Scoliosis (also known as scoliosis) is a three-dimensional spinal deformity in which one or several segments of the spine are bent to the side with vertebral rotation. Scoliosis is a symptom or x-ray sign and can be caused by a variety of conditions.
Classification of scoliosis
Commonly, idiopathic scoliosis of unknown origin is called idiopathic scoliosis (about 70-75% of all scoliosis) Li Huawei, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Scoliosis is divided into primary scoliosis (structural), secondary scoliosis (non-structural).
Secondary scoliosis: not a disease of the spine itself, but due to abnormalities outside the spine caused by scoliosis, generally no development trend, the spine itself is not stiff and no rotational deformity, but under certain conditions can produce structural changes.
Primary scoliosis: The spine undergoes intrinsic changes in the vertebrae and their supporting structures, and the spinal deformity is stiff and rotational deformity, with a significant tendency to worsen.
Adolescent idiopathic scoliosis
Adolescent idiopathic scoliosis (AIS) is a structural scoliosis deformity of the spine that occurs around the time of pubertal development. It is the most common type, approximately 70%. It is usually detected by asymmetrical posture in the standing position, but definitive confirmation requires a standing full spine x-ray.
Scoliosis is a disease that occurs in young children between the ages of 5 and 18 years.
It is a persistent orthopedic disease with complex causes that are extremely difficult to cure. According to the Ministry of Health, the prevalence of scoliosis among adolescents and children under the age of 18 is 1.6%, with more females and a male-to-female ratio of 1:5. 50% to 60% of patients suffer from scoliosis, resulting in lifelong disability or even death. Foreign reports of adolescents aged 10 to 16 years with scoliosis of more than 10° can reach 2 to 3%.
The pathogenesis of scoliosis is not known and is currently considered to be related to the following factors:
(a) genetic factors
(ii) hormonal effects: hypomelanosis
(iii) growth asymmetry factor: uneven muscle development on both sides of the spine
(iv) abnormal tissue theory: muscle, bone, ligament, intervertebral disc abnormalities, etc.
(E) Neuro-balance system dysfunction: secondary to cerebral palsy, spinal cord cavitation, etc.
(6) Abnormalities of the neuroendocrine system
Clinical manifestations
In terms of appearance, scoliosis can produce a bulging back deformity, a “razor back” deformity, or even a “funnel chest” or “chicken chest” deformity, and in combination with this back deformity, it can be accompanied by bilateral shoulder joint imbalance. This can be accompanied by bilateral shoulder imbalance or pelvic imbalance, as well as bilateral lower limb inequality, which can cause significant local deformity, height reduction, reduction in thoracic and abdominal cavity capacity, and even impairment of neurological, respiratory, and digestive functions; as well as neurodevelopmental abnormalities such as cerebrospinal bulge and invisible spina bifida in patients with dysplasia of the spinal bone structure itself. In addition, congenital scoliosis may be associated with abnormalities of the cardiovascular system, tracheo-esophageal fistula, polycystic kidney, and other multiple organ abnormalities.
Consequences
① Affects the physical and mental development of the child and affects physical development.
② Severe kyphosis of the thoracic spine, vertebral rotation and reduced respiratory muscle strength all seriously affect lung function.
③ Possible sequelae of untreated AIS include back pain, restrictive pulmonary ventilation impairment, and impact on overall function.
Psychosocial factors: Patients with scoliosis show a greater lack of self-confidence and low recognition of their own body shape.
5. Quality of life: Patients suffer from severe psychological disorders, social isolation, limited work opportunities, and low marriage rates.
6. Significant limitations in physical activity: The main causes include functional impairment and chronic back pain.
The natural history of idiopathic scoliosis
The natural history of idiopathic scoliosis is a recognized pattern of progression through adulthood, with the degree of progression largely dependent on growth potential and the type of scoliosis site.
(a) The earlier the onset of the disease, the greater the likelihood of progression
(ii) The risk of progression is higher during the peak growth period, before menstruation in women
(c) The lower the Risser’s sign (iliac epiphysis rating) at the time of onset, the greater the likelihood of progression
(d) bifurcated scoliosis is more likely to progress than unifurcated scoliosis
(e) The greater the degree of scoliosis at the time of detection, the more likely it is to progress
The onset of scoliosis may be at the age of 5 to 6 years, and the development of scoliosis accelerates at the age of 11 to 17 years, with severe structural scoliosis to be formed, and the development of scoliosis stops at the age of 18 to 20 years. Therefore, the critical period for treating scoliosis is when the adolescent is immature.
Diagnosis of scoliosis
Early diagnosis is very important to enable early treatment.
(A) Medical history
1, the onset of the situation: the first time most parents or teachers unintentionally discovered, the first discovery is often 10 to 13 years old.
2, the presence of family history: understanding the usual health status, intelligence level, mother’s pregnancy and delivery history is important to exclude non-specific scoliosis
3, clinical symptoms: back deformity as the main symptom, especially when standing posture asymmetry, such as unequal shoulders, one scapula protruding backward, asymmetric anterior chest, etc.
(B) Physical examination.
1. General condition: the patient’s health status, voice speech, secondary sexual characteristics, gait, skin condition and whether there is joint laxity and stiffness. For boys, take off all clothes except underwear, and for girls, wear a swimsuit, so as to get a full picture of the spinal deformity.
