TRUDNOŚCI DIAGNOSTYCZNE I TERAPEUTYCZNE W DEFORMACJACH KRĘGOSŁUPA.

Introduction. The diagnosis of spinal malformations impacts on the qualification of a re- habilitation course. Performing a standard kinesitherapy and a symptomatic therapy without a proper diagnosis delays or even prevents achieving a positive final therapeutic effect. Aim. The aim of this paper is to outline problems involved in diagnosing and treating congenital spinal malformation. Materials and methods. Patients with progressive disorders undergo a therapy in a preoperative rehabilitation system. Within this period, patients are gradually prepared in terms of enhancing their circulatory and respiratory efficiency, posture muscles endurance and a partial elongation of the spine. Simultaneously, therapeutic and diagnostic processes are carried out, which should prepare, as meticulously as possible, medical and physical therapy documentation in view of scheduled surgeries. In untypical spinal malformations, causes and nature of malformations must be determined, treating them as an interdisciplinary problem. In such a situation, apart from an X-ray examination, specialist diagnostics should be performed: computed tomography, including three-dimensional imaging, and magnetic resonance, which enable to determine precisely the type of malformation, its localization and possible changes in the vertebral canal, intervertebral foramen, and the position of intervertebral discs. An electromiographic examination, which monitors the effects of secondary nerves and muscles disorders in some untypical spinal malformations, may be performed as an additional, supportive examination. Results and discussion. The author emphasizes the results of clinical observations of patients, which indicate a faster progression of osseous and nerve-derivative conditions in comparison to osseous- derivative ones, their earlier period of progression and more significant disorders of the spinal statics ensuing from them. These observations are in accordance with the conclusions drawn by the majority of specialist in rehabilitation and orthopaedics. The fastest progression of changes of an unbalanced nature was observed within the thoracic section of the spine. An increased risk of progression is often connected with the coexisting synostosis involving the ribs. Conclusions. Examinations leading to a proper diagnosis and determining a preoperative rehabilitation course in cases of congenital spinal malformations should involve specialist diagnostics performed in hospital departments. Progression of disturbances in the spinal statics depends on coexisting pathologies of the central nervous system. Surgical treatment is an effective procedure in treating congenital spinal malformations. [ABSTRACT FROM AUTHOR]