TYPES OF COLUMN PROBLEMS

 
 
 
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Scoliosis

 
 
Scoliosis is a complex disease characterized by a severe morphological deformity, with deviation of the spine to the left or right, resulting in the format of "S" or "C". This deviation occurs in several planes and involves various segments of the spine.
 
 
 
 
 

Symptoms of the Disease

 
Scoliosis may be detected when a shoulder appears to be higher than the other, or when the pelvis is tilted. When the patient folds the trunk forward it is also possible to verify that there is scoliosis due to the evident asymmetry between the right and the left side of the spine.

In patient with scoliosis usually the spine is abnormally bent to one side and this may feel muscle discomfort.
 
 
 

Causes

 
The causes of scoliosis may be of a diverse nature, namely postural, however, we list some of the possible causes:

  • Idiopathic scoliosis has no known cause and accounts for 70% of cases.
  • Post-traumatic scoliosis.
  • Congenital scoliosis occurs due to problems in the formation of the vertebrae or problems of fusion of the bones of the spine, and may or may not be associated with fusion of ribs during the development of the fetus or the newborn.
  • Neuromuscular scoliosis is caused by neurological (eg, cerebral palsy) or muscle problems that determine muscle weakness, poor muscle control or paralysis due to diseases such as muscular dystrophy (eg spina bifida).
 
 
 
 
 
 

Diagnosis and Examination

 
The diagnosis of scoliosis is usually performed based on the detailed medical history, the doctor asks a series of questions about the patient's recent growth. The physical examination is then performed, examining the patient's body for signs of scoliosis.

In addition, the doctor may perform a neurological examination to check the patient's muscle weakness and abnormal reflexes.

Complementary diagnostic tests are also essential in the diagnosis of scoliosis, especially the X-ray of the total spine with the patient in the orthostatic position and barefoot, in order to be able to measure the scoliotic angle.
 
 
 

Treatment

 
Treatment depends on the cause of scoliosis, the size and location of the curvature, and the patient's age and growth rate. In most cases of idiopathic scoliosis that occurs in adolescents, the treatment goes through observation only by periodic and eventually radiographic clinical reassessments.

The use of vests is recommended to help slow the progression of the curve so that it does not reverse. Pressure mechanisms are often used to align the spine in an attempt to prevent the progression of the deformity. The vest should be adjusted according to growth.

The surgery consists of correcting the curve (though not completely) and aligning the bony structures (vertebrae). The vertebrae are fixed through metal rods and screws.
 
 
 
 
 
 
 

Lordosis

 
 
The lordosis is a physiological curvature of the spine projected into the ribcage, which is present in the cervical and lumbar region, meaning all people have lordosis. However, when there are changes in lordotic curvature - hypoordosis (reduced curvature) or hyperlordosis (pronounced curvature), spinal problems arise.
 
 
 
 
 

Symptoms of the Disease

 
The main symptoms of lumbar lordosis are back pain, tingling in the spine, weakness in the muscles of the belly, pain in the neck and difficulty in lowering and picking up in pesos.

Already in cervical lordosis is characterized by stiffness, pain in the neck, weakness in the adjacent muscles and tingling.
 
 
 

Causes

 
The lordosis is especially related to genetic causes. Although obesity, poor posture and muscular weaknesses are also important factors and should be considered.

There are also other factors linked to changes in the cervical and lumbar curvature. Are they:
  • Trauma in lower spine;
  • Inflammation between the vertebrae;
  • Osteoporosis or loss of bone density;
  • Spondylolisthesis (condition where the vertebra slips);
  • Chondroplasty (type of dwarfism);
  • Osteosarcoma (bone cancer);
  • Hyperkyphosis.
 
 
 
 
 
 

Diagnosis and Examination

 
The lordosis can be diagnosed by an orthopedist or a general practitioner. In 80% of the cases, the diagnosis is made by clinical evaluation, which includes the analysis of the patient's history and a complete physical examination to evaluate the range of different movements performed by the patient.

The physician should take into account muscle weakness, especially in the abdominal region and low joint flexibility in the dorsum and lower limbs.

In addition to physical examination, the doctor, request complementary diagnostic exams such as:
  • X-ray of the spine: to analyze the patient from the front and to the side (profile), to measure the curves of spine.
  • Computed tomography.
  • Magnetic resonance imaging.
  • Bone examinations: check for degenerative changes in the joints.
 
 
 

Treatment

 
Changes due to lordosis be cured and can be treated according to the severity of injury. Not all cases require treatment. However, when the curve is rigid, an effective and well-directed treatment is necessary, since if the vertebral curvature is severe it may require the use of belts or even minimally invasive surgery (Plasmalight nucleoplasty) for the treatment of disc hernia associated with this pathology.

In general, treatment for increased or decreased lordosis may include:
  • Medication (analgesics and anti-inflammatories) to relieve pain and swelling;
  • Muscle strengthening exercises and physical therapy;
  • Use of belts;
  • Weight loss;
  • Minimally invasive surgical techniques.
 
 
 
 
 
 
 

Kyphosis

 
 
The dorsal column, seen on the side, has a physiological curvature called kyphosis, this curve is formed out of the rib cage. Normal thoracic kyphosis has 20-40 degrees of inclination. However, in cases where there is an accentuation of kyphosis, it is called hyperkyphosis, which may be associated with bad postures, Sheuermann's disease and rheumatologic diseases of the spine. In hyperkyphosis the dorsal spine becomes more curved than normal and it is commonly said that the person is hunchbacked.
 
 
 
 
 

Symptoms of the Disease

 
Usually kyphosis is idiopathic, and is only detected by exaggerated curvature of the dorsal spine. However, in some cases it is characterized by back pain, stiffness, spine sensitivity and tiredness.
 
 
 

Causes

 
The causes of kyphosis are variable, however it is thought that it is mainly related to:
  • Poor posture (postural kyphosis);
  • Abnormal formation of the vertebrae (Scheuermann kyphosis);
  • Abnormal development of the spine in the uterus (congenital kyphosis);
  • Age (aging);
  • Post-traumatic, post-infection, neuromuscular diseases, tumors and rheumatic diseases (ankylosing spondylitis).
 
 
 
 
 
 

Diagnosis and Examination

 
Kyphosis can be diagnosed by an orthopedist or general practitioner. The diagnosis is made mostly through clinical evaluation, which includes the analysis of the patient's history and a complete physical examination to evaluate the range of different movements performed by the patient.

In addition to the physical examination, the doctor may order complementary diagnostic exams such as X-ray of the spine, to analyze the patient from the front and side (profile), to measure the curves of the spine, and bone exams to check osteoporosis for example.
 
 
 

Treatment

 
In cases of idiopathic kyphosis there is no use of drugs, only opt for dorsal muscle strengthening exercises, swimming, posture correction and physiotherapy. When the patient has pain, medication can be used.

In cases of severe, progressive and painful deformities surgical treatment may be considered and passes for correcting deformities with the use of screws and titanium rods, however, due to the complexity of the procedure and the surgical risk is only performed in severe cases.

In cases of kyphosis secondary to other diseases such as fractures, tumors and rheumatic diseases the treatment should focus on the cause of the deformity.