Surgical treatment of scoliosis (operation)

Operations on the spine are in the area of ​​complex and high-tech medicine and are possible only in specialized clinics, with the appropriate material and technical base and staff. Surgery gives positive results and significant relief from scoliosis patients, but nevertheless the case that the operation does not justify the imposed expectations. Therefore, the decision about the operation in each case must be taken very carefully and cautiously, passing a comprehensive examination and consultation with experienced professionals.

indications for surgery

The main indications for surgery for scoliosis include:
• progressive spinal deformity (with an angle of curvature of 40 degrees or more) in children, when not yet completed skeletal growth;
• spinal deformity with an angle of 60 degrees or more;
• strain, which put pressure on internal organs, primarily the heart and lungs, thereby disrupting their work;
• a strong pain that can not be removed by conservative methods of treatment;
• defect in appearance caused by the deformation of the spine.

It is believed that the most favorable time to operate is the time before the end of the growth of the spine. Operation in early childhood fraught with changes in the growth of the spine in a direction opposite to the original distortion that can cause a new strain. In adulthood, the operation, in most cases, carry out because of pain, degenerative change or desire to achieve a cosmetic effect.

Types of operations on the spine for correction of scoliosis

The operation on the spine, usually has several goals at once: stop the progression of deformation correction and stabilization of the spine, removing pressure on internal organs, the elimination of pain and spinal cord compression, removal of cosmetic defects. Correction of the deformation is carried out by fixation of adjacent vertebrae with metal. In this case the mobility of the spine, of course, is reduced. Metal staples remain in the patient's body forever. Most recently developed movable metal that can be used for the growing spine.

Appliances, tools and methodology of surgical treatment for scoliosis is constantly evolving. Development in France in 1984 and Kotrelem Dyubusse (Cotrel, Dubousset) metal structure, which reduces the amount of strain stabilizes the spine and affects the rotation of the vertebrae has become a new word in the surgical treatment of scoliosis. Before this technique was used Harrington (Harrington). These two methods are used most heavily, they became the basis for further development of spinal surgery. Below is a brief description of the operational methods used in this country and abroad.

The method of Harrington (Harrington)

The method of Paul Harrington became famous in the 60s of last century. The method is to use a metal structure, which consists of a rod and hooks, which roam freely and are attached to the back of the spine in the right places. Distractor rod mounted on the concave side of bending, fixing hooks on the articular process of thoracic and lumbar vertebrae. On the convex side of the curvature using a rod-contractor. The postoperative period is accompanied by the wearing of a plaster corset for up to two weeks. Subsequent to wear a special corset - from six months to a year.

Harrington method is the most simple and safe. The operation lasts about 3 hours. The degree of spinal deformity as a result of the operation is reduced by about 60% of the original. This value is approximately the same for other methods. Complete elimination of deformation is impossible because of the risk of spinal cord injury with a significant change in spine shape.

Method Kotrelya-Dyubusse (Cotrel-Dubousset)

This method was developed in the 80s of last century, french orthopedic surgeons. One of its main differences from the Harrington technique is to abolish the need for prolonged postoperative wearing a corset. The principle of the method Kotrelya-Dyubusse based on the use of an implant consisting of a fixation rods and hooks. The bars give the desired bend and attach them to the vertebrae. The method is widely used around the world.

Method of Luke (Luque)

In 1973 the Mexican orthopedic Eduardo Luque started working on a system for the correction of the spine.This design is a combination of L-shaped cylindrical rod and wire fixation, which allows you to spread out evenly along the length of an element of correcting spinal deformity. Postoperative fixation of the cast in most cases, the use of an operational method of Luque is not required.

Method Tsilke (Zielke)

Correction of deformity and fixation of the result by this method is based on the compression and derotation of vertebrae. The design consists of several pairs of elements: two bars and two screws. This system allows to form a solid structure, which can be used to create a sufficient correction of the curvature correction terms. After the operation is necessary to wear a plaster Zielke corset with subsequent transition to a special locking corset, worn up to 10 months.

Native methods of surgical treatment of scoliosis

In addition to these techniques are used in our country and the construction of our countrymen - distracters Kazmin, Fishchenko, plate-Rodnyansky Gupalova, Gavrilova. Often, surgery to combat the effects of scoliosis is running, using techniques Chaklin.

Kazmina distractor is used to correct the curvature of the lumbar spine. Distractor is installed so that their ends, he rested in the transverse processes of the vertebrae and the iliac bone.

