إعوجاج العمود الفقري

*        Dr. Ahmed A. N  ORTHOPAEDIC Surgeon

 

 

Scoliosis

 

Dr. Ahmed A. N *

 

  

From the reality of the cases that we have passed through in the institution’s clinic, as well as through what we have done in the field survey in some areas of the Yemeni countryside, which is what we seek to do for the purpose of surveying disability cases in the Yemeni countryside, where we presented our project to more than one party and in cooperation with a newspaper Determination in Taiz governorate to present the project to the Ministry of Social Affairs:

These are case examples.

There are three types of scoliosis:

1. Kyphosis: It is a forward curvature of the spine, especially in the upper part of the body, that is, in the upper thoracic vertebrae, accompanied by an increased cavity in the lumbar vertebrae. The symptoms of kyphosis are bending the shoulders together and a hump in the back.

2. Scoliosis: It is a side curvature of the spine to the left or right, and when it exacerbates, it often consists of two or three curvatures in succession to the left and the right, and it is the most harmful type of vertebral curvatures. The symptoms of scoliosis are pain and hump in the back, as well as the appearance of one shoulder higher than the other. And most of the times this curvature is discovered upon medical advice that aims to treat the symptoms of kyphosis.

3. Scoliosis: This combines the symptoms of Kyphosis and Scoliosis at the same time. It is important to mention here that there is a factor that stands as a stumbling block in front of the early detection of scoliosis, which is known as scoliosis in our children, especially girls among them, and this is often in the conservative eastern society, because most of them are ashamed of showing their bodies (medical examination) in front of doctors And the specialists in this matter. Therefore, the discovery of this disease remains vulnerable to chance that we do not go with our children for a periodic examination without a reason at the doctor who specializes in joint and bone diseases, and the other reason is that this disease does not cause excruciating pain that draws attention, and in the event that the child complains of back pain, we often return its cause to resulting exhaustion About playing or the like, instead of searching for the correct one and its relationship to the tooth and the formation of the child's body, bearing in mind that the appearance of the pain remarkably determines the medical exacerbation and development of the illness.

 

Parents can discover scoliosis as follows:

With family and community health education, many diseases and health problems among children can be avoided.

In cases of spinal curvature, parents ask their child to uncover his back and stand upright in front of them pressing the knees back, and then bend forward (as in a kneeling position during prayer) to monitor the back muscles on both sides of the spine:

- If one side is higher than the other.

If the Dorsals Vertebrae is not from the head down in a straight line. And we realize this just by passing our fingers over these protrusions perpendicularly.

If one shoulder is higher than the other.

If one of the girl's breasts is larger than the other.

- If there are visible bumps on one side of the rib cage (CAGE THORACIQUE).

If one foot is short, one is longer than the other. This is a result of the elevation of the basin due to the appearance of spinal curvature.

- Each of these signs, if they appear, constitutes a sufficient reason for consulting a doctor specializing in orthopedics and joints or in physical medicine or in spinal surgery in order to make a correct diagnosis. And make the necessary x-rays and thus make sure of the presence or absence of scoliosis.

- Scoliosis does not differentiate between the son of the rich or the poor, and the son of the educated and the ignorant. It affects children and juveniles of all groups. However, we notice that the health educated usually discover the disease in their children before others. Juveniles remain exposed to this disease until they reach the age of puberty. It is striking that this disease affects females at a rate of 80% and males at a rate of 20%, according to global statistical research. In the Republic of Yemen, according to the research and statistics conducted by the Manar Scientific Foundation for Health Studies and Research, this percentage is at the level of boys 45% and girls 55%, which was confirmed by the preliminary results that came out according to the initial exploratory field study in a number of Yemeni governorates.

It should be noted that most cases of scoliosis are of school age.

 

the reasons :

Scoliosis is classified into two levels:

1. Scoliosis cytogenetique: In this case, the child suffers from ascoliosis from birth due to the incomplete growth of one or more of the vertebrae, or due to the deficiency of one or more vertebrae, as well as due to polio, or cerebral palsy.

2. Scoliosis Idiopathique: This is an unknown cause of scoliosis. That is, the child is born naturally and develops as well, and suddenly we discover that he has the disease without any prior warning. This scoliosis is the subject of our current interest and research in Yemen, just as it was done before in sisterly Lebanon. A study was conducted on 100 patients with scoliosis from the age of 3 to 39 years, distributed in all Yemeni governorates, and from all social classes in their daily way of life: at home, school, work and holidays, and the following was found:

1 - The majority of children diagnosed with ascariasis from birth were not discovered by the doctor at birth, but rather by the mother between two and five years of age.

 2- Most of the children with paralysis did not receive any protection for the spine.

3- All healthy children who become infected with ascoliosis are in the study stage.

4- We focused our research on the school, so we found out that all children up to the age of 10 years carry in the school bag more than 40% of their body weight, and the permissible only 10%, which causes bending to the side subject to the weight of the school bag to achieve a balance in their body, and so on for school schools This alone is a sufficient reason to cause scoliosis.

