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102MORPHOLOGY OF IDIOPATHIC SCOLIOSIS BASED ON SEGMENT BY SEGMENT ASSESSMENT OF SPINAL COLUMN DEFORMITY
Dilrukh Ilkhomovna Khodjayeva
Bukhara State Medical Institute
ABSTRACT
This article analyzes various versions of the curvature of the spinal column and the consequences that may arise in connection with this pathological process. . The article is devoted to the morphological classification of idiopathic scoliosis based on the assessment of the degree of deformation of each vertebra and intervertebral disc. The article presents a new classification and a method for evaluating radiographs, which was used in the development of this classification
Keywords: vertebral column, cavities, changes, scale, measurements.
Currently, there are more than a dozen classifications and methods for assessing idiopathic scoliosis. In Russian practice, officially recommended for use is the 4-powermodification of V. D. Chaklin from 1999, where the 1st degree corresponds to deformation up to 100, the 2nd-11-300, the 3rd — 31-600 and the 4th-more than 600. In later works, this classification underwent minor changes, so the upper limit of the 2nd degree was considered 250, and the beginning of the 4th degree was assumed to be 45500. The last change is due to the fact that for a long period of time, this value of the scoliotic arc was the moment when the decision was made about the need for surgical correction. [1]. According to the generalized data of the world literature, the results of surgical treatment are the best for this degree of deformity [2, 3, 4]. Three-step gradations (M. I.) were also offered.Kuslik) and pyatistepennye (L. I. Shulutko). And also the 4-power classification of A. I.Kazmina, where the limit of the 1st degree was raised to 300. At the same time, the "age-related" classification of idiopathic scoliosis is widely used abroad. James (1954), which implied the allocation of 4 groups of deformities depending on the age of occurrence and gave certain information about the probability of deformity development. Despite the fact that the classification of V. D. Chaklin has found wide application in Russian orthopedics, the information contained in it cannot be considered even minimally sufficient, since it does not contain indications of the morphology of deformity. The H classification lacks this drawback. King'stheory, according to which 5 types of scoliotic deformity are distinguished, depending on the anatomical shape, the length of the arches, and the degree of their mobility. The morphology of deformation was taken into account only in the frontal plane. However, according to some authors [5, 6, 7], this classification is not fully disclose the morphological structure deformation, in this connection, in 2001 on the basis of the
classification of the king was developed morphological classification King-Lenke, which identified 6 types of deformation in the frontal plane, three options of the deformation in the sagittal plane and 3 variants of the formation of the lumbar arc in the frontal plane. This classification is widely used to determine the tactics of surgical treatment. King's classification is also important for orthotics patients with idiopathic scoliosis, because for a long period of time (from 1985 to 2008), the five types of deformity identified in this classification were the basic ones when constructing the corset model Chenault. Thus, at the present stage of development of medical knowledge, the issue of classification of scoliosis is considered closed. However, it should be noted that the existing classification, given the anatomical changes, the cause, the degree is expressed particular, variants of the course [3, 4, 5, 6, 7], and the time of appearance (J. I. P. James, 1954), do not give us information about the state of individual segments of the deformed spinal column, and the static-dynamic. At the present stage of medical development, despite the availability of such high-precision research methods as CT, MRI and spiral tomography, radiography remains the main basic method for diagnosing scoliotic deformities. Several methods are proposed to determine the magnitude of the spinal column curvature in the frontal plane. The most widely used method isCobb (CobbJ. R. Cobb, 1948), the next most frequently used method (is Ferguson (A. B. Ferguson, 1950). And also developed in the 70s of the last century, but never widely used due to labor intensity, the method of E. A. Abalmasova (1973). This method makes it possible to determine the contribution of factors such as sphenoid vertebral bodies and sphenoid intervertebral discs to the arc size [4]. It should be noted that only this method allows us to assess the actual deformation of the bone elements of the spinal column.