Common in our country endokorrektory Rodnyansky-Gupalova are of two types. Monoplate endokorrektor used in dysplastic thoracic scoliosis with a curvature angle of 30 to 50 degrees (Cobb) in the treatment of juvenile kyphosis, and vertebral fractures. Dvuhplastinchaty endokorrektor severe degrees of scoliosis is designed for surgical treatment of dysplastic thoracic scoliosis of grade 4, taking into account the curvature of more than 50 degrees (Cobb).

In the West, the surgical treatment of the spine is no longer a rarity. Elaborate tools and extensive practice of minimizing the failure rate and complications. European leader in the use of surgical treatment of scoliosis is considered to be Germany. In our country the situation is somewhat worse, and therefore need to choose carefully the clinic, it is advisable to talk not only with his future surgeon, but also with the operated patients. best clinic in Moscow, St. Petersburg and Novosibirsk. All of them are usually found in the research institutes of Traumatology and Orthopedics (NIITO). Operations on the scoliosis is very expensive. For example, the U.S. operation Kotrelyu-Dyubusse in 2009 was worth 250 thousand dollars. In our country the cost of the operation, of course, is many times lower, but the likelihood of complications is higher.

Massage for scoliosis

Therapeutic massage - this is one of the traditional methods of conservative treatment of scoliosis, which is used in combination with exercise therapy, andphysiotherapy , korsetirovaniem, swimming, and diet. The main purpose of massage is to strengthen the back muscles and rib cage to create a natural support for the spine . In line with this objective is carried differentiated massage - on the concave side of bending it is relaxing, and a convex - toning.

Massage is indicated for any degree of scoliosis , since its effect normalizes muscle tone, strengthens them, improves blood circulation and lymph flow of the body, reduces pain, if any, and, ultimately, contributes to the creation of the muscular system, which is so important to keep the spine in the correct position.

To achieve positive results in the treatment of scoliosis, a combination of two types of approaches: the first - an integrated, second - an individual. Action by the attending physician and massage therapist should be well coordinated. The physician should explain the massage therapist what areas should be given the most attention. Massage therapist must have sufficient qualifications and adhere to the recommendations developed for a particular patient. Masseur is prohibited to have a direct impact on the deformed spine areas, if there is no clear prescription from your doctor.

When performing a massage stick to the usual sequence. First, massage the back, then - the lower back and buttocks, then - the chest and abdomen. If necessary, gently massage the cervical spine, which is said to have massage therapists cervical area.

The course of massage for scoliosis can be divided into several stages. At the initial stage of the course of performing intensive massage of superficial tissues, which increases overall body tone. Then, a deeper muscle massage that will eliminate muscular hypertonicity and possible degenerative phenomenon. The next stage of the course of therapeutic massage, aimed at correcting the deformation and "fixing" the results of the correction should be more intense and prolonged.

To achieve sustainable positive results in the year it is desirable to at least three courses, including at least twenty procedures. The duration of the procedure early in the course of 15-20 minutes and gradually increase to 40-50 minutes. The first half of the course of therapeutic massage treatments carried out daily, the second - in a day.

Massage - an important component of effective comprehensive treatment of scoliosis. But the treatment can not be limited solely to the massage. Only in combination with other treatments of scoliosis massage brings tangible benefits.

Exercises physical therapy for scoliosis

Exercise therapy is assigned at all stages of the disease, but it is most effective when the initial forms of scoliosis. Exercise strengthens muscles of the torso, muscular form. This has a stabilizing effect on the spine, corrects distortion and improves posture. Full range of exercise therapy for scoliosis include gymnastics, massage, correction of the situation, an exercise in the water, the elements of sports (skiing, swimming).

The danger of self-

Important! Selection exercises in a particular form of scoliosis and the individual clinical picture is held very professional. Strongly do not recommend doing it yourself. Striving to achieve significant and rapid correction of curvature in scoliosis, for example, intensive stretching exercises or mobilize the spine, can help compensate for disruption of the process and become a starting point of rapid disease progression.

Symmetric and asymmetric exercises

So far, there is disagreement between the supporters of the symmetric and asymmetric gymnastics. Much depends on the type of scoliosis, its extent, the dynamics of the disease. It should be understood that the exercise therapy as a treatment method, especially, should be directed to the stabilization of the deformation of the spine. Only a small correction of the deformity can be performed by a functional component of the curve. Stable components of curvature of the spine (structural or organic changes in the vertebrae) is not affected corrective exercises.

Independently perform the basic course can only be symmetric simple exercises that are recommended for minor violations of posture, as well as the initial degree of curvature of the spine.