2.Torso: Observe both shoulders, the distance from the hip crack to the trans-C7 dip, the pelvis, and the lower limbs in the standing position. Observe the thoracic spine. Observe the presence of razorback deformity when the patient performs forward flexion.
3.Checking the softness and stiffness of the lateral bending arc: hanging head suspension position, lateral bending, observing the changes of the spinous process line and the degree of lateral bending.
4.Nervous system
5.Examination of heart and lung function, bone age and other concurrent deformities.
(C) X-rays
Radiographs are the main means of diagnosing scoliosis and require a full-length frontal and lateral view of the spine in the standing position, including the iliac crest on both sides, to reflect the true condition of the deformity and the balance of the trunk.
Cobb angle measurement
In the orthogonal X-ray, the upper and lower end vertebrae of scoliosis are identified, a flat line is drawn at the upper end vertebral body and a vertical line is drawn at the lower end vertebral body, and the angle of intersection of these two vertical lines is measured with a protractor.
Rehabilitation treatment for scoliosis
Experience at home and abroad shows that group screening, early detection, and timely rehabilitation are effective ways to prevent and reduce the serious harm of scoliosis to the physical and mental health of adolescents, which not only greatly reduces the proportion of surgical cases, but also significantly reduces the severity of scoliosis in surgical patients.
Timing of treatment
Accelerated growth in adolescence (girls grow fastest before menarche) is the biggest risk factor for scoliosis aggravation, so this is a critical period for scoliosis treatment.
– The rate of scoliosis aggravation slows down after growth has stopped
– In adolescence, growth accelerates (girls grow fastest before menarche), which is the biggest risk factor for scoliosis aggravation, so this is a critical period for scoliosis treatment.
– After growth has stopped, the rate of scoliosis exacerbation slows down
Choice of treatment options
Observation and follow-up for those with a Cobb angle of 25° or less
Non-surgical treatment such as brace for 25° to 45°
Surgical treatment above 45°
Non-surgical treatment
– Exercise therapy (corrective gymnastics)
– Tui na
– Physiotherapy (surface electrical stimulation therapy)
– Suspension and traction therapy
– Brace therapy
– Psychotherapy
Timely and appropriate use of these methods can achieve satisfactory results. The appropriate correction method can be selected according to the patient’s age, the severity and progress of scoliosis.
Exercise therapy: mainly for corrective gymnastics. It is early mild scoliosis, especially functional
with fibrous scoliosis, and is an important adjunct to structural scoliosis. The principle of the therapeutic effect on scoliosis is to selectively strengthen the muscles of the spine that maintain posture. The muscle balance on both sides is adjusted through training of the sacrospinous, abdominal, psoas major and psoas square muscles on the convex side.
Tui na massage techniques: improve muscle nutrition, strengthen the metabolism in the muscle, enhance the role of muscle elasticity, it can open the meridians, improve the circulation of qi and blood, soften the soft tissue and ligaments
Treatment of AIS: Bracing
The purpose of applying braces is to
1, to control the deterioration of spinal deformity; can only control the deformity and prevent the deterioration of the milder scoliosis, but can not make the more obvious scoliosis reduce the angle.
2, early childhood application of braces can often maintain a more normal development of the spine, but can not prevent the development of deformity.
3, adolescents are mainly used to prevent the development of spinal deformity.
Indications for brace treatment
1) Mild scoliosis between 20 and 40 degrees, infantile and early juvenile idiopathic scoliosis, and occasionally between 40 and 60 degrees can be treated with a brace, and adolescent scoliosis exceeding 40 degrees should not be treated with a brace.
2) Children with immature epiphyses should be treated with braces.
3) Two structural curvatures of 50 degrees or a single curvature of more than 45 degrees are not suitable for brace treatment.
4) Scoliosis with combined thoracic pronation should not be treated with bracing. The brace can aggravate the anterior convexity deformity and further reduce the anterior-posterior diameter of the thoracic cavity.
5) Long segmental curvature, brace treatment effect, such as 8 segments of 50 degrees scoliosis brace treatment effect is better than 5 segments of 50 degrees scoliosis.
6)The Boston brace is most effective for scoliosis of the lumbar or thoracolumbar segments with good elasticity below 40 degrees.
7) Patients and parents who do not cooperate should not brace treatment.
Precautions: Wearing time, not less than 20 hours per day
Contraindications.
Congenital hemivertebral scoliosis, congenital vertebral kyphosis, typical neurofibromatosis, kyphotic bulging kyphosis, anterior thoracic kyphosis, and table juvenile scoliosis with an angle of more than 45°.
Surgical treatment
Indications for surgical treatment
– Brace treatment does not control the progression of the deformity, even if the bone age is very low.
– Risser less than 3, where brace treatment is ineffective and the Cobb angle is greater than 50°.
– Risser 3 to 4 with Cobb angle greater than 50°.
– Risser 4 to 5, Cobb angle is above 40° to 50° or Cobb angle is only 40°, but anterior thoracic protrusion, thoracic rotation, razorback deformity, and oblique tilt loss of trunk are obvious.
– Scoliosis enters adulthood with early onset of low back pain, rotational subluxation, etc.
Treatment of AIS: surgical methods
1, posterior orthopedic surgery: the most commonly used surgical method, currently more commonly used are Ha’s surgery, Luque surgery and de-rotation class techniques
2, anterior orthopedic surgery: anterior TSRH, Kaneka, anterior CD and Moss-Miami, etc.