deformity, spinal fusion after removal of the hemivertebral body should be considered. Intraoperative attention should be paid to spinal cord monitoring when correcting severe deformities.
4, Cobb angle in 40 ° ~ 50 ° can first take non-surgical treatment, and close observation, if the non-surgical treatment is ineffective or deformity development is faster, then surgical treatment.
(B) Treatment of kyphosis
1, early non-surgical treatment, including etiological treatment, correction of poor posture, brace protection, physical therapy, lumbar back muscle exercise and the application of anti-inflammatory and analgesic drugs, etc.
2. For those with severe kyphosis and a history of quiescent primary disease, osteotomy and internal fixation of the spine are feasible.