Spinal deformity

　　The deviation of the coronal, sagittal, or axial position of the spine from the normal position, resulting in morphological abnormalities, is called spinal deformity. The human spine develops rapidly during the embryonic period, with all structures completed within a few weeks. After the formation of the spine, it has its morphology and stability. Then, what are the causes of spinal deformity? The following experts introduce the etiology of spinal deformity.

　　One, Genetic Factors

　　Idiopathic Scoliosis, from the etiological point of view, is not very clear, but it is related to genes and heredity, in addition, there is also the reason that the distribution of paravertebral muscles itself is unbalanced. Morphologically, it refers to the absence of structural abnormalities in the vertebrae themselves, normal vertebral separation, symmetrical pedicles, normally developed vertebral plates, and articular processes.

　　Two, Congenital Factors

　　(1) Congenital Scoliosis: Congenital scoliosis usually refers to spinal deformity caused by abnormal structure of the vertebrae themselves. The pathological structural type is usually divided into incomplete ossification or separation of the vertebrae.

　　(2) Congenital Kyphoscoliosis: Congenital kyphoscoliosis is caused by congenital fusion (separation disorder) of the vertebrae, similar to the pathogenesis of congenital scoliosis, but only affects the sagittal curvature in terms of morphology. Similarly, due to the formation of angular kyphotic deformities, it is easy to cause compression of the spinal cord, or due to hemodynamic disorders in the spinal cord itself, leading to symptoms of paralysis of both lower limbs.

　　Three, Disease Factors

　　(1) Neuromuscular Scoliosis: Neuromuscular scoliosis is mainly caused by lesions in the systemic muscle system, leading to weakness of the muscles in the chest and back itself, and the paravertebral muscles cannot adequately support the spine.

　　(2) Neurofibromatosis: Neurofibromatosis is also an important cause of scoliosis (posterior scoliosis). Neurofibromatosis itself is caused by a gene defect leading to abnormal development of neural crest cells, resulting in multiple system damage. It is classified into neurofibromatosis type I (NFI) and type II (NFII) according to clinical manifestations and genetic localization.

　　(3) Marfan Syndrome: Marfan syndrome is also a cause of scoliosis, with a similar incidence rate in males and females, and is a dominant chromosomal genetic disease (caused by a variant at 15q21.1 on chromosome 15). However, about 25% of patients are caused by chromosomal variations.

　　(4) Adult Scoliosis: Adult scoliosis mainly exists in two pathological types. The first type is due to the progression of idiopathic scoliosis during adolescence to adulthood, resulting in corresponding symptoms, known as adult idiopathic scoliosis; the second type is caused by intervertebral disc degeneration during adulthood, known as degenerative adult scoliosis (Denovo Scoliosis). Scheumann Disease: Scheumann disease is also known as Kyphoscoliotic Disease and juvenile kyphosis. According to the site of onset, it can be divided into thoracic and lumbar Scheumann disease. Diagnosis can be made if the angle between the posterior and anterior margins of three consecutive vertebrae is greater than 5° continuously, and there are 'beetle-eaten' changes in the adjacent end plates of the vertebrae, as well as Schmorl nodules and other changes. The main reason is the occlusion of the nutrient vessels of the end plates due to minor trauma, causing the end plates to lose blood supply.

　　(5) Scoliosis caused by spinal tuberculosis: Spinal tuberculosis is one of the main causes of local kyphosis. Due to the invasion of the tuberculous focus into the vertebral bodies and intervertebral spaces, intervertebral disc tissue disappears, and the vertebral bodies fuse with each other, forming a local 'angular' kyphotic deformity. Although the vertebral bodies fuse with each other, the pedicles and posterior structures (including articular process joints, vertebral plates, spinous processes, etc.) still exist, which are very easy to cause compression of the spinal cord and lead to symptoms of paraplegia. Most patients with severe deformities caused by spinal tuberculosis are adults, and the onset is often due to tuberculosis infection during adolescence or latent infection, which has been actively treated. The tuberculosis bacteria form localized encapsulation locally, leading to the occurrence of the disease.

　　(6) Ankylosing Spondylitis: It is a chronic progressive disease that invades the spine, involves the sacroiliac joints and surrounding joints. (Marie-Strumpell disease, or Von Bechterew disease), is an autosomal dominant genetic disease, mainly causing pannus-like hyperplasia of the articular process joints, with the primary site being the attachment of ligaments and joint capsules. The synovitis is characterized by granulomas, causing ossification of the ligaments, leading to ankylosis of the joints, the entire spine joints forming a 'bamboo joint' change, and accompanied by obvious osteoporosis.

　　Although spinal deformities do not pose a great threat to health in the short term, the pain they bring to patients is tremendous. Patients may encounter various inconveniences in their lives, completely disrupting their normal lives, and even their families suffer greatly. What are the complications of spinal deformities? The following experts introduce the complications of spinal deformities.

　　1. Aesthetically unappealing, causing psychological disorders.

　　2. Kyphotic deformities, especially tuberculous kyphotic deformities of the thoracic vertebrae, can cause obvious local deformities in patients, reduce height, decrease the volume of the thoracic and abdominal cavities, and even cause damage to nerve function, respiratory function, and digestive function.

