Kyphosis in children: symptoms and treatment
Kyphosis( from "kyphos", Greek.) - "bent, curved" - is a term by which is meant the pathology of the spine with the curvature of one of its divisions.In kyphosis, there is a deviation from the central axis of the spinal column in the anterior-posterior direction, that is, the convexity is directed toward the back.Table of contents: Classification of kyphosis Reasons for development of kyphosis Characteristic signs of kyphosis in children Consequences of kyphosis in children Diagnosis of kyphosis Treatment of kyphosis in children A set of exercises recommended for kyphosis in children Prevention of kyphosis
Classification of kyphosis
In the vast majority of cases, the disease affects the thoracic regionThe spine.Externally, this pathology manifests a marked violation of posture - stoop or even hunchback.
This disease of the musculoskeletal system is often combined with scoliosis, i.e. curvature of the spine in the lateral direction, so in medical practice, the diagnosis is usually "kyphoscoliosis".
Note: must distinguish pathological kyphosis from physiological.Bends relative to the sagittal axis are in any properly formed spine.They are necessary for a person to withstand loads, moving in an upright position.As physiologists and orthopedists say, "spinal diseases are our payment for uprightness."
With pathological kyphosis, not only the bulge in one compartment is noted, but, as a rule, the deflection along the entire length of the spine.
According to the well-known classification, the following main types of pathological kyphosis in children are distinguished:
With angular kyphosis( for example, with compression and tuberculosis lesions), several protrusions are prominent, while in the arcuate there is a curvature of the spine along the entire length.
Given the etiology in traumatology and orthopedics, the following types of kyphosis are distinguished:
- congenital( including genetically determined);
- is a lateral( postural);
- dorsal youth;
- is paralytic;
- is degenerative;
- secondary( develops against the background of systemic diseases with connective tissue damage);
- post-traumatic( including compression);
- mobile( against the background of weakness of the dorsal muscles);
- is rickety;
- is tubercular;
- total( normally fixed in babies of the first months of life, and in adults it develops against the backdrop of Bekhterev's disease).
There are several degrees of pathology:
- 1st( light) degree of kyphosis - angle of curvature within 30 °;
- 2nd( moderate) - from 31 ° to 60 °;
- 3rd degree of kyphosis - angle more than 60 °.
According to the alternative classification, the following can be diagnosed:
- Hypokyphosis - curvature within 15 °;
- normokifose - from 15 ° to 50 °;
- kyphotic posture( hyperkypophysis) - curvature of the spine over 50 °.
According to the simplified classification, kyphosis in children is divided into congenital and acquired.
Localization of pathological changes in children distinguishes:
- thoracic kyphosis( vertebrae Th4 - Th10 involved in the process);
- lumbar kyphosis( affected Th11, Th12, L1 and L2).
For the age at which kyphosis developed, it is customary to distinguish:
- infant( more often as a consequence of rickets);
- for children;
- is a teenager;
Reasons for the development of kyphosis
Congenital kyphosis in children may be associated with certain disorders of fetal fetal development.With this form of pathology, there is a disruption in the formation of vertebrae or underdevelopment of intervertebral discs.
Acquired kyphosis often develops on the background of rickets - a disease that is characterized by a violation of osteogenesis in the background of a severe shortage of vitamin D. Spine curvature in this case has an arcuate shape.It is formed at the level of L1-L3, i.e.In the lumbar region.
Important: is one of the causes of curvature of the spine, in particular - kyphosis, is a serious oncological disease, like leukemia.
Often the cause of kyphosis is the weakness of the dorsal muscles, which in turn can be a consequence of a sedentary lifestyle.In young children, an incorrect posture plays an important role in shaping the curvature of the spine.At school age, a reason is added, such as the need for daily wearing of heavy knapsacks or backpacks with textbooks.
The weakening or paralysis of the musculature of the dorsal region may also be a consequence of the following diseases and pathological conditions:
- cerebral palsy( cerebral palsy);
- Poliomyelitis( infectious disease with spinal cord injury);
- tumor neoplasms of the spinal column;
- osteochondrosis( it is relatively rare in childhood);
- periodic psychoemotional stresses.
Kyphosis is often post-traumatic( in this case, the angular form of the disease develops).
One of the reasons for the appearance of pathology is surgical intervention on the spine.
Characteristic signs of kyphosis in children
The presence of deviations is often noticeable even for people who do not have a special education.
In a child suffering from kyphosis, the following are noted:
- the descent of the shoulders and bringing them forward;
- belly protrusion;
- marked deviation of the upper trunk in the forward direction.
Important: is one of the most common symptoms associated with kyphosis, pain in the problematic spine.
