Scoliosis. Deformations of the
neck, chest. Clinic, diagnosis
and treatment.
PROFESSOR
Fishchenko Vladimir
Alexandrovich
BASHINSKIY GENNADIY
PETROVICH

Scoliosis (Scoliosis) - a serious disease
of the musculoskeletal system,
represented by the curvature of the
spine in the frontal plane and twisting
around its vertical axis (SARS), which
manifests itself at a young age and
progresses with the growth of the
organism

Depending on the age of the appearance of
strains of scoliosis are the following:
Infantile (diagnosed before 3 years of age)
(Infantile)
Juvenile (diagnosed from 3 years to 10
years) (Juvenile)
Junior (diagnosed between 10 and 15
years) (Adolescent)
Scoliosis in adults (diagnosed in adulthood,
after the termination of growth) (Adult)
 skeletal
changes in scoliosis,
depending on age

Of the numerous classifications of
scoliosis in accordance with the
etiology and pathogenesis of most
widespread use classification received
Cobb (1958), according to which they
are distributed into five main groups.

The first group - myopathic scoliosis .
Basically on these curvatures of the
spine is insufficient development of
muscle tissue and ligaments. This
group can be assigned and rachitic
scoliosis, which arise as a result of
degenerative process not only in the
skeleton, but also in the
neuromuscular tissue.

The second group - scoliosis
neurogenic origin: on the basis of
neurofibromatosis, syringomyelia,
spastic paralysis. In the same group
may be included scoliosis and
lyumboishialgii caused by degenerative
changes in the intervertebral discs,
often leading to compression of the
roots and cause clinically hetero-orgomo radicular syndrome

The third group - scoliosis on the basis
of of developmental abnormalities of
the vertebrae and ribs. This group
includes all congenital scoliosis, which
is associated with the occurrence of
bone dysplastic changes.

The fourth group - scoliosis caused
diseases of the chest (scar after
empyema or burns, plastic surgery
on the chest

- The fifth group idiopatic scoliosis,
the origin of which currently is still far
from understood.
These scoliosis found in the greatest
number of people
By the degree of scoliosis
deformation divided

I degree scoliosis is characterized by
small lateral deviation of the spine and
the initial degree of torsion,
radiographically detectable. Torsion on
the radiograph is defined as a small
deviation of the spinous processes of
the midline and the lack of symmetry
of the roots of the arches. Angle of the
primary arc of curvature less than 10 °

Scoliosis II degree is accompanied not
only noticeable deviation of the spine
the frontal plane, but also expressed
the rotation, the presence of
compensatory arcs. Radiographically
clearly manifested deformation of
vertebral bodies at the level of the top
of the curve. Angle of the primary arc
of curvature in the range 21-30 °.
Clinically defined muscle roller because
torsion of the spine and rib hump.

III degree scoliosis is characterized by
persistent and more severe
deformation, the large rib hump,
deformity of the chest. Angle of the
primary arc of curvature from 40 to 60
°. Radiographically on top curvature
and adjacent areas are wedge-shaped
vertebrae, intervertebral discs with the
concave side of hard traced

Scoliosis IV degree accompanied by severe
deformation of the body. Marked
kyphoscoliosis of the thoracic spine,
deformity of the pelvis, the deviation of the
body, stiffness in the spine, fixed deformity
of the chest, back and front rib hump.
Determined radiographically pronounced
sphenoid deformation bodies of the thoracic
vertebrae, and spondylosis, deformans
spondylarthrosis in the thoracic and lumbar
spine, calcification of ligamentous
apparatus. Corner of the main curvature
Сlassification of scoliosis
by Chaklin

Curvature of the spine are divided into
four levels (by Chaklin)
when I degree angle of curvature 180-175 °;
with II degree - 175-155 °;
with III degree - 155-100 °;
with IV degree - less than 100 °
How to define scoliosis

Congenital form of scoliosis in the
early stages is almost impossible to
determine. It must notice at regular
examinations by orthopedist.
Orthopedist should prescribe intensive
orthopedic treatment. Thus, we can
stop the development of scoliosis to
severe stages.

If a child is already on his feet,
parents can also do a little diagnosis,
which will help determine whether
there is a violation in posture. There
are five such points, which will help
them to see the lateral curvature.

First, the shoulders are at different
heights. Second, the uneven position
of the lower corners of the blades. To
define it is necessary to bring your
fingers under the blade and see at
what level they are located. Third, the
presence of lateral folds of the
stomach, on one side of the body
deeper one pleat, and on the other
side of the fold is absent.