 5 - Add to this how the child sits in the study seat. Most schools have a single-scale seat for all students.Some of them have a body that is too small to reach the table to write or read, so he has to cram himself into it, and the two cannot rest in their sessions for a period of 7 hours a day during the 12 or 13 years of schooling.

This wrong sitting position is carried by the child to a place, and in the future it becomes a difficult habit to give up and it also leads to a curvature of the spine.

6- As for sports programs, all schools do not have school sports programs, and the sport hour is considered a break. And when it is compulsory, it is limited to running and passing the ball, and the actual play is limited to a certain number of students in one class. As for the rest, there is no role for them, and there is no specific sports program in any of the schools in which the study was conducted that cares about lubricating the spine and strengthening its muscles such as aerobic and stretching. To all of the students. However, in some private schools, they are considered additional lessons that are paid dearly, which does not make them accessible to everyone.

7 - As for at home and holidays, the child does not engage in any sporting activities, and he rarely has a sporting hobby that he practices with passion. His interest is limited to computers and watching TV, which causes his muscles to sag and weak. Juveniles are not more fortunate, on the contrary, their movement activities may decline.

 

The extent of this disease scoliosis in the Yemeni community

 

The percentage is high and the most dangerous, and the social and economic factors in most parts of our Yemeni society, and to the customs related to the typical behavior in Yemen, which is the habit of qat spread and spending more than six hours mostly in the position of squatting and leaning on one side, in addition to the level of awareness of education workers as well as the severe deficiency in health awareness of the community that Most of them are concentrated on the pages of the readable means, some of which focus on more interesting topics or on the promotional side of the goods or other things, and the same is what can be attributed to the visual and audio ones.

Also, do not forget the low levels of Arab mother’s information regarding home medicine if it is not non-existent, as it is limited to reading non-specialized magazines, and most of the magazines read by women are concerned with art, cooking, fashion, etc. On aesthetic matters, it rarely addresses diseases that people do not want to talk about, especially if they are related to physical disability.

The fact that the vast majority of the infected are females, which represents 80 to 90% of those with Scoliosis disease. Therefore, the detection process of the disease is limited to the level of alertness and awareness of the mother who does not know anything about this disease and is possessed by fear, which refuses to ask about it because she believes that this will bring to the family Shame or shame among people in the right of the girl, represented by the presence of hunchbacks in her back, so the matter is kept secret until the disease worsens and the girl becomes in a condition that requires surgical intervention.

Unfortunately, the surgery does not completely straighten the curvature and leave traces on the skin, and in the end the child pays the price.

As for early detection of the disease, the study indicated that it is possible to completely cure this disease, contrary to what some specialists in this field claim. This prompted the "Manar Scientific Foundation for Health Studies and Research" to carry out an annual campaign for early detection of scoliosis. The campaign is aimed at educating the Yemeni mother wherever she is and urging her to pay more attention to her child, with the help of visual and written media or through lectures. The Manar Scientific Foundation for Health Studies and Research also participates with this mother in bearing the responsibility of treatment and material costs. It has been shown that through these medical awareness campaigns, the number of sick people has increased at a rate of doubling annually. Therefore, we believe that there are a lot of infections that have not been discovered yet because the parents are not aware of the existence of such a disease or the belief of others because this is a command from God and there is no trick, so they leave the matter without treatment.

What are the complications of scoliosis?

Speaking about the complications of this disease on the future of the patient’s life and those who surround it, we must not forget the social problems that are of importance

Physical complications:

1- Psychological complications related to the patient and his family, which are mostly related to the marital status (poverty and ignorance).

2- As for the physical complications, they are limited to pain in the back, fatigue and fatigue due to the narrowing of the rib cage on the opposite side of the curvature, which is smaller than the size of the lung and causes shortness of breath due to the decrease in the amount of oxygen inhaled with the air, in addition to the deformation of the body shape and the bump of the hump.

 

Treatment methods for scoliosis: Scoliosis is a disease that can be cured if it is detected early, that is, if it is discovered between six and twelve years of the child's age and that the curvature does not exceed 20 degrees.

 There are only three methods of treatment and they are:

1 - Orthodontic treatment with a corset, which is a corset. And physical therapy (Physiotherapy).

2- Surgery.

3 - Preventive treatment.

 And the first method is always approved, i.e. orthodontic treatment, even in advanced cases, i.e. more than 45 degrees on the COPP scale because it has been proven that there are cases that were judged by a number of doctors in different hospitals with the surgery and were evaluated in the (Shater Lebanon) center without surgery and sometimes with results. It is better than what the surgeons promised, so you consider that it is the child's right to have his opportunity to be treated by the orthodontic method before entering the surgery, which at (some specialized rehabilitation centers) is the last solution after the failure of the previous capabilities.

When the disease is detected, assess the location of the curvature and its development and the degree of rotation of the shoulders and the pelvis on the axis of the spine, as well as the remaining softness in the joints of the vertebrae, as well as studying the environment in which the patient lives, and other factors together to decide the fastest and best method of treatment.