When performing exercises on the symmetric deformation of the spine is minimal impact, greatly reducing the risk of their misuse.

Symmetric exercise is not the same effect on the symmetrical muscles of the trunk, which are unbalanced due to the curvature of the spine. Under the influence of exercise weak muscles are a heavy load, so that they are trained more intensively than strong muscles. The result is a correction of the neuromuscular system, and formed a balanced muscular system.

A set of exercises for scoliosis

This basic package includes the symmetric nature of the corrective exercises that strengthen the muscles of the trunk, pulling the metered spine, producing a correct posture.

The basic rules when performing compound exercises for scoliosis

1. Dosed physical load and watch the well-being by preventing its degradation. Start with the minimum load, with a gradual increase in her.
2. Do the exercises at a slow pace, carefully follow the bearing and to see how tense these or other muscle groups.
3. Eliminate visy-ups and avoid intense activity of spinal traction. Permitted only passive stretching.
4. Eliminate all the exercises to increase flexibility of the spine, do not perform exercises with elements of the torso along the vertical axis.
5. Rotate the load for the muscles of the shoulder girdle and arm with a load for the leg muscles.

Warm-up

1. Adopt a good posture by touching the wall or wall bars buttocks, calves and heels. Move away from the wall in 1-2 steps, keeping the correct posture. Breathing without delay.
2. The initial position (IP) - feet shoulder width apart, arms down. On the count of "1" to raise their hands up inhale, at the expense of "2-3" - to stretch, to "4" - give up, relax - breathe out.Run 4-5 times. Follow maintaining correct posture.
3. Section IV: feet shoulder width apart, arms down. On the count of 1 to 4 - circular motion apart ago - 4 times, with the arms down, his shoulders straightened. Then perform well at the expense of 1 to 4 circular movement of the shoulders forward - 4 times. The breath of freedom.
4. Section IV: feet shoulder width apart, hands on his belt. On the count of "1" - bending the knee to the stomach, to the "2" - take a starting position on the "3-4" - execute the same with the other leg. Perform the exercise 4-6 times. back is straight, exercise combined with the phases of respiration.
5. Section IV: standing, hands at shoulders. At the expense of "1-2" - the slope of the body forward with hands pulling forward (body and hands parallel to the floor, legs straight) - exhale at the expense of "3-4" - take the starting position, inhale. Perform 4-5 times.
6. Section IV: standing, hands behind his back to the castle. On the count of "1" - allocating the hands back at the expense of "2-5" - holding positions on the "6" - and take. § Back straight, chin lifted, shoulders are reduced, the hands do not touch the pelvis. Perform 3-4 times.
7. The main stand. On the count of 1 to 4 as you exhale slowly perform squats, arms forward. Back straight, arms straight, palms inward. At the expense of "5.8" accept a starting position, exhale. Perform 4-5 times.
8. Section IV: standing, hands in front of chest. In the "1-2" - farming hands to the sides, palms up, inhale on the "3-4" - the starting position, exhale. Back straight, arms at shoulder level.Perform 3-4 times.

The main section

1. Section IV: standing, elbows to the sides, hands at shoulders. On the count of 1 to 4 carry out the rotation elbows (first forward, then back). Movements are performed with a small amplitude, elbow rotation describe a small circle. Pace of implementation - slow. 2.3 redo.
2. Initial position: standing up. At the expense of "1-2" on the side of the thoracic scoliosis (spinal deformity convexity) omit the shoulder and tap it back to bringing the blade to the center line (the spine), the "3-4" - the starting position. Perform 6 times, not allowing the rotation of the body
3. Initial position: standing up. At the expense of "1-2" on the opposite side of the thoracic scoliosis shoulder lift and rotate it forward to pulling the shoulder blades back. We make 6 times, not allowing the rotation of the body
4. "Traction" spine. It's important to master this exercise.
   I. Section: standing. On the inhale stretch the crown of the head up, trying to become taller. This is not to become the "socks" (heels touch the floor) and lift the shoulders up. Inhaling moderate, not the maximum. After reaching a peak of stretching, hold your breath for 5-10 seconds (depending on fitness), and during this time seek to keep up (keep your muscles tense.) You can quite compare themselves with tight string or young rostochkom spring, which stretches toward the sun. Drag, and not imitate traction. Work on the traction should not be stopped for a second. Then exhale and gently remove the tension is gradually relaxed. Begin and end stretching slowly, without jerking.
The exercises lying on your back is intended to strengthen the abdominal muscles.