Fourth - different levels of sacral dimples.
Fifth - when you lean forward or when
lying down spinal curvature is maintained.
This manifestation is absent in scoliotic
posture

Treatment of severe curvature of the spine
is very difficult. Expect a significant
correction of deformation is possible only
with scoliosis I degree. Treatment usually
must be started as soon as the first signs
are found curvature of the spine

Modern methods of treatment of scoliosis
can be reduced to three main points: the
mobilization of the spine, deformity
correction and retain the achieved
correction. This is achieved by means of
physiotherapy, special corsets, or
combined methods

The main method of treatment of
scoliosis currently accepted
combination.
Gymnastics in regular employment for
several years increases muscle tone
and makes the muscles able to resist
deformation

Exercises must be carried out in the
clinic and make sure the house where
treatment is considered basic. The
clinic only studied complex, controlled
quality of its execution, introduce new
exercises. Basic exercises gymnastics
performed lying: strengthening those
muscles that standing less loaded.
Exercises should spend at least 2
times a day, morning and evening (at
least 20-30 minutes per session).
CORSET CHENOT

In world practice Corseting for over 30
years is a major scientifically proven
method of conservative treatment of
intermediate forms (II-III Art) scoliosis
in children and adolescents. Using a
corset for scoliosis is the only nonsurgical method of treatment for which
there is scientific evidence for the
effectiveness
Indications for treatment
corset CHENOT

Angle of curvature of the arc before the
onset of signs of puberty is 20 degrees.
In cases bending magnitude increases more
than 20 degrees more than 5 degrees per
year.
With the amount of curvature of more than
40 degrees and significant structural
changes in the vertebrae in patients of any
age unfavorable prognosis. In these cases,
brace therapy performed before the
optimum moment for surgery.
Funnel breast

Funnel chest (chest "cobbler") may be
congenital or acquired. It is
characterized by a funnel-shaped
recess the bottom of the chest wall
and upper abdomen, deepening crater
and bend in the dorsal direction
xiphoid process of the sternum and
costochondral junctions.
Classification depending on
depth of the "funnel" and the
degree of displacement of the
heart

There are three degrees of deformation:
I degree - depth "funnel" within 2 cm
without displacement of the heart.
Grade II - deformation depth of not more
than 4 cm and displacement of the heart
within 2-3 cm
Grade III - deformation depth of more
than 4 cm, and the displacement of the
heart more than 3 cm
Keeled chest

Characterized by an increase in the
anterior-posterior diameter of the chest
In this case the sternum and xiphoid
sharply protrude. It gives a bird's view of
the chest
Treatment of congenital
deformities of the chest

Appointed by the general and special
exercises volleyball, basketball and
swimming.
In strengthening deformation and increase
functional changes of cardio - vascular
system, the elimination of which is
possible only by surgery - by thoracoplasty
Congenital high scapulae

Congenital high standing scapula
(Sprengel's deformity) - malformation,
characterized in that one of the
scapula 4-5 cm is above the other. At
the same time it is rotated around the
sagittal axis so that the lower angle of
the scapula approached to spine, and
the outer edge is tilted downward.
Treatment-operative.
Klippel-Feil disease

It is deformity of the cervical and thoracic
spine, which arises due to malformation of
the cervical segment and is characterized
by extensive vertebral synostosis but
arches have rupture

Clinically - in patients with a short
neck, sometimes it seems that it is
absent. The boundary of the scalp is
so low that the scalp goes to the
scapula. Head tilted sharply to the side
and anteriorly so that the chin touches
the chest. Marked asymmetry of the
face and skull, marked limitation of
motion of the cervical spine, scoliosis
or kyphosis marked, high standing
shoulder girdle and scapula.
Grisel disease (torticollis or
rotational displacement of
the atlas)

Grisel French doctor in 1930 described
the etiology and pathogenesis of this
disease, called it displacement of the
atlas and nasopharyngeal torticollis.
Always precedes the appearance of
deformation inflammatory disease in
the throat or nasopharynx,
accompanied by a high fever. After the
disappearance of acute inflammation
remains the torticollis

Grisel is explained displacement of the
atlas due to contracture of paravertebral
muscles that attach to the front tubercle
of the atlas and the skull and taking part
in the movement of the skull around the
dens II cervical vertebra

The disease occurs most often in children,
mainly in frail girls 6-11 years old, weak
muscle-ligament apparatus and features of
the lymphatic system that contribute to
the deformation. The baby's head is tilted
in one side and rotated in other side