Consequences of kyphosis in children
Curvature of the spine causes very unpleasant consequences for the child or adolescent.In addition to changing the appearance that many children experience very painfully, there is a decrease in the volume of the chest.This physiological disorder leads to the development of constant oxygen starvation( hypoxia), the onset of headaches, as well as pain in the heart.Possible disruption of the blood supply to the brain leads to increased fatigue and reduced mental activity.With kyphosis, the intercostal muscles work, which adversely affects the respiratory function.
Important: to start active treatment of kyphosis is necessary immediately after confirmation of this diagnosis by a pediatric orthopedist!
Congenital kyphosis often leads to paralysis of the legs, and up to 30% of patients suffer from various dysfunctions of the urinary system.
Frequent complications of kyphosis are intervertebral hernias, which in some cases become a direct indication for surgical intervention.
Diagnosis of kyphosis
Only an orthopedic specialist can diagnose and determine the form of the pathology and degree of disturbance.
Diagnosis of kyphosis includes detailed collection of anamnesis( including family history), and a physical examination involving a series of tests.
A test is always performed to identify possible neurological disorders( although they develop relatively infrequently in childhood).
A forward tilt test is also required;This position of the child's body allows you to objectively assess the degree of curvature when viewed from the side and from behind.
Inspection involves the study of respiratory function in order to identify its possible violations due to the curvature of the thoracic spine.
In addition to the diagnosis of kyphosis, laboratory-instrumental methods of locomotor examination are used, among them:
- X-ray examination;
- CT( computed tomography;
- MRI( magnetic resonance imaging).
Note: CT provides an opportunity to identify pathological changes in bone tissue, and MRI allows you to determine the presence of structural changes and give an objective assessment of the processes occurring in the spinal cord and nerve roots.
Treatment of kyphosis in children
Conservative treatment methods include:
- manual therapy;
- wearing supporting corsets of various designs;
Unfortunately, with some forms of kyphosis, it is not possible to do without surgical treatment.
Postural( sedimentary) kyphosis, which is very typical for adolescence, almost always accompanies hyperlordosis - pathological bending of the spine anteriorly in the lumbar region.To eliminate this violation, it is advisable for a child to sleep on an even hard surface and hang more often on a horizontal bar, "stretching" his back.To improve the posture and strengthen the back muscles during the period of active growth and reconstruction of the musculoskeletal system, a complex of exercise therapy( therapeutic physical culture) has been developed.It is advisable for a young patient to attend group sessions, where the correctness of the exercises will be followed by an experienced specialist.
In the treatment of congenital kyphosis for the elimination of pathology or the stopping of its progression, in most cases an operation is indicated.
Surgical correction is also the only method of treatment of post-traumatic spine pathology.Operative intervention in kyphosis involves the stabilization of the spinal column in the correct position by means of metal( titanium) rods and screws.
A set of exercises recommended for kyphosis in children
Note: requires a tourniquet and a gymnastic stick to perform therapeutic exercises.
Basic exercises for kyphosis:
- As a warm-up you need to take your hands back so that the gymnastic stick is between the body and elbows.Shoulders align to achieve the most even posture.In this situation, walk quietly around the room for 10 minutes.
- Align the shoulders, tilt at an angle of 90 °( so that the trunk at the extreme point is parallel to the floor surface).The head and pelvic area should remain immobile.Repeat 20-30 times, making sure that breathing is even.
- Holding one hand behind the bar, you do not have to swing to hang on it until the first weak pain sensations appear.
- Run 20-40 slopes with a straight hull in the sides, making sure that the abdominal area is tightened.Jerk should be avoided!
A complex of effective exercises for kyphosis of the thoracic spine is presented in the video review:
In the event that kyphosis causes periodic painful sensations, the prescription of the doctor can take analgesics and non-steroidal anti-inflammatory drugs.As an analgesic, acetaminophen is often recommended.
Manual therapy involves warm-up of the patient back area.Procedures should be conducted only by an experienced manual technician with solid experience of working with children.
Note: with manual intervention often causes pain in a certain area.This is an indication that a group of muscles and ligaments have begun to work, that is, manipulations have a positive effect.
In a number of cases, a child with a kyphosis treatment has to wear a special orthopedic design for a long time - a corset.This auxiliary therapeutic device allows to minimize or completely prevent pain, and also to support the back, shoulders and chin in a physiologically correct position.Corsets can stop the progression of pathology.Selection of the design and determination of the duration of its wearing is the task of the attending physician.In difficult cases, patients are shown not to remove the corset most of the day( up to 20 hours).
Prevention of kyphosis
Measures to prevent acquired kyphosis involve the elimination of possible causes of pathology.The child needs to lead an active lifestyle, and spend as little time as possible in front of a computer or television.The height of the desk, as well as the chair, should correspond to the height.Since children are actively growing, regular workplace correction is required.With short-sightedness, they need to wear glasses or lenses to constantly not bend forward.
If the child begins to stoop, embarrassed by his height, he may need to consult a child psychologist.
Konev Alexander, internist