5. Exercise "scissors".
   I. Section: lying on his back, hands behind your head or along the trunk. Perform horizontal kick their feet crosswise. Mahi is desirable to produce closer to the floor. Pace of implementation - medium. Perform 2-3 sets of 30-40 seconds.
6. Exercise "bicycle".
   I. Section: lying on his back, hands behind your head or along the trunk. Feet commit motion, simulating cycling. It is important that the angle between the legs and the floor was small.Air performance is average. Perform 2-3 sets of 30-40 seconds.
7. Section IV: lying on his back, hands behind his head. On the count of "1" - raise the leg to "2" - to separate the sides, at the expense of "3-6" to hold in that position, "7" - to join up and to the "8" - omitted. Shoulders and elbows pressed to the floor, lifting a small corner. Breathing is arbitrary. Perform 6-8 times.
8. "Traction" spine.
   Exercise carry on his back, with heels are drawn "down", the crown - the "up". We carry 4.3 "traction" for 10-15 seconds.
Resting supine. Diaphragmatic breath. Then turn over on his stomach. The exercises are designed to strengthen different groups of muscles.

9. Section IV: lying on his stomach, hands at shoulder level, pressed to the floor. At the expense of "1-4" - slide your hands forward along the floor until they straighten and then stretch, the "8.5" - execute curl with palms turning upward, connect the blade at the end of the movement. The chest is pressed against the entire surface of the floor, head up, chin pressed against his neck. Perform 6-8 times.
10. Lying on his stomach, arms bent. At the expense of "1-2" - to raise his head and shoulders, breath, stand still in this position in the "3-4", at the expense of "5-6" and accept. forth, exhale. Perform the exercise 5-6 times.
11. Section IV: lying on his stomach, legs straight, his head rests on the back of the palms. Raise the legs and upper body, bending at the waist, arms outstretched, the fulcrum - the stomach. The angle of ascent of hands and feet small. Statically stops in this position for 10-15 seconds. It is advisable not hold your breath. In carrying out this exercise have to take your hips off the floor. Perform 3-4 times.
12. Exercise "scissors".
    I. Section: lying on his stomach, legs straight, his head rests on the back of the palms. Raise the legs and run skrestnye horizontal kick their feet. In carrying out this exercise have to take your hips off the floor. Air performance is average. Perform 2-3 sets of 30-40 seconds.
13. Exercise "floating".
    I. Section: lying on his stomach, legs straight, his head rests on the back of the palms. Raise the legs and upper body, bending at the waist, arms outstretched, the fulcrum - the stomach. The angle of ascent of hands and feet small. Hold this position, perform movements that mimic swimming breaststroke: arms forward - the legs to separate the sides, hand in hand - feet together, hands to shoulders, the legs are still together. Perform 2-3 sets of 10-15 reps.
14. Section IV: lying on his stomach, arms bent at the elbows, holding dumbbells, feet together. On the count of "1" bit to stretch your head forward and straighten arms forward, lift legs on the "2-3" - bend arms to the shoulders, bend in the thoracic region, the "4" - to its original position. The angle of ascent of hands and feet small. Repeat 6-8 times.
15. Section IV: lying on his stomach, arms bent, dumbbells in hands, legs parted. To "1" - to raise a body with his hands while pulling on the side of the concavity of thoracic scoliosis up - breath, at the expense of "2-3" - to keep the position, "4" - to its original position - exhale. Perform 4-6 times, keeping the body upright position.
Relax, restore breathing, and turns over on its side.

16. Section IV: lying on his side, on the side of thoracic scoliosis. Alternately, move the legs straight forward and back. The legs should not touch the floor. Exercise like "scissors." We make it 10-12 times.
17. Section IV: lying on its side on the side of thoracic scoliosis, legs parted. On the count of "1" to raise his hand to the side of the concavity of the thoracic scoliosis up, inhale on the "2" - the starting position - exhale.
18. Lie on your left side, under the ankle joints - roller. To "1" - to raise his legs, "2-5" - to hold a pose at the expense of "6" to accept a starting position. Muscles tense, back straight.Perform 4-6 times. Then repeat the exercise on the other side 4-6 times.
19. Section IV: standing on all fours. On the count of "1" hand on the side of the concavity of the thoracic scoliosis lift and pull forward, "2" - a leg on the side of the concavity of the lumbar scoliosis lift and pull back, "3" - to hold a pose at the "4" - the starting position. Body straight, leg and arm parallel to the floor. Repeat 4-5 times.

The final section

Starting position: standing up.

1. Walking on his toes, hands up.
2. Walking on heels, hands behind his back to the castle.
3. Walking with a high lifting hips and hands forward.
4. Walking with a "rebounding" legs, hands behind his back.
Starting position: standing at the gym wall.