Taking into account the above, we used the modified method of E. A. Abalmasova for extended evaluation of radiographs. Radiographs of 500 patients with idiopathic scoliosis were analyzed, and 100 patients were evaluated in dynamics over 3-5 years. The analysis was carried out as follows: radiographs were photographed with a digital camera from a negatoscope, after which they were drawn using the AutoCAD 2020 program [7-18] . For analysis, we selected only those radiographs that completely covered the thoracic and lumbar spine from C7 to S1. The vertebrae were bounded by lines running along the upper and lower edges of the projection of the vertebral body onto the frontal plane, after which the angle formed by these lines was measured. In this case, the angle between the lines bounding the vertebral body was taken as an indicator of vertebral torsion deformation (TDP), and the angle between the lines bounding the intervertebral disc was taken as an indicator of disk torsion deformation (TDD). We calculated the following parametersof arcs: Total TDP and TDD for each of each of the arcs (arch strain index — SDD)Total vertebral strain index(SDP) X TDP/TDD, which is the ratio of the sum of all TDP within the entire spine to the sum of all TDD within the
spine. If there is an intervertebral disc or vertebra with a "reverse" wedge shape in the arch, i.e. the base of the wedge the torsion strain index was taken as negative and when calculating the total torsion strain, it was subtracted from the total value of the corresponding elements. It should be noted that during the extended method assessment, we noted the presence of additional deformation arcs relative to the King classification, while arcs with the presence of TDP were evaluated as structural, and arcs with the presence of only TDD were evaluated as non-structural [19-35]. Analysis of radiographs in the standing and lying positions, as well as with maximum lateral inclinations (bending test) using the method used by us, showed that torsion deformation of the vertebra includes two components:
Thus, when a vertebra is rotated, the projection of the vertebral body to the frontal plane changes. This leads to an increase in the projection wedge shape of the vertebral bodies in the frontal plane. So, we found that the TDP index can vary within 2-3 degrees on radiographs in the "standing" and "lying down" positions, in the situation when we note on the "pictures" lying down a decrease in vertebral rotation, estimated by traditional methods. And on the X-ray images of the bendingtest, in some cases, it is possible to form a reverse projection wedge shape of the vertebra with its pronounced rotation as a result of a lateral tilt of the entire spine under study (Fig. 1). At the same time, it should be noted that if the vertebra has no torsion deformity, the projection wedge shape is not detected on X-ray images in the slope. Due to the fact that the index of vertebral torsion strain already takes into account the rotational component, we did not evaluate it separately according to generally accepted methods. It should be noted that when analyzing radiographs, we identified cases where vertebral rotation in one of the deformation arcs preserved the direction of rotation of the underlying or overlying
arch, but the projection wedge-shape (torsion deformation) was not observed.
it is directed in the opposite direction of rotation. The presence of such changes in the thoracic region was found in 7 % of cases and was mainly accompanied by the presence of a lumbar or thoracolumbar arch deformity of more than 400. At the same time, with the localization of this pathology at the level of L3-L5, the frequency of occurrence increased by more than 2 times and amounted to 15 %. In King 1 deformity, Uzbekistan www.scientificprogress.uz Page 210
we identified two variants of deformity development, which we characterized as scoliosis with 3 and 4 arches, while in the first variant a short 3-4 segmental lumbosacral arch with a vertex at the level of L5-S1 was detected, and in the second variant a high second thoracic arch was added to the lumbosacral arch described above. The predominant frequency of occurrence in this subgroup was the deformation with 3 arcs. It should be noted that in both cases, the TDP/TDD ratio for the lumbosacral arch was almost always extremely low (no more than 0.5), which indicates the compensatory nature of this arch. At the same time, the TDP/TDD ratio for the upper thoracic arch varied from 0.5 to 2.43. In several cases, there was a high non-structural thoracic arch less than 50 mm in size. When deforming King 2, two variants were also identified — with 3 and 4 arcs, but in this case, the deformation with 4 arcs prevailed. The characteristics of the additional arches were identical to those in patients with King 1 deformity. King 3 deformity revealed 2 additional