　　3. Patients with poor development of spinal bone structure may be accompanied by neural developmental abnormalities such as meningocele and concealed spinal bifida.

　　4. In addition, congenital spinal deformities may be accompanied by abnormalities in the cardiovascular system, tracheoesophageal fistula, polycystic kidney, and other organ abnormalities.

　　5. The spine loses its original stability, and even minor injuries can cause vertebral fractures, compress the spinal cord, and potentially lead to paraplegia.

　　Spinal deformities can produce back bulging deformities in appearance, such as 'razor back' deformities, and some may even produce 'funnel chest' or 'pigeon chest' deformities. At the same time, accompanying this back deformity, there may be imbalance of both shoulder joints or pelvic imbalance, as well as unequal length of both lower limbs; kyphosis deformity, especially the postural kyphosis due to tuberculosis of the thoracic vertebrae, can cause obvious local deformities in patients, a decrease in height, a decrease in the volume of the thoracic and abdominal cavities, and even damage to nerve function, respiratory function, and digestive function. At the same time, for patients with poor development of spinal bone structure, there may be manifestations of neural developmental abnormalities such as meningomyelocele and hidden spinal fissure. In addition, congenital scoliosis may also be accompanied by abnormalities in the cardiovascular system, tracheoesophageal fistula, polycystic kidney, and multiple organ abnormalities.

　　Spinal deformities are a common type of orthopedic disease. Since their occurrence has a great impact on the physical and mental health of patients, we need to take effective measures to prevent them. Then, what are the more effective prevention methods? The following is a detailed analysis by authoritative orthopedic experts, and common methods to prevent spinal deformities in daily life.

　　1. Maintain correct standing posture: Proper posture has a great impact on the spine, so whether walking or standing, we should keep our heads up, chest out, and eyes forward, which can effectively prevent the occurrence of spinal deformities.

　　2. Maintain correct sitting posture: Whether working or studying, pay attention to maintaining correct posture, keeping the back straight, and not bending over too much, which is very helpful for preventing spinal deformities.

　　3. Try to sleep on a hard bed: It is best to sleep on a hard bed, which is helpful for preventing spinal deformities. And in the morning, it is best to do some stretching exercises for the back.

　　4. Pay attention to diet and nutrition: Pay attention to the nutrition distribution in daily diet, eat more calcium-rich foods, which can not only increase muscle strength but also be conducive to the absorption of nutrients.

　　In daily life, methods to help prevent spinal deformities include maintaining correct posture, sleeping on a hard bed as much as possible, and paying attention to diet and nutrition. If we can do these methods well, we can reduce the incidence of spinal deformities and avoid the harm they may bring to our normal life and health.

　　In terms of the diagnostic criteria for scoliosis or kyphosis in radiology, it includes the measurement of Cobb angle, that is, to select the angle between the most oblique vertebrae at both ends (the most superior and most inferior) of the composition of the scoliosis or kyphosis, which is the most basic description for any spinal deformity.

　　The evaluation of vertebral rotation is usually done by the Nash-Moe classification, which is to judge the degree of symmetry of the bilateral pedicle roots. Through the description of symmetry of the vertebral pedicle roots bilaterally, information about vertebral rotation can be obtained from routine X-rays. And the evaluation of the patient's growth potential, such as the Risser sign. The Risser sign evaluates the patient's growth potential by observing the closure of the epiphysis on the surface of the bilateral iliac bones.

　　Patients with scoliosis should pay attention to rest, combine work and rest, live in an orderly manner, maintain an optimistic, positive, and upward attitude towards life, which is very helpful for the prevention of diseases. In terms of diet, regularity and rationality should be maintained, mainly with high-protein and high-vitamin foods. Choose high-nutrient plant or animal proteins, such as milk, eggs, fish, lean meat, various bean products, etc.

　　Scoliosis is a common spinal disease with a high incidence rate among adolescents and children. Scoliosis affects the normal growth and development of patients, and severe cases can lead to decreased pulmonary and cardiac function, difficulty in limb movement, even paralysis, and cause serious harm to the mental health of patients, leading to dual disabilities of both physiology and psychology. The treatment of scoliosis is very important, and the following experts introduce the methods of treating scoliosis.

　　Firstly, the treatment of scoliosis

　　1. For mild cases (Cobb angle

　　2. For Cobb angles between 20° and 40°, non-surgical treatment is mainly used, including brace correction, plaster jacket fixation, and physical therapy.

　　3. For Cobb angles exceeding 50°, surgical correction is mainly used, and selective spinal fusion surgery and instrumental surgery can be selected according to the condition. Patients with hemivertebra deformity should consider resection of the hemivertebra followed by spinal fusion surgery. During the correction of severe deformities, spinal cord monitoring should be noted during surgery.

　　4. For Cobb angles between 40° and 50°, non-surgical treatment can be adopted first, and close observation is required. If non-surgical treatment is ineffective or the deformity develops rapidly, surgical treatment should be performed.

　　Secondly, the treatment of kyphosis

　　1. In the early stage, non-surgical treatment is mainly used, including etiological treatment, correction of poor posture, brace protection, physical therapy, lumbar and sacral muscle exercises, and the application of anti-inflammatory and analgesic drugs.

　　2. For patients with severe kyphosis deformity and a stable history of the primary disease, spinal osteotomy and internal fixation can be performed.