5. On the count of "1" - hands up inhale, to the "2" - hands down, exhale.

Recommendations

A set of exercises must be performed daily, at a slow pace. After graduating classes is useful in the rest lying on its side on a padded roller for 15-20 minutes.

In addition to the basic course of exercises doctor should choose for your individual set of exercises with the asymmetric learning methods of their implementation. We deliberately do not give the asymmetrical exercise. Once again, accentuate your attention to the fact that independently develop a set of exercises for themselves and begin to implement them should not, as many movements for scoliosis is contraindicated and can lead to complications.

Causes of Scoliosis

Scoliosis can act as an independent disease, as well as a symptom of other known disease. Intricate combination of causes and effects of symptoms of scoliosis causes significant difficulties in its treatment.

Myopathic scoliosis is caused by lack of muscle and ligaments. The appearance of rachitic scoliosis caused by failure of neuromuscular and skeletal tissue. Rachitic scoliosis is found in children 2 - 3 years. In older children who have had infectious disease characterized by weakness and musculo-ligamentous apparatus of the so-called developing habitual or school scoliosis. Contribute to disease development (not being the cause) of long-term non-uniform load on the spine: sitting at an uncomfortable desk, wearing a portfolio in one hand, etc.

Scoliosis of neurogenic origin arise from polio, neurofibromatosis, syringomyelia, spastic paralysis, sciatica, lyumboishialgii and strain, leading to compression of the roots of spinal nerves.Neurogenic scoliosis are also accompanied by precipitation of the functions of individual groups of muscles and neuro-trophic changes in the spine and ligaments.

Congenital scoliosis caused by dysplastic (dysplasia - abnormal development) changes in the vertebrae and ribs. There are anomalies of the vertebral bodies (wedges, etc), handles and processes, variations in the number of vertebral anomalies are of mixed character. Congenital anomalies are detected in the first year of life, the disease usually progresses slowly. For severe dysplastic scoliosis is scoliosis of the lumbosacral caused by dysplasia, and I V lumbar sacral vertebrae, the scoliosis is found in children aged 8 - 10 years.

The most numerous group consists of idiopathic scoliosis , ie scoliosis of unknown nature. They all have similar clinical and radiological signs. The clinical picture of spinal deformity is expressed in its gradual distortion in the front (side) and sagittal (anteroposterior) planes, and torso (twist). When scoliosis first degree is determined by the weakness of the muscles of the back, shoulder girdle asymmetry, the location of the angles of the blades, lateral curvature of the spine (predominantly in the right thoracic and left - in the lumbar), the presence of the muscular ridge in the lumbar spine occurs as a result of its rotation. When scoliosis second and third degree angles of the blades are asymmetrical, there is a pronounced rib hump, shoulder girdle asymmetry is detected, and their plane does not coincide with the plane of the pelvis; protivoiskrivlenie appears in the lumbar spine and torso a deviation from the vertical axis. When scoliosis fourth degree increase in body length of stops, all of the body is shifted to the main arc of curvature of the spine, thorax strongly deformed, which leads to a shift in the internal organs, especially in severe cases, compression of the spinal cord, growing signs of paresis or even paralysis of the lower extremities.

There are many theories of origin of idiopathic scoliosis, but none of them does not give a full explanation. Anyway, most theories converge on the fact that idiopathic scoliosis is caused by musculo-ligamentous, neuromuscular impairment, or developmental disorders of bone. Some researchers (Farkas, 1954; Kazmin, 1974) believe that the abnormal return of the connective tissue leads to epiphysiolysis (sprout damage epiphyseal cartilage, which is localized in the Rostov area of ​​the bone), which in turn causes displacement of the spinal nucleus pulposus disk, prejudice the development of deformation. We see that the causes of idiopathic scoliosis is likely to lie fairly deep, at the level of tissues and metabolic processes, which explains the lack of effective methods of treatment. In the origin and development of idiopathic scoliosis is important genetic factor. Modern research has noted the high incidence of scoliosis risk in families where there are already sick, not only for the first, but for the second and third degree relatives. For example, if first-degree relatives of the incidence of scoliosis than the average for the population at 10-20.

Classification of scoliosis

Classification of scoliosis is produced in many ways, primarily by the degree of curvature. 
To measure the angle of curvature of the spine on x-rays from two horizontal lines: one for the first vertebra, which begins with a curvature, the other - at last, where the curvature of the ends. Then spend two perpendiculars to these lines and measure the angle between the perpendiculars. This is a curvature in degrees greater than the angle, the greater curvature.

