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Degenerative scoliosis.
Progressive deformity of the spine, characterized by curvature of the spine in 3 planes (in the frontal, sagittal and horizontal). Due to deformation of the chest, the normal relative position of the internal organs is disturbed. With scoliosis, several body systems are disturbed (musculoskeletal, cardiovascular, sexual, respiratory, gastrointestinal and nervous), and not only deformation of a single segment of the human body. The following types of scoliosis are distinguished, depending on when the progression of the disease began: diagnosed from birth to three years. Juvenile scoliosis - from four to nine years. Youthful - from ten years to the end of the period of sexual Adult scoliosis - manifests itself after the end of spinal growth and is accompanied by the early development of degenerative changes. Lumbar scoliosis progresses throughout life. Anatomy The spine consists of 32-34 vertebrae. There are 5 sections of the spine:
Vertebrae of different departments have a different shape depending on the purpose and functions specific to each department of the spine. The lumbar pillar of an adult has four curvatures:
When one vertebra is superimposed on another body, the vertebral arches form the spinal canal, in which the spinal cord is located, from which the nerve roots departing innervate various organs and tissues. All vertebral bodies, with the exception of the sacral ones, in adults are separated by intervertebral discs consisting of a fibrous ring and a gelatinous nucleus. This anatomical formation acts as an elastic shock absorber. The arches of each pair of vertebrae are connected by two flat joints, yellow ligaments and a developed ligamentous apparatus between the spinous, transverse processes. Vertebral notches of the edges of the arches make up the intervertebral foramen through which the spinal nerves and their accompanying vessels pass. Causes of degenerative scoliosis in adults. Degenerative adult scoliosis occurs during a combination of age-related and degenerative lesions of the spinal column, which lead to the development of spinal deformity. These include degenerative-dystrophic lesions of the spine, osteoporosis (loss of bone mass) and osteomalacia (softening of the bone). Scoliosis can also occur after spinal surgery. Degenerative scoliosis usually occurs after 40 years. In older groups, especially in women, osteoporosis often occurs. The combination of the above changes leads to the fact that the spinal column loses its ability to maintain normal shape and is deformed. The disease can develop in any part of the spine, but most often in the lumbar region. In patients with degenerative scoliosis, the spine loses its structural stability and becomes unbalanced. The larger the angle of the scoliotic curve becomes, the faster these changes lead to degeneration of the spine. This creates a vicious cycle where an increase in deformation causes a greater imbalance, which in turn leads to an increase in deformation. A gradual narrowing of the intervertebral discs occurs. The cartilage and articular surfaces of the facet joints wear out, leading to arthritis. This can cause back pain. Spinal stenosis is a chronic process characterized by pathological narrowing of the central spinal canal, lateral pocket or intervertebral foramen with bone, cartilage and soft tissue structures, with their invasion of the spaces occupied by nerve roots and spinal cord, resulting in pain in the back, pain and weakness in the limbs. Symptoms Most people with scoliosis pay attention to the deformation that has appeared. As a rule, a hump (costal hump) appears. There is a bias in the shoulders and / or pelvis. There is a decrease in growth (depending on the magnitude of the deformation angle) Scoliosis is also characterized by the following symptoms:
To diagnose scoliosis, a patient is interviewed and examined, a spine radiography in 2 projections and with functional tests. If necessary, a CT scan and / or MRI scan of the spine is performed. Depending on the magnitude of the curvature, the following degrees of scoliosis are distinguished (according to V.D. Chaklin):
Surgical treatment is carried out with the progression of spinal deformity, and in the absence or insignificant effectiveness of conservative therapy. Adult degenerative scoliosis is usually a disease of the elderly. The general somatic state of a person plays an important role in deciding whether to perform an operation. Diseases of the cardiovascular system, respiratory system, diabetes and other diseases can increase the risk of complications during or after surgery and make surgery too risky. The purpose of the operation is to improve the balance and stabilization of the spine, as well as decompression of the spinal cord and nerve roots. New surgical techniques have been developed that provide maximum correction with minimal cosmetic defects. To correct and fix the deformation, titanium rods fixed in screws and / or hooks are often used, and fixation is also carried out using a bone graft. Decompression of the spinal cord and its roots is carried out using a microsurgical technique using a microscope. In the postoperative period, the patient should wear a special corset for 3 months, engage in exercise therapy.
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