SPINE, CURVATURE OF THE. There are two distinct forms of curvature. lateral curvature, arising from weakness of the bones, ligaments, and muscles, and angular curvature, which re sults from carious disease of the vertebra.
Lateral curvature of the spine, or seoliosis, is not simply a bending of the spine laterally. In addition there is also considerable rotation or twisting of the vertebral bodies which normally are held in their proper relation and position by the ligaments and muscles. Muscular action is necessary for the maintenance of the erect pose; and if, through fatigue and exhaustion or through muscular weakness, from disease, such as rickets (q.v.), the muscle§ fail to act, a temporary deformity is brought about. If this is not remedied the ligaments become relaxed, the bones which are not yet fully developed adopt their growth to conform to the new relations, and the deformity persists. Postural habits, such as standing on one leg or sitting incorrectly at a desk, tend to distort the spine and to stretch certain ligaments, and often result in perma nent deformity.
Lateral curvature is more frequent among girls than among boys, for their muscles are less de veloped by physical exercise and their general strength is often unequal to the strain put upon them in their school life. In lateral curvature the bodies of the vertebra rotate toward the con vexity and the spines toward the concavity of the curve. In the dorsal region the ribs are car ried with the vertebra in their rotation, and therefore the chest becomes deformed and the functions of heart and lungs are seriously in terfered with. In order to maintain the erect position a compensatory curve develops. In the dorsal region the tendency is to the right, while in the lumbar region it is to the left.
The subjects of this affection do not usually complain of pain and often nothing wrong is noticed except an awkwardness in gait or a ten dency to carry one shoulder higher than the other. An examination will show the prominent
spinal processes and the abnormal curve of the spine. Spinal supports and plaster jackets are not to be used. The whole treatment should be directed to strengthening the muscles by exercise and massage. Exercise, however, must not be carried to excess, for this will only aggravate the existing conditions.
Angular curvature of the spine, commonly known as Pot l's disease, is the result of caries of the vertebrir, a disease essentially tubercular in character. It occurs most frequently in chil dren between the ages of three and twelve years, but is also met with in babes and in adults. An injury such as a blow or a fall often acts as au important factor, but at times we can trace no existing cause whatever. The must common seat of disease is in the dorsal vertebrae. The inflammation begins in the bodies of the vertebra, and as they become softened or de stroyed the spinal column above settles down upon the healthy portion below and the spines of the diseased vertebra are pushed backward, producing a deformity more or less marked.
The symptoms are rigidity of the spine with tenderness and a deformity of varying degree. Sometimes abscesses form and pus and bony debris are evacuated (especially lumbar and psoas abscesses). The pain is frequently marked and in some cases pressure upon the spinal cord or nerves gives symptoms of an aggravated type. The disease is slow, with a poor prog,nosis, al though the chances are vastly improved if treat ment is begun early. The best we can hope for is all arrest of the disease and an ankylosis at the site of the trouble. Pest of the spine is the essential factor in treatment, and is obtained by. a plaster-of-Paris jacket or some one of the surgical appliances especially adapted to special regions. General treatment and hygiene are of course necessary.