As the degree of deformation scoliosis is divided into 4 groups (by J. Cobb, 1958)

a degree of scoliosis	angle of curvature of 10 degrees, the x-ray noticeably slight twisting (torsion)
2 degrees of scoliosis	angle of curvature of 10 degrees to 25 degrees, a significant torsional deformation is evident on radiographs of the vertebral bodies at the apex of curvature, a clinically defined muscle spindle
3 degrees of scoliosis	angle of curvature of 25 to 40 degrees, chest deformity, the presence of rib hump at the top of the curvature and the surrounding areas are wedge-shaped vertebrae
4 degrees of scoliosis	angle of curvature greater than 40 degrees, severe chest deformity, scoliosis kifo-thoracic, anterior and posterior rib hump deformity of the pelvis, severe deformity of the vertebral bodies and vertebral joints, calcification of ligaments

In our country, applied clinical and radiological classification of V.D.Chaklina (1973), which is also 4 strain, but other angles of scoliosis.

a degree of scoliosis	angle to 10 degrees of scoliosis, a slight curvature of the spine in the frontal plane, vanishing in the supine position, shoulder blades and upper arm asymmetry in the thoracic and lumbar scoliosis at the waist, the asymmetry of the muscles in the curvature of the arc
2 degrees of scoliosis	angle of 11 to 30 degrees, the curvature does not vanish completely in the supine position, a small arc and a small compensatory rib hump
3 degrees of scoliosis	angle from 31 to 60 degrees, the presence of compensatory arc, chest deformity, a large rib hump, the deviation in the direction of the main body of the arc of curvature
4 degrees of scoliosis	angle of 60 degrees, heavy fixed-kifo scoliosis, a significant deformation of the skeleton, the disruption of the heart and lungs

In the form of curving scoliosis is: C-shaped (with a single arc of curvature), S-shaped (with two arcs) and sigma-shaped (three arches).

Vertebrae in anatomy and medicine mean reductions in the form of letters (the name of the spine) and the numbers that determine the number of vertebrae in the department. As we shall also use these conventional notations: cervical spine (vertebrae cervicales) - C1 to C7, thoracic (v. thoracicae) - from Th1 to Th12, lumbar (v. lumbales) - L1 to L5, sacral (v. sacrales ) - from S1 to S5.

For localization of curvature scoliosis distinguish the following:

cervico-thoracic scoliosis	curvature at the top of Th3 - Th4
thoracic scoliosis	Th8 - Th9
thoracolumbar scoliosis	Th11 - Th12
lumbar scoliosis	L1 - L2
lumbosacral scoliosis	L5 - S1

By the time of manifestation of scoliosis is divided into the following types:
infantile (scoliosis infantilis) - diagnosed in children under 3 years old child , or juvenile (juvenilis) - from 3 to 10 years, youth , or adolescence (adolescentis) - 10 years before the end of skeletal growth, adult scoliosis diagnosed after bone growth (from 18-24 years of age and older).

A classification based on the origin of scoliosis and the proposed Dzh.Kobbom (1958).
1) myopathic and rachitic scoliosis caused by failure of ligaments, the neuro-muscular and bone
2) scoliosis of neurogenic origin, and scoliosis caused by degeneration of the intervertebral disc with subsequent radicular syndromes
3) scoliosis due to congenital anomalies of the vertebrae and ribs
4) scoliosis caused by diseases of the chest
5), idiopathic scoliosis , whose origin is not clear (it is the most extensive group)

Disorders of posture

Posture is an indicator of human health and physical development. Good posture - is prevention of osteochondrosis and various back pain.

With proper posture keeps people straight body and head, shoulders slightly lowered and laid back, and chest - go ahead, belly tucked up at the same time.

Spine - the basis of the human skeleton and its impact on the state of posture. The body is supported in an upright position back muscles, neck and torso. The harmonious development of the muscles of the body - a prerequisite for the formation of a beautiful posture.

Physiological curvature of the spine

When a child begins to hold her head up, bend formed bulge forward - cervical lordosis. With increasing load on the spine (when the child begins to walk), there is unspoken curvature of the spine in the thoracic back - thoracic kyphosis, as well as the bending of the lumbar bulge forward - lumbar lordosis.

Thus, when viewed from the side of the spine, marked cervical and lumbar lordosis and thoracic kyphosis and sacral. When viewed from the back of the spine should be straight. In the normal posture bends the spine expressed uniformly.

