Surgery for scoliosis: types and methods of surgical intervention
This disease has a complex mechanism of development and is accompanied by gross anatomical deformities of the spine, so often the only option to cure scoliosis surgery. Scoliosis is a disease which is accompanied by a lateral curvature of the spine. However, the presence of «pure» scoliosis is found only in the early stages, eventually joins the anterior or posterior curvature and deformation in the twisting type about the axis. The prevalence of this illness reaches 3 % among all students.
Scoliosis is one of the most difficult pathologies to treatment. Even in the early stages conservative treatment does not give positive results, but only slows down the progression of the disease. The only effective method is surgery. For a better understanding of the indications and the technique of the operation, you must first understand the mechanism of the development of scoliosis.
How does the curvature
To the development of primary changes in the lateral curvature of the spine can result in both congenital anomalies and acquired after diseases. Scoliosis can occur as a result of the insolvency of the musculo-ligamentous apparatus and rachitic curvatures of the skeletal system. Also his appearance is observed after diseases that affect the nervous system. These include poliomyelitis, neurofibromatosis, syringomyelia, spastic paralysis, and others. Development of scoliosis can be predetermined congenital anomalies of the vertebrae and ribs, and also be a complication of extensive burns or plastic surgery on the chest with a large degree of interference. In connection with the gaps in the understanding of scoliosis allocated idiopathic scoliosis, the causes of which are unknown.
With the further development of the lateral curvature of the spine, the vertebrae starts to rotate around its axis with the direction of convexity of the spine. This leads to the formation of the rib hump on one side and an area of flattening on the other. Due to these changes there is a redistribution of weight on the surface of the vertebra. The greatest burden falls on the part of the vertebra that is located on the concave side of the spine. This leads to increasing compression of the vertebral bodies and their flattening.
The changes also affect the muscles and ligaments. Anterior longitudinal ligament that limits extension of the spine as the most powerful part of the ligaments begins to thicken because of the increased load on the affected segment of the spine, and all the others shrivel.
All these pathological changes lead to reduced mobility in the spine towards extension. Also found curvature of the spine above and below the primary tumor and scoliosis. These topographic-anatomical changes lead to a change in the location of organs and adversely affect their functioning.
Scoliosis most often develops in childhood and adolescence. The most flagrant violation found in those children who have other first signs of scoliosis.
Signs and symptoms of the disease
How to detect scoliosis in the early stages? The basic data that allow to suspect the presence of scoliosis is a different posture deviations that can be detected by inspection. Begin the examination, when the patient is in a standing position. Pay attention to the deviation of the spine away from the midline. To better define the curvature to hold the line with a colored marker on the spinous processes of the spine.
Also one of the signs of this disease is higher the location of one of the girdle relative to another. During the inspection of the blades revealed the same asymmetry. From the concavity of the spine increased waist triangle, the base of which forms a hand and a vertex point that is midway between the ribs and the iliac crest. An increase of the deformation ribs on the side of the curvature when tilting the patient forward.
There are 4 degrees of spinal deformity in scoliosis.
- I degree – the angle of deformation up to 10°. Characterized by the presence of all the above changes. The back muscles are weakened, their tone is reduced. When bending is determined by the presence of muscle cushion in the region of curvature. The pelvis is not misaligned.
- II degree – from 11° to 25°. There is S-like curvature with the presence of the rib hump. All the signs of the curvature are expressed to a significant extent. The blade on the convex side is raised above the rib cage. When the tilt is visualized muscle cushion in the lumbar region. Detected by the distortion of the pelvis and shortening of the limb on the side of the skew. On the radiograph change is observed wedge-shaped vertebrae.
- III degree – the angle of the strain from 26° to 50°. All of the above accompanied by a shortening of the trunk and neck. Restricted movements in the shoulder joints. The blades are so behind the chest that take the form of wings. On radiographs visualized the wedge-shaped vertebrae with deformity of the intervertebral discs.
- Grade IV – between 51° and more. All changes progress and become more pronounced. Show signs of deforming spondylosis, spondylosis.
Using radiography cannot visualize curvature of the spine and diagnosis in accordance with clinical manifestations.
Treatment in accordance with the degree of deformation
Scoliosis I and II degree, treated by a conservative. To strengthen the muscles of the back and abdomen is recommended physiotherapy, massage, corset chenault, medical-preventive gymnastics and swimming. Corset chenault provides fixation and correction of spinal curvature. His appointment is only in the early stages of the disease.
Spinal surgery for scoliosis is indicated for patients with III and IV degrees of severity. For analgesia is a combination of an endotracheal (supply of anesthetic in a gaseous state via the respiratory tract) and intravenous anesthesia. Surgery for scoliosis III degree is carried out according to the method of Dwyer.
It begins with the formation of front access accompanied by snacking ribs in the thoracic spine. For lumbar carry out the dissection of the anterior abdominal wall and provide displacement bodies that are located in the projected area of the spine. For visualization of the vertebrae dissected the pleura or the peritoneum. Next, remove the intervertebral disc in the region of the curvature, and vertebral bodies that are on the tops of the deformations, are found bone biofinity. Further, through the tops of the screws and clips hold the orthopedic rods of the clamps, which adjust the curvature. This design from top to close the pleura is sutured and the access location. A feature of this surgery is that the patient retains the mobility of the spine.
When IV severity surgery for scoliosis is conducted using the branch-Lenk. Anesthesia similar. The procedure is carried out with formation of rear access, which will provide visualization of spine. Enter biofinity through the arch of the vertebrae on the tops of the deformations.
However, the distinguishing point is to conduct forcible correction of lateral curvature and elimination of deformation of the twisting type about the axis. Only after that the spine fixed with rods, and then spend the closure of surgical access. The patient can walk 1 day after surgery.
However, it does completely back surgery scoliosis? No, it allows him to transfer in I severity. It restores the normal position of internal organs, their functioning and provides an almost normal posture.
Surgical intervention is indicated for patients with III and IV degree of lateral deformation of the spine.