arches — lumbosacral and obe Acute thoracic arch, i.e. a variant of deformity with 3 curvature arcs. At the same time, if the lumbosacral arch is identical to those in patients with King 1 and King 2 deformities, then the second thoracic arch in most cases is characterized by a high TDP/TDD ratio. Deformity King 4 is characterized by the presence of 3 arcs of curvature, the TDP/TDD indices are similar to those for deformity King 3.In the 5th type of deformation according to King, we identified an additional lumbar arch, which is characterized by rather low TDP/TDD ratios, i.e. a variant of deformation with 3 arcs. Large values of the TDP/TDD index in a sufficiently large number are due to the presence of discs with pronounced reverse wedge-shape in the upper thoracic arch (Fig. 4). An extended analysis of orthospondylograms showed that the King classification is not valid for determining the geometric variant of deformity, and therefore, based on the data obtained, we proposed our own morphological classification of scoliotic deformity. After analyzing patients ' radiographs using the above method, we divided all variants of spinal deformity in idiopathic scoliosis into two main groups — scoliosis with 3 curvature arcs and scoliosis with 4 curvature arcs. In the group with 3 arcs of curvature, the following subgroups were distinguished:: 1.1 .1 Short right-sided 3-4-segment lumbosacral arch with the apex at the level of L5-S1, characterized by a low TDP/TDD index (up to 0.5), left-sided lumbar arch, right-sided thoracic. The TDP/TDD indices for the thoracic and lumbar arches and SDP depend on the degree of deformity, so we found that type 3.1 is most often affected by changes (80 %). Changes of type 3.2 occur much less frequently (13 %); deformations with 4 arcs of curvature are subject to changes in 7% of cases. Changes in the morphotype 3.3 was not detected. Type 3.1 most often changes to variant 3.2 (70 %), only occasionally immediately changing to type 4. Type 3.2 is modified to scoliosis with 4 arches in 90% of cases. A 4-arc strain can change to types 3.1 and 3.2 in approximately the same number of cases (48 % and 52%, respectively). As our research has shown, the morphological type of scoliotic
deformity can change during the course of corselet therapy (20 %). It should be noted that changes in morphotypes with 4 deformity arcs occur only under the influence of corset treatment, while changes in other morphotypes can occur as a natural evolution of deformity. The frequency of changes in these morphotypes is no more than 12 %. Thus, the analysis carried out allowed us to formulate the following basic laws::formations do not fully reflect the actual changes in the elements of the spinal column. This is due to the fact that with the same degree of Chaclin deformation, with the same degrees of arc curvature, the internal structure of arcs can differ significantly. Thus, with scoliotic deformities with the same degrees of arcs, situations are possible when the vertebral lesion is minimal, but there is a pronounced torsional deformation of the disc apparatus. At the same time, in the presence of the same or less pronounced arch, torsion deformity of the vertebrae may prevail. In such cases, the severity of the condition and the prognosis of treatment of a patient with smaller arcs, but a large SDP is significantly worse than the severity of the condition and the prognosis of treatment of a patient with more pronounced arcs, but minimal SDP. Method for determining the arc degree ЬуКо66у Cobbis not precise enough, since the neutral vertebra is determined "by eye". Theme thod developed by us allows us to determine the K inga, arcs of curvature (upper thoracic and lumbosacral arcs of curvature). These curvature arcs must be taken into account to determine the true picture of the deformity and determine the treatment methods. "Mirror" variants of deformation were also identified. Such variants accounted for 6 % of the total number of respondents. ценить степень тяжести деформаOnly a comparison of the degree of arcs and the index of total spinal deformity can adequately assess the degree of deformity severity. In the processof electrolysis, we have identified two groups. In this case, all deformations with 3 arcs can be divided into three subgroups. This methodological approach allows the most accurate estimation of geometric variants of deformation. When formingthe classification, we did not use traditional (pedicle method) tools for assessing vertebral rotation, since the proposed method for assessing deformity takes into account the rotational component in the torsion strain indices. Morphologicaltype of scoliotic de the formation may change duringthe course of the corset therapy process(20 %). More often, metamorphosis occurs precisely at high values of the thoracic.
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