Types of violations of posture

Abnormal posture is formed due to changes in the state of the muscles and ligaments. It should be noted that incorrect posture is usually not accompanied by changes in the spine.

There are incorrect posture in the frontal plane (parallel to the front of the body surface), sagittal (anteroposterior), and both planes simultaneously.

Scoliotic posture

This curvature of the spine in the frontal plane. For this type of bearing defect characteristic of symmetry breaking between the two halves of the body. The spine is curved, is an arc, which is facing left or right. There is also the asymmetry of the shoulders, shoulder blades and head tilted to one side.

When violations of the lateral curvature of the spine posture is corrected in the supine position and muscle tension, and there is no twisting of the vertebrae around a vertical axis, which is characteristic for scoliosis.

Disorders of posture in the sagittal plane

Such defects of posture associated with an increase or decrease in the physiological curves of the spine.

Round the back, or stoop, associated with increased thoracic kyphosis. The shoulders are raised, the inner edge of the blade behind the chest, and shoulder joints are presented.

Kruglovognutaya spin is characterized by an increase in all the physiological curves of the spine. At the same time raised his shoulders, his head thrust forward, belly hanging down, and even acts.

With a decrease in thoracic kyphosis is observed so-called. flat spin. Marked decrease in the angle of inclination of the pelvis, chest forward biased due to the reduction of kyphosis, the lower part of the stomach protrude.

Ploskovognutaya spin is observed with a decrease in thoracic kyphosis and cervical lordosis flattening. The pelvis is displaced posteriorly, and increased the angle of it. Weakened abdominal muscles and buttocks.

Treatment of postural

For any form of incorrect posture hindered the activity of internal organs develop early damage in the intervertebral discs. In this connection it is necessary to treat the defects of posture, which respond well to correction.

Methods of treating disorders of posture include therapeutic exercises, manual therapy, therapeutic massage, and wearing a posture corrector.

Therapeutic exercise (gymnastics)

LFC - it is an effective method of correcting the defects of posture aimed at strengthening the muscles of the abdomen, buttocks and spine. A set of exercises develops the doctor, who also sets the dosage of the load, which changes over time. To correct the imbalance of the muscles for stretching exercises include hyperactive muscles and strengthen the feeble. Static exercises are interspersed with dynamic. It creates an intense motor mode in each case, but with the exception of the load on the spine.

Correction of posture

Correction of posture include reklinators, thoracic and thoracolumbar zone offsets. Application reklinators effective for minor violations of posture and weak muscles of the shoulder belt and allow to dissolve and eliminate slouching shoulders, manifested in verhnegrudnom spine. The pectoral girdle (bandages) should be more pronounced in the stoop, as well as violations of posture on the type of scoliosis, which are manifested in the thoracic spine. Thoracolumbar proofreaders combine the effects on the area of ​​thoracic kyphosis and lumbar lordosis - throughout the spinal column. The application is recommended for violations of any degree posture, scoliosis and kyphosis I-II degree. Selection of Posture Corrector performs orthopedic surgeon, taking into account the patient's age and severity of the pathological process.

The structure of the spine

The spine is made ​​up of people 33 - 34 vertebrae, which are connected by joints, ligaments and intervertebral discs. 6 - 9 fused vertebrae forming the sacrum and coccyx. There are five parts of the spine: cervical, consisting of seven vertebrae, rib - 12, lumbar - of 5, sacral - 5 and coccyx, consisting of 4 - 5 vertebrae.

Vertebra consists of a body facing anteriorly and connected with it arc vertebra. The body and vertebral arch vertebral restrict the opening.Vertebrates make holes all the vertebrae the spinal canal, which houses the spinal cord. From the spinal cord through the spinal nerves leave the hole. From the arch of each vertebra depart to 7 branches. In the pair of directed transverse processes. Each vertebra is connected to the upper and lower adjacent vertebrae by means of two lower and two upper articular processes. From the middle of the arc to the rear unpaired spinous process. In various parts of the spine spinous processes have their own characteristics. In the cervical region they are short, spinous process of the seventh cervical vertebra is longer than the others and is easily detectable under the skin. In the thoracic spinous processes of the longest and are directed downwards, in the lumbar region they are wide and laid back. The dimensions of the vertebral bodies depend on the magnitude of the burden on them, they are the lowest in the cervical region and the largest in the lumbar. top two cervical vertebrae are used for articulation with the skull and have significant differences in the structure. On the body and transverse processes of thoracic vertebrae are edge pits for articulation with the ribs. Sacrum consists of five sacral vertebrae, which in 20 years' fused into one bone that attaches to the spine of particular strength.