The treatment is always started with a corset and physical therapy.

And the Corset: It is an orthodontic device made of two gypsum for each patient according to the size of his body, and it differs from one patient to another according to the location of the curvature in the spine and its degree.

There are many types of corset, for example, which are still used worldwide:

- Corset Milwaukee.

Corset Toulouse-munster.

Corset Jacque Chenau.

- Corset Chater.

When do we use the corset and with which cases it is done:

- There are two different ways to use the corset:

- The first method: which is known as the preventive method - when the degree of curvature is below 20 degrees, this curvature is treated with physical exercises and the condition is monitored and if it worsens then the corset is used and it is the preventive method, and more often the results are negative than we find Ourselves facing greater contortions and more difficult treatment.

 

 

- The second method: It is often used with children who have not passed school age and in the first stages or basic education, and therefore it is characterized by the speed of use of the corset when detecting the curvature, regardless of the degree to which the disease has reached, due to the possibility of rapid correction in the few degrees that the spine is still Soft and lateral deviation of the vertebrae has not yet occurred.

- Here, we strongly advise on this method and to persevere in monitoring the condition until the child reaches the age of sixteen years, to avoid the curvature of the recurrence during the growth stage.

Also, we should not neglect the following factors and their importance in treatment and its success:

It is worth noting that physiotherapy alone does not correct the curvature, as it must be used for a long time, which burdens the family with great financial burdens.

Lack of time, especially during school.

- The child (the patient) does not persevere in the exercises, which makes the curvature aggravate him and makes his treatment more difficult.

- Children have advanced with age, which makes it more difficult for them to adapt to the device, especially girls.

The family discouraging the child from using the device for fear that others will notice that their child or child is using it.

It is necessary to note that the period of treatment and cooperation by the family is an important factor in obtaining satisfactory results, as the time factor is related to the extent of adherence and perseverance to continue treatment, and most of this depends on the patient and his family:

- We must not forget that the duration of treatment varies from one case to another and from one patient to another, as well as according to the degrees of curvature. The lower the degree of curvature and where there is still softness in the spine, corrective results can be obtained within a period not exceeding six months.

- In the rest of the cases it may exceed the year and according to the patient’s commitment to treatment, such as using the corset 23 hours a day, and adhering to daily exercises (designated for this purpose), with adherence to the dates of the medical review, and whenever all of these factors were followed in the correct manner as was explained to the patient, the more it contributed to obtaining Better and faster results.

- There is a disease that passed to us, and the patient was 23 years old and her degree of curvature was critical, that is, more than 35 degrees, and the case was treated within a short period as the treatment period did not exceed six months, and she is now in good condition and is practicing her normal life without any problems, as She has committed to exercising with corset therapy as well as exercising regularly. And perseverance with sports even after the treatment period.

- We have used a corset similar to the corset jaque chenau, which is the most used in Europe and some Arab countries, which gave better results than expected with the cases that we had and within a short period, in addition to being somewhat comfortable and because patients prefer it because it is not noticed under the clothes. It has also been done locally in cooperation with the Limbs Center in the capital, Sana'a. It is worth noting that it can be used for more than twenty hours a day without any problems, but this type that was done locally used to force patients to give it up during sleep.

- It is possible to use a special sleep corset only to shorten the time and speed up the calendar when the financial capabilities of the patient or his family are available.

These devices rely on the principle of opposite pressure in three straightening points.

The Corset Chater is using a different pressure technology than other devices, and here the secret can be in the success and speed of the orthodontic that the patient gets.

Among the most important stages that must be paid attention to before starting treatment:

- To take an x-ray of the child wearing the corset to ensure the effectiveness of the orthodontic, which should not be less than 20% in difficult cases and 50% in cases of 30 degrees, otherwise the corset is considered useless and useless and a waste of effort and money, as well as a waste of time.

- The approval of the doctor must be obtained for the effectiveness of the corset before receiving it from the center or source from which it is purchased where it is manufactured.

- Here in Yemen we have the state's limb center in the capital, Sana'a, which provides cooperation with the majority of patients, as many cases were sent to bring and make a corset for them, as we were met from most of the cases with satisfaction of the results obtained with them.

We are here at the Manar Scientific Foundation for Health Studies and Research, always striving to urge patients to communicate with us so that we can follow up cases and monitor the progress of treatment and for the purpose of making any necessary adjustments that may be required on the corset and based on the progress in correcting the curvature, and on the contrary, the approved pressure points In the corset it becomes useless and useless, since with the progress in the straightening of the spine, the position of the curvature changes and at the same time the locations of the pressure points. The physical therapy accompanying this, which is often adapted to the home situation, enables the patient to be performed daily.

Here, patients follow us more than once a week to make sure that they are performing the exercises properly.

 

 

                                                                                                         _______________________________________________

* Dr. Ahmed A. N ORTHOPAEDIC Surgeon