Kyphoscoliosis

Introduction Posterior spine refers to one or more segments of the spine that bend backwards from the midline of the body in the coronal plane, forming a curvature of the spine, usually accompanied by rotation of the spine and kyphosis or protrusion of the sagittal plane. The increase or decrease, as well as the ribs around the height of the ribs, the rotation of the pelvis and the abnormality of the ligaments and muscles of the paravertebral, it is a symptom or X-ray sign, which can be caused by a variety of diseases.

Cause

It is due to the relaxation of muscle ligaments, softening of the bones, and skeletal deformities caused by gravity due to sedentary standing for a long time.

1. Non-fixed malformations such as postural hunchback, kyphosis due to weak muscle strength or compensatory lordosis of the lumbar lordosis.

2. Fixed malformations such as Hugh's disease, ankylosing spondylitis (most common), kyphosis caused by senile osteoporosis, deformity caused by congenital posterior vertebral body, tuberculosis or trauma.

an examination

Related inspection

Spinal MRI examination of the spine of the spine

Early diagnosis is important to make early treatment. Therefore, it is necessary to improve the census work of primary and secondary school students and focus on prevention.

(1) medical history

Ask in detail about all conditions related to spinal deformity, such as the patient's health, age and sexual maturity. Also need to pay attention to past history, surgical history and trauma history. Children with spinal deformity should be aware of the health status of their mother during pregnancy, whether there is a history of medication during the first trimester of pregnancy, and whether there are complications during pregnancy and childbirth. Family history should pay attention to the situation of other people with spinal deformity. Family history is especially important in the neuromuscular spine.

(2) Medical examination

Pay attention to three important aspects: deformity, etiology and complications.

1. Fully exposed, only wear shorts and loose outer garments at the back, pay attention to the pigmentation of the skin, with or without coffee spots and subcutaneous tissue, and with or without hair and cysts on the back. Pay attention to the development of the breast, whether the thorax is symmetrical, with or without funnel chest, chicken breast and rib bulge and surgical scar. The examiner should carefully observe from the front, side and back.

The patient then faces the examiner and bends forward to see if the back is symmetrical: one side of the ridge indicates the rib tube and the vertebral body rotation deformity. Then the examiner observes whether the waist is symmetrical from the back of the patient and checks whether the lumbar spine is deformed. At the same time, pay attention to whether the shoulders are symmetrical. It is also necessary to measure the distance between the ribs on both sides and the sacrum. The plumb line can also be placed from the spine of the neck 7 and then the distance from the hip to the vertical is measured to indicate the degree of deformity. Then check the range of motion of the flexion, overextension and lateral curvature of the spine. Check the flexibility of each joint, such as the proximity of the wrist and thumb, the overextension of the fingers, and the recurve of the knee and elbow joints.

Finally, the nervous system should be carefully examined, especially in the lower limbs. Those suspected of having a mucopolysaccharidosis should pay attention to the upper jaw. The Marfan syndrome should pay attention to the cornea. The patient's height, weight, arm spacing, and length of both lower limbs should all be recorded.

(3) X-image inspection

1. Upright position of the full spine

When the X phase is taken, the upright position must be emphasized and the position cannot be lying. If the patient is not standing upright, it is advisable to use a sitting image to reflect the true condition of the scoliosis. It is the most basic means of diagnosis. The X image needs to include the entire spine.

2. Supine and left and right bending and traction

Reflects its softness. Cobb's angle is greater than 90 degrees or neuromuscular scoliosis. Because there is no proper muscle correction scoliosis, the traction pattern is often used to check the elasticity to estimate the correction of the lateral curvature and the length required for each column fusion. The softness of the kyphosis needs to be taken over the lateral image of the extension.

3. Oblique image

Check the condition of spinal fusion, lumbosacral oblique image for patients with spondylolisthesis and isthmus.

4. Ferguson like

Check the lumbosacral joints, in order to eliminate lumbar lordosis, the male patient's bulb is tilted 30 degrees to the head side, and the woman is tilted 35 degrees, thus giving a true positive lumbosacral joint image.

5. Stagnara image

Severe scoliosis patients (greater than 100 degrees), especially with kyphosis, vertebral body rotation, ordinary X images are difficult to see the ribs, transverse processes and vertebral deformities. It is necessary to take a rotating image to get a true front and rear image. Rotate the patient under fluoroscopy, and take the film when the maximum camber occurs. The film is parallel to the inner side of the rib bulge, and the tube is perpendicular to the piece.

6. Fault image

Check for congenital malformations with unclear lesions, fusion of bone grafts, and certain special lesions such as osteoid osteoma.

7. Cut position

The patient bends forward and the tube is tangent to the back. Mainly used to check the ribs.

8. Myelography

Not routinely applied. Indications are spinal cord compression, spinal cord mass, and suspected lesions in the dural sac. X-like images showed widened pedicle distance, spinal canal regurgitation, longitudinal spinal cord fissure, and syringomyelia. Myocardial angiography is required to understand spinal cord compression when planning a resection of the hemivertebra or a wedge-shaped resection of the hemivertebra.

9. CT and MRI. Very helpful for patients with spinal cord disease. Such as spinal cord fissure, syringomyelia and so on. Understanding the plane and extent of the epiphysis is important for orthopedics, resection of the epiphysis, and prevention of paraplegia. However, it is expensive and should not be routinely checked.

10. The main points of X image reading:

End vertebrae: the vertebral body at the head and tail of the curvature of the scoliosis.

Differential diagnosis

(1) Scoliosis: that is, part of the spine of the spine deviates from the midline of the body and is called the scoliosis of the spine. There are left convex, right convex and S-shaped curved, C-shaped curved.

(2) kyphosis: refers to the thoracic kyphosis beyond the physiological curve range.

(3) Saddleback: It means that a certain vertebral body is destroyed, and the vertebral body suddenly protrudes backward.

(4) Round back: refers to the entire spine protruding backward like a bow.

(5) Teratogenic chest: There are two types, one is that the sternum protrudes outward, and the other is that the sternum is inwardly recessed.

(6) Rotation (twisting): This is because the lumbar transverse process is formed by a high side or a low sternum, which is the most complicated and most difficult to treat.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.