The vertebrae are interconnected by means of inter ¬ vertebrate cartilage, ligaments and joints. Vertebral bodies are connected by cartilaginousintervertebral discs . Each of them consists of an outer fibrous ring and the inner nucleus pulposus. The total height of these disks is a quarter of the entire length of the spine. Interestingly, during the day gelatinous nucleus loses fluid, cartilage and intervertebral flatten ¬ Xia. As a result, man is the evening of 2 cm shorter than in the morning, the same thing occurs with prolonged ¬ load on the spine.

Along the entire length of the spine vertebral bodies and intervertebral discs are connected with long anterior and posterior longitudinal ligament.Above the tops of the spinous processes along the entire length is spinous ligament. In addition, the arc, transverse and spinous processes of adjacent vertebrae are connected by short ligaments. 

Human spine has several natural curves. curve, convexity ago, called kyphosis, the curve, convexity forward - lordosis. The man has two kyphosis (thoracic and sacral), and two lordosis (cervical and lumbar). In addition, the spine is normal can have a lateral bending (scoliosis), which appears due to the varying length of the lower limbs and the development of different muscles on different sides of the body. This scoliosis should not be confused with scoliosis as a disease, it can be attributed to violations of posture. Curves of the spine provide mitigation of shocks and tremors of the body when running and walking. Despite the low mobility of the intervertebral joints, the spine on the whole quite mobile, especially the lumbar region.

In the spinal canal is the spinal cord . At the top it goes to the brain, and the bottom ends with special reference to the level of the 2nd lumbar vertebra. Through the spinal cord central canal is filled with cerebrospinal fluid.

The spinal cord consists of 31 - 33 segments, each of which has two pairs of nerve roots: anterior (motor), by which impulses from the cells of the spinal cord are transmitted to the periphery (to the skeletal muscles, the muscles of blood vessels, internal organs), and posterior (sensory) by which impulses from the receptors of the skin, muscles, internal organs are passed into the spinal cord. The anterior and posterior roots on each side of the spinal cord, connecting with each other to form 31 mixed pair of spinal nerves. The spinal cord is involved in most of the reflex reactions of the organism, the most complex spinal reflex reactions are controlled by the brain.

For a complete familiarity with the structure of the spine look muscular system, limiting brief analysis of the back muscles.

All human skeletal muscles are composed of so-called striated muscle tissue, the reduction of these muscles occurs randomly. The simplest form of the muscle is fusiform shape. The middle part is called the belly muscles, at both ends of the muscle goes into a tendon which is attached to the bones, reducing the muscle is shortened, and the attachment points closer to each other.

Muscles engaged in opposing the action, called antagonists, such as the forearm flexor and extensor (respectively, the biceps and triceps). To carry out any movement always requires teamwork antagonist muscle for complex movements require the work of an entire group of muscles.There are long, wide and short muscles. Long muscles are located mainly on the limbs, where a large amount of movement. Short muscles especially a lot of deep back muscles. Chi ¬ rokie muscles located in the area of ​​the body: chest, abdomen and back. 

Back muscles are divided into superficial and deep. To the superficial muscles include trapezius, latissimus, rhomboid major and minor, muscle lifting the shoulder blade, upper and lower posterior serratus. Trapezius muscle starts from the occipital bone and the spinous processes of all thoracic vertebrae, is attached to the keys ¬ Tse and shoulder blade. The upper part of the muscle raises the shoulder blade, lower - it lowers the average of the blade closer to the spine. Latissimus dorsi muscle comes from the spinous processes of lower six thoracic and all the vertebrae are ¬ ary, on the iliac crest and attaches to the humerus. The muscle pulls the shoulder and arm back while rotating it inward. Rhomboids pick up shovel, bring it closer to the midline. The upper posterior serratus raised edges, the bottom drops them, ensuring the participation in the act of inspiration.

The deep back muscles form a two tract - lateral and medial, ¬ nye located on either side near the spine along its entire length from the occiput to the sacrum. Lateral tract ¬ General will make more than superficial long muscles that make up muscle, spinal straightening ¬ nick. The muscles of the medial tract (cross-awned) lie deeper than others, they represent a group of short muscle bundles, and burn through the vertebrae. In the back of the neck over the two paths is re ¬ mennaya muscle head and neck.

In addition to these muscles, forming the back part of the abdominal wall square loin muscle, which relates to the anatomy of the abdominal muscles.

Scoliosis affects other elements of the musculoskeletal system, which remained outside of this description: the clavicle and scapula, chest and ribs, pelvic area.