Treatment of this disease - antiinflammatory therapy, decontamination of
the nasopharynx, traction loop of Glisson
followed by the imposition collar Schantz
Congenital torticollis
Neck deformities which are characterized by
incorrect head position - inclination to a side and
rotation - are united under the title “torticollis”.
Most cases of congenital torticollis are of muscular
and congenital origin.
Congenital muscular torticollis is one of the most
common orthopedic diseases in children. According
to most authors it takes the third place after
congenital hip dislocation and clubfoot. The number
of the disease increased last years.
Muscular Torticollis On the Left Side
The guiding /key/ element in the pathogenesis of
torticollis is an abnormal changes in
clavisternomastoid muscle, that is lead to its fibrous
degeneration. Degenerated muscle begins to delay
in growth and in some time becomes shorter than
the opposite muscle. Shortened muscle tension
makes its points of attachment closer. This leads to
patient's head tilt /inclination/ on the affected side
and head’s turn to the opposite side. That is the way
of forming of the main symptom of the disease wrong head position, called torticollis. On the
background of it other secondary changes in skull
and spine are developed. This sequence of muscular
torticollis development makes clear why the
symptoms in newborns in the first days of life are so
poor.
In most cases the initial symptom of the disease is
the thickening and sclerotic compaction of
clavisternomastoid muscle, which appears at the
end of the second week. It is located in the middle
or lower third of the muscle and has fusiform shape.
In opinion of most authors it is a place where
tendon degeneration is observed. As a rule, at the
end of the 2nd month of life the limit in turning
head to the affected side and its inclination to the
opposite one is clearly visible. At the same time
secondary deformities – asymmetry of the skull and
face, which can be detected by different form and
size of auricles at this age –
begin to be identified.
The forced head position causes the noticeable
asymmetry of facial skeleton by 3-6 years old. All
the skull bones, especially the lower jaw, are
involved into the deformation process, forming the
so-called "scoliosis of face". The vertical size of face
decreases and the horizontal one increases on the
side of lesion. All the lines, which connect bigeminal
points of face, cross in the space on the affected
side; while nose, mouth, chin are situated on the
concave to the affected side curve /Felcker’s
symptom/. In addition, there is a compensation of
bent head position in congenital muscular torticollis
by raising the girdle of superior extremities and
lateral head displacement towards shortened
muscle. Radiography detects asymmetry of the
skull, which can be measured by a special technique
and is a sign of severe forms of disease.
Treatment of congenital muscular torticollis is
conducted by conservative and operative methods.
Patients in the age of 1 year are treated
conservatively. Effectiveness of conservative
treatment depends on early diagnosis /it’s better on
the second week of illness/.
The panel of procedure involves corrective laying,
therapeutic exercises and physiotherapy. The child
lay on the unaffected side to the wall, so that he
could turn his head to the affected side when
various stimuli appear.
Up to 3 months passive exercises are performed turnings the head to the affected side and its
inclination towards unaffected side. They perform
about 20-30 turnings and inclinations before each
feeding. The corrective position is ensured by
cotton-gauze pad /pillow/. Massage prescribed to
the patients should relax the muscles on the
affected side and reinforce the muscle tonus on the
opposite side. Physical therapy techniques include
heating procedures - solux, paraffin and
electrophoresis with potassium iodide, lidaza
Surgical treatment includes removing of the main
link of the disease - shortened clavisternomastoid
muscle. The optimal age for surgery is 1-3 years.
The most effective operation was offered by
Zatsepin. It involves dissection of sternal and
clavicular cruses of the muscle with the obligatory
dissection of the surface layer of neck fascia in a
lateral triangle. Thanks to this, the edges of the
dissected muscle dihescence, forming a diastasis
that reliably prevents the possibility of relapse of
disease. To increase the diastasis the resection of
the lower areas of clavisternomastoid muscle by
Mikulic within 2-3 cm is also performed.
Operation by Zatsepin (a), fixation of head with
the help of plaster bandage (б) and headholder
(в)
In order to achieve a better cosmetic effect some
authors recommend allongement (lengthening) of
muscle instead of its intersection, but this operation
is not widely used because of the high likelihood of
relapse.
In the postoperative period the patient is Glisson’s
skull traction tongs in order to hold the head in
hypercorrection position. After 6-7 days a plaster
collar is set for 30 days.
After the finishing of immobilization therapeutic
exercises, massage, physiotherapy are conducted
within 3-6 weeks.
In a case of perfectly performed operation and
proper management of patients the recovery is
obvious in the postoperative period.
Untreated cases lead to severe irreparable
deformations.